Carcinoma of the intact uterine cervix treated with radiotherapy alone: A french cooperative study: Update and multivariate analysis of prognostics factors

: To determine independent prognostic factors in a group of 1875 patients with invasive carcinoma of the intact uterine cervix treated with radiotherapy alone in a French cooperative study from 1970 to 1993.

: Patients were staged according to the UICC-FIGO and MDAH substaging. The distribution per FIGO stage was Ia-Ib: 25.5%; IIa: 29%; IIIa: 5%; IIIb: 25%, and IV: 3.5%. Ninety-two percent had squamous cell carcinoma. The maximum diameter of the clinically detectable cervical disease was less than 3 cm in 24.5% of Stages I–II and in 10% of Stages III–IV, more than 5 cm in 13.5% of Stages I–II, and in 16% of Stages III–IV. Nodal involvement was shown on lymphangiogram in 16% of Stages I–II and in 32.5% of Stages III–IV.

: 1) Univariate analysis of Stages I and II: stage, cervical disease diameter, and nodal involvement are significant prognostic factors. Five-year specific survival rate (5ySS) in 83.5% in Stage Ib, 81% in IIa and 71% in IIb. Five-year disease-free survival rate (5yDFS) is 86% in tumors less of 3 cm, 76% in tumors of 3 to 5 cm, and 61.5% in tumor larger than 5 cm. Lymphangiogram strongly influences the 5-year pelvic disease-free survival rate (5yPDFS): respectively, 90% in nonpositive lymphangiogram vs. 65% when positive. A significant drop in specific and disease-free survival is observed (10 and 14%, respectively (p = 0.04) when comparing adenocarcinoma and squamous cell carcinoma. Age is a significant prognostic factor for specific because patients aged less than 30 years old have 91% vs. about 75% for patients over 30 years (p = 0.03). 2) Univariate analysis of Stages III–IV: Stage and positive lymphagiogram are predictive factors for relapse and death. Te MDAH substaging is more reliable to predict the probability of pelvic disease-free survival in Stage III. At 5 years, the FIGO Stages IIIa and IIIb have a rather similar PDFS (65% vs. 59%). Conversely, the difference of survival rates between MDAH Stage IIIA and Stage IIIB is more demonstrative (69% vs. 47.5%). 3) Multivariate analysis (Cox P. H. R. model). Nodal involvement and stage remain significant for all three models in all stages (p < 0.0001). Age above 70 years influences specific survival for Stage I–II (p = 0.01). Tumors larger than 5 cm and adenocarcinoma also appear to be independent prognostic factors for specific and disease-free survival in Stage I–II (p = 0.05 and p = 0.005, respectively).

: The relevance of tumor size (less or greater than 4 cm) is now recognized in the 1995 revised FIGO staging in Stage Ib but unfortunately not in other stages. Tumor size per stage and nodal status should be systematically recorded to allow a better prediction of failure rates and to compare literature reports.     

上颌窦鳞状细胞癌术前放疗后病理反应的预后意义

  目的  分析上颌窦鳞状细胞癌术前放疗后显微镜下病理反应程度与局部控制率和长期生存率的关系。  方法  1994年1月至2003年5月接受术前放疗的上颌窦鳞状细胞癌36例, 男26例, 女10例, 中位年龄为57.5岁。临床分期: Ⅱ期2例, Ⅲ期12例, Ⅳ期22例, 受侵上颌窦区中位放疗剂量为60Gy, 中位休息23d后行上颌窦癌根治性切除术, 术后标本连续切片并HE染色, 显微镜下评价肿瘤组织放疗反应程度并分析其与肿瘤局部控制率和长期生存率的关系。  结果  依据恶性肿瘤放(化)疗后病理反应分度标准, Ⅰ度放疗反应为33.3%, Ⅱ度为16.7%, Ⅲ度为50.0%。治疗后中位随诊51个月, 随诊期间复发14例, 占38.9%, 其中局部复发13例。全组治疗后5年总生存率为70.9%, 5年无病生存率为60.5%。肿瘤组织Ⅰ、Ⅱ、Ⅲ度放疗反应的总生存率和无病生存率有显著差异, 但Ⅱ、Ⅲ度放疗反应组之间无显著性差异, 将Ⅱ、Ⅲ度合并为重度反应组, Ⅰ度定为轻度反应组, 两组的局部复发率分别为12.5%和83.3%(P < 0.001)。重度反应组与轻度反应组的5年无病生存率和总生存率分别为87.1%和91.3%与8.3%和30.0%, P值均 < 0.001。综合性别、年龄、病理分化、放疗剂量、放疗与手术间隔时间、临床分期以及肿瘤放疗反应程度的多因素回归分析提示肿瘤组织反应程度是重要的预后影响因素。  结论  上颌窦鳞状细胞癌放疗后显微镜下肿瘤组织反应程度与预后密切相关, 是重要的预后指标。      

