3051
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Abstract
Cancer immunotherapy consists of approaches that modify the host immune system, and/or the utilization of components of the immune system, as cancer treatment. During the past 25 years, 17 immunologic products have received regulatory approval based on anticancer activity as single agents and/or in combination with chemotherapy. These include the nonspecific immune stimulants BCG and levamisole; the cytokines interferon-α and interleukin-2; the monoclonal antibodies rituximab, ofatumumab, alemtuzumab, trastuzumab, bevacizumab, cetuximab, and panitumumab; the radiolabeled antibodies Y-90 ibritumomab tiuxetan and I-131 tositumomab; the immunotoxins denileukin diftitox and gemtuzumab ozogamicin; nonmyeloablative allogeneic transplants with donor lymphocyte infusions; and the anti-prostate cancer cell-based therapy sipuleucel-T. All but two of these products are still regularly used to treat various B- and T-cell malignancies, and numerous solid tumors, including breast, lung, colorectal, prostate, melanoma, kidney, glioblastoma, bladder, and head and neck. Positive randomized trials have recently been reported for idiotype vaccines in lymphoma and a peptide vaccine in melanoma. The anti-CTLA-4 monoclonal antibody ipilumumab, which blocks regulatory T-cells, is expected to receive regulatory approval in the near future, based on a randomized trial in melanoma. As the fourth modality of cancer treatment, biotherapy/immunotherapy is an increasingly important component of the anticancer armamentarium.
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Affiliation(s)
- Robert O Dillman
- Hoag Cancer Institute of Hoag Hospital , Newport Beach, California 92658, USA.
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3052
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Zhou L, Rui JA, Wang SB, Chen SG, Qu Q. Prognostic factors of solitary large hepatocellular carcinoma: The importance of differentiation grade. Eur J Surg Oncol 2011; 37:521-5. [DOI: 10.1016/j.ejso.2011.03.137] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 02/10/2011] [Accepted: 03/28/2011] [Indexed: 12/19/2022] Open
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3053
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Giessen C, Stintzing S, Laubender RP, Ankerst DP, Schulz C, Moosmann N, Modest DP, Schalhorn A, von Weikersthal LF, Heinemann V. Analysis for prognostic factors of 60-day mortality: evaluation of an irinotecan-based phase III trial performed in the first-line treatment of metastatic colorectal cancer. Clin Colorectal Cancer 2011; 10:317-24. [PMID: 21729676 DOI: 10.1016/j.clcc.2011.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 03/08/2011] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mortality rates in published irinotecan-based trials range between 1.7% and 5.0%. This analysis aimed to evaluate clinical and histopathologic factors associated with 60-day mortality in first-line therapy for metastatic colorectal cancer (mCRC). PATIENTS AND METHODS Sixty-day all-cause and disease-specific mortality rates from 479 patients who participated in a randomized phase III study comparing FUFIRI (5-fluorouracil [5-FU], leucovorin, irinotecan) (n = 238) vs. mIROX (modified irinotecan plus oxaliplatin (n = 241) were evaluated for association with prognostic factors such as platelet counts, alkaline phosphatase (AP) levels, white blood cell (WBC) counts, hemoglobin values, lactate dehydrogenase (LDH) levels, carcinoembryonic antigen (CEA) levels, and several other baseline parameters using univariate and multivariate logistic regression analyses applied to patients combined from both treatment groups. RESULTS The all-cause 60-day mortality rate was 5.0% (24/479). Thirteen patients (5.5%) in the FUFIRI arm died within the first 60 days of treatment compared with 11 (4.6%) patients in the mIROX arm (P = .68). Among the 24 patients in both treatment arms, mortality was qualified as disease related in 15 (63%) patients and treatment related in 7 (29%) patients (P = .695). In multivariate analyses, high LDH levels (P = .010) and an elevated WBC count (P = .006) remained as significant independent prognostic factors. Low Karnofsky performance status (KPS) showed a strong trend but failed to reach statistical significance (P = .057) as did AP levels and the number of metastatic sites. CONCLUSION In this study 63% of the early deaths were disease related, whereas only 29% were possibly related to study medication. Independent prognostic factors for early mortality were LDH levels and WBC counts. KPS showed a strong trend in the multivariate analysis. Future investigation may consider LDH levels and WBC counts for exclusion criteria.
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Affiliation(s)
- Clemens Giessen
- Department of Medical Oncology, Klinikum Grosshadern, University of Munich, Munich, Germany.
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3054
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Non-pharmacological interventions used by cancer patients during chemotherapy in Turkey. Eur J Oncol Nurs 2011; 15:178-84. [DOI: 10.1016/j.ejon.2010.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 06/10/2010] [Accepted: 07/16/2010] [Indexed: 02/01/2023]
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3055
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Choi JY, Ha TK, Kwon SJ. Clinicopathologic Characteristics of Gastric Cancer Patients according to the Timing of the Recurrence after Curative Surgery. J Gastric Cancer 2011; 11:46-54. [PMID: 22076201 PMCID: PMC3204481 DOI: 10.5230/jgc.2011.11.1.46] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 11/25/2010] [Indexed: 01/27/2023] Open
Abstract
Purpose There are few studies that have focused on the predictors of recurrence after gastrectomy for gastric carcinoma. This study analyzed the patients who died of recurrent gastric carcinoma and we attempted to clarify the clinicopathologic factors that are associated with the timing of recurrence. Materials and Methods From June 1992 to March 2009, 1,795 patients underwent curative gastric resection at the Department of Surgery, Hanyang University College of Medicine. Among them, 428 patients died and 311 of these patients who died of recurrent gastric carcinoma were enrolled in this study. The clinicopathologic findings were compared between the 72 patients who died within one year after curative gastrectomy (the early recurrence group) and the 92 patients who died 3 years after curative gastrectomy (the late recurrence group). Results Compared with the late recurrence group, the early recurrence group showed an older age, a more advanced stage, a poorly differentiated type of cancer and a significantly higher tendency to have lymphatic invasion, vascular invasion and perineural invasion.Especially in the gastric cancer patients with a more advanced stage (stage III and IV), the early recurrence group was characterized by a significantly higher preoperative serum carcino embryonic antigen level, perineural invasion and a relatively small number of dissected lymph nodes. Conclusions The clinicopathologic characteristics of recurrent gastric cancer are significantly different according to the stage of disease, and even in the same stage. For the early detection of recurrence after curative surgery, it is important to recognize the clinicopathological factors that foretell a high risk of recurrence. It is mandatory to make an individualized surveillance schedule according to the clinicopathologic factors.
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Affiliation(s)
- Ji Yoon Choi
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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3056
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Abstract
PURPOSE This study was designed to characterize the entity of colorectal cancer (CRC) in young patients and to evaluate whether it has any unique epidemiological or clinicopathological features. METHODS The study population consisted of all consecutive young (≤50 years old at diagnosis) patients with CRC who were diagnosed during the years 1997-2007 and were treated at our institution, and a matching group of patients (>50 years at diagnosis). The medical files of these patients were reviewed, and the epidemiological, clinical, and pathological features of both groups were compared. RESULTS There were 406 patients: 203 in each group. The features of the older group were typical for patients with CRC, but the younger group showed female predominance, different ethnic composition, prevalence of family history of cancer and hereditary CRC syndromes, and lower incidence of polyps. The incidence of left-sided tumors and advanced stages (III-IV) at diagnosis was higher in the younger patients. Mucinous/signet ring histology, grade, stage, lymphatic and vascular invasion were all predictive of survival, whereas age was not. CONCLUSIONS Colorectal cancer in young patients was found to display a cluster of unique characteristics but fewer than previously reported and young age by itself was not found to impact patient outcome.
