Expression of PD-L1 in Early-Stage Invasive Breast Carcinoma and Its Relation to Tumor-Infiltrating Lymphocytes

Objectives:

Immunotherapeutic targets became one of the promising approaches in breast cancer (BC), especially in advanced stage triple-negative subtype (TNBC). However, the role of programmed cell death ligand 1 (PD-L1) targeting in other BC subtypes, especially in early-stage carcinoma is less explored. We aimed in this study to investigate the prevalence of PD-L1 in early-stage invasive BC of different molecular subtypes and to elucidate its relation to tumor-infiltrating lymphocytes (TILS) density (cytotoxic and regulatory T-cells), established clinicopathological factors and patients’ outcome.

Material and Methods:

One hundred and nine cases of early-stage BC were enrolled in our study. Cases were classified into five molecular subtypes according to the Immunohistochemical data. PD-L1, FOXP3 and CD8 immunostaining were analyzed for all studied cases. PD-L1 expression was correlated with CD8+ cytotoxic T-cells, FOXP3+ regulatory T-cells, histopathologic parameters, BC molecular subtypes, 7-years disease-free survival (DFS) and overall survival (OS).

Results:

PD-L1 was expressed in 11% of the studied early-stage BC cases. It showed a significant correlation with high tumor grade (p= <0.001), development of metastasis (p=0.037), high FOXP3+ T-cell density (p= <0.001) and low CD8+ T-cells density (p= <0.001). PD-L1 expression was higher in TNBC (16.1%), followed by HER2/neu-enriched group (14.3%). All luminal A cases showed negative PD-L1 expression. PD-L1 was found to be an independent prognostic factor for patients’ survival (DFS; p=0.031 and OS: p=0.04).

Conclusion:

Although the impact of PD-L1 on early-stage BC outcomes had not been clearly established, our results indicated that PD-L1 is a negative prognostic marker in early settings. PD-L1 can serve as a new therapeutic target for patients with high-grade early-stage breast carcinoma.

Breast cancer in Egypt:a review of disease presentation and detection strategies

Carcinoma of the breast is the most prevalent cancer among Egyptian women and constitutes 29% of National Cancer Institute cases. Median age at diagnosis is one decade younger than in countries of Europe and North America and most patients are premenopausal. Tumours are relatively advanced at presentation. The majority of tumours are invasive duct subtype and the profile of hormone receptors is positive for estrogen receptors and /or progesterone receptors in less than half of cases. This overview examines genetic changes, potential and established predictive and prognostic markers and end results of surgery, radiotherapy and systemic therapy for early, locally advanced and metastatic disease stages. Disease presentations common to the region and early detection strategies are presented

Risk factors for inflammatory and non-inflammatory breast cancer in North Africa

PURPOSE

Studies of the etiology of inflammatory breast cancer (IBC), a rare but aggressive breast cancer, have been hampered by limited risk factor information. We extend previous studies by evaluating a broader range of risk factors.

METHODS

Between 2009 and 2015, we conducted a case-control study of IBC at six centers in Egypt, Tunisia, and Morocco; enrolled were 267 IBC cases and for comparison 274 non-IBC cases and 275 controls, both matched on age and geographic area to the IBC cases. We administered questionnaires and collected anthropometric measurements for all study subjects. We used multiple imputation methods to account for missing values and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using polytomous logistic regression comparing each of the two case groups to the controls, with statistical tests for the difference between the coefficients for the two case groups.

RESULTS

After multivariable adjustment, a livebirth within the previous 2 years (OR 4.6; 95% CI 1.8 to 11.7) and diabetes (OR 1.8; 95% CI 1.1 to 3.0) were associated with increased risk of IBC, but not non-IBC (OR 0.9; 95% CI 0.3 to 2.5 and OR 0.9; 95% CI 0.5 to 1.6 for livebirth and diabetes, respectively). A family history of breast cancer, inflammatory-like breast problems, breast trauma, and low socioeconomic status were associated with increased risk of both tumor types.

CONCLUSIONS

We identified novel risk factors for IBC and non-IBC, some of which preferentially increased risk of IBC compared to non-IBC. Upon confirmation, these findings could help illuminate the etiology and aid in prevention of this aggressive cancer.

Resistant Bacteria Isolated from Blood Culture of Febrile Neutropenic Cancer Patients

Introduction/Objective

Bacteremia is one of the major causes of life-threatening complications in patients with cancer. Significant changes in the spectrum of microorganisms isolated from blood culture BC have been reported in cancer patients over the past years.

This study aimed to determine the predominant bacterial species causing bacteremia among febrile neutropenic FN cancer patients at the National Cancer Institute in Egypt (NCI).

Methods

A total of 300 BC collected from 300 FN cancer patients at NCI, Cairo. All cases were in patients with a mean age of 51 years, 158 patients were male (53%) while 142 patients were females (47%). BC was collected for microbiological investigations. Identification of the isolated organisms by the cultural characters (Morphological of bacterial isolates, Gram stain reaction, motility test, and biochemical tests) for each organism using standard semi- automated techniques.

Results

68 (22.6%) BC were positive while 232 (77.4%) BC were negative. Gram-negative bacteria isolated and identified in 11 blood cultures (16.17%), while gram-positive isolates identified in 57 BC (83.8%). Among the Gram- negative organisms, 4 (5.8%) were Pseudomonas aeruginosa, 4 (5.8%) were E. coli, 1 (1.5%) was Klebssila pneumoni, 1 (1.5%) was Acintobacter and 1 (1.5%) was Citrobacter frenudiri. Among the Gram-positive organisms, Coagulase-negative Staphylococci CNS were most predominant in most cases 35 (61.4%). 7 (12%) were S. aureus, 5 (8%) were S. epidermises, 5 (8%) were Streptococcus spp., 1 (1.5%) were Listeria spp., 4 (5.88%) Achromobacter spp., 4 (5.88%) were Gram-Positive Cocci and 1(1.5%) Micrococcus spp. The study of R-factor in all positive BC showed the resistant bacterial isolates to the commonly used antimicrobial agents, especially to ampicillin and penicillin.

Conclusion

This study showed that patients with febrile neutropenia are vulnerable to developing bacteremia. the prevalence rate of bacteremia in post-chemotherapy FN in our center is relatively high compared to the national rate. Multidrug-resistant are the main cause of bacteremia in febrile cancer patients in Egypt. There is a need for ongoing antimicrobial surveillance to guide antimicrobial therapy and support the development of infection control programs in Egypt

Loss of p15INK⁴b expression in colorectal cancer is linked to ethnic origin

Colorectal cancers remain to be a common cause of cancer-related death. Early-onset cases as well as those of various ethnic origins have aggressive clinical features, the basis of which requires further exploration. The aim of this work was to examine the expression patterns of p15INK4b and SMAD4 in colorectal carcinoma of different ethnic origins. Fifty-five sporadic colorectal carcinoma of Egyptian origin, 25 of which were early onset, and 54 cancers of Finnish origin were immunohistochemically stained with antibodies against p15INK4b and SMAD4 proteins. Data were compared to the methylation status of the p15INK4b gene promotor. p15INK4b was totally lost or deficient (lost in ≥ 50% of tumor cell) in 47/55 (85%) tumors of Egyptian origin as compared to 6/50 (12%) tumors of Finnish origin (p=7e-15). In the Egyptian cases with p15INK4b loss and available p15INK4b promotor methylation status, 89% of cases which lost p15INK4b expression were associated with p15INK4b gene promotor hypermethylation. SMAD4 was lost or deficient in 25/54 (46%) tumors of Egyptian origin and 28/48 (58%) tumors of Finnish origin. 22/54 (41%) Egyptian tumors showed combined loss/deficiency of both p15INK4b and SMAD4, while p15INK4b was selectively lost/deficient with positive SMAD4 expression in 24/54 (44%) tumors. Loss of p15INK4b was associated with older age at presentation (>50 years) in the Egyptian tumors (p=0.04). These data show for the first time that p15INK4b loss of expression marks a subset of colorectal cancers and ethnic origin may play a role in this selection. In a substantial number of cases, the loss was independent of SMAD4 but rather associated with p15INK4b gene promotor hypermethylation and old age which could be related to different environmental exposures.

