Showing papers on "Surgical oncology published in 2008"
TL;DR: In this paper, the authors explored the prevalence of cells with different CD44/CD24 phenotypes within breast cancer subtypes and demonstrated an association between basal-like and particularly BRCA1 hereditary breast cancer and the presence of CD44+/cd24- cells.
Abstract: Human breast tumors are heterogeneous and consist of phenotypically diverse cells. Breast cancer cells with a CD44+/CD24- phenotype have been suggested to have tumor-initiating properties with stem cell-like and invasive features, although it is unclear whether their presence within a tumor has clinical implications. There is also a large heterogeneity between tumors, illustrated by reproducible stratification into various subtypes based on gene expression profiles or histopathological features. We have explored the prevalence of cells with different CD44/CD24 phenotypes within breast cancer subtypes. Double-staining immunohistochemistry was used to quantify CD44 and CD24 expression in 240 human breast tumors for which information on other tumor markers and clinical characteristics was available. Gene expression data were also accessible for a cohort of the material. A considerable heterogeneity in CD44 and CD24 expression was seen both between and within tumors. A complete lack of both proteins was evident in 35% of the tumors, while 13% contained cells of more than one of the CD44+/CD24-, CD44-/CD24+ and CD44+/CD24+ phenotypes. CD44+/CD24- cells were detected in 31% of the tumors, ranging in proportion from only a few to close to 100% of tumor cells. The CD44+/CD24- phenotype was most common in the basal-like subgroup – characterized as negative for the estrogen and progesterone receptors as well as for HER2, and as positive for cytokeratin 5/14 and/or epidermal growth factor receptor, and particularly common in BRCA1 hereditary tumors, of which 94% contained CD44+/CD24- cells. The CD44+/CD24- phenotype was surprisingly scarce in HER2+ tumors, which had a predominantly CD24+ status. A CD44+/CD24- gene expression signature was generated, which included CD44 and α6-integrin (CD49f) among the top-ranked overexpressed genes. We demonstrate an association between basal-like and particularly BRCA1 hereditary breast cancer and the presence of CD44+/CD24- cells. Not all basal-like tumors and very few HER2+ tumors, however, contain CD44+/CD24- cells, emphasizing that a putative tumorigenic ability may not be confined to cells of this phenotype and that other breast cancer stem cell markers remain to be identified.
533 citations
TL;DR: It is found that right- sided colon cancers have a worse prognosis than left-sided colon cancers, which may be due to biological and/or environmental factors and may have particular bearing, given the rising incidence of right-sided Colon cancers.
Abstract: Background
The incidence of right-sided colon cancers has been increasing in recent years. It is unclear whether patient prognosis varies by tumor location. In this study, we have compared the survival of right-and left-sided colon cancers in a longitudinal population-based database.
420 citations
TL;DR: The presence of MVI was the most important risk factor affecting recurrence and survival in HCC patients after curative resection, and this study showed that gross classification of HCC can be very helpful in predicting the presence ofMVI.
Abstract: Background
Macroscopic vascular invasion is known to be a poor prognostic factor in hepatocellular carcinoma (HCC). The aim of this study was to determine the outcomes and predictive factors after hepatic resection for HCC with microvascular invasion (MVI).
323 citations
TL;DR: The results of this meta-analysis of randomized controlled trials performed in Europe and North America suggest that preoperative chemoradiotherapy combined with surgery has the potential to improve the long-term survival of patients undergoing surgical resection of esophageal carcinoma.
Abstract: Preoperative chemotherapy: there have been three reports of meta-analyses based on randomized controlled trials carried out in Europe or North America that compared surgical resection with preoperative chemotherapy and surgical resection alone. However, the conclusions are confl icting: one found that preoperative chemotherapy does not improve 1-year and 2-year survival rates, whereas the other showed preoperative chemotherapy to slightly improve the 2-year survival rate. At present, the effi cacy of preoperative chemotherapy for resectable cases (T1–3, N0,1, M0; 2002 edition of UICC classifi cation) is unclear. Preoperative chemoradiotherapy: the results of a meta-analysis of randomized controlled trials comparing surgery alone and surgery combined with preoperative chemoradiotherapy carried out in Europe and North America showed that preoperative concurrent chemoradiotherapy (20–45 Gy) for resectable cases (T1–3, N0,1, M0) caused a signifi cant increase in operation-related mortality while signifi cantly improving the 3-year survival rate. However, when the 1-year or 2-year survival rate was the endpoint, there was no clear survival benefi t of preoperative chemoradiotherapy. Thus, the results of this meta-analysis of randomized controlled trials performed in Europe and North America suggest that preoperative chemoradiotherapy combined with surgery has the potential to improve the long-term survival of patients undergoing surgical resection of esophageal carcinoma. In Japan, this therapy is performed for locally advanced cases in a number of institutions. However, no high-level evidence is available concerning Japanese patients, and there is no fi rm basis for recommending the use of preoperative chemoradiotherapy in Japan.
