The prognostic significance of S-phase analysis in stage Ta/T1 bladder cancer. A Southwest Oncology Group Study

OBJECTIVES

An intergroup study (SWOG 8795) comparing two forms of adjunctive therapy (immuno and chemo), bacillus Calmette-Guerin (BCG) and mitomycin C (MMC), furnished preregistration index tumors for 244 patients with superficial, papillary stage Ta/T1 TCC. These were examined by flow cytometry to learn whether DNA ploidy or proliferation (low vs high S-phase fraction (SPF) helped to predict disease recurrence or progression.

METHODS

Cell cycle analysis using commercially available (Multicycle) programs was performed on 249 Ta/T1 bladder cancers. Tumor grade, available for 223 cases, was assigned by a single study pathologist. The SWOG statistical office reviewed follow-up information and other data and performed statistical analysis.

RESULTS

Disease recurrence occurred in half the cases studied. The most parsimonious model predictive of recurrence included only treatment arm and tumor grade, with the MMC arm and tumor grade greater than I indicating worse prognosis (p = 0. 014). Neither ploidy nor SPF predicted recurrence-free survival or contributed prognostic information that was additive to tumor grade. Within 5 years of follow-up, disease progression or death from bladder cancer occurred for 29/223 (13%) of patients. The most parsimonious model for progression-free survival included only grade greater than I (p<0.001) and high SPF (p = 0.029) (relative risk: tumor grade, 4.3, high SPF, 1.9).

CONCLUSIONS

Knowledge of tumor proliferation (low versus high SPF) contributes prognostic information about tumor progression that is additive to tumor grade.

The utility and reliability of computed tomography scan in the diagnosis of small bowel obstruction

Accurate diagnosis and treatment of small bowel obstruction (SBO) is critical to prevent complications and reduce costs. The purpose of the current study was to evaluate the evolving role of CT scan for patients with suspected SBO and compare its sensitivity and specificity with plain abdominal films. We identified 108 patients over a 1-year period with an admission or discharge diagnosis of SBO. Five patients treated on a clinical basis without radiographic imaging and those with indeterminate films were excluded from analysis. CT and radiograph reports were compared with operative findings or clinical course in 103 patients. By the clinical course, 66 of the patients had a partial or complete SBO. Plain film radiography correctly established the diagnosis of SBO in 50 of 66 patients (sensitivity, 75%). Nine of 17 plain films were true negatives (specificity, 53%). CT was able to correctly identify partial or complete SBO in 35 of 38 patients (sensitivity, 92%) and correctly identified the lack of obstruction in 8 of 13 patients (specificity, 71%). These data document that plain films are a less sensitive and less specific method of diagnosing SBO and confirm that the use of CT scan is a valuable modality. CT scan should be considered for use as the primary test for patients with suspected SBO.

Sequential clomiphene citrate and human menopausal gonadotrophin with intrauterine insemination: the effect of patient age on clinical outcome

The purpose of this investigation was to examine the influence of female and male patient age on pregnancy rates with sequential clomiphene citrate (CC) and human menopausal gonadotrophin (HMG) ovulation induction with intrauterine insemination (IUI) therapy after previous CC and IUI treatment failure. A total of 208 patients previously unable to conceive with CC/IUI therapy underwent 416 treatment cycles of sequential CC/HMG with IUI at a university fertility centre between May, 1991 and August, 1995. Clinical pregnancy rates, live birth rates, and the effect of female and male partner chronological age were retrospectively examined. Treatment with sequential CC/HMG with IUI resulted in clinical pregnancy rates ranging from 5.9 to 23.1% despite previous CC/IUI treatment failure. Clinical pregnancy rates, live birth rates, and cumulative pregnancy rates declined significantly in female patients > or = 35 years of age compared to those < 35 years of age. A statistically significant decline in clinical pregnancy rates could not be demonstrated as a function of increasing male partner age. Pregnancy rates in patients undergoing ovulation induction with sequential CC/HMG with IUI decline significantly with increasing female partner age.

Basal estradiol and follicle-stimulating hormone predict fecundity in women of advanced reproductive age undergoing ovulation induction therapy

OBJECTIVE

To determine the prognostic value of single basal E2 and FSH levels as predictors of fecundity in women of advanced reproductive age who are undergoing ovulation induction with IUI therapy.

DESIGN

Prospective, observational.

SETTING

Fertility service of university medical center.

PATIENT(S)

Infertile couples in which the female partner was > or = 38 years old.

INTERVENTION(S)

Single assessment of basal E2 and FSH levels and ovulation induction with IUI.

MAIN OUTCOME MEASURE(S)

Cumulative and clinical pregnancy rates and live birth rates.

RESULT(S)

All live births occurred in patients with a basal E2 < or = 80 pg/mL (conversion factor to SI unit, 3.671), a basal FSH < or = 13 mIU/mL (conversion factor to SI unit, 1.00), and a chronological age < or = 42 years. In women 38 to 42 years of age, 10.3% had elevated basal E2 (> 80 pg/mL) in combination with normal basal FSH (< or = 13 mIU/mL), and no live births occurred in these couples. The cumulative live birth rate after four treatment cycles in women 38 to 42 years of age with both normal basal E2 (< or = 80 pg/mL) and FSH levels (< or = 13 mIU/mL) was 43.9%.

CONCLUSION(S)

Basal E2 improves the ability to predict fertility potential compared with basal FSH and chronological age alone. Basal E2, in combination with basal FSH and chronological age, has useful prognostic value in prospectively counseling patients of advanced reproductive age who are considering ovulation induction and IUI therapy.

Linkage analysis of the genetic determinants of high density lipoprotein concentrations and composition: evidence for involvement of the apolipoprotein A-II and cholesteryl ester transfer protein loci

We have tested for evidence of linkage between the genetic loci determining concentrations and composition of plasma high density lipoproteins (HDL) with the genes for the major apolipoproteins and enzymes participating in lipoprotein metabolism. These genes include those encoding various apolipoproteins (apo), including apoA-I, apoA-II, apoA-IV, apoB, apoC-I, apoC-II, apoC-III, apoE, and apo(a), cholesteryl ester transfer protein (CETP), HDL-binding protein, lipoprotein lipase, and the low density lipoprotein (LDL) receptor. Polymorphisms of these genes, and nearby highly polymorphic simple sequence repeat markers, were examined by quantitative sib-pair linkage analysis in 30 coronary artery disease families consisting of a total of 366 individuals. Evidence for linkage was observed between a marker locus D16S313 linked to the CETP locus and a locus determining plasma HDL-cholesterol concentration (P = 0.002), and the genetic locus for apoA-II and a locus determining the levels of the major apolipoproteins of HDL, apoA-I and apoA-II (P = 0.009 and 0.02, respectively). HDL level was also influenced by the variation at the apo(a) locus on chromosome 6 (P = 0.02). Thus, these data indicate the simultaneous involvement of at least two different genetic loci in the determination of the levels of HDL and its associated lipoproteins.