Up to 50% of cancer patients suffer from a progressive atrophy of adipose tissue and skeletal muscle, called cachexia, resulting in weight loss, a reduced quality of life, and a shortened survival ...

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Mechanisms of Cancer Cachexia

The Armed Forces Institute of Pathology.

Purpose To provide evidence-based recommendations to practicing oncologists, surgeons, and radiation therapy clinicians to update the 2005 clinical practice guideline on the use of sentinel node biopsy (SNB) for patients with early-stage breast cancer. Methods The American Society of Clinical Oncology convened an Update Committee of experts in medical oncology, pathology, radiation oncology, surgical oncology, guideline implementation, and advocacy. A systematic review of the literature was conducted from February 2004 to January 2013 in Medline. Guideline recommendations were based on the review of the evidence by Update Committee. Results This guideline update reflects changes in practice since the 2005 guideline. Nine randomized clinical trials (RCTs) met systematic review criteria for clinical questions 1 and 2; 13 cohort studies informed clinical question 3. Recommendations Women without sentinel lymph node (SLN) metastases should not receive axillary lymph node dissection (ALND). Women with one to t...

/pdf/sentinel-lymph-node-biopsy-for-patients-with-early-stage-2w5kzoi3tr.pdf

Sentinel Lymph Node Biopsy for Patients With Early-Stage Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Diabetes mellitus has been associated with an increased risk of several types of cancers, but its relationship with breast cancer remains unclear. We conducted a meta-analysis of case-control and cohort studies to assess the evidence regarding the association between diabetes and risk of breast cancer. Studies were identified by searching MEDLINE (1966-February 2007) and the references of retrieved articles. We identified 20 studies (5 case-control and 15 cohort studies) that reported relative risk (RR) estimates (odds ratio, rate ratio/hazard ratio, or standardized incidence ratio) with 95% confidence intervals (CIs) for the relation between diabetes (largely Type II diabetes) and breast cancer incidence. Summary RRs were calculated using a random-effects model. Analysis of all 20 studies showed that women with (versus without) diabetes had a statistically significant 20% increased risk of breast cancer (RR, 1.20; 95% CI, 1.12-1.28). The summary estimates were similar for case-control studies (RR, 1.18; 95% CI, 1.05-1.32) and cohort studies (RR, 1.20; 95% CI, 1.11-1.30). Meta-analysis of 5 cohort studies on diabetes and mortality from breast cancer yielded a summary RR of 1.24 (95% CI, 0.95-1.62) for women with (versus without) diabetes. Findings from this meta-analysis indicate that diabetes is associated with an increased risk of breast cancer.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.22717

Diabetes mellitus and risk of breast cancer: a meta-analysis.

https://www.gynecologiconcology-online.net/article/S0090-8258(09)00722-7/pdf

Uterine sarcomas: A review

BACKGROUND

The hormone ghrelin and the adipocytokines leptin and adiponectin participate in body weight regulation. In response to weight loss, ghrelin and adiponectin levels increase and leptin decreases. Cancer cachexia is a complex metabolic state, characterized by loss of muscle mass and adipose tissue together with anorexia. The authors hypothesized that responses of these hormones may be attenuated in cancer cachexia.



METHODS

Fasting plasma ghrelin, adiponectin, and leptin levels, as well as weight loss, were determined in 40 cancer patients: 18 of them suffered from cancer-induced cachexia, and 22 served as a comparison group. Hormone levels were measured before administration of cancer therapy.



RESULTS

A similar distribution of age, gender, and diagnosis was observed in both study groups, but the cachectic patients had higher rates of metastatic disease and lower albumin levels. No significant correlation was observed between plasma adiponectin levels and weight loss. Mean plasma ghrelin levels were higher among cachectic compared with noncachectic patients. Notably, the association between ghrelin levels and weight loss was only modest, and in a third of the cachectic patients, ghrelin levels were equal to or lower than those in the noncachectic group. Plasma leptin levels showed gender-dependent associations, and significantly lower levels were found among cachectic women but not among cachectic men.



CONCLUSIONS

Results suggested a gender-dependent attenuation of expected physiologic responses to weight loss among cancer cachexia patients. Thus, impaired response of adiponectin, ghrelin, and leptin may play a role in the pathogenesis of cancer cachexia syndrome. Cancer 2006. © 2006 American Cancer Society.