Melastatin expression and prognosis in cutaneous malignant melanoma.

PURPOSE: Melastatin (MLSN-1), a novel melanocyte-specific gene recently identified using a genomic approach, is expressed in murine and human melanoma cells at levels inversely proportional to metastatic rates in vivo. We studied the relationship between expression of melastatin mRNA in the primary cutaneous tumor and prognosis in patients with localized malignant melanoma. PATIENTS AND METHODS: Melastatin mRNA was evaluated by in situ hybridization in primary cutaneous melanoma from 150 patients with localized disease (American Joint Committee on Cancer [AJCC] stage I and II). Multivariate Cox proportional hazards regression analysis was performed to assess the prognostic utility of melastatin mRNA expression while adjusting for other prognostic indicators. RESULTS: Uniform melastatin mRNA expression in the primary tumor was correlated with prolonged disease-free survival (P < .0001). Multivariate analysis revealed that melastatin status, mitotic rate, and tumor thickness influence disease-free survival independently. The 8-year disease-free survival rate in AJCC stage I patients whose tumors diffusely expressed melastatin mRNA was 100%, whereas in stage I patients with melastatin loss, the disease-free survival rate was 77% +/- 15% (median +/- SE). In patients with stage II disease whose tumors diffusely expressed melastatin mRNA, the 8-year disease-free survival rate was 90% +/- 7%, whereas in patients with melastatin loss, the disease-free survival rate was 51% +/- 8%. CONCLUSION: Downregulation of melastatin mRNA in the primary cutaneous tumor is a prognostic marker for metastasis in patients with localized malignant melanoma and is independent of tumor thickness and other variables. Used in combination, melastatin status and tumor thickness allow for the identification of subgroups of patients at high and low risk of developing metastatic disease.     

Prognostic Factors for Patients with FIGO Stage-IB Cervical Squamous Cell Carcinoma：Does the Tumor Size（≤4 cm or〉4 cm）Really Matter？

OBJECTIVE To investigate the factors that can accurately predict the prognosis for patients with FIGO stage-IB cervical squamous cell carcinoma treated with radical surgery. METHODS A retrospective analysis of clinical data from 174 cases of FIGO Stage-IB cervical squamous cell carcinoma treated in our institute was conducted. RESULTS The 5-year overal disease-free survival of the patients was 79.4%and the recurrence rate was 16.7%.Seventy-five percent of the 60 patients with a tumor>4 cm and 28.1%of the 114 patients with a tumor≤4 cm received preoperative radiotherapy,resuting in a significant difference be- tween the two groups(P<0.001).The 5-year disease-free survival rate for the groups with a tumor≤4 cm without and with preoperative radiotherapy, and with a tumor>4 cm without and with preoperative radiation therapy were 80.5%,85.2%,69.3%and 77.1%,respectively.There was no significant dif- ference between any of the groups(P>0.05).A univariate analysis showed that pelvic node metastasis,a positive parametrial surgical margin and post- operative adjuvant therapy were al significantly correlated with the 5-year disease-free survivals(P<0.05).Multivariate analysis revealed that pelvic node metastasis(P=0.004)and a positive parametrial surgical margin(P= 0.040)were independent factors that influenced the prognosis.The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 57.4%and 44.7%respectively in the high-risk group(patients with pelvic lymphatic metastasis and/or positive parametrial surgical margin)(P=0.575) and the recurrence ratio was 7/18 and 6/14 for the cases of the two tumor sizes in the same risk group.There was no significant difference between the two groups(P=0.821).The 5-year disease-free survivals for the cases with a tumor≤4 cm and>4 cm were 86.5%and 82.9%respectively in the low-risk group(patients without pelvic lymph-node metastasis and/or positive para- metrial surgical margin),respectively(P>0.05)and the recurrence ratio was 9/95 and 7/47 for the cases of the two tumor sizes in the same risk group. There was no significant difference between the two groups(P>0.05). CONCLUSIONS For FIGO Stage-IB cervical squamous cel carcinoma patients with radical surgery as the major means of treatment,the features of pelvic lymph-node metastasis and a positive parametrial surgical margin are independent factors that influence the prognosis.The tumor size can not be used as a criterion for predicting the prognosis.     