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3057
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Guzel-Seydim Z, Kok-Tas T, Ertekin-Filiz B, Seydim A. Effect of different growth conditions on biomass increase in kefir grains. J Dairy Sci 2011; 94:1239-42. [DOI: 10.3168/jds.2010-3349] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 11/08/2010] [Indexed: 02/01/2023]
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3058
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Kos FT, Uncu D, Özdemir N, Budakoglu B, Odabaş H, Abali H, Oksuzoglu B, Aksoy S, Zengin N. Comparison of Cisplatin-5-Fluorouracil-Folinic Acid versus Modified Docetaxel-Cisplatin-5-Fluorouracil Regimens in the First-Line Treatment of Metastatic Gastric Cancer. Chemotherapy 2011; 57:230-5. [DOI: 10.1159/000327840] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 12/16/2010] [Indexed: 11/19/2022]
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3059
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Eom BW, Ryu KW, Lee JH, Choi IJ, Kook MC, Cho SJ, Lee JY, Kim CG, Park SR, Lee JS, Kim YW. Oncologic effectiveness of regular follow-up to detect recurrence after curative resection of gastric cancer. Ann Surg Oncol 2010; 18:358-64. [PMID: 21042946 DOI: 10.1245/s10434-010-1395-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND While clinicians routinely follow up gastric cancer patients after curative resection to detect recurrence, the effectiveness of regular follow-up has not been proven, and no consensus has been reached regarding follow-up programs. METHODS Of the 1,767 patients who underwent curative resection for gastric cancer from 2001 to 2004, 310 (17.5%) developed recurrence during follow-up. The oncologic effectiveness of follow-up was evaluated using recurrence detection rates during follow-up and survivals. Clinicopathologic characteristics, the detection tools used, and times lapsed between recurrence and previous examinations were also investigated. RESULTS Two hundred thirty-three (75.2%) of the 310 patients who developed recurrence were detected by regular follow-up (detected group). The frequencies of undifferentiated and diffuse-type recurrences were higher in patients with recurrence detected based on patient-initiated findings (undetected group) than in the detected group. Computed tomography and tumor markers were the first detection tools that yielded positive findings. Times between recurrence detection and previous examinations ranged from 2.8 to 5.3 months over the first 2 years. No difference in overall survival was found between the detected and undetected groups (log rank, P = 0.2). CONCLUSIONS The oncologic effectiveness of regular follow-up after curative resection for gastric cancer was found to be unsatisfactory. A large-scale randomized controlled trial is required to identify the effectiveness of regular follow-up in terms of its oncologic, functional, psychological, and economical aspects.
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Affiliation(s)
- Bang Wool Eom
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
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3060
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Preoperative scoring systems and prognostic factors for patients with spinal metastases from hepatocellular carcinoma. Spine (Phila Pa 1976) 2010; 35:E1339-46. [PMID: 20938387 DOI: 10.1097/brs.0b013e3181e574f5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study had been conducted to compare the existing preoperative scoring systems and to find useful prognostic factors for patients with spinal metastases from hepatocellular carcinoma (HCC). OBJECTIVE To evaluate different preoperative scoring systems and prognostic factors for patients with spinal metastases from HCC. SUMMARY OF BACKGROUND DATA Different scoring systems for metastatic spinal tumor have been designed for prognostic evaluation. However, these scoring systems were formulated from many different types of tumors, so that their efficacy for a certain type of cancer needs to be validated. Furthermore, some serologic test results may enhance the accuracy of the scoring system. METHODS We conducted a retrospective study to evaluate 4 prognostic scoring systems and factors in a series of 41 cases with spinal metastases from HCC in a single center. These scoring systems include Tokuhashi revised score, Tomita score, Bauer score, and a revised van der Linden score by the authors. Serologic test items including serum albumin, aspartate aminotransferase, alanine transaminase, and lactate dehydrogenase (LDH) were also evaluated. RESULTS The revised Tokuhashi scoring system provided statistically significant differences in survival time between different groups (P = 0.012), while the Tomita and Bauer systems did not show statistically significant differences (P = 0.918 and P = 0.754, respectively). Significantly improved survival was found in patients with good performance status and no visceral metastases (Group C, P = 0.008) in revised van der Linden scores. Univariate and multivariate analyses showed serum albumin and LDH were independent prognostic factors for survival time. CONCLUSION Revised Tokuhashi scoring system is practicable and highly predictive, while serum albumin and LDH also have prognostic value in patients with spinal metastases from HCC, especially those without visceral metastases. More accurate prognosis may be obtained if the scoring systems include clinical and laboratory data in future.
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3061
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Gupta S, Bhattacharya D, Acharya AN, Majumdar S, Ranjan P, Das S. Colorectal carcinoma in young adults: a retrospective study on Indian patients: 2000-2008. Colorectal Dis 2010; 12:e182-9. [PMID: 20128837 DOI: 10.1111/j.1463-1318.2010.02223.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To highlight an increased incidence of colorectal cancer (CRC) amongst young Indian adults. METHOD A retrospective study of 305 cases of CRC admitted to SSKM Hospital, Kolkata, India during 2000-2008 was carried out. RESULTS The ratio (0.64) of under-40 to above-40 CRC patients reported in this study is comparable to those from premier Oncology Centers in India (∼0.52) and is higher than those in the Indian National Cancer Registry (∼0.20) and international average (0.07). Distinctive tumour characteristics in younger patients including left-sided lesion (69.7%), presentation at an advanced (III/IV) stage (60%), poor histological differentiation (50%) and predominance of mucin-secreting adenocarcinoma (80%) are similar to those reported in the international literature. Some features are suggestive of hereditary non polyposis colorectal cancer syndrome, which may be a possible reason for the high proportion of young CRC patients. CONCLUSION A high index of suspicion for CRC among young Indian adults is necessary.
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Affiliation(s)
- S Gupta
- Department of Surgery, IPGMER, Kolkata, India.
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3062
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Chan KK, Dassanayake B, Deen R, Wickramarachchi RE, Kumarage SK, Samita S, Deen KI. Young patients with colorectal cancer have poor survival in the first twenty months after operation and predictable survival in the medium and long-term: analysis of survival and prognostic markers. World J Surg Oncol 2010; 8:82. [PMID: 20840793 PMCID: PMC2954852 DOI: 10.1186/1477-7819-8-82] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/15/2010] [Indexed: 12/14/2022] Open
Abstract
Objectives This study compares clinico-pathological features in young (<40 years) and older patients (>50 years) with colorectal cancer, survival in the young and the influence of pre-operative clinical and histological factors on survival. Materials and methods A twelve year prospective database of colorectal cancer was analysed. Fifty-three young patients were compared with forty seven consecutive older patients over fifty years old. An analysis of survival was undertaken in young patients using Kaplan Meier graphs, non parametric methods, Cox's Proportional Hazard Ratios and Weibull Hazard models. Results Young patients comprised 13.4 percent of 397 with colorectal cancer. Duration of symptoms and presentation in the young was similar to older patients (median, range; young patients; 6 months, 2 weeks to 2 years, older patients; 4 months, 4 weeks to 3 years, p > 0.05). In both groups, the majority presented without bowel obstruction (young - 81%, older - 94%). Cancer proximal to the splenic flexure was present more in young than in older patients. Synchronous cancers were found exclusively in the young. Mucinous tumours were seen in 16% of young and 4% of older patients (p < 0.05). Ninety four percent of young cancer deaths were within 20 months of operation. At median follow up of 50 months in the young, overall survival was 70% and disease free survival 66%. American Joint Committee on Cancer (AJCC) stage 4 and use of pre-operative chemoradiation in rectal cancer was associated with poor survival in the young. Conclusion If patients, who are less than 40 years old with colorectal cancer, survive twenty months after operation, the prognosis improves and their survival becomes predictable.