Adiponectin, ghrelin, and leptin in cancer cachexia in breast and colon cancer patients

Background: Uterine leiomyosarcoma (LMS) has a poor prognosis even after early-stage diagnosis. Because there are no accurate diagnostic tools for preoperatively distinguishing LMS from uterine leiomyoma, surgeons might opt for partial surgical procedures such as myomectomy or subtotal hysterectomy. We sought to determine whether a surgical procedure that cuts through the tumor influences prognosis. Materials and Methods: Demographic and clinical data of consecutive patients with stage I LMS treated between 1969 and 2005 were reviewed. The study population was divided into group A: patients whose first surgical intervention was total hysterectomy (n = 21); and group B: patients who underwent procedures involving tumor injury, for example, myomectomy, laparoscopic hysterectomy with a morcellator knife, or hysteroscopic myomectomy (n = 16). Survival rates were analyzed and compared. A Cox proportional hazards model was used to assess the association between variables of interest and prognosis. Results: The median age at diagnosis was 50 years (range, 30-74 years). Median follow-up duration was 44 months. The 2 groups did not differ significantly in age at diagnosis, menopausal status, gravidity, parity, postoperative radiotherapy, or time to last follow-up. Kaplan-Meier curves showed significantly better survival rates (P = 0.04) and a significant advantage in recurrence rate (P = 0.03) for group A compared with group B. Survival in group A was 2.8-fold better than that in group B (95% confidence interval, 1.02-7.67). These estimates remained stable after adjustment for age, menopausal status, and radiotherapy. Conclusions: In patients with stage I LMS, primary surgery involving tumor injury seems to be associated with a worse prognosis than total hysterectomy as a primary intervention.

https://ijgc.bmj.com/content/ijgc/19/2/257.full.pdf

Uterine leiomyosarcoma: does the primary surgical procedure matter?

BACKGROUND
Because existing data regarding the relation between smoking and salivary gland tumors are sparse, tobacco is currently not classified as a salivary gland carcinogen. The objective of the current study was to assess the association between smoking and benign and malignant parotid gland tumors (PGTs) in a nationwide study.

METHODS
The sample included 459 patients with incident PGT, aged ≥18 years, who were diagnosed between 2001 and 2003 and a group of 1265 individually matched, population-based controls. Analyses of the risk of PGT associated with various smoking variables were performed by using conditional logistic regression. Data also were stratified by histologic type; statistical significance tests were 2-sided.

RESULTS
Ever smoking cigarettes was associated with an odds ratio (OR) of 1.66 (95% confidence interval [95% CI], 1.31–2.11) for developing a PGT. The risk was strongest for early ages at smoking initiation, and trends of increasing risk were observed with increasing smoking intensity, pack-years, latent period, and smoking duration (P for trend <.001 for each). Analysis by histologic type indicated remarkably high risks for Warthin tumor (OR for ever cigarette smokers: 15.3; 95% CI, 6.1–38.5). For pleomorphic adenomas and malignant tumors, the risks associated with ever smoking were 1.01 (95% CI, 0.75–1.37) and 1.69 (95% CI, 0.81–3.51), respectively.

CONCLUSIONS
Smoking plays an important role in the development of Warthin tumor. Although no association was observed for pleomorphic adenoma, the possible indication of increased risk of malignant tumors requires further investigation in larger studies. Cancer 2008. © 2008 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/cncr.23393

Smoking and risk of parotid gland tumors: a nationwide case-control study.

Objective
To address optimal timing of sentinel lymph node biopsy (SLNB) in breast cancer patients undergoing neoadjuvant treatment.

Methods
The study population included 117 patients with locally advanced cancer with clinically negative nodes treated with primary chemotherapy. Group 1 underwent SLNB and completion axillary lymph node dissection (ALND) in conjunction with lumpectomy/mastectomy, after neoadjuvant treatment (n = 31). Group 2 underwent SLNB followed by neoadjuvant therapy and subsequently surgery and completion of ALNDs (n = 58). Group 3 was treated using the same sequence as group 2, however, completion ALND was performed only for patients with positive sentinel lymph nodes (SLNs) (n = 28).

Results
SLN identification was lowest in group 1 compared to groups 2 and 3 (87% and 98.8% respectively; P = <0.05). The highest false negative rate was in group 1 (15.8% compared with 0% in group 2).

Conclusion
Neoadjuvant treatment lowers the SLN identification rate, possibly due to fibrosis within the axilla, and increases the false negative rate due to downstaging. SLN biopsy prior to chemotherapy could give a more accurate evaluation of axillary status, unaffected by any previous therapeutic intervention. J. Surg. Oncol. © 2008 Wiley-Liss, Inc.

Bernice Oberman

Papers

Adiponectin, ghrelin, and leptin in cancer cachexia in breast and colon cancer patients

Uterine leiomyosarcoma: does the primary surgical procedure matter?

Smoking and risk of parotid gland tumors: a nationwide case-control study.

Timing of sentinel lymph node biopsy in patients receiving neoadjuvant chemotherapy for breast cancer.

Association between diabetes mellitus and adverse characteristics of breast cancer at presentation