Diagnosis and Therapy of Primary Hepatic Neuroendocrine Carcinoma: Clinical Analysis of 10 Cases

Background: Primary hepatic neuroendocrine carcinoma (PHNEC) is rarer than extrahepatic gastrointestinalneuroendocrine carcinoma (NEC). It is difficult to make a correct diagnosis and poses a challenge for management.Materials and Methods: Ten PHNEC patients were admitted to our hospital from June 2006 to June 2011.Laboratory tests and imaging scans were performed for diagnosis and exclusion of extrahepatic NEC. All patientswere AFP - and CA199- . Seven patients had solid tumors with cystic changes on ultrasonography, CT and/orMRI. For the initial treatment, four patients received combined-therapy and six monotherapy. Consideringoverall treatment, six patients received combined-therapy and four patients monotherapy. Staging criteria ofprimary hepatocellular carcinoma (PHC, AJCC 7th edition) were used to differentiate the stage of all patients:3 patients were stage Ⅰ, 2 stageⅡ, 4 patients stageⅢ and 1 stageⅣ. All patients were followed up and clinicaldata were gathered. Results: The median follow-up duration was 38.5 months. The 1-year, 2-year, 3-year and6-year disease-free survival was 80.0%, 46.2% and 46.2% and 0% respectively. The overall survival rates were100%, 67.1%, 67.1% and 33.6% respectively. Patients in early-stages (Ⅰ/Ⅱ) had similar disease-free and overallsurvival as those in advanced-stages (Ⅲ/Ⅳ). Patients with monotherapy had significant shorter disease-freeand overall survival than the patients with combination-therapy. Conclusions: PHNEC has a unique specificityduring its occurrence and development. The staging criteria of PHC might not be suitable for the PHENT. Moreconvenient and effective features need to be found in imaging and laboratory detection. Surgical resection, TACE,chemotherapy and radiofrequency ablation should be performed in combination and actively for patients withPHNEC or recurrence to get the best effectiveness; they might extend the disease-free and overall survival.     

Surgical outcome of stage III and IV adrenocortical carcinoma

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare tumor usually diagnosed at an advanced stage on invasion of or adherence to adjacent organs. We report surgical outcome of stage III and IV ACCs. METHODS: ACCs from seven patients at clinical stage II (n = 1), III (n = 4), or IV (n = 2) were resected. Combined resection of the liver and inferior vena cava was performed in six patients. Morbidity, mortality, recurrence and survival were analyzed. RESULTS: The pathological stage was stage III in five patients and stage IV in two patients. The mortality was zero and the morbidity was two of seven (29%) patients. The estimated 3-year disease-free and overall survivals for stage III were 20% and 40%, respectively, with a median follow-up of 32 months (range, 11-58). The mean disease-free survival was 21.0 +/- 9.0 months (95% CI: 3.3-38.7). The 3-year disease-free and overall survivals for stage III and IV were 14.3% and 28.6%, respectively. The mean disease-free survival time was 18.6 +/- 6.7 months (95% CI: 5.4-31.8). The most frequent site of metastasis was the lungs, seen in four patients, and liver in three patients. Loco-regional, intra-abdominal lymph node, peritoneum, bone, brain recurrences were also seen in one patient each. The mean survival after recurrence was 19.0 +/- 3.3 months (95% CI: 12.6-25.5), and the 50% survival was 18.4 months with mitotan and cytotoxic drug therapy. CONCLUSIONS: Resection for stage III, IV ACCs affords the possibility of negative margins, acceptable peri-operative morbidity and mortality, and prolongs survival in selected patients.     