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Affiliation(s)
- K K Chan
- The Johor Bahru Hospital, Johor, Malaysia
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3063
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Haas M, Laubender RP, Stieber P, Holdenrieder S, Bruns CJ, Wilkowski R, Mansmann U, Heinemann V, Boeck S. Prognostic relevance of CA 19-9, CEA, CRP, and LDH kinetics in patients treated with palliative second-line therapy for advanced pancreatic cancer. Tumour Biol 2010; 31:351-7. [PMID: 20480409 DOI: 10.1007/s13277-010-0044-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 02/26/2010] [Indexed: 12/18/2022] Open
Abstract
The objective of this study was to define prognostic serum biomarkers that could serve as surrogate survival endpoints during second-line treatment for advanced pancreatic cancer. This retrospective single-center study included patients treated with second-line therapy for advanced exocrine pancreatic cancer. A pretreatment value and at least one serial measurement during the first two cycles of second-line chemotherapy for CA 19-9, CEA, CRP, and LDH had to be available in order to evaluate the prognostic role of kinetics on overall survival. A cutoff of a >20% increase from baseline during treatment was defined in order to form groups with suspected different outcomes. The effect of serial biomarker changes on survival was modeled by Cox proportional hazards regression in univariate and multivariate analyses. Overall, 70 patients treated with second-line therapy for advanced disease were included; 94% had distant metastases at treatment initiation. Median time to progression was 2.7 months and median survival 5.4 months. Univariate analysis found that an increase of >20% during treatment was significantly associated with a worse overall survival for CA 19-9 (HR 2.00, p = 0.018), CEA (HR 2.38, p = 0.004), and CRP (HR 3.06, p < 0.001). These associations remained significant within multivariate analysis for CEA (HR 2.86, p = 0.001) and CRP (HR 3.20, p = 0.001). Serum biomarker kinetics might serve as useful prognostic tools during second-line chemotherapy in advanced pancreatic cancer.
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Affiliation(s)
- Michael Haas
- Department of Internal Medicine III, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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3064
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Al-Barrak J, Gill S. Presentation and outcomes of patients aged 30 years and younger with colorectal cancer: a 20-year retrospective review. Med Oncol 2010; 28:1058-61. [PMID: 20680521 DOI: 10.1007/s12032-010-9639-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 07/21/2010] [Indexed: 12/18/2022]
Abstract
Age may influence the clinicopathological characteristics and outcome of colorectal cancer. The aim of this study is to retrospectively review the characteristics and outcomes of patients diagnosed at age 30 years and younger. All patients diagnosed with colorectal adenocarcinoma at age 30 years or younger, referred to the British Columbia Cancer Agency between 1985 and 2005, were identified. Abstracted data included demographics, presenting symptoms, risk factors, stage at presentation, treatment received and overall survival. Survival analysis was by the method of Kaplan-Meier. From 16,732 patients with colorectal cancer, 78 (0.47%) were younger than or equal to 30 years of age. Sufficient data were available for 62 patients. Twenty-three patients (37%) had a rectal primary, and 52% of colon primaries were proximal. Seventeen patients (27%) presented with metastatic disease. The stage distribution among the 45 patients with localized disease was stage I 9%, stage II 42% and stage III 49%. A positive family history was reported in 27% of patients. Pain and bleeding were the most common symptomatic presentations. Five-year overall survival was 44% in the entire cohort; 54% in stage I-III disease and 12% in stage IV disease. Very young patients with colorectal cancer represent<0.5% of all referred cases in British Columbia. The majority presented without a positive family history. The 5-year survival for patients in our young cohort with localized disease appears inferior to that expected, although 5-year survival among patients with stage IV disease was observed to be higher than expected.
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Affiliation(s)
- Jasem Al-Barrak
- British Columbia Cancer Agency, University of British Columbia, Vancouver, BC, Canada.
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3065
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Luo XR, Li JS, Niu Y, Miao L. Targeted killing effects of double CD and TK suicide genes controlled by survivin promoter on gastric cancer cell. Mol Biol Rep 2010; 38:1201-7. [PMID: 20574710 DOI: 10.1007/s11033-010-0218-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 06/11/2010] [Indexed: 10/25/2022]
Abstract
Suicide genes such as cytosine deaminase (CD) and herpes simplex virus thymidine kinase (TK) encode products that convert nontoxic substances (prodrugs) into toxic metabolites. Studies in recent years indicated that survivin(sur) expression was associated with the biological behaviors of gastric carcinoma. In the present study, targeted killing effects of double CD and TK suicide genes controlled by survivin promoter on gastric cancer cell were investigated, the recombinant pSCT vector containing CD and TK genes driven by sur promoter was constructed and transfected into SGC-7901 cells. After adding the CCV and 5-FC, the effects of double suicide genes on cell growth, cell cycle and proliferation were determined by MTT assay and flow cytometry (FCM). The results showed that sur promoter could specifically drive the expression of double CD/TK gene in SGC-7901 cells, whereas not in the normal GES-1 cell. After using CCV and 5-FC, the growth of SGC-7901 cells was inhibited. G1 phase proportion was significantly higher in SGC-7901 cells transfected with double suicide genes than the untransfected cells. These results suggest that CD and TK double suicide genes driven by sur promoter could provide a new approach for enhancing selective suicide gene therapy of CD/5-FC for the treatment of advanced gastric carcinoma.
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Affiliation(s)
- Xian-Run Luo
- Department of Gastroenterology, The First Affiliated Hospital of ZhengZhou University, No 1 Jianshe East Road, Zhengzhou, Henan, 450052, People's Republic of China
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3066
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Piedbois P, Buyse M. Méta-analyses sur données individuelles : exemple des cancers colorectaux métastatiques. Rech Soins Infirm 2010. [DOI: 10.3917/rsi.101.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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3067
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Scheidbach H, Lippert H, Meyer F. Gastric carcinoma: when is palliative gastrectomy justified? Oncol Rev 2010. [DOI: 10.1007/s12156-010-0046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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3068
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Siemerink EJM, Drenth AFJ, Mulder NH, Plukker JTM, Hospers GAP. Phase II study of oxaliplatin, UFT, and leucovorin in patients with metastatic gastric cancer. Gastric Cancer 2010; 13:95-100. [PMID: 20602196 DOI: 10.1007/s10120-010-0545-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/28/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study evaluated the efficacy and safety of oxaliplatin, UFT, and leucovorin in metastatic gastric cancer. METHODS Patients received intravenous oxaliplatin 130 mg/m(2) on day 1, followed by oral UFT capsules (350 mg/m(2) per day) and leucovorin tablets (90 mg/day), every 8 h, for 14 days, in a 3-week cycle. RESULTS Twenty-three patients (61% with > or = 2 metastatic sites), median age of 60 years (range, 39-69 years) were entered. Based on intention-to-treat analysis, one complete response and seven partial responses were found, resulting in an overall response rate (RR) of 35% (95% confidence interval [CI], 16-54), a median time to progression of 4 months (95% CI, 0.5-7.5), and a median overall survival (OS) of 8 months (95% CI, 4.5-11.5). The 1-year survival rate was 26%. Three patients did not complete the first course of 2 weeks; 1 died suddenly on day 16 with fatal lung embolism; 1 had rapid progressive disease and 1 experienced gastric hemorrhage on day 15 - both these patients withdrew. In the 20 patients assessable for toxicity no grade 4 toxicity occurred, grade 3 toxicity consisted of anemia in 1, diarrhea in 2, and neurotoxicity in 3 patients. No hand-foot syndrome (HFS) occurred. CONCLUSION Oxaliplatin is an effective drug in gastric cancer, but, as previously reported, its feasibility in combination with capecitabine is hampered due to combined hand-foot-based toxicity. The present phase II study of a combination of oxaliplatin with UFT and leucovorin appears to have efficacy and tolerability comparable to two other drug regimens used in gastric cancer, without the HFS problem.
