Pulmonary complications in survivors of childhood hematological malignancies: single-center experience.

Children treated for cancer face the risk of complications later in life, including pulmonary dysfunction. The objective of this study was to evaluate frequency and severity of pulmonary complications in survivors of childhood leukemia and lymphoma treated with chemotherapy alone or combined with radiotherapy. Seventy cancer survivors of hematological malignancies were evaluated for pulmonary complications through history taking, chest examination, high-resolution computed tomography (HRCT) chest, and pulmonary function testing (PFTs). Although most survivors were not clinically compromised, the spectrum of impaired PFTs included obstructive pattern (14.3%), restrictive pattern (5.7%), and mixed pattern (20%). Significant pulmonary dysfunction was seen in children older than 10 years of age (P = .003), and in patients treated with combined chemotherapy and radiotherapy (72.7%) compared with those treated with chemotherapy alone (25%) (P = .001). Cumulative dose of bleomycin was significantly associated with abnormal PFTs (P = .04). Multivariate analysis revealed methotrexate therapy as significant predictor of abnormal PFTs (P = .002). Male patients who received combined therapy showed higher frequency of restrictive, obstructive lung disease, abnormal respiratory reactance, and peripheral airway disease (P = .007, P = .04, P = .002, P = .003, P = .05, respectively). Those with abnormal CT findings (n = 14) had lower forced vital capacity (FVC%), forced expiratory volume in 1 second (FEV(1)%), and peak expiratory flow (PEF%) when compared to cases with normal CT (P = .001, P < 0.001, P = .001, respectively). Subclinical pulmonary function abnormalities are found in survivors of childhood hematological malignancies previously treated and off therapy. Pulmonary dysfunction is more evident with combined chemotherapy and radiotherapy, bleomycin, and methotrexate are the most incriminated chemotherapeutic agents, and males are at higher risk than females; therefore a specific and extended follow-up is warranted.

Prognostic significance of E-cadherin expression and peripheral blood micrometastasis in gastric carcinoma patients.

BACKGROUND: The primary objective is to evaluate the prognostic value of E-cadherin (E-cad) expression and peripheral blood micrometastasis (PBMM) in gastric carcinoma. Secondary objective is to study the association between these 2 markers and the clinicopathological features of the patients. MATERIALS AND METHODS: This study took place at Ain Shams University Hospitals. A total of 30 patients with histologically proven gastric adenocarcinoma after curative surgical resection were enrolled in this study. E-cad expression was assessed in tumor tissue samples. Before the start of adjuvant chemoradiotherapy, fresh blood samples were collected to detect PBMM as indicated by cytokeratin18 mRNA expression using real-time quantitative polymerase chain reaction (RQ-PCR). RESULTS: Both abnormal E-cad expression and PBMM were significantly associated with lymph node metastasis, TNM stage, and lymphatic invasion. Moreover, PBMM was significantly associated with poor tissue differentiation and vascular invasion (P < .05). We found strong agreement between E-cad expression and presence of PBMM (P = .001). Both cases with altered E-cad expression and cases with positive PPMM showed shorter relapse-free survival (RFS) (P = .003 and <.001, respectively). Cox regression analysis showed that positive PBMM was independent predictor factor for relapse (hazard ratio [HR] = 6.14; 95% confidence interval [95% CI] = 1.06-35.63; P = .04). Cases with positive PBMM showed shorter overall survival (OS) (P = .001). CONCLUSIONS: In conclusion, loss of normal E-cad expression in gastric cancer showed a close correlation with the presence of PBMM. PBMM was associated with poor RFS independent of other clinicopathological features. Additionally, detection of PBMM was a significant indicator of OS, and intensive chemotherapy seems to be indicated for these patients.