Predictive Factors for Non-Sentinel Lymph Node Metastasis in the Case of Positive Sentinel Lymph Node Metastasis in Two or Fewer Nodes in Breast Cancer.

BACKGROUND: In breast cancer, recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection results in excellent prognosis if there is sentinel lymph node (SLN) metastasis in two or fewer nodes. The aim of the present study was to investigate the association between non-SLN metastasis and clinicopathological factors in case of SLN metastasis in two or fewer nodes in breast cancer. METHODS: Patients who underwent SLNB for invasive breast cancer and were found to have positive SLN in two or fewer nodes were evaluated. The associations between non-SLN metastasis and clinicopahological factors were examined. Statistical analyses were performed using the Mann-Whitney and Chi-square tests, with statistical significance set at P < 0.05. RESULTS: A total of 358 patients were enrolled during the study period and all of these patients were female and 54 patients had SLN metastasis (15%). Positive SLN in two or fewer nodes was identified in 44 patients (81.5%). Among these patients, 17 (38.6%) were found to have non-SLN metastasis. Non-SLN metastasis was associated with invasive tumor size (P = 0.015) and lymphatic involvement (P = 0.035). Multivariate analysis showed that tumor size (P = 0.011) and lymphatic involvement (P = 0.019) remained significant independent predictors of non-SLN metastasis, and that an invasive tumor size cut-off point of 28 mm was useful for dividing patients with positive SLN in two or fewer nodes into non-SLN-positive and non-SLN-negative groups. CONCLUSIONS: Non-SLN metastasis was found in more than 30% of patients with SLN metastasis present in two or fewer nodes. Large tumor size and the presence of lymphatic involvement were significantly associated with non-SLN metastasis.

Is early enteral nutrition initiated within 24 hours better for the postoperative course in esophageal cancer surgery?

BACKGROUND: Early enteral nutrition within 24 h after surgery has become a recommended procedure. In the present study, we retrospectively examined whether initiating EN within 24 h after esophagectomy improves the postoperative course. METHODS: Among 103 patients who underwent thoracic esophagectomy for esophageal cancer, we enrolled the cases in which EN was initiated within 72 h after surgery. The patients were divided into two groups: EN started within 24 h (Group D1) and EN started at 24 - 72 h (Group D2-3). Clinical factors including days for first fecal passage, dose of postoperative albumin infusion, difference in serum albumin between pre- and postoperation, incidence of postoperative infection, and use of total parenteral nutrition were compared. Statistical analyses were performed by the Mann-Whitney U test and Chi square test, with significance defined as P < 0.05. RESULTS: There was no significant difference between the groups in clinical factors. While pneumonia was significantly more frequent in Group D1 than in Group D2-3 (P = 0.0308), the frequency of infectious complications was comparable between the groups. CONCLUSION: Initiating EN within 24 h showed no advantage for the postoperative course in esophageal cancer, and thus EN should be scheduled within 24 - 72 h, based on the patient condition.

Amplification of Genomic DNA for Decoy Receptor 3 Predicts Post-Resection Disease Recurrence in Breast Cancer Patients.

BACKGROUND: Decoy receptor 3 (DcR3), a member of the tumor necrosis factor receptor (TNFR) superfamily, shows inhibitory effects on Fas-mediated apoptosis. Currently, data are lacking on the correlation between DcR3 and the recurrence of breast cancer. The authors examined DcR3 mRNA expression and genomic amplification in breast cancer, and investigated the effect of DcR3 gene amplification on prognosis of patients. METHODS: A total of 95 patients formed the basis of the current retrospective study. DcR3 mRNA expression in breast cancer tissues was examined by RNase protection assay and in situ hybridization. DcR3 gene amplification was examined by quantitative polymerase chain reaction. The correlation between DcR3 gene amplification status and clinicopathological factors was examined and also the relationship between DcR3-Amp and relapse and survival. RESULTS: The relative copy numbers of DcR3 genomic DNA correlated significantly with the levels of DcR3 mRNA expression (ρ = 0.755, P = 0.0067). In addition, lymphatic invasion correlated significantly with DcR3 gene amplification (P = 0.012). However, there was no correlation between the remaining clinicopathological factors and DcR3 gene amplification. In the univariate analysis, the recurrence-free survival (RFS) rate of patients who were positive for DcR3 gene amplification was significantly lower than that of patients who were negative for DcR3 gene amplification (P = 0.0271). Multivariate analysis showed that DcR3 gene amplification (P = 0.028) and disease stage (P < 0.001) remained significant independent predictors of RFS. CONCLUSIONS: DcR3 gene amplification was significantly correlated with lymphatic invasion, and also DcR3 gene amplification predicts recurrence after resection, which may be an important prognostic factor in breast cancer patients.

[Utility of serum human epidermal growth factor receptor-2 extracellular domain(HER2 ECD)assessment in patients with advanced or recurrent breast cancer and those who received neoadjuvant therapy].

Levels of serum human epidermal growth factor receptor-2 extracellular domain(HER2ECD )were measured in breast cancer patients. Fifty-six patients had advanced or recurrent disease, and 21 others were preoperation patients who received neoadjuvant therapy. In the tissue HER2-positive group of advanced or recurrent patients, levels of serum HER2ECD at first recurrence were high(≥15. 3 ng/mL)in 75%of patients, and significantly higher(p=0. 03)than in the tissue HER2-negative group. In neoadjuvant therapy patients, the levels of serum HER2ECD were high in 50% of the tissue HER2-positive group, and within the normal limit in all the tissue HER2-negative group(p=0. 015). The levels of serum HER2ECD were closely correlated with treatment efficacies in both recurrent and neoadjuvant patients. In this study, the levels of serum HER2 ECD appeared to be useful for diagnosis of recurrence in HER2-positive breast cancer and for estimation of therapy in recurrent and neoadjuvant patients as a secondary bio-marker.

[Evaluation of hepatic resection for synchronous liver metastasis from gastric cancer].

To evaluate the effect of hepatic resection for synchronous liver metastasis from gastric cancer, the clinicopathological factors of gastric cancer, the size and number of liver metastasis and surgical procedures for liver metastasis were studied. Between 1977 and 2006, a total of 49 patients (38 men and 11 women) underwent hepatic resections and gastrectomy. The median age was 70 years old (range 41-81). As for pathological type, intestinal/diffuse was 26/23. T1/T2/T3/T4 was 4/14/23/8. For lymph node metastasis, N0/N1/N2/N3 was 4/15/18/12. The number of liver metastasis: 27 patients had 1 lesion, 9 patients had 2 lesions, and 13 patients had more than 3 lesions. A partial resection was performed for 37 patients. MST was 663 days. The 5-year survival rate was 19.7%. Univariate analysis pointed out several prognostic factors such as histological type of primary lesion, T-factor, lymph node metastasis, the number and size of liver metastasis and the procedures for hepatic resection. Multivariate analysis revealed that two factors of N0 or N1 in lymph node metastasis and partial resection of liver metastasis were favorable independent prognostic factors (p=0.0108 and p=0.0192). In conclusion, N0 and N1 state and partial resection of the liver metastasis would be good candidates for gastrectomy and synchronous resection of liver metastatic lesions.