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Affiliation(s)
- Ester J M Siemerink
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3069
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Choi MK, Ahn BJ, Yim DS, Park YS, Kim S, Sohn TS, Noh JH, Heo JS, Lee J, Park SH, Park JO, Lim HY, Kang WK. Phase I study of intraperitoneal irinotecan in patients with gastric adenocarcinoma with peritoneal seeding. Cancer Chemother Pharmacol 2010; 67:5-11. [PMID: 20213078 DOI: 10.1007/s00280-010-1272-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 02/03/2010] [Indexed: 10/24/2022]
Abstract
PURPOSE The objectives of this phase I study were to determine the maximum-tolerated dose (MTD), dose-limiting toxicities (DLTs), and preliminary efficacy of intraperitoneally administered irinotecan (CPT-11) in gastric cancer patients with peritoneal seeding. EXPERIMENTAL DESIGN Gastric adenocarcinoma patients with surgical biopsy proven peritoneal seeding were enrolled at the time of surgery. Prior to IP chemotherapy, patients underwent palliative gastrectomy and CAPD catheter insertion in which CPT-11 was administered on postoperative day 1. The IP CPT-11 was initiated at 50 mg/m(2), which was escalated to 100, 150, 200, 250, and 300 mg/m(2). IP CPT-11 chemotherapy was repeated every 3 weeks. RESULTS Seventeen patients received a total of 56 cycles at five different CPT-11 dose levels. The DLTs were neutropenic fever, neutropenia, and diarrhea. At the dose level 2 (100 mg/m(2)), there were one DLTs in one of the first cohort of three patients, but no DLTs at the second cohort of this level. At the dose level 5 (250 mg/m(2)), two DLTs were detected in the first two patients; thus, the accrual was stopped resulting in the recommended dose of IP CPT-11 of 200 mg/m(2). Median progression-free survival was 8.6 months (95% CI, 5.9,11.2), and median overall survival was 15.6 months (95% CI, 8.4,22.8). Pharmacokinetic results of the study showed that the C (max) of peritoneal SN-38 was achieved earlier than that of plasma SN-38. CONCLUSIONS Intraperitoneally administered CPT-11 was feasible and tolerable. Further, phase II study of IP CPT-11 in gastric cancer patients with peritoneal seeding is warranted.
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Affiliation(s)
- Moon Ki Choi
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea
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3070
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Power DG, Kelsen DP, Shah MA. Advanced gastric cancer--slow but steady progress. Cancer Treat Rev 2010; 36:384-92. [PMID: 20176443 DOI: 10.1016/j.ctrv.2010.01.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 01/22/2010] [Accepted: 01/26/2010] [Indexed: 12/14/2022]
Abstract
Progress in gastric cancer has been slow, but steady. Historically, patients commonly presented with significant disease related co-morbidity and received treatment of marginal benefit but unfortunately associated with significant toxicity. Today there is no universally accepted reference standard chemotherapy for this disease. However, there is reason for optimism. Meta-analyses of randomized trials have shown a benefit for first-line combination chemotherapy. Current three drug chemotherapy regimens remain toxic, though perhaps less so than previously, and can result in a small but significant survival advantage in carefully chosen patients. Incremental improvements have been observed in both treatment-related toxicity and survival after first-line therapy. More patients are candidates for chemotherapy beyond progression with first-line therapy and response rates with second-line regimens are similar to those seen in other solid tumor malignancies. Although there is no randomized data to support its use second-line treatment should be considered in appropriate patients. Even before the integration of targeted therapies in the treatment of gastric cancer, it was evident that survival for more than 2 years is possible in a subset of patients and large retrospective studies have highlighted clinicopathologic factors associated with improved survival. Presently, with the addition of targeted therapy, especially anti-angiogenic and anti-Her2 therapy, and a better understanding of the biology of the disease, perhaps a sense of optimism should indeed suppress the nihilism commonly associated with this disease.
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Affiliation(s)
- Derek G Power
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, USA.
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3071
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Kopetz S, Hoff PM, Morris JS, Wolff RA, Eng C, Glover KY, Adinin R, Overman MJ, Valero V, Wen S, Lieu C, Yan S, Tran HT, Ellis LM, Abbruzzese JL, Heymach JV. Phase II trial of infusional fluorouracil, irinotecan, and bevacizumab for metastatic colorectal cancer: efficacy and circulating angiogenic biomarkers associated with therapeutic resistance. J Clin Oncol 2009; 28:453-9. [PMID: 20008624 DOI: 10.1200/jco.2009.24.8252] [Citation(s) in RCA: 365] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We investigated the efficacy of fluorouracil (FU), leucovorin, irinotecan, and bevacizumab (FOLFIRI + B) in a phase II trial in patients previously untreated for metastatic colorectal cancer (mCRC), and changes during treatment in plasma cytokines and angiogenic factors (CAFs) as potential markers of treatment response and therapeutic resistance. PATIENTS AND METHODS We conducted a phase II, two-institution trial of FOLFIRI + B. Each 14-day cycle consisted of bevacizumab (5 mg/kg), irinotecan (180 mg/m(2)), bolus FU (400 mg/m(2)), and leucovorin (400 mg/m(2)) followed by a 46-hour infusion of FU (2,400 mg/m(2)). Levels of 37 CAFs were assessed using multiplex-bead assays and enzyme-linked immunosorbent assay at baseline, during treatment, and at the time of progressive disease (PD). RESULTS Forty-three patients were enrolled. Median progression-free survival (PFS), the primary end point of the study, was 12.8 months. Median overall survival was 31.3 months, with a response rate of 65%. Elevated interleukin-8 at baseline was associated with a shorter PFS (11 v 15.1 months, P = .03). Before the radiographic development of PD, several CAFs associated with angiogenesis and myeloid recruitment increased compared to baseline, including basic fibroblast growth factor (P = .046), hepatocyte growth factor (P = .046), placental growth factor (P < .001), stromal-derived factor-1 (P = .04), and macrophage chemoattractant protein-3 (P < .001). CONCLUSION Efficacy and tolerability of FOLFIRI + B appeared favorable to historical controls in this single arm study. Before radiographic progression, there was a shift in balance of CAFs, with a rise in alternate pro-angiogenic cytokines and myeloid recruitment factors in subsets of patients that may represent mechanisms of resistance.
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Affiliation(s)
- Scott Kopetz
- University of Texas MD Anderson Cancer Center; Lyndon B Johnson Hospital, Harris County Hospital District, Houston, TX, USA.
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3072
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Solimando DA, Waddell JA. Epirubicin, Cisplatin, and Fluorouracil (ECF) Regimen. Hosp Pharm 2009. [DOI: 10.1310/hpj4412-1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparing, dispensing, and administering antineoplastic therapy and to the agents, commercially available and investigational, used to treat malignant diseases.
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3073
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Li M, Li JY, Zhao AL, Gu J. Do Young Patients with Colorectal Cancer Have a Poorer Prognosis than Old Patients? J Surg Res 2009. [DOI: 10.1016/j.jss.2009.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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3074
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Landherr L, Nagykálnai T. [The development of the first line treatment of metastatic colorectal cancer (mCRC)]. Magy Onkol 2009; 53:237-46. [PMID: 19793687 DOI: 10.1556/monkol.53.2009.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Chemotherapy options of metastatic colorectal cancer (mCRC) have been progressed rapidly in the last years. Besides of the standard fluorouracil/folinic acid treatment some new active agents (oxaliplatin and irinotecan) have been introduced, and more recently the "targeted" biologicals (bevacizumab, cetuximab, panitumumab) have demonstrated their high effectiveness. This review summarizes the development of the first line treatment of mCRC.
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Affiliation(s)
- László Landherr
- Fôvárosi Onkormányzat Uzsoki utcai Kórháza Onkoradiológiai Központ, Budapest, Uzsoki.