Assessment of diagnosis of inflammatory breast cancer cases at two cancer centers in Egypt and Tunisia

The diagnosis of inflammatory breast cancer (IBC) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in North Africa where a higher proportion of breast cancer is diagnosed as IBC than in the United States (U.S.). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute (NCI) - Cairo, Egypt, and the Institut Salah Azaiz (ISA), Tunisia, recorded extent and duration of signs/symptoms of IBC on standardized forms, and took digital photographs of the breast. After second-level review at study hospitals, photographs and clinical information for confirmed IBC cases were reviewed by two U.S. oncologists. We calculated percent agreement between study hospital and U.S. oncologist diagnoses. Among cases confirmed by at least one U.S. oncologist, we calculated median extent and duration of signs and Spearman correlations. At least one U.S. oncologist confirmed the IBC diagnosis for 69% (39/50) of cases with photographs at the NCI-Cairo and 88% (21/24) of cases at the ISA. All confirmed cases had at least one sign of IBC (erythema, edema, peau d'orange) that covered at least one-third of the breast. The median duration of signs ranged from 1 to 3 months; extent and duration of signs were not statistically significantly correlated. From the above-mentioned outcomes, it can be concluded that the diagnosis of a substantial proportion of IBC cases is unambiguous, but a subset is difficult to distinguish from other types of locally advanced breast cancer. Among confirmed cases, the extent of signs was not related to delay in diagnosis.

P53 mutations in egyptian bladder-cancer

Cancer of the bladder is a frequent malignancy in Egypt and other developing countries in which bladder infection with the parasite Schistosoma haematobium is common. Several epidemiological, histopathological and clinical characteristics of cancer of the Bilharzial bladder suggest that it is distinct from bladder cancer seen in industrialized countries. Little is known, however, about molecular aberrations in Egyptian bladder cancer. We studied the status of p53 in a series of 25 cases of Egyptian bladder cancer using immunohistochemistry to detect the p53 protein and SSCP/sequencing to identify mutations in the p53 gene. Ten of 25 (40%) tumor samples showed a mutation by SSCP/sequencing. Mutations were seen in both the squamous and transitional cell variants. The presence of mutations was associated with advanced stage of disease. Immunohistochemistry had a sensitivity of 70%, and a Specificity of 85% for detecting p53 mutations. Our data show that p53 mutations are a common event in Egyptian bladder cancer, and may be an indicator of advanced disease. Immunohistochemistry is both sensitive and specific for detecting p53 mutations in this tumor, and may be used to assess the prognostic value of p53 mutations in this disease.

Characterization of Mycobacterium tuberculosis isolated from cancer patients with suspected tuberculosis infection in Egypt: identification, prevalence, risk factors and resistance pattern

Data are sparse on Mycobacterium tuberculosis infection among patients with cancer in Egypt. We sought to detect the presence of tuberculosis (TB) disease among patients with malignant conditions and suspected TB and to study the main risk factors. Also, we compared different diagnostic procedures and detected the antimicrobial susceptibility of M. tuberculosis isolates against rifampin and isoniazid. One hundred patients were included in this study, all of them had malignant conditions and were suspected by the clinicians of having TB. Identification of M. tuberculosis in different specimens was performed by smear microscopy, followed by Lowenstein-Jensen medium and Mycobacterium growth indicator tube (MGIT) cultures and artus(®) real-time PCR. In addition, an indirect MGIT anti-TB susceptibility test was carried out against rifampin and isoniazid. A total of 76% of studied cases were found to be TB positive. The frequencies of TB-positive cases in the bronchogenic, haematological and solid tumour malignancy groups were 21%, 25% and 30%, respectively. Significant differences between pulmonary and extrapulmonary TB in different malignancy groups were recorded. Real-time PCR showed the highest overall diagnostic efficiency. Multidrug-resistance of M. tuberculosis to both rifampin and isoniazid was detected in 28.6% of examined isolates. Infection in cancer patients with TB was significantly more often recorded among elderly patients and those suffering from poverty. Pulmonary TB is more common than extrapulmonary TB in patients with malignancy. Real-time PCR is the most accurate and rapid method for TB diagnosis. MGIT-rifampin resistance may be used as a reliable marker for detection of multidrug-resistant TB. Diagnosis and instituting treatment course for active or latent TB infection are crucial before starting anticancer therapy.

Distinct genetic and epigenetic signatures of colorectal cancers according to ethnic origin

BACKGROUND

The outcome of colorectal cancer varies depending on ethnic origin. Egyptian colorectal carcinoma is surprisingly young-age disease with high proportion of rectal and advanced stage cancers.

METHODS

We characterized 69 sporadic Egyptian colorectal cancers for promoter methylation at 24 tumor suppressor genes, microsatellite instability, and expression of mismatch repair, p53, and β-catenin proteins. Data were compared with 80 Western colorectal carcinoma of sporadic and familial origin from Finland.

RESULTS

Egyptian colorectal carcinomas showed significantly higher methylation of the microsatellite stable (MSS) tumors as reflected by the average number of methylated genes per case (P = 0.00002) and tumor suppressor gene methylator phenotype (TSGMP), defined here as methylation of ≥ 5 genes, (P = 0.0001) compared with the sporadic Western cancers. The TSGMP was associated with advanced stage in the Egyptian cancers (P = 0.0016). Four genes were differentially methylated between Egyptian and Western cases, of which the association of CDKN2B/p15 methylation with Egyptian origin was outstanding (P = 4.83 E-10). Egyptian carcinoma also showed significantly lower frequency of nuclear β-catenin localization than the sporadic Western cancers (P = 0.00006) but similar to that of the familial Western subset designated as familial colorectal cancer type X.

CONCLUSIONS

We show novel pathway in colon carcinogenesis marked by high methylation of MSS cancers, remarkable CDKN2B/p15 methylation, and low frequency of Wnt signaling activation.

IMPACT

Our findings highlight the possible effect of environmental exposures in carcinogenesis through DNA methylation and should have applications in prevention, molecular diagnosis, prognosis, and treatment.

Analysis of RhoC expression and lymphovascular emboli in inflammatory vs non-inflammatory breast cancers in Egyptian patients

Understanding the molecular factors that distinguish inflammatory breast cancer (IBC) from non-IBC is important for IBC diagnosis. We reviewed the records of 48 IBC patients and 64 non-IBC patients from Egypt. We determined RhoC expression and tumor emboli and their relationship to demographic and reproductive characteristics. Compared with non-IBC patients, IBC patients had significantly lower parity (P=0.018) and fewer palpable tumors (P<0.0001). IBC tumors showed RhoC overexpression more frequently than non-IBC tumors (87% vs. 17%, respectively) (P<0.0001). Tumor emboli were significantly more frequent in IBC tumors than non-IBC tumors (Mean+/- SD: 14.1+/-14.0 vs. 7.0+/-12.9, respectively) (P<0.0001). This study illustrates that RhoC overexpression and tumor emboli are more frequent in tumors of IBC relative to non-IBC from Egypt. Future studies should focus on relating epidemiologic factors to molecular features of IBC in this population.

Drug-resistant tuberculosis in Egyptian children using Etest

AIM

Etest (AB Biodisk, Solna, Sweden) is a new rapid and accurate alternative for susceptibility testing. It also can measure the minimal inhibitory concentration. The aim of this study was to assess the prevalence of drug-resistant Mycobacterium TB (MT) in newly diagnosed tuberculous Egyptian children, and to determine the effectiveness of the Etest to detect drug-resistant MT.

METHODS

This prospective study included 150 newly diagnosed pulmonary and extrapulmonary tuberculous children. The organism was isolated and identified after decontamination. Antimicrobial susceptibility testing was performed by proportion method using Lowenstein-Jensen medium (PMLJ) and Etest. Minimal inhibitory concentration for both first and second line anti tuberculous drugs was determined by Etest. Comparison between the two methods was done.

RESULTS

Age range was 6 months - 15 years (mean of 7.4+/-3.3). Pulmonary tuberculosis (TB) and extrapulmonary cases were 85/150 (55.3%) and 67/150 (44.7%) respectively. Seventy three isolates of MT were obtained from patients or contacts. Using Etest, the over all drug resistant of MT was 24.7% which is resistance to one drug (any drug). Resistance to first-line drugs; isoniazid, rifampicin, streptomycin and ethambutol was 5.4%, 2.7%, 6.8% and 1.4% respectively. Rifampicin resistance strongly correlated with isoniazid resistance. The prevalence of multi-drug resistance was 2.7%. Resistance to second line was 2.7% for amikacin and 1.4% for ciprofloxacin. Etest showed an overall specificity of 97.89 and sensitivity of 81.8. Overall agreement of Etest with reference proportion method range was 94.5-100%.

