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Tumour Histology (tumour + histology)
Selected AbstractsDrug-eluting bead therapy in primary and metastatic disease of the liverHPB, Issue 7 2009Stewart Carter Abstract Background:, Drug-eluting bead transarterial chemoembolization (DEB-TACE) is a novel therapy for the treatment of hypervascuarized tumours. Through the intra-arterial delivery of microspheres, DEB-TACE allows for embolization as well as local release of chemotherapy in the treatment of hepatic malignancy, providing an alternative therapeutic option in unresectable tumours. Its role as an adjunct to surgical resection or radiofrequency ablation (RFA) is less clear. The purpose of this review is to summarize recent studies investigating DEB-TACE in order to better define safety, efficacy and outcomes associated with its use. Methods:, A systematic review of all published articles and trials identified nine clinical trials and 23 abstracts. These were reviewed for tumour histology, stage of treatment, delivery technique, outcome at follow-up, complications and mortality rates. Results:, Publications involved treatment of hepatocellular carcinoma (HCC), metastatic colorectal carcinoma (MCRC), metastatic neuroendocrine (MNE) disease and cholangiocarcinoma (CCA). Using Response Evaluation Criteria in Solid Tumours (RECIST) or European Association for the Study of the Liver (EASL) criteria, studies treating HCC reported complete response (CR) rates of 5% (5/101) at 1 month, 9% (8/91) at 4 months, 14% (19/138) at 6 months and 25% (2/8) at 10 months. Partial response (PR) was reported as 58% (76/131) at 1 month, 50% (67/119) at 4 months, 57% (62/108) at 6,7 months and 63% (5/8) at 10 months. Studies involving MCRC, CCA and MNE disease were less valuable in terms of response rate because there is a lack of comparative data. The most common procedure-associated complications included fever (46,72%), nausea and vomiting (42,47%), abdominal pain (44,80%) and liver abscess (2,3%). Rather than reporting individual symptoms, two studies reported rates of post-embolic syndrome (PES), consisting of fever, abdominal pain, and nausea and vomiting, at 82% (75/91). Six of eight studies reported length of hospital stay, which averaged 2.3 days per procedure. Mortality was reported as occurring in 10 of 456 (2%) procedures, or 10 of 214 (5%) patients. Conclusions:, Drug-eluting bead TACE is becoming more widely utilized in primary and liver-dominant metastatic disease of the liver. Outcomes of success must be expanded beyond response rates because these are not a reliable surrogate for progression-free survival or overall survival. Ongoing clinical trials will further clarify the optimal timing and strategy of this technology. [source] Preoperative hCG, and CA 72-4 are prognostic factors in gastric cancerINTERNATIONAL JOURNAL OF CANCER, Issue 6 2004Johanna Louhimo Abstract In gastric cancer, the role of tumour markers in assessment of prognosis is unconfirmed. In our study, we evaluated the prognostic significance of serum tumour markers carcinoembryonic antigen (CEA), CA 19-9, CA 72-4, CA 242 and free , subunit of human chorionic gonadotropin (hCG,) in gastric cancer. Preoperative serum samples were obtained from 146 patients with gastric cancer, including 29 with stage I, 11 with stage II, 42 with stage III and 64 patients with stage IV cancer. Quantitation of CEA, CA 19-9, CA 72-4 and CA 242 in serum was performed with commercial assays. HCG, was measured with an in-house immunofluorometric assay based on monoclonal antibodies specific for the free ,-subunit of hCG. Survival analysis was performed with Kaplan-Meier life-tables and log-rank test, and with multivariate Cox regression analysis. Disease-specific cumulative 2-year survival rate was 40%. Serum levels of CEA, CA 72-4, CA 242 and hCG, showed significant correlation with stage (p<0.027); for CA 19-9 the association was of borderline significance (p=0.056). Of the studied markers, CA 19-9, CA 72-4, CA 242 and hCG, were found to be prognostic factors in univariate analysis (p< 0.022). In multivariate analysis, stage had the statistically most significant association with prognosis followed by hCG,, tumour histology according to the Laurén classification and by CA 72-4. In gastric cancer, tumour markers hCG, and CA 72-4 are independent prognostic factors in addition to stage and histological type of the tumour. © 2004 Wiley-Liss, Inc. [source] Prognostic factors of tracheobronchial mucoepidermoid carcinoma,15 years experienceRESPIROLOGY, Issue 2 2008Chien-Hung CHIN Background and objectives: Mucoepidermoid carcinoma of the tracheobronchial tree is a rare tumour which displays a variable degree of clinical aggressiveness and malignancy. The relationship between the patient's prognosis and the tumour's histological features and clinical behaviour is uncertain. The aim of this study was to identify the clinicopathological features and analyse the outcomes of patients with this type of cancer. Methods: A retrospective analysis of the medical records of patients diagnosed with mucoepidermoid carcinoma of the lung between 1991 and 2006 was conducted. Results: The study comprised 15 patients. Higher histological grade tumours had a higher proportion of squamoid cells (P = 0.019); the tumours of patients with lymph node metastases also had a higher proportion of squamoid cells than did the tumours of patients without lymph node metastases (P = 0.015). Patients with early stage tumours (stage IA, IB, IIB) had better outcomes (10-year survival rate = 87.5%), than did patients with late-stage tumours (stage IIIB, IV) (1-year survival rate = 28.6%; 2-year survival rate = 0%, P = 0.001). Patients with lower-grade tumours (grade 1 and grade 2) had better outcomes (1-year survival rate = 80%; 5-year survival rate = 57.1%) than did patients with higher-grade tumours (grade 3) (1-year survival rate = 20%, P = 0.035). Tumour staging was a significant independent predictor of survival on Cox proportional hazards analysis. Conclusions: The proportion of squamoid cells on tumour histology may be an indicator of the level of tumour malignancy. Tumour, node, metastasis staging is a significant determinant