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3075
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Hur H, Song KY, Park CH, Jeon HM. Follow-up strategy after curative resection of gastric cancer: a nationwide survey in Korea. Ann Surg Oncol 2009; 17:54-64. [PMID: 19777193 DOI: 10.1245/s10434-009-0676-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 05/12/2009] [Accepted: 05/19/2009] [Indexed: 12/31/2022]
Abstract
BACKGROUND To date, guidelines for follow-up after curative resection in patients with gastric cancer have not been reported. Thus, most centers have managed the process according to institution-specific protocols. We investigated current follow-up practices after curative resection of gastric cancer using a nationwide survey in Korea, where gastric cancer is epidemic. METHODS From July to September 2007, questionnaires were sent out to 205 members of the Korean Gastric Cancer Association (KGCA). The questionnaire packet contained a covering letter, general information, and a questionnaire about follow-up schedules and methodologies. RESULTS Forty-six percent (96/205) of the members of the KGCA returned the survey. The majority of responders indicated that patients with early gastric cancer were followed up every 6 months (64.4%) for the first year, every 12 months (47.9%) for the next 4 years, and every 12 months (68.8%) from the fifth year after surgery on. For patients with advanced gastric cancer, follow-up studies were carried out every 3 months (43.8%) for the first year, every 6 months for the next 4 years, and every 12 months (75.0%) from the fifth year onward. After surgery, most responders used computed tomography for imaging, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 as tumor markers, and serum iron among follow-up measures. CONCLUSIONS Clinicians have a variety of approaches regarding the extent of follow-up and methodologies used after curative resection for gastric cancer. Therefore, a multicenter randomized trial will be needed to compare routine follow-up with intensive schedules. Our results could facilitate the design of such studies.
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Affiliation(s)
- Hoon Hur
- Department of Surgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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3076
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Abstract
Metastatic penile carcinoma is rare and usually originates from genitourinary tumors. The presenting symptoms or signs have been described as nonspecific except for priapism. Rectal adenocarcinoma is a very unusual source of metastatic penile carcinoma. We report a case of metastatic penile carcinoma that originated from the rectum. Symptomatic improvement occurred with palliative radiotherapy.
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3077
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Gastric cancer. Crit Rev Oncol Hematol 2009; 71:127-64. [PMID: 19230702 DOI: 10.1016/j.critrevonc.2009.01.004] [Citation(s) in RCA: 318] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 01/08/2009] [Accepted: 01/15/2009] [Indexed: 02/08/2023] Open
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3078
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González-Billalabeitia E, Hitt R, Fernández J, Conde E, Martínez-Tello F, Enríquez de Salamanca R, Cortés-Funes H, González-Billalabeitia E. Pre-treatment serum lactate dehydrogenase level is an important prognostic factor in high-grade extremity osteosarcoma. Clin Transl Oncol 2009; 11:479-83. [DOI: 10.1007/s12094-009-0388-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3079
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Impact of plasma tissue inhibitor of metalloproteinase-1 on long-term survival in patients with gastric cancer. Gastric Cancer 2009; 12:31-6. [PMID: 19390929 DOI: 10.1007/s10120-008-0494-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 11/22/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND The expression of tissue inhibitor of metalloproteinase-1 (TIMP-1) is correlated with tumor invasion and metastases. METHODS The plasma TIMP-1 concentration was examined preoperatively in 149 patients with gastric cancer who underwent a surgical resection. The cutoff value of TIMP-1 was set at 112.5 ng/ml based on a previous report. These patients were followed up for more than 5 years prospectively. RESULTS Plasma TIMP-1 was positive in 30 of the 149 patients (20.1%). The overall survival rate was 78.2% at 5 years in patients with negative plasma TIMP-1, while this rate was 26.7% at 5 years in patients with positive plasma TIMP-1. By univariate analyses, T, N, M, and R category, and TIMP-1, were significant prognosticators. Multivariate analyses demonstrated T, N, and TIMP-1 to be significant prognosticators. The survival curve was clearly separated with respect to TIMP-1. CONCLUSION These results suggest that plasma TIMP-1 is a strong independent prognosticator for the long-term survival of patients with gastric cancer.
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3080
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Systemic treatment of gastric cancer. Crit Rev Oncol Hematol 2009; 70:216-34. [DOI: 10.1016/j.critrevonc.2008.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 07/21/2008] [Accepted: 08/13/2008] [Indexed: 02/07/2023] Open
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3081
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Cancer’s craving for sugar: an opportunity for clinical exploitation. J Cancer Res Clin Oncol 2009; 135:867-77. [DOI: 10.1007/s00432-009-0590-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 04/09/2009] [Indexed: 12/22/2022]
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3082
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Contributions of meta-analyses based on individual patient data to therapeutic progress in colorectal cancer. Int J Clin Oncol 2009; 14:95-101. [PMID: 19390939 DOI: 10.1007/s10147-009-0879-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Indexed: 12/22/2022]
Abstract
Meta-analysis is the statistical process of combining information from several studies addressing the same question. Meta-analyses based on individual patient data are far more reliable and informative than those based on summary statistics obtained from the trialists or extracted from the published literature. Meta-analysis of randomized clinical trials may contribute to therapeutic progress through (1) establishing efficacy benefits beyond a reasonable doubt, (2) identifying sources of heterogeneity between trials, (3) studying subsets reliably, (4) confirming differences in toxicity profiles, (5) evaluating the cost-effectiveness of experimental therapies, (6) assessing surrogate endpoints, and (7) addressing ancillary questions. All of these potential contributions are illustrated with examples in early and advanced colorectal cancer.
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3083
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Abstract
BACKGROUND Although there are many studies of the predictors of death in hepatocellular carcinoma (HCC), most combine patients with and without cirrhosis and many combine those with compensated and decompensated cirrhosis. OBJECTIVE To perform a systematic review of the literature evaluating the predictors of death in patients with cirrhosis and HCC and to evaluate whether the predictors differ between patients with compensated and decompensated cirrhosis. INCLUSION CRITERIA (i) publication in English, (ii) adult patients, (c) >80% of the patients had cirrhosis, (iv) follow-up >6 months and (v) multivariable analysis. Quality was based on the accepted quality criteria for prognostic studies. RESULTS Of the 1106 references obtained, 947 were excluded because they did not meet the inclusion criteria. A total of 23 968 patients were included in 72 studies (median, 177/study); 77% male, median age 64, 55% Child-Pugh class A. The most robust predictors of death were portal vein thrombosis, tumour size, alpha-foetoprotein and Child-Pugh class. Sensitivity analysis using only 15 'good' studies and 22 studies in which all patients had cirrhosis yielded the same variables. In the studies including mostly compensated or decompensated patients, the predictors were both liver and tumour related. However, these studies were few and the results were not robust. CONCLUSIONS This systematic review of 72 studies shows that the most robust predictors of death in patients with cirrhosis and HCC are tumour related and liver related. Future prognostic studies should include these predictors and should be performed in specific patient populations to determine whether specific prognostic indicators are more relevant at different stages of cirrhosis.
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Affiliation(s)
- Puneeta Tandon
- Digestive Diseases Section, Yale University School of MedicineNew Haven, CT, USA,VA Connecticut Healthcare SystemWest Haven, CT, USA,Division of Gastroenterology, University of AlbertaEdmonton, AB, Canada
| | - Guadalupe Garcia-Tsao
- Digestive Diseases Section, Yale University School of MedicineNew Haven, CT, USA,VA Connecticut Healthcare SystemWest Haven, CT, USA
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3084
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Ikeguchi M, Miyake T, Matsunaga T, Yamamoto M, Fukumoto Y, Yamada Y, Fukuda K, Saito H, Tatebe S, Tsujitani SI. Recent results of therapy for scirrhous gastric cancer. Surg Today 2009; 39:290-4. [PMID: 19319634 DOI: 10.1007/s00595-008-3860-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 10/06/2008] [Indexed: 01/09/2023]
Abstract
The prognosis of patients with scirrhous gastric cancer (SGC) is extremely poor. However, recent advances in therapeutic strategies against SGC, using effective anticancer drugs, have prolonged the survival of patients with SGC. This paper reviews the recent therapeutic outcomes of this type of gastric cancer and introduces a new treatment protocol for SGC.