The impact of pathologic close margin on the survival of patients with early stage oral squamous cell carcinoma

Pathologic positive margin (PPM) has been proved to be an adverse prognostic factor for patients with oral squamous cell carcinoma (OSCC). Pathologic close margin (PCM) may occur as a result of limited resection. However, it's impact on the survival of early stage OSCC patients is relatively unclear. The medical records of all patients with early stage OSCC between 1999 and 2006 were reviewed. We analyzed 407 early stage OSCC patients, including 362 patients with pathologic safe margin (PSM), 14 patients with PPM and 31 patients with PCM. All patients with PCM didn't receive adjuvant radiotherapy, while 11 patients with PPM received adjuvant radiotherapy. The 5-year disease-free survival rates of patients with PSM, PPM and PCM were 78.2%, 61.4% and 50.8%, respectively (p=.002). The 5-year overall survival rates of patients with PSM, PPM and PCM were 91.2%, 85.1% and 70.1%, respectively (p=.001). On multivariate analyses using the Cox logistic regression method, PCM was the independent adverse prognostic factor for disease-free survival and overall survival (p=.002 and .006, respectively). Pathologic close margin is a poor prognostic factor for disease-free and overall survivals of patients with early stage OSCC. Postoperative adjuvant radiotherapy or revised surgery with a wider margin might be necessary for early stage OSCC patients with PCM.     

Adjuvant postoperative radiation therapy for rectal adenocarcinoma.

From October 1975 to August 1988, 261 patients at high risk for local recurrence after curative resection of rectal carcinoma underwent high-dose postoperative irradiation. Patients received 45 Gy by a 4-field box usually followed by a boost to 50.4 Gy or higher when small bowel could be excluded from the reduced field. Since January 1986, patients also received 5-fluorouracil (5-FU) for 3 consecutive days during the first and last week of radiotherapy. Five-year actuarial local control and disease-free survival decreased with increasing stage of disease; patients with Stage B2 and B3 disease had local control rates of 83% and 87% and disease-free survivals of 55% and 74%, respectively. In patients with Stage C1 through C3 tumors, local control rates ranged from 76% to 23%, and disease-free survivals ranged from 62% to 10%, respectively. For patients with Stage C disease, disease-free survival decreased progressively with increasing lymph node involvement, but local control was independent of the extent of lymph node involvement. For each stage of disease, local control and disease-free survival did not correlate with the dose of pelvic irradiation. Preliminary data from this study suggest a trend toward improved local control for patients with Stage B2, C1, and C2 tumors who receive 5-FU for 3 consecutive days during the first and last weeks of irradiation compared with patients who do not receive 5-FU. Current prospective randomized studies are addressing questions regarding the optimum administration of chemotherapy with pelvic irradiation for patients following resection of rectal carcinoma.     

Analysis of prognostic variables among patients with locally advanced head and neck cancer treated with late chemo-intensification protocol: impact of nodal density and total tumor volume

OBJECTIVE: The aim of the present study was to define the prognostic impact of nodal density (ND) and total tumor volume along with many other tumor, treatment and patient related variables using the late chemo-intensification treatment regimen with conventionally fractionated radiotherapy (70 Gy/7 weeks). METHODS: A total of 74 patients with Stage III and IV biopsy proven squamous cell carcinoma of oropharynx, hypopharynx and larynx were treated with this regimen. ND and total tumor volume was measured on high resolution CT scans for all the patients. Chemotherapy consisted of continuous infusion of 5 FU at 350 mg/m(2)/day and cisplatin as 1 h infusion at 10 mg/m(2)/day on days 1-5 of week 6 and 7 of radiotherapy. RESULTS: Grade III mucositis was present in 48 (64.9%) patients. Overall complete response rate was 77%. At 28 months, locoregional relapse-free survival (LRFS), overall survival (OS) and distant metastases-free survival (DMFS) was 70.8%, 66.9% and 81.9%, respectively. In the final multivariate Cox-regression model tumor stage, ND, primary site and nodal stage were independent variables predicting for LRFS. Similarly AJCC group staging, ND and total treatment volume were found to have significant impact, independently over LRFS. CONCLUSIONS: There is tremendous variation in terms of ND and total tumor volume within AJCC nodal staging and tumor staging, respectively. ND had significant impact over LRFS and OS. Future phase III trial may need stratification on the basis of these variables.     

