Characteristics of Newly Diagnosed Hepatocellular Carcinoma Patients Across Turkey: Prospective Multicenter Observational 3K Registry Study

AIMS

To evaluate patient profile for epidemiological and clinicopathological characteristics and potential risk/prognostic factors in newly diagnosed hepatocellular carcinoma (HCC) patients across Turkey.

METHODS

A total of 547 patients (mean (SD) age 62.6 (10.3) years, 81.9% were males) were included in this registry study. Data on patient characteristics, etiologies of HCC, laboratory values, and tumor characteristics and stages were recorded at study enrollment.

RESULTS

HBV infection (68.2%) was the leading etiology, followed by HCV infection (17.2%), HDV infection (5.5%), alcohol (6.4%), and NAFLD (3.5%), as the major etiologies. Considering that 51.6% of the patients had >5 cm HCC, 44% were Child-Pugh B/C and 57% were BCLC B-D, it appears that a significant group of HCC patients were diagnosed at advanced stages. Of 540 patients, 271 (50.2%) were referred or applied with the diagnosis of HCC. Patients with HCC at presentation had larger tumor size (median (min-max) 6.6 (0-30) vs. 4.8 (0-90) cm, P < .001) and more advanced BCLC stage (Stage C-D in 40.8% vs. 26.4%, respectively, P = .005), compared to patients who were diagnosed during follow-up.

CONCLUSIONS

Our findings revealed that HBV infection was the leading etiology and a moderate-to-advanced disease was evident in more than half of patients at the time of diagnosis. HCC patients diagnosed at follow-up had smaller tumor size and earlier BCLC stage.

Human Papillomavirus in Laryngeal Cancer in Northern Region of Turkey

Background and context: Human papilloma virus (HPV) has recently emerged as a new important etiological factor in the development of head and neck squamous cell carcinoma (HNSCC). The association of HPV in laryngeal squamous cell carcinoma (LSCC) is investigated in several studies but controversial results are established. Aim: This retrospective study aimed to evaluate the HPV DNA positivity in LSCC patients diagnosed and treated in 2 otorhinolaryngology referral center in northern region of Turkey. Strategy/Tactics: 52 formalin-fixed, paraffin-embedded (FFPE) tissue blocks of laryngeal cancers, diagnosed and treated between 2010 and 2016, were included. Detection and genotyping of HPV genotypes were done using a polymerase chain reaction (PCR) protocol. Program/Policy process: The study was planned as a retrospective investigation of laryngeal squamous cell cancer patients who had been diagnosed and treated in Samsun 19 Mayis University Hospital and Samsun Training and Research Hospital - otorhinolaryngology referral centers - between January 2010 and December 2016. Samsun is in the middle part of northern Turkey and stated as an oncology center in this region. Approval for the study was granted by the 19 Mayıs University Ethics Committee. The clinical characteristics of the patients were obtained from the computerized database. LSCC tissue samples fixed using 10% neutral buffered formalin and embedded blocks were used. Outcomes: PCR amplification was successful in 40 of 52 patients. Among the 40 LSCC samples HPV DNA was detected in 1 patient (2.5%). HPV 16 subtype was detected in this male patient aged 70 years, with a smoking history and stage III laryngeal cancer. After surgery, the patient received adjuvant radiotherapy and was still alive at 48 months without relapse. What was learned: In northern region of Turkey, this is the first study that evaluated HPV positivity in LSCC. Our results may suggest that HPV-related LSCC has not yet emerged as a significant health burden in our region. This finding may be due to the genetic, cultural or religious characteristics of our patients that are not conducive to oral HPV transmission. Unfortunately tobacco smoking is still the main reason for HNSCC in our city. There is a need for a nationwide screening study to investigate HPV prevalence variability among different regions in Turkey.

The value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in salivary gland tumors

e17592

Background: Salivary gland tumors are rare, comprising only 6 to 8 percent of head and neck neoplasms. Most of them are benign and commonly occur in the parotid gland. In the last decade elevated hematological inflammatory parameters like neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were identified as predictive and prognostic factors in various malignancies. The aim of this study was to evaluate the differences of preoperative of NLR and PLR levels in benign and malignant causes of salivary gland tumors. Methods: This retrospective study was made of a total of 133 patients with salivary gland tumors (age range: 17-89 years; 68 male and 65 female) who were treated between January 2006 and May 2016. Preoperative counts and levels of hematological parameters were obtained from the recorded computerized database in benign and malignant tumors. Results: NLR and PLR levels were significantly higher in the malignant salivary gland tumor group than the benign group( NLR: 0.66±1.3 vs 0.59±0.31 p=0.001, PLR: 160.3±85.7 vs 124.6±44.1 p=0.014). Conclusions: The results of the current study revealed the potential predicitve role of NLR and PLR in patients with salivary gland tumors. These cheap and easily available blood count parameters could be useful biomarkers in the future; but further investigations are needed to confirm our findings. [Table: see text]