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Affiliation(s)
- Masahide Ikeguchi
- Department of Surgery, Division of Surgical Oncology, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan
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3085
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Goulart BHL, Clark JW, Lauwers GY, Ryan DP, Grenon N, Muzikansky A, Zhu AX. Long term survivors with metastatic pancreatic adenocarcinoma treated with gemcitabine: a retrospective analysis. J Hematol Oncol 2009; 2:13. [PMID: 19291303 PMCID: PMC2663565 DOI: 10.1186/1756-8722-2-13] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 03/16/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic pancreatic adenocarcinoma has a short median overall survival (OS) of 5-6 months. However, a subgroup of patients survives more than 1 year. We analyzed the survival outcomes of this subgroup and evaluated clinical and pathological factors that might affect survival durations. METHODS We identified 20 patients with metastatic or recurrent pancreatic adenocarcinoma who received single-agent gemcitabine and had an OS longer than 1 year. Baseline data available after the diagnosis of metastatic or recurrent disease was categorized as: 1) clinical/demographic data (age, gender, ECOG PS, number and location of metastatic sites); 2) Laboratory data (Hematocrit, hemoglobin, glucose, LDH, renal and liver function and CA19-9); 3) Pathologic data (margins, nodal status and grade); 4) Outcomes data (OS, Time to Treatment Failure (TTF), and 2 year-OS). The lowest CA19-9 levels during treatment with gemcitabine were also recorded. We performed a univariate analysis with OS as the outcome variable. RESULTS Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively). Median OS and TTF on gemcitabine were 26.9 (95% CI = 18 to 32) and 11.5 (95% CI = 9.0 to 14.3) months, respectively. Two-year OS was 56.4%, with 7 patients alive at the time of analysis. CONCLUSION A subgroup of patients with metastatic pancreatic cancer has prolonged survival after treatment with gemcitabine. Only bilirubin and CA 19-9 levels were predictive of longer survival in this population. Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.
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Affiliation(s)
- Bernardo H L Goulart
- Division of Hematology/Oncology, Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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3086
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Abstract
Pancreatic cancer is the fifth most common cause of cancer death. Identification of defined patient groups based on a prognostic index may improve the prediction of survival and selection of therapy. Many prognostic factors have been identified often based on retrospective, underpowered studies with unclear analyses. Data from 653 patients were analysed. Continuous variables are often simplified assuming a linear relationship with log hazard or introducing a step function (dichotomising). Misspecification may lead to inappropriate conclusions but has not been previously investigated in pancreatic cancer studies. Models based on standard assumptions were compared with a novel approach using nonlinear fractional polynomial (FP) transformations. The model based on FP-transformed covariates was most appropriate and confirmed five previously reported prognostic factors: albumin, CA19-9, alkaline phosphatase, LDH and metastases, and identified three additional factors not previously reported: WBC, AST and BUN. The effects of CA19-9, alkaline phosphatase, AST and BUN may go unrecognised due to simplistic assumptions made in statistical modelling. We advocate a multivariable approach that uses information contained within continuous variables appropriately. The functional form of the relationship between continuous covariates and survival should always be assessed. Our model should aid individual patient risk stratification and the design and analysis of future trials in pancreatic cancer.
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3087
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Cho JN, Kim YH. Clinicopathologic Evaluation of Patients with Recurrence of Gastric Cancer within 6 Months after Curative Resection. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.6.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeong Nam Cho
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yong Ho Kim
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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3088
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Kim YI, Ki HS, Kim MH, Cho DK, Cho SB, Joo YE, Kim HS, Choi SK, Rew JS. Analysis of the clinical characteristics and prognostic factors of ruptured hepatocellular carcinoma. THE KOREAN JOURNAL OF HEPATOLOGY 2009; 15:148-58. [DOI: 10.3350/kjhep.2009.15.2.148] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Young-Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ho-Seok Ki
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Min-Hyoung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Keun Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Bum Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young-Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Kyu Choi
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Sun Rew
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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3089
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Zeng ZC, Fan J, Tang ZY, Zhou J, Wang JH, Wang BL, Guo W. Prognostic factors for patients with hepatocellular carcinoma with macroscopic portal vein or inferior vena cava tumor thrombi receiving external-beam radiation therapy. Cancer Sci 2008; 99:2510-7. [PMID: 19032365 PMCID: PMC11158789 DOI: 10.1111/j.1349-7006.2008.00981.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Prognostic factors in patients with hepatocellular carcinoma (HCC) with tumor thrombosis are not well established, especially for those given external-beam radiation therapy (EBRT). Patients (n = 136) with HCC who had portal vein (PV) or inferior vena cava (IVC) tumor thrombus received EBRT between January 1998 and October 2007. Demographic variables, laboratory values, tumor characteristics, and treatment modalities were determined at diagnosis and before EBRT. The total radiation dose ranged from 30 to 60 Gy (median, 50 Gy) and was focused on the tumor thrombi. Predictors of survival were identified using the univariate and multivariate analysis. Of the 136 patients, the tumor thrombus completely disappeared in 41 patients (30.1%), 36 patients (26.5%) had a partial response, 49 patients (36%) had stable disease, and 10 patients (7.4%) had progressive disease. On multivariate analysis, pretreatment unfavorable predictors were associated with lower albumin, higher gamma-glutamyltransferase and alpha-fetoprotein levels, poorer Child-Pugh classification, intrahepatic multifocality, lymph node metastases, poorer response to EBRT, and 2-dimension EBRT technique. Survival rates at 1, 2, and 3 years were 31.8%, 17.5%, and 8.8% for patients with PV tumor thrombi; 66.3%, 21.1%, and 15.8% for IVC tumor thrombi; and 25%, 8.3%, and 0% for PV plus IVC tumor thrombi, respectively. Overall median survival was 9.7 months. This study provides detailed information about the survival outcomes and prognostic factors of HCC with tumor thrombi in a relatively large cohort of patients treated with radiation, and the results will help in understanding the potential factors that influence survival for patients with HCC after EBRT.
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Affiliation(s)
- Zhao-Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 136 Yi Xue Road, Shanghai 200032, China.
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3090
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Yao Y, Zhao H, Sun Y, Lin F, Tang L, Chen P. Combined chemotherapy of hydroxycampothecin with oxaliplatin as an adjuvant treatment for human colorectal cancer. TOHOKU J EXP MED 2008; 215:267-78. [PMID: 18648187 DOI: 10.1620/tjem.215.267] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Colorectal cancer (CRC) is a major cause of morbidity and mortality for cancer worldwide, but many patients with CRC are resistant to chemotherapy. We therefore investigated the therapeutic mechanism and clinical effect of combined chemotherapy of hydroxycampothecin (HCPT) with oxaliplatin (L-OHP) on CRC. HCPT represents a potential antitumor agent of Chinese herb. Mice carrying the xenografted human LS174T CRC cells were injected into peritoneal cavities with different drugs: HCPT + L-OHP (OH), HCPT, L-OHP, or saline. Treatment of mice with OH caused the decrease in the volume of tumor and the expression of p53, but increased the apoptotic rate and Fas-L expression, compared to those of animals treated with HCPT or L-OHP, or control animals. Thus, the combination of HCPT with L-OHP could more effectively induce the apoptosis of CRC cells. Furthermore, 56 patients with CRC were treated with HCPT and L-OHP (28 cases, OH group) or L-OHP plus leucovorin plus 5-fluorouracil (28 cases, OFL group), then reviewed the response rate, survival rate and toxicity. The one-year survival rate was 35.07% in OH group and 24.21% in OFL group. However, the occurrence of anemia (51.8%) or diarrhea (60.7%) was higher in OH group than that of 19.6% or 46.4% in OFL group. The clinical results suggest that HCPT plus L-OHP combined chemotherapy could increase the survival time of patients. Taken together, the present study indicates that the combined chemotherapy of HCPT with L-OHP could become a new adjuvant treatment for CRC.
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Affiliation(s)
- Yang Yao
- Department of medical oncology, Sixth People's Hospital, Shanghai Jiaotong University, China.
