ABSTRACT
BACKGROUND: This study was designed to determine the debated prognostic significance of reverse transcriptase-polymerase chain reaction (RT-PCR) positivity in melanoma patients' sentinel lymph node (SLN) negative by conventional histopathology (PATH). PATIENTS AND METHODS: Patients with primary stage I-II cutaneous melanoma underwent radioguided sentinel lymphadenectomy. Their SLNs were assessed for tyrosinase (Tyr) and melanoma antigens recognized by T-cells (MART-1) mRNA expression using RT-PCR, in parallel with hematoxylin and eosin staining and immunohistochemistry. Tyr and MART-1 expression in the SLNs were correlated with PATH assay results, standard prognostic factors, time to progression and overall survival. RESULTS: Twenty-three of the 124 patients (18.5%) had positive SLNs by both PATH and RT-PCR (PATH+/PCR+). Sixteen patients (13%) were negative by PATH and positive by RT-PCR (PATH-/PCR+). Eighty-five patients (68.5%) had SLNs that were negative by both PATH and RT-PCR (PATH-/PCR-). At a median follow-up of 30 months, recurrence rates among the three cohorts were statistically different (PATH+/PCR+, 60%; PATH-/PCR+, 31%; PATH-/PCR-, 9.4%). Seven of 23 (30%) and two of 16 (12.5%) patients died in the PATH+/PCR+ and PATH-/PCR+ SLN groups, respectively, whereas no patient died in the PATH-/PCR- SLN group. CONCLUSIONS: RT-PCR is more sensitive than PATH to detect SLN metastases and it is a reliable predictor of disease relapse in stage I-II melanoma patients.
Subject(s)
Melanoma/pathology , Monophenol Monooxygenase/genetics , Neoplasm Proteins/genetics , Sentinel Lymph Node Biopsy , Skin Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Antigens, Neoplasm , Cohort Studies , Disease Progression , Female , Follow-Up Studies , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/genetics , Head and Neck Neoplasms/pathology , Humans , Lymph Node Excision , MART-1 Antigen , Male , Melanoma/drug therapy , Melanoma/genetics , Middle Aged , Neoplasm Recurrence, Local/drug therapy , Neoplasm Recurrence, Local/genetics , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Prognosis , RNA, Messenger/genetics , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Skin Neoplasms/drug therapy , Skin Neoplasms/genetics , Survival Rate , Time FactorsABSTRACT
Data are presented concerning our experience with hemodiafiltration (HD-HF) in uremic patients. Ten patients previously submitted to regular dialysis treatment, cuprophane membrane (RDT), for the last year twelve hours weekly, were treated for one year, nine hours weekly, HD-HF. Five of ten had suffered discomfort by RDT and five spontaneously chose HD-HF owing to its shorter treatment period. The follow-up of the two treatment schedules did not show any significant difference in absolute and percentage values of small molecules. Hematocrit, body weight and blood arterial pressure were not different following both treatment. Patients submitted to HD-HF complained of no discomfort including patients suffering of dialytic discomfort under RDT. HD-HF has proved as useful and more comfortable than RDT in long-term treatment of patients with chronic renal failure.