CONCLUSION

Etest appears to be a good alternative method for testing susceptibility of Mycobacterium tuberculosis.

Somatic FGF9 mutations in colorectal and endometrial carcinomas associated with membranous beta-catenin

We previously described striking molecular features including high frequency of membranous beta-catenin in subsets of familial colon cancers with as yet unknown predisposition. We hypothesized that such tumors might carry mutations in Wnt/beta-catenin target genes. Fibroblast growth factor 9 (FGF9) was an attractive target, as it maps to a common area of loss of heterozygosity (LOH) in colorectal carcinomas on 13q12.11. Here, we report, for the first time, the occurrence of FGF9 mutations in human cancers. We found a total of six distinct FGF9 mutations including one frameshift, four missense, and one nonsense, in 10 (six colorectal and four endometrial) out of 203 tumors and cell lines. The frameshift mutation was detected in five different tumors. Mapping of these mutations onto the crystal structure of FGF9 predicted that they should all lead to loss of function albeit through variable mechanisms. The p.R173K mutation should diminish ligand affinity for heparin/heparan sulfate, the p.V192M, p.D203G, and p.L188YfsX18 (FGF9(Delta205-208)) mutations should negatively impact ligand's interaction with receptor, while p.G84E and p.E142X (FGF9(Delta142-208)) mutations should interfere with ligand folding. Consistent with these structural predictions, the p.V192M, p.D203G, and p.L188YfsX18 (FGF9(Delta205-208)) mutations impaired the ability of ligand to activate mitogen-activated protein kinase (MAPK) cascade in cultured cells expressing FGF receptors. LOH was observed in seven out of nine FGF9 mutant tumors, supporting the predicted loss of function. Interestingly, eight out of 10 (80%) of the FGF9 mutant tumors showed normal membranous beta-catenin expression and the absence of mutation in the beta-catenin gene (CTNNB1). These data suggest that FGF9 plays a role in colorectal and endometrial carcinogenesis.

Molecular epidemiologic features of inflammatory breast cancer: a comparison between Egyptian and US patients

BACKGROUND

Inflammatory breast cancer (IBC) is a lethal form of breast cancer with unknown etiology. A higher frequency of IBC and a more aggressive IBC phenotype was reported in Egypt than in the United States. This difference in disease frequency and presentation might be related to molecular epidemiologic factors.

METHODS

We used tumor blocks and demographic, epidemiologic, and clinical data of 48 IBC patients from Egypt and 12 patients from the United States. We counted tumor emboli in tumors before and after immunohistochemical staining with lymphatic vessel endothelial receptor-1 (LYVE-1), and measured the expression of RhoC GTPase protein in the two groups.

RESULTS

Erythema, edema, and peau d'orange were found in 77% of the Egyptian patients as compared with 29% found in the US patients (P=0.02). The number of tumor emboli was significantly higher in tumors from Egypt (mean+/-SD, 14.1+/-14.0) than in the tumors from the United States (5.0+/-4.0, P=0.01). The number of tumor emboli in LYVE-1 positive vessels was higher in tumors from Egypt (3.5+/-2.8) than tumors from the United States (1.6+/-0.5, P=0.15). We detected a high level of RhoC in 87% of the tumors from Egypt and 14% of the tumors from the United States (P=0.0003).

CONCLUSION

Patients from Egypt have a more aggressive form of IBC than those in the United States. Our analysis of IBC patients shows that distinct molecular phenotypes can be found when these two study populations are compared. Future studies should explore the epidemiologic and environmental exposures and the genetic factors that might lead to the different clinical and molecular features of IBC in patients from these two countries.

Can bladder adenocarcinomas be distinguished from schistosomiasis-associated bladder cancers by using array comparative genomic hybridization analysis?

Bladder cancer is the most common malignancy in many tropical and subtropical areas, correlating well with the endemicity of schistostomiasis. The majority of schistostomiasis-associated (SA) bladder cancers are squamous cell cancers, whereas the majority of non-SA cases in the Western world are transitional cell cancers, suggesting different carcinogenetic mechanisms. Approximately 6% of SA and 1% of non-SA cases are adenocarcinomas. To achieve fine-resolution information of DNA copy number changes in SA adenocarcinomas, 10 tumor samples were analyzed on an oligonucleotide-based CGH array. The frequency of aberrations ranged from 2 to 17, with an average of 10 alterations per sample. The most frequently gained regions were 20q and 8q (in 70 and 60% of the cases, respectively), whereas the most frequently lost regions were 5q and 8p (both in 40% of the cases). In addition, six regions of amplification were found in three samples, containing both well characterized and novel regions. Comparison of the DNA copy number profiles to previously reported profiles of SA transitional cell carcinoma and squamous cell carcinoma revealed similarities (e.g., gains at 5p and 8q), as well as differences (e.g., TCC- and SCC-associated losses at 18p and 20p, and adenocarcinoma-associated gains at 20q). The results suggest that although SA cancers share genetic features, there also exist histology-specific regions of gain and loss.

Genomic imbalances in Schistosoma-associated and non–Schistosoma-associated bladder carcinoma. An array comparative genomic hybridization analysis

Carcinoma of the urinary bladder is the most common malignancy in many tropical and subtropical countries due to endemic infection by Schistosoma hematobium (bilharzia). In the current study, we performed a high-resolution analysis of gene copy number amplifications using array comparative genomic hybridization to compare DNA copy number changes in pools of Schistosoma-associated (SA) and non-Schistosoma-associated (NSA) bladder cancer (BC). Many DNA copy number changes were detected in all studies, with multiple gains and losses of genetic material. The most frequent alterations were gains on 5p15.2 approximately p15.33, 8q13.1, and 11q13, and losses on 8p21.3 approximately p22 and 22q13. Even when SA pools showed no Schistosoma-specific gene copy number profiling as compared to NSA pools, some genes seemed to be gained (ELN on 7q11.23) and some lost (PRKAG3 on 2q35 and PRDM6 on 5q23.2) in SA-SCC. The following genes were gained in all histopathologic categories: SRC (20q11.23), CEBPB (20q13.13), and GPR9 (Xq13.1). Our study did not provide clear evidence of differences in carcinogenesis of SA-BC and NSA-BC.

Receiver operating characteristic analysis for the selection of threshold values for detection of capping in powder compression

The acoustic emission (AE) energy obtained from compressing lactose powder to form pharmaceutical tablets was chosen for condition monitoring of the tablets. The method used was based on the setting of an AE energy decision threshold such that problems of tablet capping and lamination were successfully identified. Capping and lamination are the most common types of problem that can occur in tablets manufacturing using a powder compression process. To assess the performance of a classifier, use was made of a receiver operating characteristic curve (ROC) obtained by plotting the correct detection probability against the false alarm probability based on AE energy distributions for capped and non-capped tablets. The area under the ROC curve, referred to as the AUC, determines the level of competency of the classifier. A value of 0.5 suggests a mere hazarding of guesses whilst a value of 1 indicates correct classification every time. The AE energy approach for tablet capping monitoring gives an AUC value of 0.96, thereby suggesting the possibility of a highly accurate classifier. With the assumption that penalties for false alarm and missed detection are equally severe, using the graphical method of expected penalty cost (EPC), the optimal AE energy decision threshold was established to be 1.2x10(8) units, at which the maximum correct capping detection rate of 95% was achieved. The paper also explains how a decision threshold can be obtained when the two penalties are not equal.