Irradiation with or without misonidazole for patients with stages IIIB and IVA carcinoma of the cervix: final results of RTOG 80-05. Radiation Therapy Oncology Group.

PURPOSE: The purpose of this study was to evaluate tumor response, progression-free survival, local tumor control, patterns of relapse, and toxicity in patients with Stages IIIb and IVa squamous cell carcinoma of the uterine cervix treated with irradiation or irradiation and misonidazole. This is a report of the final results of the study. METHODS: This study was a prospective randomized Phase III trial performed by the Radiation Therapy Oncology Group (RTOG). Between August 1980 and November 1984, 120 patients with Stages IIIb and IVa squamous cell carcinoma of the cervix were randomized to receive either standard irradiation or standard irradiation and misonidazole. Irradiation consisted of 46 Gy to the pelvis plus a 10 Gy parametrial boost followed by intracavitary brachytherapy or external irradiation boost to the primary tumor. Misonidazole was administered at 400 mg/m2 daily, 2-4 h before irradiation. Patients in the 2 treatment groups were evenly distributed by stage, Karnofsky Performance Status, and positive para-aortic lymph nodes. RESULTS: Sixty-one patients were treated with irradiation alone, and 59 patients received irradiation and misonidazole. Complete response in the pelvis occurred in 44 (75%) of those treated with irradiation and in 38 (64%) of those treated with irradiation and misonidazole. The progression-free survivals were 22% at 5 years for the control group, and 29% at 5 years for the misonidazole group. At the time of last follow-up, 18 patients in the control arm were free of disease, and in the experimental arm, 19 were free of disease. The patterns of failure for those treated with irradiation alone were local-only in 9 patients, distant-only in 8 patients, and local and distant in 11 patients. The patterns of failure for those receiving irradiation and misonidazole were local-only in 3 patients, distant-only in 8 patients, and local and distant in 8 patients. The maximum toxicity experienced per patient was grade 3 in 18%, grade 4 in 8%, and no grade 5 toxicity for those treated with irradiation alone compared to 8%, 2%, and 2%, respectively, for the experimental arm. CONCLUSION: There were no statistically significant differences in pelvic response, disease-free survivals, patterns of failure, or toxicity for the irradiation alone group or for the irradiation and misonidazole group as administered in this study for patients with Stages IIIb and IVa squamous cell carcinoma of the uterine cervix.     

Good tumor control and survivals of squamous cell carcinoma of buccal mucosa treated with radical surgery with or without neck dissection in Taiwan

The aim was to analyze the survival and prognostic factors in 232 patients with squamous cell carcinoma of the buccal mucosa (BSCC) treated with radical surgery with or without neck dissection (ND). The 5-year survivals for local, locoregional control, overall, disease-free, and disease-specific were demonstrated. Pathologic nodal status was the independent risk factor for local and locoregional control. Both pathologic nodal status and cell differentiation were the significant prognostic factors of disease-free survival. For cT1N0, 11.1% had neck metastases. All were tumor depth of > or =6 mm. Our result showed a relatively better tumor control and survivals in BSCC with radical surgery with or without ND. The possible reason may be due to the benefit from widely surgical resection with ND and post-operative radiotherapy or concurrent chemoradiotherapy in those with risk factors. In treating early cT1N0, we suggest that elective ND is indicated only when tumor depth > or =6 mm.     