Human papillomavirus detection in head and neck squamous cell carcinoma in Turkey

e17538

Background: Head and neck squamous cell carcinoma (HNSCC) is the sixth most common type of cancer worldwide. In Turkey, 5538 new cases and 2340 deaths from head and neck cancer are estimated to occur every year. Tobacco and alcohol are the most important etiological risk factors but in the past three decads tobacco usage is decreased and Human Papilloma Virus (HPV) has changed HNSCC epidemiology. Many new reports suggests that almost 25% of all cases of HNSCC are related to HPV. But its prevelans shows a wide variation among different populations.Today in Turkey HPV positivity in HNSCC is currently not known and this retrospective study aimed to to evaluate the HPV infection in our HNSCC patients. Methods: We included 125 HNSCC patients diagnosed and treated in our hospital beween January 2010 and December 2016. Oral cavity, oropharyngeal, laryngeal and hypopharyngeal cancers were included. Nasopharyngeal and salivary gland cancers were exculuded. Head and neck cancer tissue samples fixed using 10% Neutral Buffered Formalin and embedded blocks were used. From an initial evaluation of 125 patients records 77 of the paients blocks could be adequate for the HPV testing. Detection and genotyping of HPV genotypes were done using a polymerase chain reaction (PCR) protocol. Results: PCR amplification was succesful in 61 of 77 patients. Among the 61 HNSCC patients only 3 patients were HPV positive(4.9 %). HPV 16 subtype was detected in one patient who was 70 years old male, stage III laryngeal cancer with a smoking history. The subtypes detected in other two patients were different from 16 and 18. One of these patients was 42 years old nonsmoker female stage IVa hypopharyngeal cancer and the other one was 56 years old smoker male with stage II oropharyngeal cancer. Conclusions: In Turkey, this is the first study that evaluated HPV positivity in HNSCC. Our results suggest a low prevelance of HPV in Turkish HNSCC patients; large scale population based studies are needed to confirm our findings.

The effect of anticancer therapy on anti-hepatitis B antibody titres in patients with haematological malignancies and solid tumours

Objective

To investigate the effect of immunosuppressive anticancer therapy on titre levels of anti-hepatitis B surface antibodies (anti-HBs) in hepatitis B surface antigen (HBsAg) negative and anti-HBs positive patients with haematological malignancies or solid tumours.

Methods

This retrospective study reviewed the medical records of patients with haematological malignancies or solid tumours. Pretreatment HBsAg negative and anti-HBs positive patients were included in the analysis. Anti-hepatitis B core antibody status was used to evaluate vaccinated patients and those with resolved HBV infections.

Results

The medical records of 237 patients were reviewed retrospectively. The median anti-HBs titre decreased significantly after anticancer therapy compared with the pretreatment median anti-HBs titre in all patients (71 mIU/ml versus 57 mIU/ml). Anti-HBs titre decreased significantly in patients with haematological malignancies (70 mIU/m versus 37 mIU/ml) and in patients administered rituximab-based chemotherapy (67 mIU/ml versus 33 mIU/ml) following chemotherapy, whereas there was no significant change in patients with solid tumours. After chemotherapy, patients with low pretreatment anti-HBs titres (<100 mIU/ml) were more likely to become seronegative (<10 mIU/ml).

Conclusion

High levels of anti-HBs may have a protective effect against the reactivation of HBV especially in patients with haematological malignancies who received immunosuppressive anticancer therapy.

A case of gastric cancer with liver metastases had a complete response with cisplatin and capecitabine as third-line chemotherapy

Advanced gastric cancer has a poor prognosis, and only chemotherapy improves survival. Further chemotherapy after progression is controversial. Eastern Cooperative Oncology Group performance status is an important indicator for new chemotherapy decision. Complete response (CR) after recurrent disease is very rare, but could occur in some cases with chemotherapy. The 68-year-old male received chemotherapy for metastatic gastric adenocarcinoma. He received epirubicin, cisplatin and fluorouracil in the first line, capecitabine in the second line and cisplatin-capecitabine in the third line. CR was observed after third-line chemotherapy with four courses. Mediastinal and abdominal metastases were completely resolved. We decided to report this patient because it is very unusual to achieve CR in a patient in whom the best supportive care might be reasonable.

Epithelial membrane protein 1 expression in ovarian serous tumors

The present study aimed to analyze the clinical significance of epithelial membrane protein 1 (EMP1) expression in ovarian serous tumors. A total of 84 cases of ovarian serous tumor (50 patients with malignant ovarian serous tumors and 34 patients with borderline and benign serous tumors) were retrospectively analyzed. Differences in the expression levels of EMP1 between the malignant and non-malignant tumor groups were evaluated by immunohistochemical staining. In addition, the association between EMP1 expression and prognostic factors in malignant ovarian serous tumors was investigated. The expression levels of EMP1 were significantly reduced in all the 50 malignant ovarian serous tumors, compared with the 34 non-malignant ovarian serous tumors (P<0.000). Reduced expression of EMP1 was correlated with high grade (P=0.009) and stage (P<0.000) of malignant tumors. EMP1 expression was not observed to be correlated with any other investigated parameters, including surgery, type of operation and chemotherapy response (P>0.005). These results indicated that EMP1 may have a significant role as a negative regulator in ovarian serous tumors, and reduced EMP1 expression in serous tumors may be associated with increased disease severity.

Virchow's node metastasis: an unusual presentation of ovarian cancer

Ovarian primaries of supraclavicular metastases are extremely rare. The present study reports the case of a 64-year-old female with a left supraclavicular mass without any other symptoms. After performing a fine needle aspiration biopsy for pathological examination and positron emission imaging, she was diagnosed with FIGO Stage IV high-grade serous epithelial ovarian carcinoma. After three cycles of chemotherapy with paxlitaxel and carboplatin, complete response was achieved. There are only a few reports in literature that address patients with the initial symptom of left supraclavicular mass and final diagnosis of ovarian cancer. To the best of the authors' knowledge, this is the first report to describe the successful use of PET/CT to determine the primary site.

