The relationship between the histological parameters of primary lesions and lymph node metastasis in supraglottic and hypopharyngeal
cancers has not been elucidated. This analysis is important to evaluate the requirement for additional elective neck dissection
when clinically node-negative cancers are treated by transoral surgery.
Methods
This study included 40 previously untreated patients with supraglottic and hypopharyngeal cancers who underwent transoral
en bloc tumor resection in two academic tertiary referral centers. Nodal status was confirmed by neck dissection for cases
with findings or suspicion of lymph node metastases or by observation of clinically node-negative cases for more than 1 year.
Patients? medical records and pathological features were analyzed retrospectively. The correlation of histological parameters
with lymph node metastases, including occult metastases, was evaluated by univariate and multiple logistic regression analyses.
Results
Univariate analysis showed that lymph node metastasis was correlated with tumor depth (P = 0.00087) and venous invasion (P = 0.027). Multiple logistic regression analysis showed that it was significantly correlated only with tumor depth (P = 0.007).
Conclusions
Tumor depth is the most useful parameter for predicting lymph node metastases. In clinically node-negative cases, when tumor
depth exceeds 1 mm, elective neck dissection must be considered and, when it is less than 0.5 mm, regular clinical follow-up
is recommended. Patients with tumor depth between 0.5 and 1 mm should be carefully observed, since they also have a chance
of developing nodal metastasis. Venous invasion also indicates high rates of nodal metastasis, therefore elective neck dissection
must be considered for these cases.
Content Type Journal Article
Category Head and Neck Oncology
DOI 10.1245/s10434-010-1219-5
Authors
Masayuki Tomifuji, National Defense Medical College Department of Otolaryngology-Head and Neck Surgery Tokorozawa Saitama Japan
Yorihisa Imanishi, Keio University School of Medicine Department of Otolaryngology-Head and Neck Surgery Tokyo Japan
Koji Araki, National Defense Medical College Department of Otolaryngology-Head and Neck Surgery Tokorozawa Saitama Japan
Taku Yamashita, National Defense Medical College Department of Otolaryngology-Head and Neck Surgery Tokorozawa Saitama Japan
Sohei Yamamoto, National Defense Medical College Department of Basic Pathology Tokorozawa Saitama Japan
Kaori Kameyama, Keio University School of Medicine Department of Pathology Tokyo Japan
Akihiro Shiotani, National Defense Medical College Department of Otolaryngology-Head and Neck Surgery Tokorozawa Saitama Japan
There are few reports on a dual dye and isotope approach using laparoscopy in gastric cancer sentinel node mapping. The aim
of this study is to evaluate the feasibility of laparoscopic sentinel basin dissection for gastric cancer using simultaneous
indocyanine green (ICG) and 99mTc-antimony sulfur colloid (ASC) injections.
Methods
Sixty-eight patients were enrolled who had been diagnosed with cT1?T2 and cN0 stage gastric cancers. They underwent laparoscopic
sentinel basin dissection between June 2005 and May 2008. ICG and 99mTc-tin colloid (separate injections in the first phase, n = 16) or ICG and 99mTc-ASC (simultaneous injections in the second phase, n = 52) were injected into the submucosa endoscopically. After performing the sentinel basin dissection, laparoscopy-assisted
gastrectomy with curative lymphadenectomy was done. Green-stained or radioactive sentinel nodes (SNs) were analyzed by hematoxylin
and eosin staining and by immunohistochemistry for cytokeratin.
Results
SNs were identified in 62 of the 68 patients (91.2%; mean 3.3 per patient). Eighteen patients had lymph node metastases. The
sensitivity and specificity were, respectively, 72.2 and 100% using the dye method and 83.3 and 100% by the isotope method.
However, the dual dye/isotope procedure improved both sensitivity and specificity to 100%. Patients receiving this protocol
had significantly more SNs than those receiving separate ICG and 99mTc-tin colloid injections (3.3 vs. 1.9, P = 0.008).
Conclusion
Simultaneous ICG and 99mTc-ASC-guided laparoscopic sentinel basin dissection is an effective tool for gastric cancer SN mapping, giving a high detection
rate and excellent sensitivity.
Content Type Journal Article
Category Gastrointestinal Oncology
DOI 10.1245/s10434-010-1221-y
Authors
Do Joong Park, Seoul National University Bundang Hospital Department of Surgery, Seoul National University College of Medicine Seongnam Korea
Hyung-Ho Kim, Seoul National University Bundang Hospital Department of Surgery, Seoul National University College of Medicine Seongnam Korea
Young Soo Park, Seoul National University Bundang Hospital Department of Internal Medicine Seongnam Korea
Hye Seung Lee, Seoul National University Bundang Hospital Department of Pathology Seongnam Korea
Won Woo Lee, Seoul National University Bundang Hospital Department of Nuclear Medicine Seongnam Korea
Hyuk-Joon Lee, Seoul National University Hospital Department of Surgery Seoul Korea
Han-Kwang Yang, Seoul National University Hospital Department of Surgery Seoul Korea
To assess the long-term safety of no axillary clearance in elderly patients with breast cancer and nonpalpable axillary nodes.
