Worse histological grade of proximal colorectal tumors and its relation with stage

PURPOSE

Accumulated data seem to support the concept that proximal and distal colorectal cancers (CRC) should be considered as different disease entities. We investigated a particular aspect of this assumption by examining variation of stage and grade distribution according to tumor site in a Greek patients' group.

METHODS

A total of 200 cases having had undergone surgery for primary CRC was retrospectively analysed. Fifty-seven proximal tumors were compared to 143 distal lesions regarding tumor stage (TNM I-IV) and grade of differentiation (well, moderate and poor). Grade distribution by site was also examined within each particular stage and within additional stage categories (I-II, III-IV, I-III, II-IV, II-III).

RESULTS

There was an almost significant trend of distal tumors for earlier stage (I) presentation (p=0.055), whereas proximal cancers were more frequently diagnosed with stages II-III (p=0.08). Poorly differentiated lesions displayed a strong predilection for proximal site (p=0.002), while tumors with moderate differentiation were preferentially found distally (p=0.001). Such segmental differences in grade distribution were also ascertained within most particular stages and all additional stage subsets (especially the last three). Moreover, both the proximal and the poorly differentiated lesions showed a parallel decrease in their incidence during the study period.

CONCLUSION

The consistently recorded worse histological pattern of proximal tumors implies a different biological behavior of these lesions possibly due to distinct tumorigenic pathways involved in their development, whereas their tendency for late stage presentation demands further investigation before considered supportive to this concept.

Site impact on colorectal cancer biological behavior in terms of clinicopathological and molecular features

PURPOSE

We investigated the biological behavior of proximal and distal colorectal adenocarcinomas (CRC), intending to determine specific segmental differences, possibly arising from the distinct genetic pathways involved in their development.

METHODS

Thirty-six proximal and 83 distal cancers were comparatively and retrospectively analyzed, regarding tumor stage, grade and Ki-67, p53 and Bcl-2 immunohistochemical expression.

RESULTS

Proximal tumors were more likely to be poorly differentiated (p=0.005) and to exhibit low Ki-67 and p53 expression (<20% and ≤ 30% stained nuclei respectively; p=0.026 and 0.0014, respectively). Distal lesions were more likely to be moderately differentiated (p=0.001), to display moderate Ki-67 expression (20-50% stained nuclei, p= 0.013) and p53 staining higher than 30% stained nuclei (p= 0.0014). Such segmental variations regarding mainly p53 and to a lesser extent Ki-67 were seen within most of the specific sub-groups of patients (stratified by stage, grade, gender and age). An association between Bcl-2 expression and distal site was also observed among females (p=0.008).

CONCLUSION

Proximal and distal cancers displayed different clinicopathological and molecular patterns, reinforcing the proposal that they are genetically and biologically different entities. Potential clinical applications of these findings should be investigated.

Phase II study of gemcitabine plus 5-fluorouracil biologically modulated by folinic acid plus long-acting formulation of octreotide (LAR) in patients with advanced pancreatic cancer

PURPOSE

To investigate the efficacy and toxicity of gemcitabine, in combination with 5-fluorouracil (5-FU) biologically modulated by folinic acid (FA) plus a somatostatin analogue (octreotide acetate-long acting formulation-LAR) that can both inhibit the action of several growth factors and angiogenesis, in patients with advanced pancreatic cancer.

PATIENTS AND METHODS

Thirty-two patients with advanced symptomatic pancreatic cancer with measurable disease and median age 64 years (range 50-72) received the following combination: 5-FU, given at 350 mg/m(2) i.v. bolus, biologically modulated by FA 350 mg/m(2) on days 1, 2, 8 and 9; and gemcitabine, given by short i.v. infusion at 1000 mg/m(2) on days 1 and 8. The regimen was administered every 3 weeks. LAR 30 mg was given intramuscularly every 4 weeks.

RESULTS

Objective tumor response was documented in 7 out of 32 evaluable patients (all partial responses-PR), yielding a 22% response rate (RR) (95% CI 10.5-35). Sixteen (50%) patients (95% CI 31.4-60.8) remained with stable disease (SD), while 9 (28%) patients (95% CI 20.4-48.4) progressed while on chemotherapy. The median response duration (RD) was 7 months (range 4-18). The median time to tumor progression (TTP) was 7 months (range 2-20), while the median survival was 7 months (range 4-29). The probability of surviving beyond 12 months was 20%. Of the 32 patients with tumor-related symptoms who were considered evaluable for clinical benefit response, 25 (78%) had pain improvement, while 14 (44%) experienced weight gain during treatment. In general, performance status improved in 16 (50%) patients during treatment. Serum concentrations of Ca 19-9 were decreased by more than 50% in 14 (44%) of the 32 assessable patients. Chemotherapy was well tolerated with mild myelotoxicity. Gastrointestinal toxicity was moderate with mild mucositis.

CONCLUSION

The combination of gemcitabine and 5-FU/FA plus LAR 30 was well tolerated and showed a moderate antitumor activity and a significant palliative effect on tumor-related symptoms. It would be interesting to evaluate in a randomized study the impact of octreotide administration on the palliative effect of the regimen.

Tumor histology and stage but not p53, Her2-neu or cathepsin-D expression are independent prognostic factors in breast cancer patients

BACKGROUND

Several factors are currently employed for prognosis assessment and treatment determination in breast cancer. An array of molecular parameters, such as p53, Her2-neu (c-erbB 2) and Cathepsin-D, are also examined to improve clinical patient management. We have conducted a statistically powerful study of the prognostic value of conventional factors and of the investigational factors p53, Her2-neu and Cathepsin-D in patients with invasive breast carcinoma, in order to compare their significance. Our analysis was extended to determine the associations of p53 and Her2-neu with risk of death and relapse among patients with and without lymph node metastases.

MATERIALS AND METHODS

In a set of 125 primary breast tumors, p53 and Her2-neu expression were immunohistochemically evaluated. Cathepsin-D, estrogen and progesterone receptor concentrations were determined in cytosols by a standard immunoradiometric assay.

RESULTS

Over a mean of 62 months, 49 patients (39%) had a relapse and 29 patients (23%) died. Overexpression of p53, Her2-neu and Cathepsin-D was observed in 31%, 46% and 88% of cases, respectively. Overall survival was associated with histology (hazard ratio 0.04, 95% confidence interval: 0.01, 0.49 for lobular tumors) and stage (hazard ratio 5.94, 95% confidence interval: 1.30, 27.15 for stage III samples). Disease-free survival was also related to histology (hazard ratio 0.23, 95% confidence interval: 0.08, 0.73 for lobular tumors) and stage (hazard ratio 4.27, 95% confidence interval: 1.36, 13.36 for stage III tumors). Patients with both negative nodal status and Her2-neu overexpression tended to display an elevated risk of death.

CONCLUSION

Our results support the prognostic power of tumor histology and stage and emphasize the need for further studies on the prognostic impact of p53. Her2-neu and Cathepsin-D in breast cancer. Additionally, our analysis indicates that deregulation of Her2-neu might characterize a subgroup of node-negative patients with poor prognosis who could benefit from an aggressive adjuvant therapy.