High levels of oxidative DNA damage in lymphocyte DNA of premenopausal breast cancer patients from Egypt

Egypt shows a parallel increase in premenopausal breast cancer and environmental pollution. The purpose of this study is to explore a possible relationship between oxidative DNA damage, urinary estrogen metabolites and breast cancer in Egyptian premenopausal women. We conducted a pilot study of Egyptian breast cancer involving 29 cases and 32 controls and analysed lymphocyte DNA levels of 7,8-dihydro-8-oxo-2'-deoxyguanine (8-oxo-dG), a measure of oxidative DNA damage using high performance liquid chromatography with electro-chemical detection (HPLC-ECD) method. We analysed levels of urinary estrogen metabolites, 2-hydroxyestrone (2-OHE) and 16alpha-hydroxyestrone (16alpha-OHE) by an enzyme immuno assay. We also collected residential, occupational, and reproductive histories of all study subjects. We detected, in all subjects, exceptionally high levels of 8-oxo-dG and thus oxidative DNA damage, the levels (mean 8-oxo-dG/10(5) dG+/-SD) were significantly (P<0.01) higher in breast cancer cases (139.4+/-78.4) than in controls (60.9+/-51.5). Urinary 2-OHE and 16alpha-OHE or their ratio was not significantly different between cases and controls. However, 8-oxo-dG levels were positively correlated (P<0.05) with 2-OHE and 16alpha-OHE from cases while controls showed a negative correlation (P<0.05). Urban residence (Odds Ratio [OR] 3.1; Confidence interval [CI], 1.1-9.3), infertility (OR [9.8]; CI [1.1-89.7]), age (OR [2.6]; CI [1.4-4.6]) and 8-oxo-dG (OR 5.8; CI 1.9-17.5) levels were found to be significant predictors of breast cancer. Our finding of exceptionally high levels of 8-oxo-dG, a common result of oxidative DNA damage, warrant future studies on a larger population of premenopausal women in Egypt with consideration of other susceptibility markers and dietary characteristics.

Serum organochlorine levels and history of lactation in Egypt

We conducted a study in Egypt to assess the determinants of organochlorine serum levels among premenopausal women and the risk of premenopausal breast cancer for women with high organochlorine serum levels. We included 69 breast cancer patients and 53 controls consisting of visitors to the hospitals of the cancer patients. We found low levels of dichlorodiphenyldichloroethylene (DDE), total dichlorodiphenyltrichloroethane, and beta-hexacholorhexane (beta-HCH) in most subjects. Mean DDE levels were 12.7 +/- 20.3 ppb for cases and 16.6 +/- 30.1 ppb for controls (P = 0.60); beta-HCH levels were 2.1 +/- 3.8 ppb for patients and 2.1 +/- 3.9 ppb for controls (P = 0.71). Interestingly, subjects with low levels had breast fed their children for an average period of 18 months. Women with no lactation history had much higher organochlorine levels than women who breast fed (P = 0.002 for DDE). Younger age, older age at first childbirth, and shorter duration of breast feeding were significant predictors of higher levels of serum DDE levels. Younger age, older age at first childbirth, and higher body mass index were significant predictors of higher beta-HCH levels. This study suggests that organochlorine serum levels in Egyptian women are quite low, but indicates an effect of breast feeding in eliminating organochlorines, which would imply exposure to children. Organochlorine serum level was not a risk factor of breast cancer in this population.

Breast cancer in Egypt: a review of disease presentation and detection strategies

Carcinoma of the breast is the most prevalent cancer among Egyptian women and constitutes 29% of National Cancer Institute cases. Median age at diagnosis is one decade younger than in countries of Europe and North America and most patients are premenopausal. Tumours are relatively advanced at presentation. The majority of tumours are invasive duct subtype and the profile of hormone receptors is positive for estrogen receptors and/or progesterone receptors in less than half of cases. This overview examines genetic changes, potential and established predictive and prognostic markers and end results of surgery, radiotherapy and systemic therapy for early, locally advanced and metastatic disease stages. Disease presentations common to the region and early detection strategies are presented.

Multivariate analysis of bcl-2, apoptosis, P53 and HER-2/neu in breast cancer: a short-term follow-up

BACKGROUND

Several molecular genetic alterations in breast cancer, including aneuploidy, altered apoptosis, aberrant expression of p53, HER-2/neu and Bcl-2, have been associated with poor prognosis in breast cancer patients. To determine the importance of molecular-genetic factors relative to more traditional surgical-pathological prognostic factors, multivariate analysis was performed.

PATIENTS AND METHODS

Ninety-four fresh tissue samples of primary breast carcinoma were studied with flow cytometry for DNA ploidy. On the same specimens, steroid hormone receptors (ER and PR) were measured in the cytosol fraction using Abbott ELISA assays. HER-2/neu was determined in the membrane fraction and mutant p53 protein in the nuclear fraction, both, by Oncogene Science ELIZA procedures. Bcl-2 and apoptosis (cell death) were measured in cell lysates by Oncogene Science & Boehringer Mannheim ELISA assays. In addition, information regarding surgical-pathological features of the tumor was obtained. Multivariate analysis using an unconditional logistic regression model was done to identify variables predictive of poor prognosis.

RESULTS

Using univariate analysis, histological grade, tumor stage, lymph node status, HER-2/neu and mutant p53 were predictive of poor short-term prognosis. By multivariate analysis, tumor stage, lymph node status and HER-2/neu were independent factors. Grade subgroup analysis versus time of relapse, illustrated a predictive value of Bcl-2 in only low-grade tumors while apoptosis was significant in high-grade type.

CONCLUSION

Among a panel of molecular-genetic factors investigated, HER-2/neu was the most strongly predictive of poor short-term prognosis in breast cancer. Patients with HER-2/neu-positive tumors can benefit from Herceptin therapy.

Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: influence of proliferation

Based on the assumption that an accelerated proliferation process prevails in tumour cell residues after surgery, the possibility that treatment acceleration would offer a therapeutic advantage in postoperative radiotherapy of locally advanced head and neck cancer was investigated. The value of T(pot) in predicting the treatment outcome and in selecting patients for accelerated fractionation was tested. Seventy patients with (T2/N1-N2) or (T3-4/any N) squamous cell carcinoma of the oral cavity, larynx and hypopharynx who underwent radical surgery, were randomized to either (a) accelerated hyperfractionation: 46.2 Gy per 12 days, 1.4 Gy per fraction, three fractions per day with 6 h interfraction interval, treating 6 days per week or (b) Conventional fractionation: 60 Gy per 6 weeks, 2 Gy per fraction, treating 5 days per week. The 3-year locoregional control rate was significantly better in the accelerated hyperfractionation (88 +/- 4%) than in the CF (57+/- 9%) group, P=0.01 (and this was confirmed by multivariate analysis), but the difference in survival (60 +/- 10% vs 46 +/- 9%) was not significant (P=0.29). The favourable influence of a short treatment time was further substantiated by demonstrating the importance of the gap between surgery and radiotherapy and the overall treatment time between surgery and end of radiotherapy. Early mucositis progressed more rapidly and was more severe in the accelerated hyperfractionation group; reflecting a faster rate of dose accumulation. Xerostomia was experienced by all patients with a tendency to be more severe after accelerated hyperfractionation. Fibrosis and oedema also tended to be more frequent after accelerated hyperfractionation and probably represent consequential reactions. T(pot) showed a correlation with disease-free survival in a univariate analysis but did not prove to be an independent factor. Moreover, the use of the minimum and corrected P-values did not identify a significant cut-off. Compared to conventional fractionation, accelerated hyperfractionation did not seem to offer a survival advantage in fast tumours though a better local control rate was noted. This limits the use of T(pot) as a guide for selecting patients for accelerated hyperfractionation. For slowly growing tumours, tumour control and survival probabilities were not significantly different in the conventional fractionation and accelerated hyperfractionation groups. A rapid tumour growth was associated with a higher risk of distant metastases (P=0.01). In conclusion, tumour cell repopulation seems to be an important determinant of postoperative radiotherapy of locally advanced head and neck cancer despite lack of a definite association between T(pot) and treatment outcome. In fast growing tumours accelerated hyperfractionation provided an improved local control but without a survival advantage. To gain a full benefit from treatment acceleration, the surgery-radiotherapy gap and the overall treatment time should not exceed 6 and 10 weeks respectively.