294 citations
TL;DR: Despite the absence of palpable neck nodes, PTMC is associated with a high rate of central lymph node metastasis to ipsilateral and pretracheal subsites, and in patients with PTMC involving one lobe and positive nodes, neck dissection may exclude the contralateral side.
Abstract: Background
Although several factors are thought to predict the occurrence of lymph node metastases from papillary thyroid microcarcinoma (PTMC), the pattern of nodal metastasis has been rarely studied. We evaluated the pattern and factors predictive of central cervical metastasis from PTMC.
155 citations
TL;DR: Laparoscopic liver resection is a procedure of significant risk and is more technically demanding in comparison with traditional open method and should be performed in selected patients as the postoperative quality of life of patients is better than that with open resection.
Abstract: Background
Laparoscopic hepatectomy is feasible for hepatocellular carcinoma (HCC) today. This is a retrospective study of the patients with HCC treated by liver resection with a totally laparoscopic approach.
145 citations
TL;DR: Several variables associated with LN metastasis in EGC, including female sex, tumor location in the lower part of the stomach, larger tumor size, undifferentiated tumors, increasing depth of submucosal invasion, lymphatic tumor invasion, vascular tumors invasion, and increased sub mucosal vascularity are identified.
Abstract: Accurate prediction of lymph node (LN) status is of crucial importance for appropriate treatment planning in patients with early gastric cancer (EGC). However, there is no definitive consensus yet on which patient and/or tumor characteristics are associated with LN metastasis. A systematic search for studies investigating the relationship between patient and/or tumor characteristics and LN metastasis in EGC was performed in PubMed/MEDLINE. Patient and/or tumor characteristics associated with LN metastasis were identified by meta-analyzing results of individual studies. Forty-five studies were included. Variables significantly associated with LN metastasis in gastric cancer limited to the mucosa were: age younger than 57 years, tumor location in the middle part of the stomach, larger tumor size, macroscopically depressed tumor type, tumor ulcerations, undifferentiated tumors, diffuse tumor type according to the Lauren classification, lymphatic tumor invasion, tumors with a proliferating cell nuclear antigen (PCNA) labeling index of more than 25%, and matrix metalloproteinase-9-positive tumors. Variables significantly associated with LN metastasis in gastric cancer limited to the submucosa were: female sex, tumor location in the lower part of the stomach, larger tumor size, undifferentiated tumors, increasing depth of submucosal invasion, lymphatic tumor invasion, vascular tumor invasion, increased submucosal vascularity, tumors with a PCNA labeling index of more than 25%, tumors with a gastric mucin phenotype, and vascular endothelial growth factor-C-positive tumors. We identified several variables associated with LN metastasis in EGC. These variables should be included in future research, in order to assess which of these variables remain as significant predictors of LN metastasis.
138 citations
TL;DR: Although the functional role of AR in these neoplasms is still unclear, the results confirm that AR are commonly expressed in breast cancer, and are correlated with the expression of some MMPs and TIMP-2.