of prognosis in patients with tracheobronchial mucoepidermoid carcinoma. [source] Magnetic resonance imaging for assessment of deep endometrial invasion for patients with endometrial carcinomaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009Jong Ha HWANG Aims: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion. Methods: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results. Results: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764. Conclusion: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary. [source] Pathological tumour diameter predicts risk of conventional subtype in small renal cortical tumoursBJU INTERNATIONAL, Issue 10 2008Melissa A. Laudano OBJECTIVE To examine whether pathological tumour diameter assists in predicting conventional vs other histological subtypes in renal cortical tumours (RCTs) of ,4 cm diameter. PATIENTS AND METHODS In all, 393 patients from Columbia University's Comprehensive Urologic Oncology Database who underwent radical or partial nephrectomy between 1988 and 2005 and had RCTs of ,4 cm were analysed. Logistic regression analysis using tumour diameter as a continuous variable was used to determine whether size predicted histological subtype. Odds ratios (ORs) were calculated to estimate the likelihood of having conventional histology based on diameter. RESULTS The median patient age at surgery was 64.3 years and median tumour diameter was 3 cm, In all, 256 (65.1%) of the RCTs were conventional subtype and 137 (34.9%) were nonconventional. Logistic regression analysis showed that for every 1 cm increase in diameter up to 4 cm, the RCT was 1.27 times more likely to be conventional (P = 0.020). The ORs showed that a 4-cm RCT was 2.06 times more likely to be conventional than tumours of 0.6,1.5 cm. CONCLUSION There was a positive association between RCT diameter and the risk of having conventional renal cell carcinoma (RCC). Given that RCC histological subtype is a prognostic indicator for outcome, these findings may be applied in the selection of treatment options. Further studies investigating tumour size and other variables predictive of tumour histology will help clinicians better predict the RCC subtype. [source] ,-catenin expression pattern and DNA image-analysis cytometry have no additional value over primary histology in clinical stage I nonseminomatous testicular cancerBJU INTERNATIONAL, Issue 3 2002J.R. Spermon Objective To determine whether the ,-catenin expression pattern and DNA content have additional value over primary tumour histology, including information on vascular invasion and tunica albuginea invasion, in detecting occult metastasis in patients with clinical stage I nonseminomatous germ cell tumours of the testis (NSGCT). Patients and methods Fifty consecutive patients with clinical stage I NSGCT underwent retroperitoneal lymphadenectomy (RPLND) between 1986 and 1992. The orchidectomy specimens were histopathologically reviewed and immunohistochemically stained with mouse monoclonal anti-,-catenin antibody. The presence of an aberrant or negative staining in >10% of the malignant cells was defined as abnormal; in all other cases tumours were classified as normal. Furthermore, intact nuclei were isolated from 50 µm thick paraffin sections of the primary tumour, Feulgen stained, and analysed with an image-analysis system. Results Of the 50 patients, 14 had positive retroperitoneal nodes (stage IIa, 28%), one pathologically staged I patient developed a lung metastasis (stage IV) within 3 months of RPLND. Univariate analysis showed that the presence of embryonal cell carcinoma, vascular invasion and tunica albuginea invasion were predictive for occult metastases. In multivariate logistic regression analysis only vascular and tunica albuginea invasion were significant. All 11 patients with no embryonal cell carcinoma in the primary tumour were classified as having pathological stage I disease. Also, the tumours which were DNA-diploid (three) or DNA-polyploid (two) were pathologically stage I. In screening for occult metastases the DNA content and the ,-catenin expression pattern had no additional value. Conclusion Vascular and tunica albuginea invasion have prognostic value in identifying patients with clinical stage I NSGCT at high risk for occult retroperitoneal disease. In contrast, the absence of embryonal cell carcinoma could predict all patients at low risk for metastasis. The DNA-ploidy also identified patients at low risk. Other DNA-analyses and the ,-catenin expression pattern provided no additional information. Further studies are recommended to identify patients who are at low or high risk for metastasis. [source] Clinical impact of false-negative sentinel node biopsy in primary breast cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2002M. T. Nano Background: The aim was to assess the false-negative sentinel node biopsy rate in women with early breast cancer and its implications in patient treatment. Methods: Between January 1995 and March 2001, 328 consecutive patients with clinically lymph node-negative primary operable breast cancer underwent lymphatic mapping and sentinel node biopsy using a combination of preoperative lymphoscintigraphy and/or blue dye. All underwent immediate axillary dissection. The intraoperative success rate in sentinel node identification, false-negative rate, predictive value of negative sentinel node status and overall accuracy were assessed. The clinical features and primary tumour characteristics for each false-negative case were reviewed. Results: The sentinel node was identified in 285 (86·9 per cent) of 328 women. The false-negative rate was 7·9 per cent (eight of 101). Most members of the breast multidisciplinary team would have instituted adjuvant systemic therapy for six false-negative cases based on clinical features and primary tumour histology. In all, only two (0·7 per cent) of 285 women who had sentinel node biopsy may have had their management and survival prospects potentially jeopardized owing to a false-negative sentinel node. Conclusion: The results of this study suggest that the clinical impact of a false-negative sentinel node is low. © 2002 British Journal of Surgery Society Ltd [source] | ||||||||||