Prognostic significance of number of lymph node metastasis on survival in patients with pathological T3 esophageal carcinoma.

The aim of this study was to evaluate the impact of the number of metastatic lymph nodes (MLN) and other risk factors on survival in patients with pathological T3 (pT3) esophageal carcinoma who were treated by esophagectomy. We analyzed 70 patients who received primary curative resection for pT3 esophageal cancer from 1997 to 2011. The prognostic role of age, gender, tumor location, cell type, pathological lymph node status (pN), number of MLNs (<3 vs ≥3), metastatic lymph node ratio (MLR), type of resection, local recurrence, and distant metastasis on overall survival (OS) were examined by univariate and multivariate analyses. Survival curves were calculated using Kaplan-Meier method and survival differences were assessed by log-rank test. A receiver operating characteristic analysis was used to determine the optimum cut-off point for the MLR. The median follow-up time was 42 (range, 8-128) months, and the 1-, 3- and 5-year OS rates were 78.6%, 38.1%, and 22.5%, respectively. Tumor location, pN, the number of MLNs, local recurrence, and distant metastasis had a significant effect on OS in the univariate analysis. In the multivariate model, the number of MLNs (p=0.02; hazard ratio (HR), 2.1; 95% confidence interval (CI), 1.1-4.1) and distant metastasis (p=0.007; HR, 5.1; 95% CI, 1.5-16.8) were independent risk factors for OS. Patients with pT3 esophageal cancer who have 3 or more MLNs and distant metastasis have a poor OS, and this result can be used as a factor for better estimation of prognosis.

Breast cancer subtypes can be a predictor of pathologic complete response and survival in the neoadjuvant setting for T4 noninflammatory breast cancer.

BACKGROUND: The aim of this study is to identify whether the breast cancer subtypes are predictors of pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) and survival in patients with T4 noninflammatory breast cancer. METHODS: The records of 181 patients treated with anthracycline +/- taxane based NAC followed by mastectomy and radiation therapy +/- hormonotherapy were evaluated. The role of intrinsic subtypes of the tumor including luminal A, luminal B, HER2, and triple-negative on pCR and survival were analyzed. RESULTS: The median follow-up was 44 months (range: 16-82 months). All patients received a median four cycles of NAC. Twenty-three patients (12.7%) were found to have pCR. In the univariate analysis, the intrinsic subtypes of the tumor had significant effect on pCR (p < 0.01). Also, intrinsic subtypes were significant predictors of pCR to NAC in the multivariate analysis (p < 0.01; hazard ratio, 2.4; 95% confidence interval, 1.1-6.8). While patients with triple-negative tumors had the highest rate of pCR (29%), this rate was the lowest in patients with HER2 tumors (4.2%). Five-year DFS was also significantly lower in patients with triple-negative (24%) and HER2 (21%) tumors compared to luminal A (61%) subtype (p < 0.0001). Likewise, 5-year OS was poorer in patients with triple-negative tumors (30%) and HER2 tumors (%31) compared to both luminal A (70%) and luminal B (68%) subtypes (p < 0.0001). CONCLUSIONS: It can be concluded that breast cancer subtyping defines the extent of response to NAC and has a significant effect on survival in patients with T4 noninflammatory breast cancer.

Is there any venous gradient in serum thyroglobulin levels in patients with differentiated thyroid cancer?

Some patients with differentiated thyroid cancer (DTC) have high serum thyroglobulin (Tg) levels although no evidence of disease can be detected on radioiodine scanning or other imaging methods. The aim of this study is to determine whether a gradient exists between the Tg levels of venous samples adjacent to primary tumour and systemic circulation. Twenty-six patients underwent thyroidectomy and/or lymph node dissection for primary and recurrent DTC. To detect Tg levels, blood samples were concurrently collected via venipuncture from the internal jugular vein adjacent to the tumor and ipsilateral antecubital vein. Serum Tg level was measured by a chemiluminescence assay. Tg levels were significantly higher in the adjacent internal jugular vein compared to the ipsilateral antecubital vein (p=0.001). The ratio of mean Tg values was higher 2.4-fold in the internal jugular vein than antecubital vein (median Tg ratio: 2.0:1; range, 0.7-29.6). Documentation of a venous gradient in Tg levels in patients with DTC is a new investigational topic. According to the results of this prospective study, venous sampling for Tg may be a useful tool to localize recurrent or perhaps persistent DTC in the neck for patients who have no detectable disease on radioiodine scans or other imaging studies.