High body-mass index is not associated with worse clinicopathological characteristics in predominantly obese breast cancer patients

BACKGROUND

Breast cancer (BC) is the most common cancer among women. A high body-mass index (BMI) is related to increased incidence of BC with poorer prognosis.

AIM

The aim of the study was to evaluate the association in patients with BC between BMI at the time of diagnosis and biological characteristics, according to the menopausal status.

MATERIALS AND METHODS

This retrospective study comprised a total of 318 women with BC. Clinicopathological differences between normal, overweight and obese patients according to menopausal status were evaluated.

RESULTS

Premenopausal women had a significantly lower BMI than postmenopausal patients (28.7 vs. 31.5, respectively; p = 0.00001). No statistically significant association was determined between BMI and clinicopathological characteristics in either the premenopausal or the postmenopausal group (all p values are > 0.05).

CONCLUSIONS

There are many conflicting results in literature on this relationship. The results of this study showed that a high BMI is not associated with worse clinicopathological characteristics in a predominantly obese population. In current medical oncology practice, BC should be evaluated on an individual patient basis and the impact of obesity on BC prognosis seems to be difficult to estimate especially in an obese population.

Primary testicular lymphoma: a single centre experience

AIM

Primary testicular lymphoma (PTL) is an uncommon and aggressive form of extranodal non-Hodgkin's lymphoma (NHL). We aimed to analyse the clinicopathological characteristics and outcomes of our PTL cases.

MATERIALS AND METHODS

A review was made of the medical records of 339 NHL patients who were treated in the Medical Oncology Department between January 2005 and December 2013.

RESULTS

8 PTL patients were identified from the 339 NHL patients. The average age of the patients was 67.7 ± 7.9 years (range 53-79 years). The mean follow-up time was 24.8 months (range 7-98 months). Inguinal orchiectomy was performed as a diagnostic and initial therapy and all the patients underwent 4-6 cycles of chemoimmunotherapy consisting of cyclophosphamide, doxorubicin, vincristine and prednisone plus rituximab. 4 of 8 patients received intrathecal prophylactic chemotherapy and 6 of 8 patients continued contralateral testis irradiation. Relapse occured in only 1 patient in central nervous system after 6 months who had not received intrathecal prophylaxis. No contralateral testis relapse was observed.

CONCLUSIONS

Primary testicular NHL is an uncommon entity and we evaluated 8 patients; with one relapse in central nervous system and no relapse in the contralateral testis.

Efficacy and safety of docetaxel or epirubicin, combined with cisplatin and fluorouracil (DCF and ECF), regimens as first line chemotherapy for advanced gastric cancer: a retrospective analysis from Turkey

OBJECTIVES

Advanced gastric cancer (AGC) patients have a poor prognosis. The best benefit of chemotherapy is usually achieved by first line setting. Very few studies have compared combination regimens. This study was designed to compare two combination regimens.

METHODS

Patients with advanced gastric cancer receiving first line chemotherapy were retrospectively collected, and divided into two groups, receiving DCF (docetaxel, cisplatin and fluorouracil) or ECF (epirubicin, cisplatin and fluorouracil) regimens. Data were collected for the retrospective analysis in a single center.

RESULTS

Eighty-six patients were eligible for analysis. Median overall survival (OS) was 10.0 months in the ECF group and 11.0 months in the DCF group (p=0.31). Median progression free survival (PFS) for ECF and DCF was equal at 6.0 months. Second line chemotherapy were administered in more than one third of patients. Both regimens had similar toxicity.

CONCLUSIONS

This is the first study investigating the outcomes of gastric cancer chemotherapy in this region. ECF and DCF regimens have similar efficacy and a similar tolerability profile for first line treatment of advanced gastric cancer. The decision of the first line chemotherapy in advanced gastric cancer could be improved with patient selection according to clinical parameters and molecular markers.

Quality of life in colorectal cancer patients during chemotherapy in the era of monoclonal antibody therapies

PURPOSE

Colorectal cancer (CRC) survivors are currently living longer due to better therapies but they also need to maintain their quality of life (QoL). QoL is increasingly being used as primary outcome measure in clinical studies. This study was designed to gain knowledge about QoL during chemotherapy across different lines and different regimens.

METHODS

The study comprised 101 CRC out patients receiving chemotherapy who completed the EORTC QLQ-C30 questionnaire. The Shapiro-Wilk, Kruskal-Wallis, and Mann-Whitney U tests were used for statistical analyses.

RESULTS

The demographics of the patients were evaluated for QoL. Prior surgery, prior radiotherapy, working status, stage, comorbidity and sex had no effect on global health status in CRC patients, although some other demographics such as education, monthly income, age and type of chemotherapy regimen did have an effect on global health status. Role functioning was worse in older than in younger ones (p<0.05). Adjuvant chemotherapy did not affect the QoL scores negatively but palliative chemotherapy negatively affected the cognitive function, appetite loss and nausea/vomiting scores (p<0.05). According to chemotherapy regimen, the best QoL was observed with adjuvant FUFA regimen. In the palliative setting FOLFOX/Bevacizumab was associated with the best QoL scores whereas FOLFIRI/Cetuximab were associated with the worst QoL scores.

