Increasing Stage (increasing + stage)

Distribution by Scientific Domains

Selected Abstracts

External validation of a risk group defined by recursive partitioning analysis in patients with head and neck carcinoma treated with surgery and postoperative radiotherapy

Xavier León MD
Abstract Background: Several clinical trials have proved that concurrent chemoradiotherapy is more efficacious than radiotherapy alone among high-risk patients with head and neck squamous cell carcinoma (HNSCC) who undergo surgery. A risk-group classification defined according to a recursive partitioning analysis (RPA) for these patients has been recently proposed. The objective of the present study was to carry out an external validation of this RPA-derived classification system. Methods: A retrospective study of 442 HNSCC patients treated with surgery and postoperative radiotherapy was conducted. The external validity of the RPA-derived classification system was assessed, and its ability to stage patients and to predict locoregional control of the disease was compared with the TNM system. Results: The RPA-derived classification system succeeded in obtaining a monotonic prognosis gradient in locoregional control of the disease with increasing stage, and achieved greater differences in survival between stages than the TNM and pTNM classifications. Besides, the RPA method had a better homogeneity of the categories included in each stage, and in the heterogeneity between stages. Conclusions: The RPA-derived classification system allowed for the clear definition of prognostic groups in surgically treated HNSCC patients, improving the prognostic capacity of the TNM and pTNM classifications. The RPA-derived classification system is a useful tool in the definition of patients who, given a poor prognosis, should be considered candidates to adjuvant chemoradiotherapy. © 2007 Wiley Periodicals, Inc. Head Neck, 2007 [source]

Adenoid cystic carcinoma: A retrospective clinical review

Atif J. Khan M.D.
Abstract Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were identified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer's criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recurrence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was significantly associated with increasing stage. No other variables were predictive for recurrence. Additionally, we found that nasosinal tumors were more likely to display higher stage at presentation, and were more often associated with perineural invasion. Also of interest was the association of perineural invasion with margin status, with 15 of 20 patients with positive margins displaying perineural invasion, while only 5 of 17 with negative margins showed nerve invasion (P = 0.02). On immunohistochemistry, 2 cases of the 29 (7%) tumor specimens found displayed HER-2/neu positivity. No correlation between clinical behavior and positive staining could be demonstrated. Our data concur with previous reports on ACC in terms of survival and recurrence statistics. Stage and site of primary were important determinants of outcome. Grade may still serve a role in decision making. We could not demonstrate any differences attributable to primary modality of therapy, perhaps due to the nonrandomization of patients into the various treatment tracks and the inclusion of palliative cases. Similarly, perineural invasion, radiation dose and field size, and HER-2/neu positivity did not prove to be important factors in our experience. © 2001 Wiley-Liss, Inc. [source]


ABSTRACT A study was conducted to determine changes in firmness, ethylene and ethylene biosynthetic enzymes, and the activities of ,-galactosidase (,-GAL) and ,-L-arabinofuranosidase (,-AF) during peach ripening and softening. The activities of 1-aminocyclopropane-1-carboxylic acid (ACC) synthase, ACC oxidase and polygalacturonase increased in parallel with ethylene production and declined in firmness during peach ripening, and they appeared at maximum simultaneously at maturity IV. ,-GAL activity was high in unripe peach fruit and it experienced an overall decline during peach ripening. While ,-AF activity changed placidly at the initial stage (maturity I,III), after that it experienced a rapid increasing stage. The preliminary result indicated that ,-GAL and ,-AF, as well as ethylene biosynthetic enzymes, may be involved in the ripening and softening of peach fruit. [source]

An assessment of the immunological status of patients with renal cell carcinoma based on the relative abundance of T-helper 1- and -2 cytokine-producing CD4+ cells in peripheral blood

T. Onishi
Objective To assess the immunological status of patients with renal cell carcinoma (RCC), by analysing the proportion of cluster-of-differentiation 4-positive (CD4+) cells showing intracellular cytokine production, i.e. interferon-, derived from T-helper (Th) 1 and interleukin-4 derived from Th2 cells, among peripheral blood lymphocytes from these patients Patients, subjects and methods Peripheral blood samples (5 mL) were collected from 36 patients (mean age 61 years, range 44,78) with RCC before and after they underwent nephrectomy. The proportion of cytokine-producing CD4+ cells was determined by flow cytometric analysis after stimulating the cells with phorbol 12-myristate 13-acetate, ionomycin and brefeldin A, and staining the cells with fluorescein isothiocyanate-labelled anti-interferon-,, anti-interleukin-4 and anti-immunoglubulin-2b antibodies. The results were expressed as the percentage of cytokine-producing cells in the CD4+ population. As a control, peripheral blood obtained from 35 healthy volunteers (mean age 34 years, range 22,49) was also analysed. Results The proportion of CD4+ cells producing interferon-, and interleukin-4 was significantly higher (P < 0.04 and P < 0.001, respectively) in patients with RCC than in controls. The Th1/Th2 ratio (i.e. the ratio of CD4+ cells producing each cytokine) was significantly lower in patients with RCC (P < 0.001). There was a significant correlation in the controls between interferon-, and interleukin-4 production (r = 0.489, P < 0.01) but not in patients with RCC. The proportion of CD4+ cells producing interleukin-4 was significantly higher and the Th1/Th2 ratio significantly lower in patients with high-stage than in those with low-stage RCC (P < 0.05). The percentage of CD4+ cells producing interleukin-4 was significantly less after nephrectomy in those with low-stage RCC (P < 0.01) and the Th1/Th2 ratio significantly greater (P < 0.05) than before nephrectomy; there was no such trend in patients with high-stage RCC. Conclusion An evaluation of the production of interferon-, and interleukin-4 in CD4+ peripheral blood lymphocytes is useful for assessing the immunological status of patients with RCC; there is a change in the predominant response from Th1 to Th2 with increasing stage of RCC. [source]