Prognosis After Surgical Resection of M1a/M1b Esophageal Squamous Cell Carcinoma

This study was undertaken to examine prognosis after resection for M1 disease in squamous cell esophageal carcinoma. Fifty-six patients with M1 esophageal cancer underwent esophageal resection with two or three-field nodal dissection from 1994 to 2001. Operative mortality occurred in 3 patients. Primary tumor sites were as follows; 10 upper, 23 middle, and 20 lower thoracic esophagus. They were found to have M1 disease by pathologic examination of dissected nodes, 24 M1a and 29 M1b. Forty-two patients (79%) were considered to have undergone curative resection. Chemotherapy and/or radiation therapy was given to 38 patients perioperatively. Recurrence was identified in 35 patients (66%) during a mean follow-up of 23 months. Overall median and 5-yr survivals were 19 months and 12.7%. Five-year survivals for M1a and M1b disease were 23.9% and 6.1%, respectively (p=0.0488). Curative resection tended to show better survival (p=0.3846). Chemotherapy and/or radiation therapy provided no advantage (p=0.5370). Multivariate analysis showed that M1b was significant risk factor over M1a disease. Our conclusion is that surgical resection can provide acceptable survival in thoracic squamous esophageal cancer with M1a disease. Survival differences between M1a and M1b disease support the current subclassification staging system

Collection of population-based cancer staging information in Western Australia – a feasibility study

BACKGROUND: Routine data from cancer registries often lack information on stage of cancer, limiting their use. This study aimed to determine whether or not it is feasible to add cancer staging data to the routine data collections of a population-based Western Australian Cancer Registry (WACR). METHODS: For each of the five most common cancer types (prostate, colorectal, melanoma, breast and lung cancers), 60 cases were selected for staging. For the 15 next most common cancer types, 20 cases were selected. Four sources for collecting staging data were used in the following order: the WACR, the hospital based cancer registries (HBCRs), hospital medical records, and letters to treating doctors. If the case was unable to be fully staged, due to lack of information on regional lymph node invasion or distant metastases, we made the following assumptions. Cases which had data available for tumour (T) and regional lymph nodes (N), but no assessment of distant metastasis (MX) were assumed to have no distant metastases (M0). Cases which had data for T and M, but no assessment of regional nodal involvement (NX) were assumed to have no regional nodal involvement (N0). RESULTS: The main focus of this project was the process of collecting staging data, and not the outcomes. For ovary, cervix and uterus cancers the existence of a HBCR increased the stageable proportion of cases so that staging data for these cancers could be incorporated into the WACR immediately. Breast and colorectal cancer could also be staged with adequate completeness if it were assumed that MX = M0. Similarly, melanoma and prostate cancer could be staged adequately if it were assumed that NX = N0 and MX = M0. Some cases of stomach, lung, pancreas, thyroid, testis and kidney cancers could be staged, but additional clinical input – on pathology request forms, for example – would be required to achieve useable levels of completeness. For the remaining cancer types either staging is widely regarded as not relevant, and no generally-accepted system exists, or an acceptable level of completeness is not achievable. CONCLUSION: Adding stage to routinely collected information in a cancer registry is possible for many cancer types, particularly if the assumptions regarding missing data are found to be acceptable or if the guidelines for MX = M0 asumptions are clarified. These findings should be generalizable to most cancer registries in developed countries, if hospital-based cancer registries or other specialized databases are accessible

Long-term results after liver transplantation for primary hepatic epithelioid hemangioendothelioma

Background: Hepatic epithelioid hemangioendothelioma (PHEHE) is a multifocal, low-grade malignant neoplasia characterized by its epithelial-like appearance and vascular endothelial histogenesis. The outcome of 16 patients treated with orthotopic liver transplantation (OLT) is the subject of this report. Methods: A retrospective study of 16 patients with HEHE (7 men, 9 women) with ages ranging from 24 to 58 years (mean 37 ± 10.6 years). Follow-up intervals ranged from 1 to 15 years (median of 4.5 years). Results: Actual patient survival at 1, 3, and 5 years was 100, 87.5, and 71.3%, respectively. Disease-free survival at 1, 3, and 5 years was 81.3, 68.8, and 60.2%, respectively. The 90-day operative mortality was 0. Involvement of the hilar lymph nodes or vascular invasion did not affect survival. The 5-year survival of HEHE compares favorably with that of hepatocellular carcinoma at the same stage (stage 4A): 71.3 versus 9.8% (p=0.001) Conclusions: The long-term survival obtained in this series justifies OLT for these tumors even in the presence of limited extrahepatic disease. © 1995 The Society of Surgical Oncology, Inc