CONCLUSIONS

Palliative chemotherapy maintained QoL irrespective of the chemotherapy line in metastatic CRC (mCRC) patients. Some demographics affect QoL and different chemotherapy regimens showed different QoL scores.

Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis

BACKGROUND

Lung cancer (LC) is still the primary cause of cancer deaths worldwide, and late diagnosis is a major obstacle to improving lung cancer outcomes. Recently, elevated preoperative or pretreatment neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) detected in peripheral blood were identified as independent prognostic factors associated with poor survival with various cancers, including colon cancer, esophageal cancer, gastric cancer and breast cancer.

OBJECTIVE

The aim of this study was to examine whether MPV, NLR and PLR could be useful inflammatory markers to differentiate lung cancer patients from healthy controls. An investigation was also made of the relationship between these markers and other prognostic factors and histopathological subgroups.

MATERIALS AND METHODS

Retrospectively eighty-one lung cancer patients and 81 age-sexes matched healthy subjects included into the study. Patients with hypertension, hematological and renal disease, heart failure, chronic infection, hepatic disorder and other cancer were excluded from the study. The preoperative or pretreatment blood count data was obtained from the recorded computerized database.

RESULTS

NLR and PLR values were significantly higher in the LC patients compared to the healthy subjects.( NLR: 4.42 vs 2.45 p=0.001, PLR: 245.1 vs 148.2 p=0.002) MPV values were similar in both groups (7.7 vs 7.8). No statistically significant relationship was determined between these markers (MPV, NLR and PLR) and histopathological subgroups and TNM stages.

CONCLUSIONS

NLR and PLR can be useful biomarkers in LC patients before treatment. Larger prospective studies are required to confirm these findings.

Single dose regorafenib-induced hypertensive crisis

Gastrointestinal stromal tumors (GISTs) are uncommon tumors of the gastrointestinal (GI) tract. Regorafenib is a new multikinase inhibitor and is approved for the treatment of GISTs in patients who develop resistance to imatinib and sunitinib. The most common drug-related adverse events with regorafenib are hypertension, hand-foot skin reactions, and diarrhea. Grade IV hypertensive side effect has never been reported after a single dose. In this report, we present a case of Grade IV hypertensive side effect (hypertensive crisis and seizure) after a single dose of regorafenib. A 54-year-old male normotensive GIST patient was admitted to the emergency department with seizure and encephalopathy after the first dosage of regorafenib. His blood pressure was 240/140 mmHg upon admission. After intensive treatment with nitrate and nitroprusside, his blood pressure returned to normal levels in five days. Regorafenib was discontinued, and he did not experience hypertension again. This paper reports the first case of Grade IV hypertension after the first dosage of regorafenib. We can suggest that hypertension is an idiosyncratic side effect unrelated to the dosage.

Ovarian metastases in colorectal carcinoma

e14697

Background: 5-30 % of all ovarian tumors are metastatic and only 3-14 % of them derive from gastrointestinal tract. The aim of this study is to determine the rate of colorectal cancer patients with ovarian metastases and also to identify the features in the management of these patients. Methods: 972 colorectal cancer patients admitted to our clinic between 01/2001 and 12/2011 were included in the study. Among these patients, only 9 had ovarian metastases. Age, menopausal status, initial symptom, operation status, localisation of colorectal tumor, stage at diagnosis, tumor grade, histopathological type, colorectal tumor-ovarian metastases interval, having synchronous or metachronous metastases, the place of metastases and concurrent metastatic disease were evaluated. SPSS 16 is used. Results: Mean age of patients was 45 years (range between 21-72 years). 66.7 % had premenopausal state. 55 % of them had right colon tumor. 5 patients had stage IV disease. 5 patients had synchronous metastases (55 %). Colorectal cancer-ovarian metastases interval was 6-49 months in the patients with metachronous metastases. Among patients; 5 had right and 1 had left ovarian metastases and 3 had metastases to both ovaries. 2 of 3 bilateral ovarian metastases were derived from right-sided tumors (66.6 %). 7 patients also had metastases to other different parts and most of those had peritoneal involvement (85.7 %). PFS was between 2 and 27 months. At the time of ovarian metastases, 7 patients had high CA 125 levels and 3 had high CEA levels. All patients with high levels of CA 125 during diagnosis continued to have high levels of CA 125 with ovarian metastases. Conclusions: Premenopausal patients seem to have higher risk of ovarian metastases. This study support that examining CA 125 levels in colorectal cancer patients who have abnormal findings in the gynecological examination preoperatively may help not to miss synchronous ovarian metastases.The finding of ovarian metastases should make consideration that the disease is disseminated. Ovaries should be examined preoperatively and it should be kept in mind that CA 125 levels may be a valuable marker in this setting.