Survival in squamous cell carcinoma of the oral cavity: differences between pT4 N0 and other stage IVA categories

BACKGROUND: According to the American Joint Commission on Cancer (AJCC, 5(th) edition) classification system, pT4 N0 oral cavity squamous cell carcinoma (OSCC) qualifies for stage IVA status, with its implied poor prognosis. However, preliminary observations suggested that patients with pT4 N0 OSCC might have better survival than other stage IVA categories. The authors sought to identify accurate prognosticators in patients with stage III/IVA OSCC. METHODS: The authors retrospectively reviewed 513 consecutive patients with stage III/IVA OSCC who were undergoing radical surgery. Survival was plotted by Kaplan-Meier analysis. RESULTS: One hundred seventy-eight patients were in stage III, and 335 were in stage IVA. The 335 stage IVA patients were divided into pT4 N0 (n = 105) and pT4 N1/TAny N2 (NO pT4 N0 M0, n = 230). By univariate analysis, 5-year neck control rates (P < .0001), distant metastases (P < .0001), disease-free survival rates (P < .0001), and overall survival rates (P < .0001) were significantly different in pT4 N0 compared with NO pT4 N0 patients. No significant difference in survival between pT4 N0 stage IVA and pstage III could be shown. Multivariate analysis for overall survival demonstrated that the following factors were independently associated with pT4 N0: tumor depth >or=35 mm, vessel invasion, lymph invasion, and perineural invasion. In contrast, tumor depth >or=25 mm, treatment with surgery alone, poor differentiation, extracapsular spread, and pathological nodal metastases (>or=8 lymph nodes) were independent predictors of overall survival in NO pT4 N0. CONCLUSIONS: In patients with stage IVA OSCC (AJCC, 1997), the survival rates for pT4 N0 are better than those for NO pT4 N0 and similar to those of patients with pstage III.     

Prognostic factors in localized invasive cutaneous melanoma: high value of mitotic rate, vascular invasion and microscopic satellitosis

The aim of this study was to determine independent clinical and pathological prognostic factors for overall and disease-free survival in Spanish melanoma patients. Eight hundred and twenty-three patients with localized melanoma and complete clinical and pathological information were evaluated. The age at diagnosis, gender, location, tumour thickness, invasion level, ulceration, histological subtype, inflammatory infiltrate, mitotic rate, vascular invasion, microscopic satellitosis, regression and cell type were all included. Univariate and multivariate Cox regression analyses were performed for overall and disease-free survival. Gender, histological subtype, tumour thickness, invasion level, ulceration, inflammatory infiltrate, microscopic satellitosis, vascular invasion and mitotic rate were related to overall and disease-free survival in univariate analysis. Age and location were only related to disease-free survival. Only tumour thickness, vascular invasion and gender exhibited independent significance for overall survival in multivariate analysis. For disease-free survival, tumour thickness, location, mitotic rate, vascular invasion and microscopic satellitosis were the sole independent factors. It can be concluded that the Breslow thickness remains the most significant prognostic factor for the survival of patients with localized cutaneous melanoma. Our results support the inclusion of microscopic satellitosis and vascular invasion in the current American Joint Committee on Cancer (AJCC) staging system, although further studies evaluating their separate influence are needed. Mitotic rate is confirmed as an objective and independent predictor of disease-free survival for melanoma patients that should be considered in further revisions of the mentioned staging system.     

Survivin expression in laryngeal squamous cell carcinomas and its prognostic implications

We examined the expression of survivin using immunohistochemistry in 102 cases of laryngeal squamous cell carcinoma (LSCC). Overall, 65.7% (67 out of 102) of tumors were positive for survivin expression and significantly associated with tumor site, poor differentiation, tumor size, lymph node metastasis and advanced stage. Kaplan-Meier analysis showed that survivin expression was significantly associated with shorter disease-free and overall survival respectively. When survivin expression and clinical stage were combined, patients with both survivin-positive and advanced stage (III, IV) revealed poorer disease-free and overall survival when compared with the other cases (p = 0.0002 and p = 0.0002, respectively). Additionally, in early stage (I, II) cases, survivin expression also showed a significant prognostic trend for disease-free and overall survival (p = 0.0727 and p = 0.0701, respectively). By the multivariate analysis, tumor size, lymph node metastasis and survivin expression were independent prognostic factors both in disease-free and overall survival. These findings indicate that survivin expression is associated with unfavorable clinicopathological parameters and represents an independent marker for prognosis of LSCC.     