Prognostic Value of Tumor Volume in Nasopharyngeal Carcinoma

Tumor bulk has been recognized as an important prognostic factor in the treatment of malignancy. The purpose of the present study is to investigate the prognostic value of tumor volume in nasopharyngeal carcinoma. Sixty patients with nasopharyngeal carcinoma were included in this study. Tumor contour was outlined on each of the computed tomography (CT) images using an image analyzer. The primary tumor volume (PTV) and nodal tumor volume (NTV) were calculated by a summation-of-areas technique, and the maximal perimeter of primary tumor (MPP) was measured. The loco-regional control rates and disease-specific survival rates were analyzed according to several variables. The patients had a 5-year local control rate of 75.5%, 5-year nodal control rate of 74.6%, and 5-year disease-specific survival rate of 60.2%. Large PTV (> 30 cm3) was associated with a significantly lower local control (p=0.005). Large NTV (> 5 cm3) was associated with a significantly lower nodal control (p=0.019) and lower disease-specific survival (p=0.046). Large MPP (> 18 cm) was associated with a significantly lower local control (p=0.017). In multivariate analysis, the PTV and NTV were found to be independent factors in predicting the local (p=0.015) and nodal (p=0.039) control, respectively. The NTV (p=0.012) and cranial nerve involvement (p=0.009) were factors that predicted disease-specific survival. Our results suggest that the estimation of tumor volume may identify a subgroup of patients with a greater risk of loco-regional failure and can be used to refine the current staging system

Effect of reproductive factors on stage, grade and hormone receptor status in early-onset breast cancer

INTRODUCTION: Women younger than 35 years who are diagnosed with breast cancer tend to have more advanced stage tumors and poorer prognoses than do older women. Pregnancy is associated with elevated exposure to estrogen, which may influence the progression of breast cancer in young women. The objective of the present study was to examine the relationship between reproductive events and tumor stage, grade, estrogen receptor and progesterone receptor status, and survival in women diagnosed with early-onset breast cancer. METHODS: In a population-based, case–case study of 254 women diagnosed with invasive breast cancer at age under 35 years, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression with tumor characteristics as dependent variables and adjusting for age and education. Survival analyses also examined the relationship between reproductive events and overall survival. RESULTS: Compared with nulliparous women, women with three or more childbirths were more likely to be diagnosed with nonlocalized tumors (OR = 3.1, 95% CI = 1.3–7.7), and early age (<20 years) at first full-term pregnancy was also associated with a diagnosis of breast cancer that was nonlocalized (OR = 3.0, 95% CI = 1.2–7.4) and of higher grade (OR = 3.2, 95% CI 1.0–9.9). The hazard ratio for death among women with two or more full-term pregnancies, as compared with those with one full-term pregnancy or none, was 2.1 (95% CI = 1.0–4.5), adjusting for stage. Among parous women, those who lactated were at decreased risk for both estrogen receptor and progesterone receptor negative tumors (OR = 0.2, 95% CI = 0.1–0.5, and OR = 0.4, 95% CI = 0.2–0.8, respectively). CONCLUSION: The results of the present study suggest that pregnancy and lactation may influence tumor presentation and survival in women with early-onset breast cancer

Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108704/1/cncr28801.pd

Cancerization of cutaneous flap reconstruction for oral squamous cell carcinoma: report of three cases studied with the mtDNA D-loop sequence analysis

International audienceAims: tissue defects, resulting from surgical resection of oral squamous cell carcinoma (OSCC), are routinely reconstructed with skin graft. OSCC arising from the grafted skin have been described, however, it is still unclear whether primary and second tumours have a common clonal origin. By screening mitochondrial DNA D-loop region (mtDNA), we evaluated the clonal relationship between the primary OSCC and the second neoplastic features appearing in the skin graft in three patients. Methods and Results: in all the three cases, the neoplastic lesions arising in the skin graft showed a clonal relationship with the previous OSCC and, on the basis of the results obtained with the mtDNA analysis, could be considered a recurrence of the primary OSCC rather than a second primary OSCC. Conclusions: Starting from a field of genetically altered cells of the oral mucosa, the spreading of the clonal cell population to the cutaneous flap might be stimulated by cytokines produced by the grafted skin. More studies are needed to evaluate the molecular relationship between primary and second OSCC to identify patients at higher risk of developing a second tumour of the skin graft