Background
Lymph node evaluation in elderly patients with early breast cancer and clinically negative axillary nodes is controversial.
Our randomized trial with 5-year follow-up showed no breast cancer mortality advantage for axillary clearance compared with
observation in older patients with T1N0 disease.
Methods
We further investigated axillary treatment in a retrospective analysis of 671 consecutive patients, aged ?70 years, with operable
breast cancer and a clinically clear axilla, treated between 1987 and 1992; 172 received and 499 did not receive axillary
dissection; 20 mg/day tamoxifen was prescribed for at least 2 years. We used multivariable analysis to take account of the
lack of randomization.
Results
After median follow-up of 15 years (interquartile range 14?17 years) there was no significant difference in breast cancer
mortality between the axillary and no axillary clearance groups. Crude cumulative 15-year incidence of axillary disease in
the no axillary dissection group was low: 5.8% overall and 3.7% for pT1 patients.
Conclusions
Elderly patients with early breast cancer and clinically negative nodes did not benefit in terms of breast cancer mortality
from immediate axillary dissection in this nonrandomized study. Sentinel node biopsy could also be foregone due to the very
low cumulative incidence of axillary disease in this age group. Axillary dissection should be restricted to the small number
of patients who later develop overt axillary disease.
Content Type Journal Article
Category Breast Oncology
DOI 10.1245/s10434-010-1217-7
Authors
Gabriele Martelli, Fondazione IRCCS Istituto Nazionale dei Tumori Breast Unit via Venezian 1 Milan Italy
Rosalba Miceli, Fondazione IRCCS Istituto Nazionale dei Tumori Unit of Clinical Epidemiology and Trial Organization Milan Italy
Maria Grazia Daidone, Fondazione IRCCS Istituto Nazionale dei Tumori Unit of Biomolecular Determinants in Prognosis and Therapy Milan Italy
Gaetano Vetrella, Melegnano Hospital Unit of Preventive Gynecology Melegnano Italy
Anna Maria Cerrotta, Fondazione IRCCS Istituto Nazionale dei Tumori Unit of Radiotherapy Milan Italy
Domenico Piromalli, Fondazione IRCCS Istituto Nazionale dei Tumori Breast Unit via Venezian 1 Milan Italy
Roberto Agresti, Fondazione IRCCS Istituto Nazionale dei Tumori Breast Unit via Venezian 1 Milan Italy
Detection of aberrant microRNA (miR) expression may contribute to diagnosis and prognosis of various cancers. The aim of this
study is to evaluate the correlation between miR-203 expression and prognosis of patients with pancreatic adenocarcinoma after
curative resection.
Methods
A total of 113 formalin-fixed paraffin-embedded tissue samples of pancreatic adenocarcinoma, 20 samples of chronic pancreatitis,
and 8 samples of normal pancreas were obtained. We investigated the association of miR-203 expression measured by quantitative
reverse-transcription polymerase chain reaction assays with clinicopathological parameters and survival times.
Results
miR-203 was overexpressed in pancreatic adenocarcinoma samples compared with chronic pancreatitis (P < 0.001) and normal pancreas (P = 0.001) samples. An association between miR-203 expression and clinicopathological factors of pancreatic adenocarcinoma
was not observed. On univariate analysis, the high-miR-203 group and the subgroup (20%) of cases with the highest miR-203
overexpression had significantly shorter survival time (P = 0.048 and P = 0.024, respectively). Multivariate analysis revealed that miR-203 expression was an independent predictor of poor prognosis
in cases with no residual tumor (relative risk 2.298, P = 0.027).
Conclusions
miR-203 expression is a new prognostic marker in pancreatic adenocarcinoma patients.
Content Type Journal Article
Category Pancreatic Tumors
DOI 10.1245/s10434-010-1188-8
Authors
Naoki Ikenaga, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Kenoki Ohuchida, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Kazuhiro Mizumoto, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Jun Yu, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Tadashi Kayashima, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Hiroshi Sakai, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Hayato Fujita, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Kohei Nakata, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Masao Tanaka, Kyushu University Departments of Surgery and Oncology, Graduate School of Medical Sciences Fukuoka Japan
Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior
recurrence.
