Prognostic factors determining survival in patients with node positive differentiated thyroid cancer: a retrospective cross-sectional study.

OBJECTIVE: The prognostic factors for the disease-free status and overall survival among patients who had differentiated thyroid cancer with cervical lymph node metastasis were evaluated to develop a better understanding of the possible effects of lymph node metastasis on the disease process. DESIGN: The data from 101 patients who underwent modified radical neck dissection to determine the presence of cervical node positive differentiated thyroid cancer was evaluated and disease-free survival and overall survival rates were calculated. Prognostic factors predicting these survival rates were evaluated. SETTING: This research took place between July of 1994 and December of 2006 in the Department of General Surgery at Ankara Oncology Training and Research Hospital. PARTICIPANTS: One hundred and one patients underwent a modified radical neck dissection after the cervical nodes were assessed as positive for the presence of cancer. MAIN OUTCOME MEASURES: Ten-year disease-free survival and overall survival rates were measured. RESULTS: We calculated the 10-year disease-free survival rate at 67.3% and the overall survival rate at 86.1%. Age, thyroidal extracapsular invasion, vascular invasion, metastasis, age, completeness of resection, size score and TNM staging were found to be relevant to disease-free survival and overall survival in both the univariate and the multivariate analyses. While the age, metastasis, extent of disease score was relevant to disease-free survival and overall survival in the univariate analysis, this association is not found in the multivariate analysis. The histological type of the tumour was not predictive of disease-free survival, but the follicular type was closely related to the prognosis for overall survival. CONCLUSION: Cervical node metastasis in thyroid carcinoma slightly reduces overall survival. Prognostic factors can help identify high-risk patients and point towards an adequate therapeutic approach.

Application of sentinel node biopsy in breast cancer patients with clinically negative and positive axilla and role of axillary ultrasound examination to select patients for sentinel node biopsy.

PURPOSE: To evaluate the identification rate and the false-negative (FN) rate of sentinel lymph node biopsy (SLNB) using preoperative axillary ultrasound (AU) in patients with clinically negative and positive axilla and to prove that SLNB could also be performed in clinically axillary positive patients. METHODS: Three hundred and fifty seven consecutive T1-2 invasive breast cancer patients with clinically negative or positive axilla were enrolled in our Institution between 2006 and 2011. All patients had preoperative AU, and underwent SLNB followed by breast conserving surgery or mastectomy with level 1, 2 axillary dissection. SLNB was performed using 5 mL of 1% methylene blue. The identification (ID) rate and the FN rate of SLNB were calculated for patients with clinically negative and positive axilla, and for patients with negative AU. RESULTS: Two hundred thirty two patients (65%) were clinically axillary-negative and 125 (35%) were clinically axillary-positive. The ID rates of SLNB were 91 and 89% and the FN rates were 7 and 9%, respectively, in patients with clinically negative and positive axilla. The ID rate of SLNB increased to 94% and the FN rate decreased to 4% after the exclusion of 85 patients (24%) with metastatic lymph nodes on AU. CONCLUSION: SLNB can be safely applied to T1 tumors regardless of the clinical status of the axilla. Use of AU before SLNB significantly increases the ID rate and decreases the FN rate of SLNB in clinically axillary negative as well as in positive patients.

Prognostic factors for survival in breast cancer patients who developed distant metastasis subsequent to definitive surgery.

INTRODUCTION: The present study was undertaken to define the prognostic factors for overall survival subsequent to definitive surgery, and for survival after the development of distant metastasis in breast cancer patients who developed distant metastasis subsequent to definitive surgery. METHODS: The records of 470 breast cancer patients with T1-3 tumours and distant metastasis following surgery were reviewed. Prognostic factors were compared to the first metastatic sites as solitary skeletal, multiple skeletal, and visceral metastases, and were analysed for overall survival following surgery and survival after metastasis. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. RESULTS: 79 patients (17 percent) had a solitary skeletal metastasis, 105 (22 percent) had multiple skeletal metastases, and 286 (61 percent) had a visceral metastasis. The five-year overall survival was significantly better for patients with a solitary bone metastasis (73 percent) compared to patients who had multiple bone metastases (46 percent), or a visceral metastasis (22 percent) (p-value is less than 0.0001). Pathological lymph node status 3, stage IIIC, grade 3, oestrogen receptor negativity, and visceral metastases were found to have independent detrimental influence on overall survival following surgery and survival after metastasis. A long-term metastasis-free interval affected post-metastatic outcome favourably. Radiotherapy improved overall survival. CONCLUSION: Pathological lymph node status, stage, grade, and oestrogen receptor status predicted survival after surgery as well as after the development of metastasis. Solitary bone metastasis has a more favourable prognosis than multiple bone metastases, and compared to visceral metastasis, skeletal metastasis has a more favourable prognosis.