48例复发性肝细胞癌再次切除术后的疗效及预后因素分析

目的:分析复发性肝细胞癌行再次切除术后的疗效和影响预后的因素。方法:回顾性分析中山大学附属肿瘤医院和江西省人民医院1995年7 月至2003年7 月48例复发性肝细胞癌患者行再次肝切除术的临床病理资料,包括患者性别、年龄、原发肿瘤和复发肿瘤的病理学特征、再次肝切除术前全身状况、复发的出现时间及生存期等,根据随访结果计算总生存率和无瘤生存率,并作单因素及多因素分析。结果:48例患者再次切除术后中位生存时间36.3 个月,1、3、5 年累积生存率分别为81.3% 、45.8% 、27.1% ,1、3、5 年无瘤生存率分别为70.8% 、25.0% 、16.7% 。单因素分析结果显示:原发肿瘤TNM分期、原发肿瘤伴血管侵犯、复发间隔时间、复发肿瘤大小、复发肿瘤TNM分期、复发肿瘤伴血管侵犯影响再切除术后累积生存率;复发间隔时间、原发肿瘤TNM分期、复发肿瘤大小、复发肿瘤有无血管侵犯、复发肿瘤病理分级和AFP 水平影响再切除术后无瘤生存率。多因素分析显示:复发间隔时间、复发肿瘤TNM分期是影响复发性肝癌再切除术后累积生存的独立危险因素;复发间隔时间、复发肿瘤大小是影响其无瘤生存的独立危险因素。结论:肝内复发间隔时间短（≤24个月）、复发肿瘤直径>5cm、复发肿瘤TNM分期越晚,提示再次切除术后预后不良。      

WT1 expression as an independent marker of poor prognosis in colorectal cancers

WT1 has been proven to be a prognostic marker and molecular target in various human cancers. In this study, we aimed to investigate the prognostic role of WT1 in colorectal cancers (CRCs). Archival tissue samples from 157 CRC cases who underwent curative surgery in our institute from February 1999 to May 2004 were subjected to WT1 expression studies using an immunohistochemistry technique. Number of positive staining per 500 tumor cells and staining intensities were analyzed against overall survival. Of 157 CRCs, 83 were colonic and 74 were rectal cancers. The mean follow-up period was 116 (range 77-145) months. Five-year and seven-year OS rates were 60.9% and 52.8%, respectively. WT1 immunostaining was positive in 143 cases (91%). The median number of positive cells was 120 (range 0-420). Univariate analysis by Log-rank test showed that AJCC stage, tumor site (rectal cancer), number of positive cells > 120 and high staining intensity (score ++/+++) were significantly associated with poorer survival (p-value < 0.01). Five-year survival rates in cases with positive cells of ? 120 cells and > 120 cells were 72.2% and 49.4%, respectively. Five-year survival in cases with staining intensity of ++ or more was 45.3%, compared with 69% in cases with intensity of less than ++. Multivariate regression analysis demonstrated that the staining intensity, high tumor stage and rectal site were independent factors indicating poorer survival. Our findings indicate that WT1 expression is a marker of poor prognosis in CRCs, independent of AJCC staging.     

Neoadjuvant chemotherapy and radiation therapy compared with radiation therapy alone in advanced nasopharyngeal carcinoma

PURPOSE: To analyze the impact of neoadjuvant chemotherapy on the treatment of locoregionally advanced nasopharyngeal carcinoma and to assess the outcomes of patients receiving such treatment. METHODS AND MATERIALS: We analyzed 137 previously untreated and histologically confirmed advanced stage nasopharyngeal carcinoma patients treated with either radiation therapy only or combined radiation therapy and chemotherapy at the Seoul National University Hospital between 1984 and 1996. The stage distribution was as follows: AJCC Stage III-21, Stage IV-61 in the radiation therapy group (RT group); AJCC Stage III-1, Stage IV-54 in neoadjuvant chemotherapy and radiation therapy group (CT/RT group). The median follow-up for surviving patients was 48 months. RESULTS: The 5-year overall survival (OS) rates were 71% for the CT/RT group and 59% for the RT group (p = 0.04). The 5-year actuarial disease-free survival (DFS) rates were 63% for the CT/RT group and 52% for the RT group (p = 0.04). Distant metastasis (DM) incidence was significantly lower in the CT/RT group. The 5-year freedom from distant metastasis rates were 84% for the CT/RT group and 66% for the RT group (p = 0.01). The incidence of locoregional failures was also lower in the CT/RT group, although this difference did not reach statistical significance (69% vs. 56%, p = 0.09) CONCLUSION: While not providing conclusive evidence, historical evidence from this institution suggests that neoadjuvant chemotherapy significantly improves both overall and the disease-free survival of patients with advanced stage nasopharyngeal carcinoma.     