Contrasting molecular pathology of colorectal carcinoma in Egyptian and Western patients

Colorectal carcinoma is uncommon in Egypt, but a high proportion of cases occurs before age 40 years and in the rectum. We compared the molecular pathology of 59 representative Egyptian patients aged 10-72 to Western patients with sporadic, young-onset, or hereditary non-polyposis colorectal cancer syndrome (HNPCC)-associated carcinoma and found significant differences. Most Egyptian cancers were rectal (51%) and poorly differentiated (58%). High levels of microsatellite instability (MSI-H) were frequent (37%) and attributable in some cases (36%) to methylation of the promoter of the hMLH1 mismatch repair gene, but no MSI-H cancer had loss of hMSH2 mismatch repair gene product of the type seen with germline hMSH2 mutation in HNPCC. K-ras mutation was uncommon (11%). In subset analyses, high frequencies of MSI-H in rectal carcinomas (36%) and p53 gene product overexpression in MSI-H cancers (50%) were found. MSI-H and K-ras mutation in Egyptians under age 40 were unusual (17% and 0%, respectively), and schistosomiasis was associated with MSI and K-ras mutation. Cluster analysis identified 2 groups: predominantly young men with poorly differentiated mucinous and signet-ring cell colorectal carcinoma lacking K-ras mutation; older patients who had well- or moderately differentiated adenocarcinoma often with MSI-H, K-ras mutation and schistosomiasis. Our findings show that the molecular pathology of colorectal cancer in older as well as younger Egyptians has unique differences from Western patients, and schistosomiasis influences the molecular pathogenesis of some tumours.

Contrasting molecular pathology of colorectal carcinoma in Egyptian and Western patients

Colorectal carcinoma is uncommon in Egypt, but a high proportion of cases occurs before age 40 years and in the rectum. We compared the molecular pathology of 59 representative Egyptian patients aged 10-72 to Western patients with sporadic, young-onset, or hereditary non-polyposis colorectal cancer syndrome (HNPCC)-associated carcinoma and found significant differences. Most Egyptian cancers were rectal (51%) and poorly differentiated (58%). High levels of microsatellite instability (MSI-H) were frequent (37%) and attributable in some cases (36%) to methylation of the promoter of the hMLH1 mismatch repair gene, but no MSI-H cancer had loss of hMSH2 mismatch repair gene product of the type seen with germline hMSH2 mutation in HNPCC. K-ras mutation was uncommon (11%). In subset analyses, high frequencies of MSI-H in rectal carcinomas (36%) and p53 gene product overexpression in MSI-H cancers (50%) were found. MSI-H and K-ras mutation in Egyptians under age 40 were unusual (17% and 0%, respectively), and schistosomiasis was associated with MSI and K-ras mutation. Cluster analysis identified 2 groups: predominantly young men with poorly differentiated mucinous and signet-ring cell colorectal carcinoma lacking K-ras mutation; older patients who had well- or moderately differentiated adenocarcinoma often with MSI-H, K-ras mutation and schistosomiasis. Our findings show that the molecular pathology of colorectal cancer in older as well as younger Egyptians has unique differences from Western patients, and schistosomiasis influences the molecular pathogenesis of some tumours.

Deletion of p16 and p15 genes In schistosomiasis-associated bladder cancer (SABC)

Alterations of p16 and p15 genes have been reported in cancer cell lines and in certain malignant neoplasm. These genes are designated as candidate tumor suppressor genes because they encode proteins that function as negative cell cycle regulators at G(1)-S checkpoint. One hundred and sixty eight tumor tissue, 20 schistosomal tissue, and 50 normal tissue samples were examined. The status of p16 and p15 genes in these tissues was determined by the polymerase chain reaction and by sequencing the DNA fragments produced during PCR. In addition, the expression of p16 and p15 proteins was examined by Western blot analysis. p16 and p15 genes were detected in all normal and schistosomal tissues. Deletion of both p16 and p15 genes was observed in 72 and 36 bladder tumors, respectively. Twenty eight of the 72 cases that exhibited p16 deletions also displayed deletions of p15. Only eight cases showed loss of the p15 gene while retaining p16 gene, and p16 deletion with apparently intact p15 gene was identified in 44 cases. The present analysis also reveals that deletion in the two genes are associated with low-stage, low grade bladder cancer, schistosomiasis-associated bladder cancer (SABC) and squamous cell carcinoma type (SCC). No point mutations were identified in either gene. The expression of p16 and p15 proteins was undetectable in 75 and 38 bladder tumors, respectively, by Western blot analysis. Alteration of the p16 and p15 genes appears to be an early event in bladder cancer which occurs more frequently in SABC and SCC, and may play an important role in the development of schistosomal bladder cancer.

Determination of cytosolic citrulline and nitrate as indicators of nitric oxide in bladder cancer: possible association with basic fibroblast growth factor

BACKGROUND

Nitric Oxide (NO) and nitrosamines have been implicated in bladder carcinogenesis. Apart from its implication in carcinogenesis, NO contributes to the regulation of tumor angiogenesis via angiogenic peptides exemplified by basic fibroblast growth factor (bFGF).

OBJECTIVES AND METHODS

In order to examine NO pattern in normal, schistosomal, and malignant bladder cytosols, we have used a combined approach by measuring nitrate and the amino acid citrulline. The results were correlated to bFGF, which were measured in bladder cytosols by an EIA method.

RESULTS

Comparison between normal, schistosomal, and malignant bladder groups showed that patients with schistosomiasis and bladder cancer had significantly higher cytosolic nitrate, citrulline, and bFGF levels. There were no apparent correlations between these investigated parameters and tumor histologic features. The level of citrulline was strongly correlated to nitrate level and both were correlated to bFGF level in bladder cancer and schistosomiasis groups.

CONCLUSIONS

Our findings indicate that NO and bFGF were significantly elevated in schistosomiasis and bladder cancer compared to normal bladders. Moreover, the consistent association of NO with bFGF found in the present work, support the hypothesis that the angiogenic peptide bFGF may be modulated by NO and suggest a useful target in antiangiogenic therapy in bladder cancer.

Correlation between EBV DNA and rearrangement and expression of Bcl-2 gene in aggressive non-Hodgkin's lymphoma

Previous in vitro studies have shown that bcl-2 expression can be induced by transfection of Epstein-Barr virus (EBV)-negative non-Hodgkin's lymphoma (NHL) cell lines with EBV. This induced expression of bcl-2 is important for the long survival of EBV-positive cells and might be a first step in tumorigenesis. The purpose of the present study was to investigate the possibility of similar correlation between bcl-2 expression and EBV infection in vivo in a cohort of patients with aggressive NHL, who were uniformly evaluated and treated with effective chemotherapy. The 42 patients included were 25-65 years old. None had prior treatment, discordant lymphoma, or human immunodeficiency virus seropositivity. Fresh biopsied samples were obtained and stored frozen for analysis of bcl-2 gene rearrangement major break point and of EBV DNA by PCR. Bcl-2 protein expression was estimated by Western blot, and enzyme immunoassay. With a median follow-up of 30 months, overall survival (OS) and disease-free survival (DFS) were measured to determine the prognostic significance of these variables. Analyzable DNA was present in all samples, 24% demonstrating bcl-2 rearrangement and 33% showing EBV DNA. Patients with bcl-2 gene rearrangement tended to have shorter DFS, and OS than patients without translocation. Bcl-2 protein expression was not correlated to gene rearrangement and had no significant influence on survival. The presence of EBV DNA in NHL had no prognostic significance but was correlated to bcl-2 expression. EBV-positive tumors showed higher bcl-2 expression than EBV-negative tumors did. Our results suggest a role of EBV infection in inducing bcl-2 expression as a survival factor for EBV-positive cells.

Expression of p21WAF1/CIP1 in bladder cancer: relation to schistosomiasis

Cell cycle regulation is mediated in part through expression of the cyclin-dependent kinase inhibitor p21WAF1/CIP1. Loss of p21WAF1/CIP1 expression may, therefore, contribute partially to schistosomal carcinogenesis in the urinary bladder. We compared p21WAF1/CIP1 expression in schistosomal and nonschistosomal bladder cancer to explore possible differences in p21WAF1/CIP1 expression between the two subtypes and the possible association between schistosomiasis and loss of p21WAF1/CIP1 expression. Tumor specimens were obtained from 130 patients who underwent transurethral biopsy or cystectomy. p21WAF1/CIP1 was determined by immunodot blot, Western blot, and enzyme immunoassay (EIA). We validated a highly sensitive quantitative EIA assay for determination of p21WAF1/CIP1 in cell lysates. Precision, analytical recovery, and linearity were all excellent. Our results did not show any correlation between p21WAF1/CIP1 expression and most clinicopathologic variables. Lower expression of p21WAF1/CIP1 was evident in squamous cell carcinoma (SCC) and schistosomal subtype than in transitional cell carcinoma and nonschistosomal tumors. Our data suggest a potential role for p21WAF1/CIP1 alteration in schistosomal carcinogenesis.

