Intense cytoplasmic ezrin immunoreactivity predicts poor survival in colorectal cancer.

Ezrin is a membrane-cytoskeleton anchor, which, in experimental models, regulates tumor cell invasion and metastatic ability. We carried out immunohistochemical analysis of ezrin in 74 advanced colorectal cancer patients and correlated it to clinicopathologic variables and disease outcome. In contrast to the predominantly membraneous immunoreactivity of normal colorectal epithelium, ezrin expression in the colorectal cells was typically cytoplasmic. Altogether, 16.2% (12/74) of the tumors showed negative/weak ezrin staining, 35.1% (26/74) had moderate staining, and 48.6% (36/74) had intense staining. The expression was more intense in colon than in rectal carcinomas (P = .003). Increased ezrin expression was associated with adverse outcome, that is, shorter disease-specific survival; 48.3 months and 36.6 months for negative-weak versus intense expression (P = .041) as well as shorter survival with metastases at 36 months (P = .030); the metastases(36) rates in ezrin(neg/weak), ezrin(moderate), ezrin(intense) are 58.3%, 25.0%, and 18.4%, respectively. In univariate survival analysis, dichotomized (negative/weak versus moderate/strong) ezrin expression significantly predicted both the 5-year disease specific survival (P = .035) and 5-year metastases (P = .018) but lost this predictive power in multivariate (Cox) analysis. High ezrin expression was also related to high E-cadherin (cytoplasmic) expression, DNA aneuploidy, and high thymidylate synthase expression (P = .046, P = .042, P = .046, respectively). These results suggest that ezrin may play a role in colorectal cancer progression and that ezrin expression might provide clinically valuable information in predicting the biological behavior of colorectal cancer.

Nuclear area is a prognostic determinant in advanced colorectal cancer.

BACKGROUND: The prognostic value of morphometric nuclear features in Dukes' Stages B/C and D colorectal cancer (CRC) was assessed. PATIENTS AND METHODS: Primary tumours from 86 CRC patients were analysed, using an image overlay drawing system (Prodit Morphometry Program), for the following nuclear features: area, perimeter, diameter, form factor, roundness. RESULTS: The median nuclear area (NA) was 104.6 microm2 (range 57.2 - 237.2 microm2). The NA was larger in patients with lymph node metastasis (p < 0.02). Altogether, 43% of the patients showed clinical response to irinotecan-based chemotherapy. All six patients with complete response (CR) had a NA above the median (p < 0.03). The disease-specific survival of the patients with a NA above the median was significantly better than in patients with smaller NA (p < 0.02). CONCLUSION: Using the median NA as the cut-off value seems to effectively discriminate patients who are likely to respond to irinotecan-based chemotherapy (with improved prognosis) from those who are non-responsive and develop progressive disease.

Female patients tend to alter their diet following the diagnosis of rheumatoid arthritis and breast cancer.

BACKGROUND: Breast cancer and rheumatoid arthritis are common diseases which change everyday life among women. This study investigated the beliefs and attitudes of female patients regarding diet and their need for dietary counseling in relation to years since diagnosis, age, and education. METHODS: Breast cancer (BC) patients were compared to patients with rheumatoid arthritis (RA) with a validated questionnaire. Logistic regression models were used to adjust for the differences in demographic patient characteristics between BC and RA. In addition, the influence of demographic variables was studied further in the BC and RA groups, separately or combined. chi(2) testing was used to analyze the associations between demographic and dietary variables. RESULTS: Eight percent of BC patients and 40% of RA patients considered diet a factor contributing to their disease (P < 0.0001). Thirty percent of BC patients and 51% of those with RA reported having changed their diet after their diagnosis (P = 0.0003, chi(2)). The patients with RA had a 3.9 times higher assumption on the diet and disease connection compared to breast cancer patients (OR = 3.92, P = 0.002). Longer (>5 years) time to diagnosis increased the probability 2.6 times. The main reason for the change in diet was the desire for cure. The main changes reported included reduced consumption of animal fat, sugar, and red meat and increased consumption of fruit and vegetables. The source of information was most commonly the mass media and a need for more information on dietary factors relating to disease was expressed. CONCLUSIONS: We observed the patients to express an interest in alternative dietary habits, with the focus on a healthier diet. The lack of precise dietary recommendations for individual disease situations was expressed strongly and patients depended on information from outside their treatment center.