Contribution of plasminogen activators and their inhibitors to the survival prognosis of patients with Dukes' stage B and C colorectal cancer.

Despite the advances in pre-, peri- and post-operative medical care of colorectal carcinoma patients, the prognosis has improved only marginally over recent decades. Thus, additional prognostic indicators would be of great clinical value to select patients for adjuvant therapy. In previous studies we found that colorectal carcinomas have a marked increase of the urokinase-type of plasminogen activator (u-PA), and the inhibitors PAI-1 and PAI-2, whereas the tissue-type plasminogen activator (t-PA) is found to be decreased in comparison with adjacent normal mucosa. In the present study we evaluated the prognostic value of several plasminogen activation parameters, determined in both normal and carcinomatous tissue from colorectal resection specimens, for overall survival of 136 Dukes' stage B and C colorectal cancer patients, in relation to major clinicopathological parameters. Uni- and multivariate analyses indicated that a high PAI-2 antigen level in carcinoma, a low t-PA activity and antigen level and a high u-PA/t-PA antigen ratio in adjacent normal mucosa are significantly associated with a poor overall survival. A high ratio of u-PA antigen in the carcinomas and t-PA antigen in normal mucosa, i.e. u-PA(C)/t-PA(N), was found to be predictive of a poor overall survival as well. All these parameters were found to be prognostically independent of the clinicopathological parameters. Multivariate analysis of combinations of these prognostically significant plasminogen activation parameters revealed that they are important independent prognostic indicators and have in fact a better prognostic value than their separate components. Based on these combined parameters, subgroups of patients with Dukes' stage B and C colorectal cancer could be identified as having either a high or a low risk regarding overall survival. In conclusion, these findings emphasize the relevance of the intestinal plasminogen activation system for survival prognosis of patients with colorectal cancer and, in the future, might constitute a patient selection criterion for adjuvant therapy

Quality of life after breast cancer surgery

All patients (N = 41) who participated in a randomized clinical trial in the Leiden University Hospital comparing mastectomy to tumorectomy have been studied with respect to their quality of life 11 months (+/- 5) after surgery. The body image of patients is more severely impaired after mastectomy than after tumorectomy (P less than .01). The studied groups did not differ, as has been suggested, with respect to fear of recurrence and death. These fears, however, turned out to be inversely related to the age of the patients (r = -.34, P = .02

Significance of tumor invasion and lymph node involvement on the prognosis and selection for surgery of adenocarcinoma of the cardia

Between 1970 and 1983, 66 patients with adenocarcinoma of the cardia underwent resection in our institute. Hospital mortality within 30 days of surgery was 18.2%. Overall hospital mortality irrespective of time was 27.3%. The 4-year survival rate for all patients excluding overall hospital mortality was 29%. There was a significant difference in cumulative survival between T2 (n = 29) and T3 tumours (n = 15) (P = 0.035). Comparison in this 44-patient group of cumulative survival of patients with negative nodes (N0, n = 13) and positive nodes (N+, n = 31) was also significant (P = 0.01). The application of tumor invasion and lymph node involvement as peri-operative parameters for the selection of patients for resection was evaluated in a retrospective study. Forty-four patients were found eligible to be rearranged in a system using the following clinicopathological parameters: T = 3 versus T = 2 and N+ (positive nodes in N1 and/or N2 groups) versus N0. This system revealed no distinct group of patients who should be withheld from resection according to the criteria held in our institute. Resection provided excellent relief of dysphagia in most patients. The various findings are discussed, and further prospective studies will be needed. At present, in the absence of haematogenous metastases, we prefer surgical resection for all patients whose general condition allows major surger

Ten-year results of a randomized trial evaluating prolonged low-dose adjuvant chemotherapy in node-positive breast cancer : a joint European Organization for Research and Treatment of Cancer-Dutch Breast Cancer Working Party study

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The effect of radical and conserving surgery on the quality of life of early breast cancer patients

In a randomized trial at the Leiden University Hospital, comparing (modified) radical mastectomy with tumorectomy followed by radiotherapy, all patients have been studied with respect to the quality of their lives 11 months and 18 months after surgery. The body image of women was more severely impaired after mastectomy than it was after breast conserving treatment (P less than 0.01). This was true for both younger and older women. Fear of recurrence of cancer was not related to the type of treatment. Thus, from a psychological point of view, breast conserving treatment is to be preferred in women of all ages. The overall quality of life improved and the suffering from psychological and physical complaints decreased with time in both groups of patients. This change may, therefore, have to be attributed to getting over the experience of having had cancer, and not to the treatment schedul

Stromaceltumor van de maag.

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