Regulators of apoptosis in human breast cancer

OBJECTIVES

Apoptosis or programmed cell death represents a mechanism by which tumor cells with DNA damage can be deleted. Bcl-2 and p53 gene products have been both linked to apoptosis. Bcl-2 plays a role as an inhibitor of apoptosis that may extend the viability of cells containing genetic alterations and facilitate tumor progression. Mutant p53 has a similar effect. The purpose of this study was to investigate expression of bcl-2 in 70 malignant and 30 benign breast lesions using different methods (enzyme immunoassay, immunodot blot, Western blot) and to compare it with the established clinicopathological prognostic factors (age, tumor size, type, grade, lymph node status) and some molecular genetic markers in breast cancer.

RESULTS

bcl-2 and mutant p53 were highly expressed in breast cancer than benign breast lesions and aneuploidy was more frequently detected in malignant breast samples. No correlation could be observed between bcl-2 expression and node status, tumor size, differentiation, type, age at excision or mutant p53 expression. However, a strong positive associations were seen between bcl-2 and estrogen receptors (ER), DNA aneuploidy. Eighty-five percent of bcl-2 positive tumors were ER positive and 65% were aneuploid, while in bcl-2 negative tumors only 28% were ER positive and 37% were aneuploid.

CONCLUSIONS

The association seen between bcl-2 and ER raises the possibility that bcl-2 is an ER-regulated gene which suggests a potential important role for bcl-2 as a modulator of response to hormonal therapy in breast cancer. Monitoring hormonal therapy can easily be done by bcl-2 quantitative EIA method.

Quantitation of bcl-2 protein in bladder cancer tissue by enzyme immunoassay: comparison with Western blot and immunohistochemistry

Apoptosis (programmed cell death) and the genes regulating this process (e.g., bcl-2), have recently become a focus of interest in the study of cancer development and progression. We adapted and evaluated a new enzyme immunoassay method (EIA) for quanitifying bcl-2 in cell lysates. The range of detection of the assay was 5-400 kilounits/L with inter- and intraassay CVs of 5.5-9.2% and 5.0-8.8%, respectively. The recovery of added bcl-2 protein to cell lysates was 96-104%. The concordance rates with Western blotting and immunohistochemistry were 97.5% and 93.7%, respectively. Bcl-2 concentrations were measured in the cell lysate of bladder tumors. The amount of bcl-2 in 158 bladder cancer (mean rank, 71.3 kilounits/g protein; range, 8.4-324 kilounits/g protein), was significantly higher than in nondiseased bladder tissues distant to the tumors (mean rank, 31.5 kilounits/g protein; range, 5-54.9 kilounits/g protein), P = 0.00001. Bcl-2 expression was correlated to tumor proliferative capacity, which was measured by DNA flow cytometry as the percentage of cells in the synthetic phase of the cell cycle. The enzyme immunoassay provides a rapid, quantitative, and reliable technique for measurement of bcl-2 in tumor tissue. The detection of substantial amounts of bcl-2 in invasive tumors (compared with nondiseased tissues) suggests that the assay should be a useful tool for investigating the prognostic value of bcl-2 in bladder tumors and for selecting patients for future anti-bcl-2 therapy.

Comparison of flow cytometric DNA content analysis in fresh and paraffin-embedded ovarian neoplasms: a prospective study

DNA ploidy analysis was performed on both fresh and paraffin-embedded preparations from each of 54 malignant ovarian neoplasms. Aneuploidy was detected in both the fresh and the paraffin-embedded tissue in 19 out of 54 (35%) malignant cases. In addition, aneuploidy was detected exclusively in fresh tissue in seven of the malignant cases, and exclusively in paraffin-embedded tissue in one of the malignant cases, yielding a total of 27 out of 54 (50%) aneuploid cases. The correlation coefficient (r-value) for fresh and paraffin-embedded tissue ploidy analysis in the malignant specimens was 0.91. Although the frequency of recurrence was higher and overall survival lower in the malignant aneuploid specimens of both types, the combined analysis of DNA and survival rates indicated superior prognostic significance of fresh tissue. Of the seven patients in whose specimens aneuploidy was detected exclusively in fresh tissue, all died of recurrent disease during the follow-up period. Our finding indicates that data generated by flow cytometry analysis of formalin-fixed tissue should be interpreted with caution before the data can be used to draw clinical inferences.

Epstein-Barr virus, human papillomavirus, and flow cytometric cell cycle kinetics in nasopharyngeal carcinoma and inverted papilloma among Egyptian patients

It is widely accepted that the Epstein-Barr virus is etiologically associated with the development of nasopharyngeal carcinoma. The human papillomavirus is also associated with inverted papilloma. We used the polymerase chain reaction technique to detect both viruses in both types of tumors. Flow cytometry was also used to study the DNA pattern and proliferative behavior of the tumors in relation to the viruses. EBV was detected in 13/20 (65%) of NPC specimens, and in none of IP (n = 10) or control specimens (n = 10). This indicates the contribution of EBV as an etiologic factor in NPC. Five cases of NPC (25%) were positive for HPV 16, two of them were EBV positive. Four HPV 16 positive cases were found among cases with inverted papilloma, but none among the control cases. Flow cytometry revealed that all NPC, IP, and control samples were diploid except one aneuploid NPC sample. Proliferative capacity (PC) of primary tumors was predictive of tumor recurrence in NPC. Using 13.6% as a cut-off point for PC, we were able to discriminate between high risk and low risk groups with 100% sensitivity and 86% specificity. PC can be used as a baseline prognostic parameter in NPC, making it possible to modify courses of treatment in an attempt to inhibit tumor recurrence.

Expression of cyclin D1, but not cyclins E and A, is related to progression in bilharzial bladder cancer

The present study was conducted to analyze the alterations affecting cyclins D1, E, and A in bilharzial bladder cancer and to assess their potential clinical significance. A total of 125 cases were examined. Histopathological subtypes included 68 squamous cell carcinomas, 55 transitional cell carcinomas, and 2 adenocarcinomas. Immunohistochemical analyses were performed using a panel of well-characterized antibodies. The results were correlated with proliferative index, as assessed by Ki67 antigen expression. The cyclin D1-positive phenotype, defined as the identification of positive immunoreactivity in the nuclei of >/=20% of tumor cells, was found in 33 of 107 (31%) evaluable cases. A significant association was observed between the cyclin D1-positive phenotype and deep muscle invasion (P = 0.02), high tumor grade (P = 0.02), and Ki67 high proliferative index (P = 0.03). The cyclin E-positive phenotype, defined as per cyclin D1, was found in 79 of 106 (75%) evaluable cases. The cyclin A-positive phenotype, defined using the above criteria, was identified in 60 of 108 (56%) evaluable cases. No statistically significant association was found between cyclins E or A and clinicopathological parameters or proliferative index. However, there was a strong association between the expression of cyclin D1 and the coexpression of cyclins A and/or E (P = 0.05). Ki67 proliferative index was considered high when >/=20% of tumor cells displayed positive nuclear staining, a phenotype that was observed in 99 of 115 (86%) cases. These data support the hypothesis that cyclin D1 activation determines the evolution of a particular subset of aggressive bladder tumors. In addition, cyclins E and A seem to follow an unscheduled pattern of expression, based on the high frequency of identifying a positive phenotype for these cyclins and the lack of correlation between their expression and Ki67 high proliferative index. It may be postulated that the expression of G1 cyclin genes is deregulated in bilharzial bladder cancer, and that cyclin D1 acts as an oncogenic event in these neoplasms. Moreover, the moderate number of tumors displaying the cyclin D1-positive phenotype (31%) versus the high frequency observed for both cyclins E (75%) and A (56%), suggests a short G1 disbalanced by a long S phase and a rapid transversal of the cell cycle, as evidenced by a high Ki67 index observed in 86% of these cases. This imbalance in the cell cycle, together with alterations reported on the p53 pathway, might underline the accumulation of DNA damage and the aggressive clinical course of bilharzial bladder cancer.