A comparison of the outcomes of non-randomised chemotherapy regimens in node positive breast cancer.

Adjuvant chemotherapy increases disease-free survival (DFS) and overall survival (OS) following surgery for breast cancer. However, debates concerning the type of adjuvant chemotherapy continue. The effect of adjuvant chemotherapy on loco-regional recurrence-free survival (LFS) was also reported. The present study was undertaken to compare the results of adjuvant FAC (5-fluorouracil, Doxorubicin, Cyclophosphamide) and CMF (Cyclophosphamide, Methotrexate, 5-fluorouracil) chemotherapy on DFS, OS and LFS for node positive breast carcinoma treated with mastectomy in a non-randomised setting. Data from 688 consecutive lymph node positive breast cancer patients who underwent radical or modified radical mastectomy and received adjuvant FAC (600/60/600 mgr/m2 for 6 cycles every three weeks) or CMF (600/40/600 mgr/m2 for 6 cycles on days land 8 every four weeks) chemotherapy were reviewed. The effect of FAC on DFS, OS and LFS as compared with CMF was analysed. Survival curves were generated by the Kaplan-Meier method, and a multivariate analysis was performed by the Cox proportional hazard model. Adjuvant FAC was found to improve DFS, OS and LFS. 5-year DFS, OS and LFS were longer for patients treated with FAC as compared to CMF (67% versus 53%, p < 0.001; 77% versus 66%, p < 0.001, and 97% versus 91%). Adjusted hazard ratio (HR) for potential risk factors and tamoxifen treatment showed that FAC treated patients much benefitted in terms of survival as compared to CMF treated patients (HR 0.53, CI 0.40-0.69 for DFS; HR 0.48, CI 0.35-0.65 for OS, and HR 0.33, CI 0.16-0.65 for LFS). In conclusion, adjuvant FAC improves DFS, OS and LFS as compared to CMF in node positive breast carcinoma patients treated with mastectomy.

The effect of high-flux hemodialysis on dialysis-associated amyloidosis.

Amyloidosis is an important cause of mortality and morbidity in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD). In this study, depending on the idea that the clearance of middle and high molecular weight toxins could be improved, we aimed to investigate the effect of high-flux dialyzer on clearance of beta-2 microglobulin (beta2-MG) and calcium (Ca) phosphorus (P) metabolism in patients under HD treatment. Forty-eight patients with ESRD under chronic HD treatment were included in the study. All patients were randomized into two groups, and HD was performed with low-flux or high-flux dialyzer for 6 months. In the high-flux group, the reduction of beta2-MG and P levels during dialysis was significantly higher when compared with the low-flux group (p<0.001). During the follow-up period, while beta2-MG levels decreased significantly in the high-flux group (p<0.05), there was an increase in the low-flux group (p<0.05). As a result, our findings suggest that use of high-flux dialyzer can be an efficient alternative in terms of controlling the clearance of beta2-MG and impaired Ca and P metabolism. These beneficial effects of high-flux dialyzers are probably mediated by the improved clearance of middle and high molecular weight toxins.

Effect of different enteral nutrients on bacterial translocation in experimental obstructive jaundice.

Obstructive jaundice leads to bacterial translocation (BT) by disruption of the gut barrier, intestinal microecology, and impaired host immune defence. The objective of the present study is to investigate the effects of different enteral nutrients on BT that is induced by obstructive jaundice in rats. Eighty male Wistar-Albino rats were randomly assigned into 4 groups. Group 1: 20 rats underwent laparotomy, common bile duct (CBD) was not actually ligated and transected, but sham ligation of CBD was performed. Groups 2-4: 60 rats underwent laparotomy, CBD ligation and transection. Group 1 and 2 rats were given rat chow, group 3 rats were fed a glutamine and arginine supplemented enteral diet, and group 4 rats were fed an arginine, m-RNA and omega-3 supplemented enteral diet, an immunonutrient. Rats in groups 3 and 4 had significantly less BT to mesenteric lymph nodes compared to rats in group 2 (p = 0.001). These findings suggest that oral administration of an arginine and glutamine supplemented diet and immunonutrition reduce BT in rats with obstructive jaundice.

Effects of locally applied recombinant human granulocyte-macrophage colony-stimulating factor on ischemic bowel anastomoses in rat.