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3091
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Grande M, Milito G, Attinà GM, Cadeddu F, Muzi MG, Nigro C, Rulli F, Farinon AM. Evaluation of clinical, laboratory and morphologic prognostic factors in colon cancer. World J Surg Oncol 2008; 6:98. [PMID: 18778464 PMCID: PMC2543015 DOI: 10.1186/1477-7819-6-98] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 09/08/2008] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The long-term prognosis of patients with colon cancer is dependent on many factors. To investigate the influence of a series of clinical, laboratory and morphological variables on prognosis of colon carcinoma we conducted a retrospective analysis of our data. METHODS Ninety-two patients with colon cancer, who underwent surgical resection between January 1999 and December 2001, were analyzed. On survival analysis, demographics, clinical, laboratory and pathomorphological parameters were tested for their potential prognostic value. Furthermore, univariate and multivariate analysis of the above mentioned data were performed considering the depth of tumour invasion into the bowel wall as independent variable. RESULTS On survival analysis we found that depth of tumour invasion (P < 0.001; F-ratio 2.11), type of operation (P < 0.001; F-ratio 3.51) and CT scanning (P < 0.001; F-ratio 5.21) were predictors of survival. Considering the degree of mural invasion as independent variable, on univariate analysis, we observed that mucorrhea, anismus, hematocrit, WBC count, fibrinogen value and CT scanning were significantly related to the degree of mural invasion of the cancer. On the multivariate analysis, fibrinogen value was the most statistically significant variable (P < 0.001) with the highest F-ratio (F-ratio 5.86). Finally, in the present study, the tumour site was significantly related neither to the survival nor to the mural invasion of the tumour. CONCLUSION The various clinical, laboratory and patho-morphological parameters showed different prognostic value for colon carcinoma. In the future, preoperative prognostic markers will probably gain relevance in order to make a proper choice between surgery, chemotherapy and radiotherapy. Nevertheless, current data do not provide sufficient evidence for preoperative stratification of high and low risk patients. Further assessments in prospective large studies are warranted.
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Affiliation(s)
- Michele Grande
- University Hospital Tor Vergata, department of surgery, University hospital Tor Vergata, Viale Oxford, 81 00133 Rome, Italy.
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3092
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Alacacioglu A, Somali I, Simsek I, Astarcioglu I, Ozkan M, Camci C, Alkis N, Karaoglu A, Tarhan O, Unek T, Yilmaz U. Epidemiology and survival of hepatocellular carcinoma in Turkey: outcome of multicenter study. Jpn J Clin Oncol 2008; 38:683-8. [PMID: 18753360 DOI: 10.1093/jjco/hyn082] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Hepatocellular cancer (HCC) is one of the important health problems in Turkey. We aimed to determine the clinical and demographic features of HCC in the Turkish population and to evaluate the prognostic and survival features. METHOD Two hundred and twenty-one patients with HCC from five hospitals in Turkey are included in this study. RESULTS In 44.4% of the 221 patients with hepatitis B virus and in 21.3% of the 221 patients with hepatitis C virus were found to be responsible for HCC etiology. It has been shown that HCC developed on cirrhosis basis in 74.2% of the patients. HCC was presented with single solitary nodule in 69.2% of the patients. Non-liver metastasis was present in 12.5% of the patients. In 21.7% of the patients, alpha-fetoprotein (AFP) levels were above the diagnostics level of 400 ng/ml. The median overall survival (OS) of 221 patients was 14 months. The median OS of the patients with Child-Pugh A class was significantly longer than that with Child-Pugh B and C classes. The OS of the individuals with normal AFP levels was also longer than that with high AFP levels. The OS of the patients with Stage I HCC according to tumor node metastasis (TNM) classification, the female patients and the treated patients group was found to be significantly good. CONCLUSIONS In conclusion, the viral etiology (hepatitis B and C infections) in Turkish population is found to be an important factor in HCC development. The Child-Pugh classification, AFP levels, TNM classification, being female and treatment were determined to be important prognostic factors in HCC patients.
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Affiliation(s)
- Ahmet Alacacioglu
- Dokuz Eylul University, Institute of Oncology, Balcova, Izmir, Turkey
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3093
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Kolev Y, Uetake H, Takagi Y, Sugihara K. Lactate dehydrogenase-5 (LDH-5) expression in human gastric cancer: association with hypoxia-inducible factor (HIF-1alpha) pathway, angiogenic factors production and poor prognosis. Ann Surg Oncol 2008; 15:2336-44. [PMID: 18521687 DOI: 10.1245/s10434-008-9955-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/10/2008] [Accepted: 04/15/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lactate-dehydrogenase-5 (LDH-5) is an important isoenzyme converting pyruvate to lactate under hypoxic conditions and might play an important role in the development and progression of malignancies. However, the role of LDH-5 in gastric cancer is still unclear. In this study, we investigated the clinical significance of LDH-5 expression in gastric carcinoma. METHODS LDH-5 expression in 152 patients with different grade and stage gastric carcinoma was analyzed by immunohistochemistry. In addition, hypoxia-inducible factor 1alpha (HIF-1alpha) as a marker of tumor hypoxia, as well as vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) as angiogenesis parameters were also assessed in this study. Correlations between the expression of investigated proteins and various clinicopathological factors including survival were determined. RESULTS There were 94 cases (61.8%) showing high LDH-5 expression, and 95 patients (62.5%) had high HIF-1alpha expression. Positive correlation was found between LDH-5 expression and HIF-1alpha, VEGF, and COX-2. The overexpression of LDH-5 was more prevalent in advanced tumors having positive vessel invasion. Patients with overexpression of LDH-5 showed far lower disease-free (63.5% vs 82.7%) and overall (56.3% vs 78.4%) survival rates compared with patients with low LDH-5 expression. HIF-1alpha expression was shown to have no significance on survival. In multivariate analysis, high LDH-5 expression kept its independence as a negative prognostic indicator. CONCLUSION The results of the current study show that LDH-5 expression may be a useful prognostic factor for patients with gastric carcinoma.
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Affiliation(s)
- Yanislav Kolev
- Surgical Oncology Department, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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3094
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Goto O, Fujishiro M, Kakushima N, Kodashima S, Ono S, Yamaguchi H, Nomura S, Kaminishi M, Omata M. Endoscopic submucosal dissection as a staging measure may not lead to worse prognosis in early gastric cancer patients with additional gastrectomy. Dig Liver Dis 2008; 40:293-7. [PMID: 18191627 DOI: 10.1016/j.dld.2007.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 11/21/2007] [Accepted: 11/21/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection is a novel endoluminal technique that enables resection of early stage gastrointestinal malignancies in an en bloc fashion. AIM To assess whether preceding endoscopic submucosal dissection affected the prognoses of patients who underwent additional gastrectomy with lymph node dissection due to suspicion of nodal metastasis from endoscopic submucosal dissection specimens. PATIENTS AND METHODS Thirty-one patients with early gastric cancer who underwent gastrectomy after endoscopic submucosal dissection were retrospectively investigated in terms of their survival and tumour recurrence. Additional gastrectomy was performed when histology of the endoscopic submucosal dissection specimens revealed that the tumours did not meet the criteria for node-negative cancers. RESULTS Twenty-three (74%) and eight (26%) patients had undergone endoscopic submucosal dissection previously due to clinical diagnoses of node-negative cancers and possible node-positive cancers, respectively. Histology of the resected stomachs and lymph nodes revealed residual carcinoma of the stomach in two (6.5%) patients and nodal metastases in four (13%) patients. All patients remain alive without recurrence (median follow-up, 3.4 years; range, 0.6-5.2 years). CONCLUSIONS Based on the histology of endoscopic submucosal dissection specimens, preceding endoscopic submucosal dissection itself had no negative influence on a patient's prognosis when additional gastrectomy was performed. It may be permissible to resect some early gastric cancers by endoscopic submucosal dissection as a first step to prevent unnecessary gastrectomy, if technically resectable.