Multivariate analysis of DNA ploidy, p53, c-erbB-2 proteins, EGFR, and steroid hormone receptors for short-term prognosis in breast cancer

BACKGROUND

Several molecular-genetic alterations in breast cancer, including aneuploidy, aberrant expression of p53, c-erbB-2, and EGFR have been associated with poor prognosis in breast cancer particularly in lymph node negative patients. To determine the importance of molecular-genetic factors relative to more traditional surgical-pathologic prognostic factors, a multivariate analysis was performed particularly in lymph node positive breast cancer cases.

METHODS

One hundred fresh samples of primary breast carcinoma have been studied with flow cytometry for DNA ploidy. On the same specimens steroid hormone receptors (ER and PR) were measured in cytosol fraction using Abbott ELIZA assays, c-erbB-2 and EGFR were determined in the tissue homogenate and mutant p53 protein in the nuclear fraction by Oncogene Science ELISA procedures. In addition, information regarding surgical-pathologic features of the tumor was obtained. Multivariate analysis using Cox's proportional hazards model was done to identify variables predictive of poor prognosis.

RESULTS

With univariate analysis, tumor size, lymphnode number, p53, c-erbB-2 were predictive of poor short term prognosis. In the multivariate analysis, only c-erbB-2 (P = 0.001) and p53 (P = 0.05) were significant. Subgroup analysis by nodal status yielded significant association of c-erbB-2 (P = 0.001) and p53 (P = 0.04) with lymph node positive breast cancer.

CONCLUSIONS

Among molecular-genetic prognostic factors, c-erbB-2 was the most strongly predictive of poor short term prognosis followed by p53 in lymph node positive breast cancer.

Role of thallium-201 chloride and Tc-99m methoxy-isobutyl-isonitrite (sestaMIBI) in evaluation of breast masses: correlation with the immunohistochemical characteristic parameters (Ki-67, PCNA, Bcl, and angiogenesis) in malignant lesions

The aim of this project was to study the kinetics of both Tl and Tc-99m MIBI in PBM by evaluating tumor to normal tissue ratio in early (E) images acquired within 1/2 hour and delayed (D) images acquired three hours following the i.v. injection of 3 mCi (111 MBq) of Tl and 20 mCi (740 MBq) of MIBI on 2 separate days in 49 patients. The washout index was calculated from E ratio minus D ratio divided by E ratio. A negative ratio indicating build up of activity in D images and a positive ratio indicated washout of activity from the E images. In addition, the findings were correlated with the following immunohistochemical parameters: pathological grading, number of cells in mitotic division (PCNA- Ki-67), angiogenesis (well formed and ill formed blood vessels) and presence or absence of Bcl 2 Oncogene (release antiapoptotic signals). Results showed that in all benign and malignant lesions, MIBI showed consistent washout varying from 19-27% while with Tl, there was persistent washout in all benign lesions and mixed washout or buildup varying from +16% to minus 17% in malignant lesions, (E) ratios showed a reasonable correlation between Tl and MIBI (r = 0.5). There was more significant correlation between the D ratios (r = 0.8). Due to high (E) MIBI uptake ratios and their higher percentage of washout than Tl, delayed ratios came close to each other. Immunohistochemical analysis revealed benign lesions presented with low mitotic rate: Ki-67 (71.4%), PCNA (14.2%), low amount of ill formed blood vessels (42.8%) and high amount well formed blood vessels (100%). While malignant lesions presented with high mitotic rate Ki-67 was (96.7%), PCNA (100%), high amount of ill formed blood vessels (73.3% in GII and 100% in Grade III) and less amount of well formed blood vessels of 90% and 83.4% in Grade II and III respectively. Bcl-2 was variable in both benign and malignant lesions with 71.4% in benign, 73.4% in GII and 16.7 in GIII malignancy. In conclusion, early uptake ratio in both benign and malignant tumors is related to the degree of angiogenesis, percentage of ill formed blood vessels, high mitotic activity reflected by high grade of tumor and high percentage of PCNA and Ki-67.

Altered endometrial progesterone/oestrogen receptor ratio in luteal phase defect

The total oestrogen and progesterone receptor levels (TER, TPR) were measured in endometrial biopsy samples of 10 infertile patients with luteal phase defect (LPD) and compared to those of controls. Serum levels of progesterone (P), obtained in the luteal phase, were also measured. Midluteal phase P values were significantly decreased in LPD cycles; however some overlap of values existed. LPD cycles had significantly lower endometrial TER and TPR concentrations than did control cycles. TPR/TER ratio was found to be a reliable test for diagnosis; having a sensitivity, and specificity of 90% and the odds ratio of 81. The TPR/TER ratio for inphase endometria ranged between 1.13 and 58.22, with 95% confidence. It seems that abnormal folliculogenesis, as a cause of LPD, results in wide ranges of endometrial TER and TPR concentrations, yet with well defined alteration in TPR/TER ratio. Summation of the results of the present study along with those previously reported, indicates that TPR/TER ratio may be of great value in characterisation of a well defined endometrial receptor imbalance in luteal phase defect, whatever the underlying aetiology.

Flow cytometric cell cycle kinetics and quantitative measurement of c-erbB-2 and mutant p53 proteins in normal, hyperplastic, and malignant endometrial biopsies

OBJECTIVES

The purpose of this study is to biologically characterize endometrial hyperplasia by investigating changes in DNA ploidy pattern, the expression of c-erbB-2 p185 and mutant p53 proteins.

METHODS AND RESULTS

Our results show that all normal endometria (n = 62) were exclusively diploid and 2 (2.5%) of 79 endometrial hyperplasias and 22 (68.8%) of 32 endometrial carcinomas were aneuploid. Upper 95% normal values for synthetic phase fraction (SPF), c-erbB-2 and p53 were applied as cut-off values to discriminate between normal and malignant endometria. When 9%, 3.2 HNU (Human Neu Unit)/microgram protein, and 0.39 ng/mg protein were used as cut-off values for SPF. c-erbB-2, and p53 respectively, 13.9%, 20.2%, and 0% of endometrial hyperplasia and 50%, 56.3%, and 12.5% of endometrial carcinoma showed raised levels of the corresponding parameters.

CONCLUSIONS

Our results indicate that subsets of endometrial hyperplasia are biologically different as evidenced by the presence of DNA aneuploidy, high SPF and c-erbB-2 overexpression, which may provide biological markers for assessing progression to endometrial carcinoma.

Alterations affecting the p53 control pathway in bilharzial-related bladder cancer

Bilharzial-related bladder carcinoma (BBC) is the most common malignant neoplasm in Egypt, also occurring with a high incidence in other regions of the Middle East and East Africa. The clinical and pathological features of BBC are different than those described for the conventional transitional cell carcinoma of the bladder, including the high incidence of squamous cell carcinoma reported in BBC and the fact that over 90% of BBC cases at presentation are advanced-stage tumors (P3 and P4). This study was conducted to better define the phenotypic alterations associated with BBC affecting the p53 cell cycle control pathway, including altered patterns of expression of downstream effector proteins such as mdm2 and p21/WAF1. A well-characterized cohort of 125 patients affected with bilharzial-related bladder tumors was studied. Tumors were classified as squamous carcinomas (n = 68), transitional cell carcinomas (n = 55), or adenocarcinomas (n = 2). The products encoded by TP53, mdm2, and p21/WAF1 genes were analyzed by immunohistochemistry. Furthermore, the patterns of expression of these molecules were correlated with the Ki67 proliferative index. In addition, the microanatomical distribution of programmed cell death was assessed in a subset of tumors, using the so-called terminal deoxynucleotidyl transferase-mediated nick end labeling method. p53 nuclear overexpression was identified in 25 (20%) of 125 cases. Nuclear overexpression of mdm2 was detected in 74 (59.2%) of 125 cases. There was a statistically significant association between coexpression of both p53 and mdm2 and detection of lymph node metastases (P = 0.04). p21/WAF1 expression was detected in 87 (72%) of 121 evaluable cases. A high Ki67 proliferative index was observed in 99 (86%) of 115 evaluable cases. There was a statistically significant association between high Ki67 proliferative index and mdm2-positive phenotype (P = 0.005) and deep muscle invasion (P3b; P = 0.026) as well as lymph node metastases (P = 0.039). Apoptosis was observed in terminally differentiated tumor cells identified in the superficial layers of well-differentiated squamous carcinoma or exfoliating cells in transitional lesions. However, only rare apoptotic tumor cells were found in basal or suprabasal layers as well as in the invasive elements of the neoplasms studied. These results suggest that the frequency of p53 nuclear overexpression in BBC is lower than that reported for conventional transitional cell carcinoma. Nevertheless, tumors with p53 alterations have a greater propensity to progress. The prominent number of cases displaying an mdm2-positive phenotype suggests that this may be an early incident in BBC and should be regarded as a potential oncogenic phenomenon. This is supported by the significant correlation between high Ki67 proliferative index and mdm2 overexpression. The association of an aggressive clinical course with the coexpression of both p53 and mdm2 products might be viewed as a cooperative effect that develops in tumor progression.