Methods
Postoperative results from 62 consecutive patients operated for recurrent pleomorphic adenoma were analyzed. It was the first
recurrence for 49 patients (79%), the second or more for 13 patients (21%).
Results
Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial
nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma
in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial
palsy, 95% had postoperative facial paralysis ?grade II (House?Brackmann scale), and 11.3% still had ?grade III facial palsy
after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered
after a new intervention in 40% of these patients. Initial partial parotid surgery [hazard ratio (HR) = 8.477, P = 0.008], microscopic multinodular recurrent disease (HR = 11.717, P = 0.005), and ?1 recurrence number (HR = 10.608, P = 0.01) were associated with increased risk of ulterior recurrence.
Conclusion
Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%).
Nevertheless, a definitive facial paralysis ?grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence
after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.
Content Type Journal Article
Category Head and Neck Oncology
DOI 10.1245/s10434-010-1173-2
Authors
Marc Makeieff, CHU Department of Head and Neck Surgery Montpellier France
Pierfrancesco Pelliccia, CHU Department of Head and Neck Surgery Montpellier France
Flavie Letois, CHU Department of Medical Information Montpellier France
Grégoire Mercier, CHU Department of Medical Information Montpellier France
Sebastien Arnaud, CHU Department of Head and Neck Surgery Montpellier France
Cartier César, CHU Department of Head and Neck Surgery Montpellier France
Renaud Garrel, CHU Department of Head and Neck Surgery Montpellier France
Louis Crampette, CHU Department of Head and Neck Surgery Montpellier France
Bernard Guerrier, CHU Department of Head and Neck Surgery Montpellier France
Mucinous gastric carcinoma (MGC) is a rare type of gastric cancer; its biological behavior is controversial. In this study,
we attempted to clarify the clinical and pathological features as well as the prognostic significance of MGC. We also compared
the expression patterns of CDX-2 and ?-catenin between MGC and nonmucinous gastric carcinoma (NMGC).
Methods
We reviewed the records of 9218 patients with gastric cancer who underwent gastric cancer surgery between January 1997 and
December 2006. The clinicopathological features and clinical outcome of MGC (n = 197) were compared to NMGC (n = 9021). Immunohistochemical staining using the tissue array method was performed on MGC (n = 194) and NMGC (n = 89) tissues.
Results
MGC had a larger size and a higher frequency of Borrmann type I findings in advanced cases than NMGC. In addition, MGC had
deeper invasion, more lymph node and lymphatic involvement, a more advanced tumor stage, and lower 5-year survival rates than
NMGC. Age, depth of invasion, lymph node metastasis, lymphatic invasion, and curability were independent prognostic factors;
but the mucinous histological type itself was not predictive of outcome. ?-Catenin immunoreactivity was statistically significantly
weaker in MGC than NMGC; however, there was no difference in CDX-2 expression between the two groups.
Conclusions
MGC presents at a more advanced stage and was larger than NMGC. The poor prognosis of MGC was related to the more advanced
tumor stage at diagnosis; the histological type was not an independent prognostic factor. The result of immunohistochemical
staining suggests that MGC has a distinct pathway of carcinogenesis from NMGC.
Content Type Journal Article
Category Gastrointestinal Oncology
DOI 10.1245/s10434-010-1184-z
Authors
Min-Gew Choi, Sungkyunkwan University School of Medicine Department of Surgery, Samsung Medical Center Seoul Korea
Chang Ohk Sung, Sungkyunkwan University School of Medicine Department of Pathology, Samsung Medical Center Seoul Korea
Jae Hyung Noh, Sungkyunkwan University School of Medicine Department of Surgery, Samsung Medical Center Seoul Korea
Kyoung-Mee Kim, Sungkyunkwan University School of Medicine Department of Pathology, Samsung Medical Center Seoul Korea
Tae Sung Sohn, Sungkyunkwan University School of Medicine Department of Surgery, Samsung Medical Center Seoul Korea
Sung Kim, Sungkyunkwan University School of Medicine Department of Surgery, Samsung Medical Center Seoul Korea
Jae Moon Bae, Sungkyunkwan University School of Medicine Department of Surgery, Samsung Medical Center Seoul Korea
To identify prognostic indicators of local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) of the breast
treated with breast conserving surgery (BCS) alone.
Methods
A retrospective study was conducted of all women with pure DCIS, diagnosed 1985?1999, referred for tertiary oncologic opinion
in British Columbia, treated with BCS without adjuvant radiotherapy. Kaplan?Meier local control (LC) and breast cancer specific
survival (BCSS) estimates for the entire group were plotted. Stratified analyses identified subgroups with high Kaplan?Meier
10-year LR. Cox multivariate modeling was used to assess predictors of LR. Kaplan?Meier BCSS rates were compared between two
cohorts: those who experienced LR and those who did not have LR.