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Affiliation(s)
- O Goto
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
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3095
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Low serum level of cholinesterase at recurrence of pancreatic cancer is a poor prognostic factor and relates to systemic disorder and nerve plexus invasion. Pancreas 2008; 36:241-8. [PMID: 18362836 DOI: 10.1097/mpa.0b013e31815b6b2b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Systemic disorder is a characteristic of advanced pancreatic cancer. Clinical prognostic factors in earlier disease state than terminal stage are expected to be sensitive markers for the foresight of systemic disorder. This study aimed to find the associations between these sensitive markers and morphological factors of primary tumor that may indicate finding a way of pathogenesis of systemic disorder. METHODS The current study examined 75 patients who received macroscopic curative resection for pancreatic cancer in our institution as follows: (1) identification of clinical prognostic factors at initial recurrence after resection of primary tumor and (2) analysis of correlations between clinical prognostic factors and histological findings in primary tumor. RESULTS Important prognostic factors were peritoneal dissemination and serum levels of carbohydrate antigen 19-9 and cholinesterase. Only low levels of serum cholinesterase correlated to nerve plexus invasion in histological findings of primary tumor. Patients with low cholinesterase levels show systemic disorder, including poor performance status, anemia, and hypoalbuminemia. CONCLUSIONS Nerve invasion may thus result in low functional state of the liver followed by systemic disorder. This mechanism may be useful for elucidating cancer cachexia in future studies.
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3096
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Patel PR, Yao JC, Hess K, Schnirer I, Rashid A, Ajani JA. Effect of timing of metastasis/disease recurrence and histologic differentiation on survival of patients with advanced gastric cancer. Cancer 2008; 110:2186-90. [PMID: 17896785 DOI: 10.1002/cncr.23046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Patients with advanced gastric cancer have a median survival (MS) of <9 months. It is unclear whether the MS of patients who have advanced cancer at the time of diagnosis (synchronous, Group A) is different from that for patients who develop advanced cancer after curative surgery (metachronous, Group B). It was hypothesized that survival would be similar. METHODS The medical records of all patients treated at the University of Texas M. D. Anderson Cancer Center who were in either Group A or Group B were reviewed. Survival of patients was assessed by the Kaplan-Meier method. A Cox proportional hazards model was used for multivariate hazards ratios that were adjusted for the effects of location of recurrence, histologic differentiation, patient sex and age, the location of the primary tumor, and timing of disease recurrence (Group A or Group B) on survival. RESULTS In all, 773 consecutive patients qualified for the analysis. The distribution of age, race, histologic differentiation, and primary tumor location was similar in both groups. The MS of Group A (n = 603 patients) and Group B (n = 170 patients) was the same (7.6 months). Similarly, the location of the primary tumor and patient sex were found to have no impact on survival. Patients with poorly differentiated tumors (World Health Organization grade 3 or 4) were found to have a shorter survival compared with those with well-differentiated or moderately differentiated tumors (grade 1 or 2; P = .004). Patients with distant metastases had a shorter survival (P = .01) than those with locoregional disease recurrence. CONCLUSIONS The data show that MS is similarly poor in patients with advanced gastric cancer with synchronous metastasis (Group A) or those with metachronous metastasis/disease recurrence (Group B). Poor differentiation and anatomically distant site of metastasis were found to impact MS adversely.
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Affiliation(s)
- Pooja R Patel
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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3097
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Prognostic factors in patients with advanced pancreatic adenocarcinoma treated with intra-arterial chemotherapy. Pancreas 2008; 36:56-60. [PMID: 18192882 DOI: 10.1097/mpa.0b013e31812e9672] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study is to identify the prognostic factors of a large group of patients with pancreatic cancer who underwent the same regimen of intra-arterial chemotherapy. METHODS 5-fluorouracil (1000 mg/m2), leucovorin (100 mg/m2), epirubicin (60 mg/m2), and carboplatin (300 mg/m2) were administered every 3 weeks into celiac axis (FLEC regimen). Kaplan-Meyer survival curve for univariate analysis and Cox regression model for multivariate one were used to determine factors predictive of survival. RESULTS Data of 211 patients with advanced pancreatic cancer who underwent FLEC regimen were analyzed. Eighty-nine had locally advanced disease, and 112 had distant metastases. Median overall survival was 9.2 months. In both univariate and multivariate analyses, pain reduction after treatment (< or =30% of baseline level vs >30%; overall survival, 7.6 vs 11.5 months), stage of disease (III vs IV; overall survival, 10.5 vs 6.6 months), and number of administered cycles (< or =3 vs >3; overall survival, 5.9 vs 12.3 months) were significant and independent predictors of survival. CONCLUSIONS Pain reduction, stage of disease, and number of administered cycles are independent prognostic factors of overall survival in a multivariate analysis of patients with advanced pancreatic cancer receiving FLEC regimen intra-arterially.
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3098
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Ohtsuka T, Sato S, Kitajima Y, Tanaka M, Nakafusa Y, Miyazaki K. False-positive findings for tumor markers after curative gastrectomy for gastric cancer. Dig Dis Sci 2008; 53:73-9. [PMID: 17476595 DOI: 10.1007/s10620-007-9825-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 03/16/2007] [Indexed: 12/09/2022]
Abstract
The objective of this study was to assess the frequency and characteristics of false-positive results for tumor markers after curative gastrectomy for gastric cancer. Carcinoembryonic antigen and/or carbohydrate antigen 19-9 were periodically assessed for 168 patients who underwent curative gastrectomy. Cancer recurrence was observed for 17 (10.1%) patients and 151 (89.9%) were disease-free during the mean follow-up period of 23.1 months after the operation. The frequency of false-positive findings for tumor markers after gastrectomy was 14.3% (24/168) for all followed-up patients. Three different patterns of marker elevation were observed in the false-positive group. A false-positive finding for these markers was observed for patients with early-stage cancer and for those with chronic benign diseases, for example bronchitis, liver dysfunction, diabetes mellitus, and renal dysfunction. For most patients with false-positive findings for a marker a spontaneous decrease in the tumor marker was observed 1-2 months after the marker was first observed at a high level after the operation. Surgeons and oncologists should therefore keep in mind the high frequency of false-positive findings for tumor markers after curative gastrectomy for gastric cancer.
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Affiliation(s)
- Takao Ohtsuka
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan.
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3099
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Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, Khorana AA. Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 2007; 122:299-306. [PMID: 18045666 DOI: 10.1016/j.thromres.2007.10.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 10/18/2007] [Accepted: 10/22/2007] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hemostatic activation may be important for tumor biology. Hepatocellular carcinoma (HCC) is commonly associated with portal vein thrombosis (PVT). Little is known about factors predictive for PVT in patients with HCC or its correlation with systemic venous thromboembolism (VTE). METHODS We conducted a retrospective chart review of 194 consecutive patients diagnosed with HCC at the University of Rochester between 1998 and 2004 to identify the frequency and risk factors for PVT and its correlation with VTE and survival. RESULTS Sixty patients (31%) had PVT with a higher rate in the non-transplant group compared to transplanted patients (34% vs. 24%; p=0.15). In multivariate analysis, Child Turcotte Pugh (CTP) class, stage, major vessel involvement, serum albumin, and serum AFP were independently associated with PVT (p<0.05 for each). The presence of PVT was associated with reduced survival (median survival 2.3 months for those with PVT versus 17.6 months for those without PVT, HR 2.05, p=0.004). The incidence of systemic VTE in the total population was 6.7%, and patients with PVT had a higher rate of systemic VTE compared to patients without PVT (11.5% vs. 4.4%; p=0.04). CONCLUSION PVT is common in patients with HCC, indicates advanced disease, is associated with worse survival and correlates with systemic VTE, suggesting a common mechanism of hemostatic activation. Advanced stage, higher CTP class, major vessel involvement, low serum albumin, and high AFP levels are predictive of PVT in patients with HCC.
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