Breast cancer in the elderly

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Background: Breast cancer is one of the age-related tumors that accompany with population ageing and approximately 50 % of this disease occur in 65 years of age or older and also more than 30 % occur after age of 70. This study aims to examine characteristics of patients with breast cancer 65 years or older. Methods: The study was carried out on a series of 177 breast cancer patient followed up at our outpatient clinic who are 65 years or older chosen among 848 breast cancer patients during the period 1995-2012. Physical examination, annual chest x-ray, mammography, abdominal ultrasonography and bone scan were the tools to assess the disease status. SPSS 16 was used. Results: The mean age was 70.8 years old (range 65-85 years). There was only one patient whose age is older than 85 years. 85 % of histopathology was infiltratif ductal carcinoma. 83 % of patients underwent mastectomy while 92 % was performed axillary dissection. 56 % had node positivity and 54 % had 2 cm or bigger tumor. ER/PR status was both negative in 54 women (30 %) and both positive in 82 of them. Also cerbB2 was negative in most of the patients (70 %). At the diagnosis, 20 patients (11.3 %) had metastatic disease and 157 were without metastases. Totally 44 patients (32 %) had metastatic disease and most of them (29 patients) had bone disease. Only 52 did not have endocrine therapy with 48 % had tamoxifen as a part of hormonal therapy. Most of them received radiotherapy (54 %). DFS was within 7-182 months with a median of 54 months. PFS was between 2-60 months and patients had a median OS about 61 months. 30 patients died because several causes owing to ageing causes. Conclusions: Breast cancer is the most significant cancer of women and the screening modalities with adjuvant postoperative therapies have increased survival. Acute and chronic medical conditions, nutritional status, poly-pharmacy, level of activity, disease-spesific symptoms and patient decision all need to be taken into consideration. Both in early and advanced stages of the disease, quality of life and related aspects have critical importance in elderly women who have more limited life-expectancy. It is also essential that women with breast cancer 65 years and older be included in trials and that they be recommended the best therapies available.

Baseline lymphopenia as a prognostic marker for colorectal carcinoma

e14107

Background: Baseline lymphopenia has been proved to be a marker for poor prognosis, chemotherapy-induced toxicity and increased risk of febrile neutropenia, trombocytopenia and anemia in advanced solid neoplasms. This study aims to evaluate the effect of pretreatment lymphopenia on prognosis and hematological toxicity in colorectal cancer patients who received first line systemic chemotherapy. Methods: Lymphocyte count was evaluated in 386 pretreated colorectal cancer patients who do not have a seconder malignancy, HIV infection, bone involvement and primary G-CSF prophylaxis. Overall survival, progression free survival and disease free survival were calculated from date of diagnosis to date of relapse, progression and death. Kaplan-Meier, chi-square and Student-t test were used. Results: Mean follow-up was 30 months (range 1-180 months). Mean age was 57.4±12.5 years. Of all patients, 160 (41 %) were women. Rectum ( 26.2 %) and transvers colon (4.7 %) were the most and the least common anatomic locations, respectively. Mean lymphocyte count before treatment was 1964/µl (170-7000/µl). There were no relationship between lymphopenia and age, sex, performans status, presence of initial metastasis, adjuvant or palliative chemotherapy and hematological toxicity (p>0.05). Grade 3-4 hematological toxicity was found in 40 patients and was significantly higher in patients receiving bi- or tri-chemotherapy regimen (p:0.017). Among 208 patients with relapse or progression, 40 patients had lymphopenia (19.2 %). 1, 3 and 5-year OS were significantly lower in lymphopenic patients (p:0.033). DFS was longer in non-lymphopenic patients but this data didn’t have statistical significance (p>0.05). Conclusions: This study support that lymphocyte number prior to chemotherapy may be a simple but useful prognostic and predictive marker in untreated colorectal cancer patients. Patients with lower pretreatment lymphopenia have lower OS when compared to others (p<0.05). This study has the highest colorectal cancer population in the literature.

The prognostic value of thrombocytosis in newly diagnosed lung cancer patients: a retrospective analysis

PURPOSE

The importance of thrombocyte count as a prognostic factor has not been adequately investigated in patients with lung cancer. We retrospectively examined the value of thrombocytosis as a prognostic factor and investigated its relationship with other clinicopathologic factors and survival.

METHODS

The medical records of 260 patients with lung cancer were reviewed. Pretreatment thrombocyte count, histopathological diagnosis, disease stage, gender, age, performance status (PS), thrombotic episodes, weight loss and paraneoplastic syndromes were recorded. Overall survival (OS), progression-free survival (PFS) and disease-free survival (DFS) were evaluated in all patient subgroups. Thrombocytosis was defined as platelet count >400,000/μl. We assessed statistically the possible correlation between thrombocytosis, other clinicopathologic factors and survival parameters. A two-sided p value < 0.05 was considered significant.

RESULTS

There were no statistically significant differences between histological subgroups (small cell/SCLC and non-small cell/NSCLC) according to age, disease stage and gender. Sixty-six (25.38%) patients had thrombocytosis before starting treatment. We found no relationship between thrombocytosis and disease stage, gender, age, PS and thrombotic episodes. Thrombocytosis was significantly correlated only with weight loss (p=0.011) and paraneoplastic syndromes (p=0.027). OS was shorter in the thrombocytosis group, but without statistical significance. PFS and DFS did not differ between thrombocytemic and non-thrombocytemic patients.

CONCLUSION

Pretreatment thrombocytosis is not an independent prognostic factor of survival in lung cancer patients and is related with paraneoplastic syndromes.