Squamous cell carcinoma of the superior gingival-buccal complex

Squamous cell carcinoma of the superior gingival-buccal complex are rare and few English-language data have been published on their biological behaviour. Reported in this paper are the clinical behaviour and treatment outcomes of squamous cell carcinoma of the upper gingival-buccal complex. We reviewed the charts of 110 patients with squamous cell carcinoma restricted to the upper gingiva, superior gingival-buccal sulcus and adjoining buccal mucosa, seen between 1997 and 2001. Separate outcome analyses were carried out among 86 patients who had undergone surgery, and 24 patients treated by radiotherapy or chemo-radiation. Disease-free survival at 2 and 5 years was 48.9% and 36%, respectively, and was independent of epicentre of disease. Five-year, disease-free survival was 48.8% and 0% for surgical treatment and non-surgical treatment groups. T stage (p=0.024) and extra-capsular spread of disease (p=0.036) were independent predictors of disease-free survival on multivariate analysis. Adequate surgical resection and adjuvant treatment, in the first instance, offers the best chance of disease control.     

Expression profiling defines a recurrence signature in lung squamous cell carcinoma

Lung cancer remains the leading cause of cancer death worldwide. Overall 5-year survival is approximately 10-15% and despite curative intent surgery, treatment failure is primarily due to recurrent disease. Conventional prognostic markers are unable to determine which patients with completely resected disease within each stage group are likely to relapse. To identify a gene signature associated with recurrent squamous cell carcinoma (SCC) of lung, we analyzed primary tumor gene expression for a total of 51 SCCs (Stages I-III) on 22 323 element microarrays, comparing expression profiles for individuals who remained disease-free for a minimum of 36 months with those from individuals whose disease recurred within 18 months of complete resection. Cox proportional hazards modeling with leave-one-out cross-validation identified a 71-gene signature capable of predicting the likelihood of tumor recurrence and a 79-gene signature predictive for cancer-related death. These two signatures were pooled to generate a 111-gene signature which achieved an overall predictive accuracy for disease recurrence of 72% (77% sensitivity, 67% specificity) in an independent set of 58 (Stages I-III SCCs). This signature also predicted differences in survival [log-rank P=0.0008; hazard ratio (HR), 3.8; 95% confidence interval (CI), 1.6-8.7], and was superior to conventional prognostic markers such as TNM stage or N stage in predicting patient outcome. Genome-wide profiling has revealed a distinct gene-expression profile for recurrent lung SCC which may be clinically useful as a prognostic tool.     

Postoperative adjuvant chemotherapy in non-small cell lung cancer: prognostic value of DNA ploidy and post-recurrent survival.

Eighty-six patients with non-small cell lung cancer who underwent curative operations were postoperatively randomized to control and adjuvant chemotherapy groups. In the adjuvant chemotherapy group, patients received cisplatin-based combination chemotherapy 3 or 4 weeks after operation and the average cycle of chemotherapy was 2.3 (from 1 to 6 cycles). In this trial, no evidence of improved survival or delayed recurrence was seen in the treated patients. In multivariate analysis of prognostic variables, the most important factor was the pathological stage of the disease and, second, DNA ploidy of the primary tumor. Although histology (squamous vs. non-squamous cell carcinoma) had a trend to influence the survival, it was not a significant factor. A total of 33 patients had recurrences: 17 and 16 patients were in control and adjuvant chemotherapy groups, respectively. Postrecurrent survival in the adjuvant chemotherapy group was significantly shorter than that in the control group, as determined by the generalized Wilcoxon and log rank tests. Median survival time after recurrence in the control and adjuvant therapy groups was 18.5 and 7.5 months, respectively. These results suggest that DNA ploidy of primary tumors should be considered as a prognostic factor in future trials of adjuvant therapy. Furthermore, analysis of postrecurrent survival in the adjuvant chemotherapy trial, as well as that of overall and disease-free survivals should be done.