Abstract: In the present study we analyze, in patients with breast cancer, the tumor expression of androgen receptors (AR), its relationship with clinicopathological characteristics and with the expression of several matrix metalloproteases (MMPs) and their inhibitors (TIMPs), as well as with prognosis. An immunohistochemical study was performed using tissue microarrays and specific antibodies against AR, MMPs -1, -2, -7, -9, -11, -13, -14, and TIMPs -1, -2 and -3. More than 2,800 determinations on tumor specimens from 111 patients with primary invasive ductal carcinoma of the breast (52 with axillary lymph node metastases and 59 without them) and controls were performed. Staining results were categorized using a score based on the intensity of the staining and a specific software program calculated the percentage of immunostained cells automatically. A total of 83 cases (74.8%) showed a positive immunostaining for AR, but with a wide variation in the staining score values. There were no significant associations between the total immunostaining scores for AR and any clinicopathological parameters. However, score values for MMP-1, -7 and -13, were significantly higher in AR-positive tumors than in AR-negative tumors. Likewise, when we considered the cellular type expressing each factor, we found that AR-positive tumors had a higher percentage of cases positive for MMP-1, -7, -11, and TIMP-2 in their malignant cells, as well as for MMP-1 in intratumoral fibroblasts. On the other hand, multivariate analysis demonstrated that patients with AR-positive tumors have a significant longer overall survival than those with AR-negative breast carcinomas (p = 0.03). Our results confirm that AR are commonly expressed in breast cancer, and are correlated with the expression of some MMPs and TIMP-2. Although we found a specific value of AR expression to be a prognostic indicator in breast cancer, the functional role of AR in these neoplasms is still unclear and further data are needed in order to clarify their biological signification in breast cancer.
129 citations
TL;DR: PGRMC1 phosphorylation may be involved in the clinical differences that underpin breast tumors of differing ER status, suggesting an altered keratin pool, and increased inflammation and wound responses in estrogen receptor negative tumors.
Abstract: Introduction
Breast tumors lacking the estrogen receptor-α (ER-α) have increased incidence of resistance to therapy and poorer clinical prognosis.
122 citations
TL;DR: The complex management of healthy women and breast cancer patients with familial susceptibility to breast and ovarian cancer requires an individualized prevention or treatment strategy by an experienced team.
Abstract: Background
Advances in understanding molecular and genetic mechanisms underlying cancer promise an “individualized” management of the disease. Women with a BRCA1 or BRCA2 germ-line mutation are at very high risk of breast and/or ovarian cancer. Because high-quality data are lacking from randomized trials, prevention strategies and treatment of patients with BRCA-associated breast cancer are complex.
121 citations
TL;DR: This review summarizes the results of prospective clinical trials of several categories of systemic therapy, with emphasis on the more promising results from recent trials of biologically targeted therapeutic agents in HCC.
Abstract: Conventional cytotoxic chemotherapy has not provided clinical benefit or prolonged survival for patients with advanced HCC. This review summarizes the results of prospective clinical trials of several categories of systemic therapy, with emphasis on the more promising results from recent trials of biologically targeted therapeutic agents in HCC.
TL;DR: WD and DD have distinct biological behaviors and treatment should reflect these biologic differences by maximizing survivorship while avoiding unnecessarily extensive multivisceral resection, presents outcomes of two different surgical approaches implemented at the UTMDACC.
Abstract: Background
Division of retroperitoneal liposarcoma (RPLS) into well-differentiated (WD) and dedifferentiated (DD) subtypes is established; however, WD and DD are usually treated similarly. We hypothesized that WD and DD have distinct biological behaviors mandating different treatments.
TL;DR: Significant differences in tumor-related gene methylation patterns relevant to ER and HER2/neu status of breast tumors are demonstrated and may be of significance in the assessment of targeted therapy resistance related to ER-positive and ER-negative status in breast cancer patients.
Abstract: Estrogen receptor (ER)-positive breast cancers are considered prognostically more favorable than ER-negative tumors, whereas human epidermal growth factor receptor (HER)2/neu-positive breast cancers are associated with worse prognosis. The objective of the present study was to determine whether ER-positive and ER-negative status relates to epigenetic changes in breast cancer-related genes. To evaluate epigenetic differences in tumor-related genes relating to ER and HER2/neu status of primary tumors, we examined the promoter methylation status of the promoter region CpG islands of eight major breast tumor-related genes (RASSF1A, CCND2, GSPT1, TWIST, APC, NES1, RARβ2, and CDH1). Paired ER-positive (n = 65) and ER-negative (n = 65) primary breast tumors (n = 130) matched for prognostic factors were assessed. DNA was extracted from paraffin-embedded tumor tissue after microdissection, and methylation-specific PCR and capillary-array electrophoresis analysis were performed. In early stages of tumor progression (T1 and N0), RASSF1A and CCND2 were significantly (P < 0.05) more methylated in ER-positive than in ER-negative tumors. GSTP1 hypermethylation was more frequent in the lymph node metastasis positive group than in the negative group. Double negative (ER-negative, HER2/neu-negative) breast cancers had significantly lesser frequencies of RASSF1A, GSTP1, and APC methylation (P < 0.0001, P < 0.0001, and P = 0.0035, respectively). Both ER and HER2/neu status correlated independently with these epigenetic alterations. We demonstrated significant differences in tumor-related gene methylation patterns relevant to ER and HER2/neu status of breast tumors. This may be of significance in the assessment of targeted therapy resistance related to ER and HER2/neu status in breast cancer patients.