Prediction of occult nipple-areola complex involvement in breast cancer patients.

The aim of this study was to evaluate predictive factors for the nipple-areola complex (NAC) involvement, and to define a subgroup of patients who may benefit from skin-sparing mastectomy with the NAC preservation in breast cancer patients. Univariate and multivariate analyses were carried out in the retrospective data of 397 eligible patients. The NAC involvement was histopathologically proved in 58 (14.6%) of the patients. In the multivariate logistic regression analysis showed that tumor location (central vs peripheral; p<0.0001; hazard ratio [HR], 7.5; 95% confidence interval [CI], 3.4-14.6), number of positive axillary lymph nodes (> or = 10 vs <10; p<0.005; HR, 2.9; CI, 1.3-6.1), and lymphatic vascular invasion (yes vs no; p<0.0001; HR, 3.5; CI, 1.7-7.1) were the most important prognostic factors. Whereas patients with 2 or 3 risk factors were accepted as high-risk group for the NAC involvement, those with no or 1 risk factor was defined as low-risk group. These groups had a 50.0% NAC involvement rate and a 8.1% NAC involvement rate, respectively (p<0.0001). In conclusion, this study showed that patients with 2 or 3 predictive factors had a high risk of the NAC involvement. These risk factors should be taken into consideration in patient selection for skin-sparing mastectomy with the NAC preservation. Key words: nipple-areola complex; involvement; breast cancer; mastectomy.

The surgical management of incidental gallbladder carcinoma.

AIMS: To report the surgical management of carcinoma of the gallbladder. METHODS: A retrospective study in 65 patients who underwent simple (SC) or extended (EC) cholecystectomy for gallbladder carcinoma. RESULTS: 28 patients underwent extended cholecystectomy (EC) and 37 had simple cholecystectomy (SC). The multivariate analysis showed that lymph-node status (positive vs negative, p=0.001, Hazard Ratio [HR]:14.2, 95% Confidence Interval [CI]:3.1-62.8) and type of surgery (SC vs EC, p=0.01, HR:10.2, 95% CI:1.7-62.8) were the most important prognostic factors related to death. This analysis indicated that EC in those with pT(2) or pT(3) was associated with a reduce hazard of death by 90% in the follow-up period. CONCLUSIONS: In gallbladder cancer patients who diagnose after simple cholecystectomy, those with pT(1) with clear margins need no further surgery. In patients with pT(2) or pT(3) incidental carcinoma, the completion radical re-operation is the only chance for long-term survival.

Is invasive lobular carcinoma different from invasive ductal carcinoma?

AIMS: The purpose of this study is to determine whether the histopathologic features and outcome in invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) are different, and whether the histologic type is a prognostic factor for outcome. METHODS: A retrospective cohort study was conducted in consecutive 510 stage I/II breast carcinoma patients who underwent modified radical mastectomy. The features of 65 patients with ILC were compared with those of 445 patients with IDC. In patients with median follow-up period of 44 months, univariate and multivariate prognostic factor analyses for cancer-specific death and relapse were carried out. RESULTS: The median ages in patients with ILC and those with IDC were 52 and 41 (P=0.04). Tumor size, estrogen receptor positive expression and nodal positivity were not significantly different between the histologic types. Patients with ILC had more frequently (81.5%) low grade tumors and less lymphatic vascular invasion (9.3%) in primary tumor than those with IDC (P<0.05). Whereas the rates of 5-year overall survival were 94% in ILC and 90% in IDC, the rates of 5-year event-free survival were 71 and 67%, respectively (P=NS). Multivariate analyses in all patients demonstrated that tumor size, pathologic lymph node status and age at diagnosis were the most important prognostic factors for overall and event-free survival. Histologic type was not statistically significant for both outcomes. CONCLUSIONS: Although patients with ILC had older age, low grade tumor and less lymphatic vascular invasion, they had no survival advantage comparing with their counterparts. Histologic type was not an independent prognostic factor for outcome.