BACKGROUND: Ischemia is one of the most common causes of anastomosis disruption. In the present study we investigated the effect of locally injected recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on ischemic bowel anastomosis in rats. METHODS: 144 male Sprague-Dawley rats were randomized into four groups: in group 1, colon anastomoses were performed; in group 2, anastomoses were performed then 50 microg rhGM-CSF was injected subserosally into the perianastomotic area; in group 3, anastomoses were performed on ischemic colon segments, and in group 4, colon anastomoses were performed on ischemic segments and then 50 microg rhGM-CSF was injected subserosally into the perianastomotic area. On the 3rd and 7th post-operative days, the rats were sacrificed and anastomotic bursting pressures were measured. Hydroxyproline contents were studied on the tissues from the anastomotic line. Three anastomotic segments were saved from each group for histopathological studies before bursting pressure measurement. RESULTS: The bursting pressure in group 3 was significantly weaker than in the other groups. There were no significant differences between the bursting pressures in groups 1 and 4. The levels of hydroxyproline content in group 4 were significantly greater than in group 3. CONCLUSIONS: These data suggest that the local injection of rhGM-CSF improves the healing of ischemic and even normal colon anastomoses.

Prognostic significance of axillary node and infraclavicular lymph node status after mastectomy.

AIMS: The American Joint Committee on Cancer staging system for breast carcinomas has been revised. According to this revised staging system, metastasis to infraclavicular lymph nodes and number of positive axillary nodes have prognostic significance and a new stage, stage IIIC, has been introduced. The aim of this study is to investigate the association of positive axillary nodes by level and number with survival and stage migration between the old and the new stages in a large series of mastectomy patients. METHODS: Data from 1277 consecutive breast cancer patients treated by mastectomy were studied, retrospectively. Prognostic value of number of positive axillary nodes and entirely invasion of apex axillary nodes were analysed. Survival curves were generated by Kaplan-Meier method, and multivariate analysis was performed by Cox proportional hazard model. RESULTS: Five-year survival rates for metastasis to axillary level III and for stage IIIC breast cancer were 35.4 and 38.2%, respectively. Metastases to apex axillary nodes, 4-9 and 10 or more positive lymph nodes were found to be adverse and independent prognostic factors for survival in lymph node positive patients. CONCLUSION: Invasion of infraclavicular nodes and 4-9 and > or =10 positive axillary lymph nodes were independent predictors for survival in node positive breast carcinomas in this series. Patients with the new stage IIIC had the worst survival among breast cancer patients.

Prognostic factors affecting local recurrence and survival for operable rectal cancers.

The aim of this study was to define the local recurrence, survival rates and independent prognostic factors for survival, and local recurrence in patients with rectal carcinoma treated throughout 7 years. Between January 1990 and January 1998, 197 consecutive patients with rectal carcinoma, who underwent resection by conventional technique in Ankara Oncology Hospital, were retrospectively reviewed. Several clinical and pathological characteristics of patients were categorized. Kaplan-Meier method was used to obtain survival curves, and independent prognostic factors affecting survival and local recurrence were obtained by Cox regression analysis. 5-year survival, and local recurrence rates were 59%, and 33%, respectively. Stage, location of the tumour in distal one third, anterior resection, and poor differentiation were found to be independent detrimental influence on local recurrence. The independent prognostic factors for survival were invasion of tumour into serosa and adjacent organs, lymph node metastases and the total number of resected lymph nodes. Adjuvant therapy affected favourably local recurrence in stage II and III patients, and survival in stage III patients. In conclusion our local recurrence is high in stage I patients as well as in stage II and III patients although most of the patients received adjuvant therapy. Conventional technique might be responsible for high local recurrence rates; therefore, total mesorectal excision technique may be the proper choice to achieve a local recurrence rate under 10% and to have a better survival.

Nitric oxide biosynthesis and malondialdehyde levels in advanced breast cancer.

BACKGROUND: Nitric oxide (NO) is a free oxygen radical studied in many tissues. Its tumour killing structure is shown especially by macrophages. The end products of NO are nitrite and nitrate. Their plasma levels are used biochemically to determine nitric oxide synthase (NOS) activity. The proliferative capacity of cancer cells accompanies the alteration in oxidant-anti-oxidant status. The risk of breast cancer is decreased in association with an increased level of polyunsaturated fatty acids in the erythrocyte membranes. The more the anti-oxidant capacity increases, the more the transformed cells grow. Malondialdehyde (MDA) is a lipid peroxidation marker, and low plasma levels of MDA are associated with advanced stages of breast cancer. METHODS: In the present study, the alteration of serum plasma levels of nitrate, nitrite and MDA were determined in patients with stage IIIB breast cancer and controls. RESULTS: It was found that products of NO biosynthesis were higher and plasma MDA levels were lower in patients with breast cancer. CONCLUSIONS: It can be stated that in advanced breast cancer, the NO radical production is increased while the lipid metabolism is altered, and these changes can be related to an alteration in oxidant-anti-oxidant status.