TL;DR: Lymph node dissection during LADG should be performed cautiously to prevent surgical complications like vascular injuries, especially during the surgeon's early learning period, despite increasing popularity of this procedure.
Abstract: Background
Information on surgical complications of laparoscopy-assisted distal gastrectomy (LADG) and their risk factors is limited in the literature despite increasing popularity of this procedure. This study was performed to identify the surgical complications and their associated risk factors of LADG in early gastric cancer.
TL;DR: This review summarizes the genetic alterations that have been reported in bladder cancer and relates these to the current two-pathway model for tumor development.
Abstract: Bladder tumors show widely differing histopathology and clinical behavior. This is reflected in the molecular genetic alterations they contain. Much information has accumulated on somatic genomic alterations in bladder tumors of all grades and stages and when this information is related to the common histopathological appearances, a model for the pathogenesis of two major groups of bladder tumors has emerged. This review summarizes the genetic alterations that have been reported in bladder cancer and relates these to the current two-pathway model for tumor development. The molecular pathogenesis of high-grade noninvasive papillary tumors and of T1 tumors is not yet clear and possibilities are discussed.
TL;DR: Surgical extirpation of the primary tumor in patients with synchronous stage IV disease is associated with improved metastatic PFS when performed more than 3 months after diagnosis, and Resection should be planned with the intent of obtaining negative margins.
Abstract: Background
Recent studies demonstrate improved progression-free survival (PFS) and improved overall survival (OS) with extirpation of the primary tumor in breast cancer patients who present with metastatic disease at initial diagnosis. The subset of patients who would most benefit from surgery remains unclear. This study evaluates the pathological attributes and optimum timing for surgery in patients who present with stage IV breast cancer and an intact primary.
TL;DR: It is found that laparoscopic surgery offers significant short-term benefits for patients, including shorter hospital stay, improved recovery of gastrointestinal functions and post-operative morbidity.
Abstract: CRD summary The authors reviewed published studies comparing the safety and outcomes of laparoscopic versus open surgery for Crohn's disease in adults. The review found that laparoscopic surgery offers significant short-term benefits for patients, including shorter hospital stay, improved recovery of gastrointestinal functions and post-operative morbidity. The conclusions of this review accurately reflect the evidence presented.
TL;DR: Management of the giant phyllodes tumor presents the surgeon with unique challenges and should be limited to patients with pathologic evidence of tumor in the lymph nodes.
Abstract: Background
Phyllodes tumors are biphasic fibroepithelial neoplasms of the breast. While the surgical management of these relatively uncommon tumors has been addressed in the literature, few reports have commented on the surgical approach to tumors greater than ten centimeters in diameter – the giant phyllodes tumor.
TL;DR: Complete endoscopic resection may be acceptable as a curative treatment for intramucosal undifferentiated EGC when the tumor size is less than or equal to 2 cm, and when LVI is absent in the postoperative histological examination.
Abstract: Background
Endoscopic surgery has not been accepted as a curative treatment for intramucosal undifferentiated early gastric cancer (EGC) The purpose of this study was to evaluate the predictive factors of lymph node metastasis and explore the possibility of using endoscopic surgery for undifferentiated EGC
TL;DR: The successful curative resection and an early stage of the RGC led to good outcomes, and in considering the different latency periods of the two initial gastric diseases, appropriate follow-up programs should be developed.
Abstract: Background
The incidence of gastric cancer in the remnant stomach after distal gastrectomy is increasing. The aim of this study was to evaluate the clinicopathological features and surgical outcomes of remnant gastric cancer (RGC).
TL;DR: The number of nodes positive for metastasis was the only independent risk factor for recurrence after curative surgery in patients with lymph node-positive early gastric cancer and these high-risk patients may obtain additional survival benefit if targeted with adjuvant chemotherapy.
Abstract: Background
Early gastric cancer (EGC) has an excellent prognosis, but some patients with lymph node-positive disease will develop recurrence. In this study we investigated the risk factors for recurrence in this selected group of patients.