Expression of Plakophilins (PKP1, PKP2, and PKP3) in breast cancers

Plakophilins (PKP) are desmosomal plague proteins, which belong to the p120ctn subfamily of armadillo repeat containing proteins. We aimed to analyze the role of plakophilins in breast cancer and its clinical progress. We have performed immunohistochemical study of the PKP1,2,3 in breast carcinoma. The study included 108 patients with breast cancer and 26 age- and sex-matched healthy controls. We investigated the associations between staining intensity and some clinicopathologic features like tumor size, axillary node status, stage, lymphovascular invasion, perineural invasion, grade, hormone receptor status, and c-erb B2. The mean age of patients was 46 years (22-78). In breast cancer, compared with normal tissue, PKP1 and PKP2 expressions were indifferent (P > 0.05), but PKP3 expression was significantly increased in breast cancer (P = 0.0014). Although PKP1 and PKP2 expression levels were not correlated with clinicopathological parameters, increased PKP3 expression was positively correlated with node positivity and grade (P = 0.000, P = 0.000).

CONCLUSION

Overexpressed PKP3 is likely to be an essential contributor to a growth-promoting pathway and to aggressive features of breast cancer.

Electrocardiographic findings of palonosetron in cancer patients

PURPOSE

Nausea and vomiting are among the major problems occurring during and after the chemotherapy treatments of cancer patients. The recently developed 5-HT(3) antagonists have proved much more effective than former agents. Several studies have shown that these agents cause certain ECG changes. We aimed to evaluate the ECG changes caused by palonosetron, one of the new 5-HT(3) antagonists.

METHODS

Our study includes a total of 50 patients diagnosed with solid-organ tumors receiving chemotherapy. The patients were applied 12-lead ECG before palonosetron infusion. Afterwards, subsequent ECGs were applied on the 30th, 60th, and 90th minutes following the infusion of palonosetron. Arterial blood pressure was measured before and after the infusion. PR, QRS, QT, QTmax, QTmin, QTd, Pmax, Pmin, Pd, QTc, QTcmax, QTcmin, and QTcd values were evaluated for each ECG.

RESULTS

We did not detect significant correlations between the systolic and diastolic blood pressures before and after (30 min) palonosetron infusion (p > 0.05). However, there was a statistically significant decrease in heart rate (p = 0.000). The evaluation of ECG findings revealed that there was a significant prolongation in PR distance, as shown by the comparisons of 0 min with 30, 60, and 90 min. On the other hand, there was no significant difference in QRS, QT, QTmax, QTmin, QTd, Pmax, Pmin, Pd, QTc, QTcmax, QTcmin, and QTcd values (p > 0.05).

CONCLUSION

In this study, we revealed that palonosetron did not cause any severe rhythmic disorders or symptomatic ECG changes. We concluded that it could be safe to administer palonosetron antiemetically.

Expression of plakophilins (PKP1, PKP2, and PKP3) in gastric cancers

BACKGROUND

The importance of cell-cell junction proteins (including armadillo proteins) in tumor biology is known, but limited with regard to plakophilins. We explored the relationship between plakophilins (PKP1, PKP2, PKP3) to gastric cancer via immunohistochemical techniques.

METHODS

We compared the immunohistochemistry of PKPs in 34 gastric adenocarcinomas and 20 normal gastric tissues.

RESULTS

In gastric cancer, PKP1 expression was unchanged but PKP2 and PKP3 were significantly decreased as compared to normal controls. There was no observable clinical association with PKP1 or PKP2 expression; however, low PKP3 level and poor prognosis appeared to correlate with regards to node number and tumor stage. The mean disease-free survival (DFS) was 38 ± 3 months (range: 32 - 44) and mean overall survival (OS) 42 ± 4 months (range: 38 - 50). Decreased PKP2 appeared to negatively impact DFS.

CONCLUSION

Decreased PKP2 and PKP3 may be early prognostic markers and loss of PKP3 expression during gastric carcinoma progression may indicate an invasive phenotype.

Topical henna for capecitabine induced hand-foot syndrome

Capecitabine is a chemotherapeutic drug for use in cancers. Hand-foot syndrome (HFS) is side effect of capecitabine which can lead the cessation of the therapy or dose reduction. Henna (Lawsonia inermis) is a traditionally used plant of Middle-East that is applied on hands and feet. Some of cancer patients in capecitabine treatment who developed HFS, we recommended to apply henna. In these patients, six patients were grade 3 HFS and four were grade 2 HFS. Complete response (CR) were seen in four of grade 3 HFS and all of grade 2; two grade 3 HFS improved to grade 1. So far, in the chemotherapy, there was no need of dose reduction and also no side effect of henna seen. Clinical improvement in these patients may relate to anti-inflammatory, antipyretic and analgesic effects of henna. Prospective studies are needed to show this therapeutic effect of henna.

Subcutaneous effusion resulting from an epidural catheter fragment

The breakage of an epidural catheter within a patient is uncommon, but troublesome, complication of epidural block, and its cause is rarely discovered. In this case report, our aim was to present an effusion between s.c. tissue and fascia in the lumbar region because of a broken fragment of epidural catheter which was unnoticed during its removal.

