Can the clinical outcome in stage II colon carcinomas be predicted by determination of molecular marker expression?

BACKGROUND: Conventional staging procedures are often unable to precisely predict prognosis in colon cancer (CC). In this study, we set out to investigate the possible role of molecular/structural indicators involved in cell cycle regulation (Ki-67, p53), apoptosis (p53 and bcl-2) and tumour neoangiogenesis (anti-VIII factor) in predicting tumour behaviour and clinical outcome in stage II CC patients. EXPERIMENTAL DESIGN: Analysis of the above indicators was performed by immunohistochemistry on 162 CC patient samples with curative intention surgery. Clinicopathological data included tumour grade, vascular and nervous invasion, production of mucin, lymphatic permeation and carcinoembryonic antigen levels. RESULTS: p53 protein was overexpressed in 58%, bcl-2 overexpression in 21.5%, Ki-67 in 60.1% and anti-VIII factor stained positive in 40.16% of the cases. Multiple regression analysis showed that some molecular markers were correlated. A significant relationship was seen between p53 and Ki-67, and bcl-2 and p53, but there was no correlation between bcl2 and Ki- 67 overexpression. Stepwise regression selected Ki-67 and anti-VIII factor as the best combination of variables capable of predicting both disease-specific and diseasefree survival. CONCLUSIONS: Only Ki-67 and anti-VIII factor were shown to be useful for the prediction of outcome and recurrence rate in curatively treated CC patients. In conjunction with clinical and pathological staging, they may provide a stronger indication of clinical outcome than staging alone and help better select therapeutic options in CC patients.

Can the clinical outcome in stage II colon carcinomas be predicted by determination of molecular marker expression?

BACKGROUND: Conventional staging procedures are often unable to precisely predict prognosis in colon cancer (CC). In this study, we set out to investigate the possible role of molecular/structural indicators involved in cell cycle regulation (Ki-67, p53), apoptosis (p53 and bcl-2) and tumour neoangiogenesis (anti-VIII factor) in predicting tumour behaviour and clinical outcome in stage II CC patients. EXPERIMENTAL DESIGN: Analysis of the above indicators was performed by immunohistochemistry on 162 CC patient samples with curative intention surgery. Clinicopathological data included tumour grade, vascular and nervous invasion, production of mucin, lymphatic permeation and carcinoembryonic antigen levels. RESULTS: p53 protein was overexpressed in 58%, bcl-2 overexpression in 21.5%, Ki-67 in 60.1% and anti-VIII factor stained positive in 40.16% of the cases. Multiple regression analysis showed that some molecular markers were correlated. A significant relationship was seen between p53 and Ki-67, and bcl-2 and p53, but there was no correlation between bcl2 and Ki- 67 overexpression. Stepwise regression selected Ki-67 and anti-VIII factor as the best combination of variables capable of predicting both disease-specific and diseasefree survival. CONCLUSIONS: Only Ki-67 and anti-VIII factor were shown to be useful for the prediction of outcome and recurrence rate in curatively treated CC patients. In conjunction with clinical and pathological staging, they may provide a stronger indication of clinical outcome than staging alone and help better select therapeutic options in CC patients (AU)

Influence of physical factors on the development of gastroesophageal reflux in man: analysis by means of an experimental mechanical model.

In this paper, the isolated influence of physical factors on the development of gastroesophageal reflux in man is analyzed by means of a mechanical model. We evaluate the influence of gravity, intraabdominal pressure, intrathoracic pressure, transmission of intraabdominal pressure to the high pressure zone, filling volume of the stomach, and the existence of a high pressure zone on the appearance of gastroesophageal reflux. PH-metry is used to record the episodes of reflux in the model. We wish to demonstrate the importance of gravity and intraabdominal pressure in the production of reflux. Intrathoracic pressure acts as an antireflux mechanism only when associated with a zone of high pressure. The intraabdominal pressure may be transmitted to the high pressure zone as a purely mechanical effect and the greater gastric filling volume may, when associated with the intraabdominal pressure, facilitate reflux without physical changes in the high pressure zone (the equivalent of a reduction in the length of the lower esophageal sphincter in man). We conclude that this model may help to explain the influence of the physical factors mentioned above on the development of gastroesophageal reflux in man.

[Results of esophagus extirpation without thoracotomy]. / Ergebnisse nach Oesophagusexstirpation ohne Thoracotomie.

Between January 1978 and May 1988 229 patients have been treated because of malignant and benign conditions of the oesophagus by oesophagectomy without thoracotomy at the Surgical University Hospital "Doce de Octubre" Madrid. 132 patients suffered from oesophageal carcinoma, 68 from carcinoma of the cardia, 9 from carcinoma of the hypopharynx and 20 from different benign oesophageal diseases. Tumor staging and surgical tactics are described. The postoperative mortality was 6.9%, which could principally be put down to respiratory complications (31.2%). The 5-year survival rate of oesophageal carcinoma was 11.9%, that of cardial carcinoma 48.3%.

[Indications and results of surgical treatment of cavernous hemangioma of the liver]. / Indikationen und Resultate der chirurgischen Behandlung von cavernösen Hämangiomen der Leber.

Over a period of 6.5 years, 29 patients with liver hemangiomas have been examined. In 8 patients, the most frequent symptom was pain; in 11, a tumor was found. The diagnosis was made by means of scintigraphy with 99mTc, followed by real-time sonography, computed tomography using a contrast medium, and selective arteriography. In 16 patients (15 women, 1 man), the tumor radius was more than 6 cm and in 9 of these, more than 10 cm. In 3 patients, a left lobectomy was carried out, and in 5 a right lobectomy; in an additional 5 patients, a extended right lobectomy (three segments excised) was done. In the rest, a medial lobectomy, a segmentectomy on the left side, or a segmentectomy on the right was performed. The only complications observed in the whole series were: pleural effusion (1 case), subphrenic abscess (1), and transitory biliary fistula (1). All hemangiomas with a radius of more than 10 cm should be removed operatively, as should smaller symptomatic hemangiomas and tumors that are not clearly benign.