Multivariate analysis of DNA ploidy, p53, c-erbB-2 proteins, EGFR, and steroid hormone receptors for prediction of poor short term prognosis in breast cancer

BACKGROUND

Several molecular-genetic alterations in breast cancer, including aneuploidy, aberrant expression of p53, c-erbB-2 and EGFR, have been associated with poor prognosis in breast cancer patients particularly those who are lymph node negative. To determine the importance of molecular-genetic factors relative to more traditional surgical-pathologic prognostic factors, multivariate analysis was performed on lymph node positive breast cancer cases.

METHODS

One hundred fresh samples of primary breast carcinoma were studied with flow cytometry for DNA ploidy. On the same specimens steroid hormone receptors (ER and PR) were measured in the cytosol fraction using Abbott ELIZA assays, c-erbB-2 and EGFR were determined in the membrane fraction and mutant p53 protein in the nuclear fraction by Oncogene Science ELISA procedures. In addition, information regarding surgical-pathologic features of the tumor was obtained. Multivariate analysis using Cox's proportional hazards model was done to identify variables predictive of poor prognosis.

RESULTS

Using univariate analysis, tumor size, lymph node number, p53, c-erbB-2 were predictive of poor short term prognosis. By multivariate analysis, only c-erbB-2 (P = 0.001) and p53 (P = 0.05) were significant. Subsgroup analysis by nodal status yields a significant association of c-erbB-2 (P = 0.001) and p53 (P = 0.04) with lymph node positive breast cancer.

CONCLUSIONS

Among molecular-genetic prognostic factors, c-erbB-2 was the most strongly predictive of poor short term prognosis followed by p53 in lymph node positive breast cancer.

DNA ploidy in hepatic cirrhosis, dysplasia and carcinoma

Hepatocellular carcinoma (HCC) is the most common and aggressive form of primary liver tumors. The evolution and the putative association of this neoplasm with hepatic cirrhosis and liver cell dysplasia remain uncertain. We analyzed the DNA ploidy by flow cytometry in a cohort of 130 liver specimens representing liver cirrhosis, hepatic cell dysplasia and hepatocellular carcinoma to determine the incidence and potential biological relevance of this feature. Our results show that four (8.0%) of the 50 cirrhotic lesions, four (26.7%) of 15 dysplastic, and 51 (78.5%) of the 65 HCC manifested DNA aneuploidy. Moreover, DNA aneuploidy was manifested in 60% of histologically negative hepatic resection margins of HCC. Our results indicate that: i) the presence of DNA aneuploidy in some cirrhotic livers and liver cell dysplasias support the potential evolution of HCC from a subset of these lesions that harbor such clonal alterations, ii) DNA aneuploidy in histologically negative resection margins of HCC in some cases support the concept of field cancerization in these tumors and iii) the predominance of DNA aneuploidy and high proliferative index (PI) in liver cell carcinomas underscore their aggressive biological behavior.

Comparative study between sonography, pathology and UGP in women with perimenopausal bleeding

Adenocarcinoma is the commonest primary malignancy encountered in the endometrium. Adenomatous hyperplasia represents an important precancerous endometrial lesion. In this study, different techniques have been applied in a trial to early detect endometrial carcinoma and to distinguish between hyperplasia with minimal and high risk of progression to endometrial adenocarcinoma. Eighty women were included in this study and classified into 4 groups: 10 with adenocarcinoma, 28 with simple hyperplasia, 12 with hyperplasia with atypia and 30 normal healthy women. All individuals were subjected to Doppler endovaginal ultrasonography (EVS) for endometrial thickness and uterine artery resistance index (RI). Endometrial biopsy was taken for histopathological examination and DNA analysis. 24-hr urine was collected for the estimation of UGP by ELISA using reagents supplied by Ciba Corning Diagnostica, Alameda, CA, USA (Triton UGP-EIA). On referring to histopathological findings, no single parameter was seen to be specific and sensitive enough to differentiate between benign and malignant endometrial lesions. Doppler endovaginal ultrasonography could detect 76% of endometrial abnormalities. DNA ploidy and UGP showed equal sensitivity rate (60%) in endometrial carcinoma but DNA ploidy was more specific than UGP (0% and 10% false positivity in benign endometrial diseases respectively.

Multivariate analysis of DNA ploidy, steroid hormone receptors, and CA 125 as prognostic factors in ovarian carcinoma: a prospective study

The prognosis in ovarian cancer patients remains poor, and there is a need to identify patients who are less likely to respond to treatment. In a prospective study of patients with ovarian carcinoma treated by a standard protocol, variables such as age, tumor type, International Federation of Gynecology and Obstetrics stage, histologic grade, results from flow cytometry, receptors for estrogen (ER) and progesterone (PR), and serum CA 125 were correlated to relapse and survival. Univariate analysis revealed that stage, histologic grade, DNA ploidy, ER, PR, and CA 125 were of significant association to survival, but only stage, DNA ploidy, PR, and CA 125 were found to be of significant value to relapse. Multivariate analysis identified DNA ploidy as an independent prognostic variable for both relapse and survival.

Tps in serum and urine of egyptian bladder-cancer patients

TPS levels were determined in the serum and urine of 136 Egyptian patients with infiltrating bladder cancer and compared with the levels in 45 normal controls and 45 patients with urinary tract Bilharziasis. At 95% specificity the sensitivy in bladder cancer patients in serum and urine was 34.6% and 96.3%, respectively. Elevated TPS levels did not correlate with histological type, staging, grade, lymph node involvement or Bilharziasis. The determination of urinary TPS could probably be a useful tool in the follow-up of patients with superficial transitional cell carcinoma of the bladder. This urine test is less invasive and cheaper than cystoscopy and could, eventually, in combination with cytological examination of the urine, indicate the need of less frequent cystoscopy.

Luminoimmunometric assay of tissue polypeptide antigen (TPA) and cancer antigen 125 (CA-125) in breast cancer patients

Serum TPA and CA-125 were determined in 86 individuals (66 with breast cancer representing the different stages and grades of the disease and 20 normal healthy controls). TPA and CA-125 were estimated using the LIA reagents supplied by BYK Sangtec. TPA showed sensitivity rates of 31.8%, 42.4% and 51.5% while CA-125 showed sensitivities of 16.3%, 18.6% and 25.6% at specificity levels of 100%, 95% and 90% respectively. Combined determination of the two markers resulted in some improvement in sensitivity. For follow-up of breast cancer patients after surgery both markers were of value and showed near-identical patterns.

A randomized pilot study of high-dose epirubicin as neoadjuvant chemotherapy in the treatment of cancer of the bilharzial bladder

Seventy-one patients with T2 and T3 bladder cancer were randomized to receive either two courses of epirubicin 120 mg/m2 i.v. push every 21 days pre-operatively, and four additional courses post-operatively (group I = 34 patients), or radical surgery (group II = 37 patients). At a median follow-up of 24 months (range 22 months to 38 months) 25 patients from group I and 14 patients from group II are still alive and disease-free. The estimated two-year disease-free survival percentages were 73.5 and 37.9%, respectively (P = 0.05). After initial chemotherapy, resected specimens were subjected to histopathological study of chemotherapeutic effects. Necrosis was detected in 95% of cases with squamous cell carcinoma and in 57.3% of cases with transitional cell carcinoma. We conclude that the benefit which was obtained by pre-operative and post-operative chemotherapy with epirubicin is promising and may represent a significant improvement in the treatment of patients with carcinoma of the bilharzial bladder.