Results
A total of 460 women comprised the study cohort. Median follow-up was 9.4 years. The 15-year LC and BCSS rates were 82% and
97%, respectively. Stratified analyses of LR identified comedo histology, high nuclear grade, tumor size >4 cm or indeterminate
size, and positive margins to be associated with significantly higher LR risk, with 10-year LR risks approximating 15?30%.
The 10-year BCSS rates for the LR group were 94% compared with 99% for the NoLR group. On Cox regression modeling, high nuclear
grade, the presence of comedocarcinoma, and positive margins were significant factors for higher risk of LR.
Conclusions
Women with DCIS treated with BCS alone had higher LR risk, and those with a LR were more likely to die of breast cancer. Optimal
local treatment is mandatory to minimize the risk of breast cancer death for women with this curable disease.
Content Type Journal Article
Category Breast Oncology
DOI 10.1245/s10434-010-1214-x
Authors
Elaine S. Wai, BC Cancer Agency?Vancouver Island Centre Radiation Therapy Program Victoria BC Canada
Mary L. Lesperance, University of Victoria Department of Mathematics and Statistics Victoria BC Canada
Cheryl S. Alexander, BC Cancer Agency Breast Cancer Outcomes Unit Victoria BC Canada
Pauline T. Truong, BC Cancer Agency?Vancouver Island Centre Radiation Therapy Program Victoria BC Canada
Patrizia Moccia, University of British Columbia Department of Dermatology Vancouver BC Canada
Matthew Culp, Memorial University of Newfoundland St. John?s NL Canada
Jennifer Lindquist, University of Victoria Department of Mathematics and Statistics Victoria BC Canada
Ivo A. Olivotto, BC Cancer Agency?Vancouver Island Centre Radiation Therapy Program Victoria BC Canada
We hypothesized that metastasis beyond the sentinel lymph nodes (SLN) to the nonsentinel nodes (NSN) is an important predictor
of survival.
Materials and methods
Analysis was performed of a prospective multi-institutional study that included patients with melanoma ?1.0 mm in Breslow
thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for all SLN metastases. Disease-free
survival (DFS) and overall survival (OS) were computed by Kaplan?Meier analysis; univariate and multivariate analyses were
performed to identify factors associated with differences in survival among groups.
Results
A total of 2335 patients were analyzed over a median follow-up of 68 months. We compared 3 groups: SLN negative (n = 1988), SLN-only positive (n = 296), and both SLN and NSN positive (n = 51). The 5-year DFS rates were 85.5, 64.8, and 42.6% for groups 1, 2, and 3, respectively (P < 0.001). The 5-year OS rates were 85.5, 64.9, and 49.4%, respectively (P < 0.001). On univariate analysis, predictors of decreased OS included: SLN metastasis, NSN metastasis, increased total number
of positive LN, increased ratio of positive LN to total LN, increased age, male gender, increased Breslow thickness, presence
of ulceration, Clark level ? IV, and axial primary site (in all cases, P < 0.01). When the total number of positive LN and NSN status were evaluated using multivariate analysis, NSN status remained
statistically significant (P < 0.01), while the total number of positive LN and LN ratio did not.
Conclusions
NSN melanoma metastasis is an independent prognostic factor for DFS and OS, which is distinct from the number of positive
lymph nodes or the lymph node ratio.
Content Type Journal Article
Category Melanomas
DOI 10.1245/s10434-010-1208-8
Authors
Russell E. Brown, University of Louisville, James Graham Brown Cancer Center Division of Surgical Oncology, Department of Surgery Louisville KY USA
Merrick I. Ross, University of Texas, MD Anderson Cancer Center Department of Surgical Oncology Houston TX USA
Michael J. Edwards, University of Cincinnati College of Medicine Department of Surgery Cincinnati OH USA
R. Dirk Noyes, LDS Hospital Department of Surgery Salt Lake City UT USA
Douglas S. Reintgen, Lakeland Regional Cancer Center Department of Surgery Lakeland FL USA
Lee J. Hagendoorn, Advertek, Inc. Louisville KY USA
Arnold J. Stromberg, University of Kentucky Department of Statistics Lexington KY USA
Robert C. G. Martin, University of Louisville, James Graham Brown Cancer Center Division of Surgical Oncology, Department of Surgery Louisville KY USA
Kelly M. McMasters, University of Louisville, James Graham Brown Cancer Center Division of Surgical Oncology, Department of Surgery Louisville KY USA
Charles R. Scoggins, University of Louisville, James Graham Brown Cancer Center Division of Surgical Oncology, Department of Surgery Louisville KY USA
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