TL;DR: Liver resection, when done in combination with adjuvant therapy, can improve the prognosis of selected patients with BCLM, and the number of liver metastases was identified as a significant independent factor of survival.
Abstract: Purpose
To assess the outcome and prognostic factors of liver surgery for breast cancer metastasis.
TL;DR: This poster presents a poster presented at the 69th annual meeting of the American Association for the Study of Radiation Oncology (AAS) in Chicago, USA, presenting the findings of a two-year study of the effects of radiolysis on the response of the immune system to chemotherapy.
Abstract: Division of Radiation Oncology, M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Unit 097, Houston, Texas 77030, United States Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea Department of Radiation Oncology, University of Tsukuba, Tsukuba, Japan Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Lyon Pierre Benite, France
TL;DR: In this cohort of postmenopausal women, breast cancer risk reduction appeared to be limited to vigorous forms of activity; it was apparent among normal weight women but not overweight women, and the relation did not vary by hormone receptor status.
Abstract: Introduction
To prospectively examine the relation of total, vigorous and non-vigorous physical activity to postmenopausal breast cancer risk.
TL;DR: Annexin A1 expression decreased significantly as gastric cancer progressed and metastasized, suggesting the importance of ANXA1 as a negative biomarker for gastrics cancer development and progression.
Abstract: Aims Annexin A1 (ANXA1) is a calcium- and phospholipid-binding protein that has been implicated in the regulation of inflammation, cell proliferation, and apoptosis. Its role in tumor development and progression is controversial, whereas its role in gastric cancer is unknown. We investigated ANXA1 expression and determined its clinical significance in gastric cancer. Methods and results Tissue microarray blocks containing primary gastric cancer, lymph node metastasis, and adjacent normal mucosa specimens obtained from 1,072 Chinese patients were constructed. Expression of ANXA1 in these specimens was analyzed using immunohistochemistry. Complete loss of ANXA1 expression was observed in 691 (64%) of the 1,072 primary tumors and 146 (86%) of 169 nodal metastases. Loss of ANXA1 expression was significantly associated with advanced T stage, lymph node metastasis, advanced disease stage, and poor histological differentiation. Loss of ANXA1 expression correlated significantly with poor survival rates in both univariate and multivariate analyses. Conclusions ANXA1 expression decreased significantly as gastric cancer progressed and metastasized, suggesting the importance of ANXA1 as a negative biomarker for gastric cancer development and progression.
TL;DR: New targeted therapeutic approaches to induction of apoptosis or inhibition of anti-apoptosis, cell cycle progression, signal transduction and angiogenesis, and the molecular pathways and their inhibitory or repair mechanisms are described.
Abstract: Targeting the oestrogen receptor, HER2 (human epidermal growth factor receptor 2) and vascular endothelial growth factor has markedly improved breast cancer therapy. New targeted therapeutic approaches to induction of apoptosis or inhibition of anti-apoptosis, cell cycle progression, signal transduction and angiogenesis are described. The molecular pathways and their inhibitory or repair mechanisms are discussed in the preclinical and clinical settings.
TL;DR: R0/R1 resection during CS + IPHC compared with margin-negative hepatic resection demonstrated no significant difference in overall survival and for select patients should be considered a viable treatment option.
Abstract: Background
Surgical resection is the treatment of choice for colorectal hepatic metastases (HM). In contrast, metastatic disease to the peritoneum is treated with systemic therapy. We examined our experience with cytoreductive surgery (CS) and intraperitoneal hyperthermic chemotherapy (IPHC) for peritoneal surface disease (PSD) compared with liver resection for HM.
TL;DR: Evaluated expression patterns of Bag-1 in a large cohort of breast tumors may identify a subset of patients with a favorable prognosis, who might not benefit from chemotherapy or who might benefit from Bcl-2 targeting agents in addition to antihormonal therapy.
Abstract: Introduction
Bcl-2 antanogene-1 (Bag-1) binds the anti-apoptotic mediator Bcl-2, and enhances its activity. Bcl-2 and Bag-1 are associated with chemotherapy resistance in cancer cells. Drugs that target Bcl-2 are currently in clinical development. The purpose of the present study was to examine expression patterns of Bag-1 in a large cohort of breast tumors and to assess the association with Bcl-2, estrogen receptor, progesterone receptor and Her2/neu, and other clinical/pathological variables.
TL;DR: For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency.
Abstract: Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD) with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP) is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP) with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the abovementioned topics.