Importance of pfkA for rapid growth of Enterobacter cloacae during colonization of crop seeds

Enterobacter cloacae A-11 is a prototrophic, glycolytic mutant of strain 501R3 with a single transposon insertion in pfkA. The populations of strain A-11 on cucumber and radish seeds were smaller than the populations of strain 501R3 in natural soil, but the populations of these two strains on pea, soybean, sunflower, and sweet corn seeds were similar (D. P. Roberts, P. D. Dery, I. Yucel, J. Buyer, M. A. Holtman, and D. Y. Kobayashi, Appl. Environ. Microbiol. 65:2513-2519, 1999). The net effect of the mutation in pfkA in vitro was a shift from rapid growth on certain carbohydrates detected in seed exudates to much slower growth on other carbohydrates, amino acids, and organic acids. The impact of the mutation in pfkA was greatest on the growth rate of E. cloacae on the seeds that released the smallest quantities of fructose, other carbohydrates, and amino acids. Corn, pea, soybean, and sunflower seeds released total amounts of carbohydrates and amino acids at rates that were approximately 10- to 100-fold greater than the rates observed with cucumber and radish seeds for the first 24 h after inhibition began. The growth rate of strain A-11 was significantly less (50% less) than the growth rate of strain 501R3 on radish seeds, and the growth rate of strain A-11 was too low to estimate on cucumber seeds in sterile sand for the first 24 h after inhibition began. The growth rate of strain A-11 was also significantly lower on soybean seeds, but it was only 17% lower than the growth rate of strain 501R3. The growth rates of strains 501R3 and A-11 were similar on pea, sunflower, and corn seeds in sterile sand for the first 30 h after imbibition began. Large reductions in the growth rates of strain A-11 on seeds were correlated with subsequent decreased levels of colonization of seeds compared to the levels of colonization of strain 501R3. The strain A-11 populations were significantly smaller than the strain 501R3 populations only on radish and cucumber seeds. The mutation in pfkA appears to decrease the level of colonization by E. cloacae for seeds that release small quantities of reduced carbon compounds by decreasing the size of the pool of compounds that support rapid growth by this bacterium.

Role of pfkA and general carbohydrate catabolism in seed colonization by Enterobacter cloacae

Enterobacter cloacae A-11 is a transposon mutant of strain 501R3 that was deficient in cucumber spermosphere colonization and in the utilization of certain carbohydrates (D. P. Roberts, C. J. Sheets, and J. S. Hartung, Can. J. Microbiol. 38:1128-1134, 1992). In vitro growth of strain A-11 was reduced or deficient on most carbohydrates that supported growth of strain 501R3 but was unaffected on fructose, glycerol, and all amino acids and organic acids tested. Colonization by strain A-11 was significantly reduced (P Collapse

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MESH Headings

• Carbohydrate Metabolism
• DNA, Bacterial/genetics
• Enterobacter cloacae/genetics
• Enterobacter cloacae/physiology
• Genes, Bacterial
• Molecular Sequence Data
• Phosphofructokinase-1/genetics
• Phosphofructokinase-1/metabolism
• Plasmids/genetics
• Seeds/chemistry
• Seeds/metabolism
• Seeds/microbiology
• Vegetables/growth & development
• Vegetables/microbiology

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Affiliation(s)

D P Roberts Biocontrol of Plant Diseases Laboratory, USDA Agricultural Research Service, Beltsville, Maryland 20705, USA.
P D Dery
I Yucel
J Buyer
M A Holtman
D Y Kobayashi

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Mexican papita viroid: putative ancestor of crop viroids

The potato spindle tuber disease was first observed early in the 20th century in the northeastern United States and shown, in 1971, to be incited by a viroid, potato spindle tuber viroid (PSTVd). No wild-plant PSTVd reservoirs have been identified; thus, the initial source of PSTVd infecting potatoes has remained a mystery. Several variants of a novel viroid, designated Mexican papita viroid (MPVd), have now been isolated from Solanum cardiophyllum Lindl. (papita güera, cimantli) plants growing wild in the Mexican state of Aguascalientes. MPVd's nucleotide sequence is most closely related to those of the tomato planta macho viroid (TPMVd) and PSTVd. From TPMVd, MPVd may be distinguished on the basis of biological properties, such as replication and symptom formation in certain differential hosts. Phylogenetic and ecological data indicate that MPVd and certain viroids now affecting crop plants, such as TPMVd, PSTVd, and possibly others, have a common ancestor. We hypothesize that commercial potatoes grown in the United States have become viroid-infected by chance transfer of MPVd or a similar viroid from endemically infected wild solanaceous plants imported from Mexico as germplasm, conceivably from plants known to have been introduced from Mexico to the United States late in the 19th century in efforts to identify genetic resistance to the potato late blight fungus, Phytophthora infestans.

Avirulence gene avrPphC from Pseudomonas syringae pv. phaseolicola 3121: a plasmid-borne homologue of avrC closely linked to an avrD allele

Cosmid clone pPsp01 from race 1 Pseudomonas syringae pv. phaseolicola isolate 3121 conferred a unique pattern of soybean cultivar reactions when expressed in P. s. pv. glycinea R4. The avirulence phenotype was shown to result from the presence in clone pPsp01 of an avrD allele as well as an additional avirulence gene located approximately 5-kb upstream. The new gene, called avrPphC, shows high identity to and is phenotypically identical to avrC, previously cloned from P. s. pv. glycinea race 0. avrD and avrPphC occur on an approximately 120-kb indigenous plasmid in P. s. pv. phaseolicola 3121. Although commonly observed in Xanthomonas campestris, this is the first noted occurrence of multiple avirulence genes on a single plasmid in Pseudomonas syringae. Unlike avrD, however, avrPphC does not appear to occur widely in pathovars of Pseudomonas syringae.

Two different classes of avrD alleles occur in pathovars of Pseudomonas syringae

Considerable variation was observed in the occurrence of avirulence gene D (avrD) in different isolates and pathovars of Pseudomonas syringae. Three functional alleles of avrD were cloned and characterized from P. s. pv. phaseolicola and P. s. pv. lachrymans. These avrD genes occurred on indigenous plasmids in both pathovars, like the allele originally cloned from P. s. pv. tomato. P. s. pv. lachrymans was unique in that it carried two different alleles on plasmids of different sizes. These alleles were cloned on 5.6- or 3.8-kb HindIII fragments that are conserved in several other P. syringae pathovars. Surprisingly, the two avrD alleles from P. s. pv. lachrymans were the most divergent of those compared, with only 85% amino acid identity. Allele 1 from P. s. pv. lachrymans was 95% identical to avrD from P. s. pv. tomato but less similar to the other three avrD genes. These two alleles were accordingly called homology class I. The avrD gene from P. s. pv. phaseolicola and allele 2 from P. s. pv. lachrymans were 97 and 98% identical, respectively, at the amino acid level with the nonfunctional P. s. pv. glycinea allele. These three alleles were therefore grouped into homology class II. Comparison of all the avrD alleles permitted the identification of four amino acid substitutions unique to the P. s. pv. glycinea allele at positions 19, 245, 280, and 304.

Amino acid residues required for the activity of avrD alleles

Certain Pseudomonas syringae pathovars harbor avrD alleles belonging to two different homology classes. The nonfunctional avrD allele of P. s. pv. glycinea is highly homologous to active class II avrD alleles but has five unique amino acid substitutions. Three of these five amino acid changes were shown to be absolutely required for restoration of avrD activity to the P. s. pv. glycinea allele by oligonucleotide site-directed mutagenesis. They were cysteine 19 to arginine, alanine 280 to valine, and leucine 304 to serine. In addition, changing leucine 301 to phenylalanine was required for high activity. However, alteration of the leucine at position 245 of the P. s. pv. glycinea allele to serine, present in the active alleles, did not affect avrD activity. Results from recombinant gene constructs between the nonfunctional P. s. pv. glycinea avrD gene and the functional allele from P. s. pv. phaseolicola identified six other amino acid residues that may form contextual motifs important for AvrD function. These were a four amino acid stretch comprised of glutamate 41, alanine 42, asparagine 43 and arginine 44 in addition to aspartate 243 and phenylalanine 301. Some divergence is tolerated within the four amino acid motif, but phenylalanine 301 appears to be necessary for highly active class II avrD proteins.

Influence of Pseudomonas syringae culture conditions on initiation of the hypersensitive response of culture tobacco cells

The inhibitor sensitivity and timing of the ionic response of suspension-cultured tobacco cells were used as a bioassay for the Pseudomonas syringae signal that elicits the hypersensitive response in resistant plants. The ionic response of tobacco cell suspensions inoculated with P. syringae pv. syringae 61 and P. syringae pv. pisi grown in rich media was inhibited by rifampin, tetracycline, and streptomycin during a 2- to 2.5-h induction stage. Coculturing the bacteria with tobacco cells for 3 h or more before inoculating fresh tobacco cells specifically abolished the sensitivity of the ionic response to these inhibitors and reduced the response time of the tobacco cells from 3 to 1 h. The apparent activation of the bacteria during coculture was not dependent on the plant cells and could be achieved by incubating the bacteria in a nitrogen-deficient medium containing a metabolizable carbon source. Addition of proteose peptone and Casamino Acids to this medium suppressed activation of the bacteria. The results suggest that the hypersensitive response-eliciting signal forms late in the induction stage, perhaps as a result of the derepression of some of the P. syringae genes functional in elicitation of the hypersensitive response. The nature of the activated state remains elusive but is consistent with the accumulation of protein(s) whose activity indirectly elicits the ionic response.

Molecular cloning of a Pseudomonas syringae pv. syringae gene cluster that enables Pseudomonas fluorescens to elicit the hypersensitive response in tobacco plants

A cosmid clone isolated from a genomic library of Pseudomonas syringae pv. syringae 61 restored to all Tn5 mutants of this strain studied the ability to elicit the hypersensitive response (HR) in tobacco. Cosmid pHIR11 also enabled Escherichia coli TB1 to elicit an HR-like reaction when high levels of inoculum (10(9) cells per ml) were infiltrated into tobacco leaves. The cosmid, which contains a 31-kilobase DNA insert, was mobilized by triparental matings into Pseudomonas fluorescens 55 (a nonpathogen that normally causes no plant reactions), P. syringae pv. syringae 226 (a tomato pathogen that causes the HR in tobacco), and P. syringae pv. tabaci (a tobacco pathogen that causes the HR in tomato). The plant reaction phenotypes of all of the transconjugants were altered. P. fluorescens(pHIR11) caused the HR in tobacco and tomato leaves and stimulated an apparent proton influx in suspension-cultured tobacco cells that was indistinguishable from the proton influx caused by incompatible pathogenic pseudomonads. P. syringae pv. tabaci(pHIR11) and P. syringae pv. syringae 226(pHIR11) elicited the HR rather than disease symptoms on their respective hosts and were no longer pathogenic. pHIR11 was mutagenized with TnphoA (Tn5 IS50L::phoA). One randomly chosen mutant, pHIR11-18, no longer conferred the HR phenotype to P. fluorescens. The mutation was marker-exchanged into the genomes of P. syringae pv. syringae strains 61 and 226. The TnphoA insertions in the two pseudomonads abolished their ability to elicit any plant reactions in all plants tested. The results indicate that a relatively small portion of the P. syringae genome is sufficient for the elicitation of plant reactions.