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Comparison of response evaluation methods of neoadjuvant chemotherapy in breast cancer patients.

Bing SUN ; San-tai SONG ; Shi-kai WU ; Ze-fei JIANG ; Tao WANG ; Shao-hua ZHANG ; Yi-bing ZHAO ; Cheng-ze YU ; Xiao-bing LI ; Tao YANG ; Gong-jie LI

Chinese Journal of Oncology.2009;31(10):783-785.

OBJECTIVETo compare the efficiency of response evaluation by clinical examination, ultrasonograghy and mammography in neoadjuvant chemotherapy (NAC) for breast cancer.

METHODSA retrospective cohort study was conducted to analyze the data of 141 patients treated with neoadjuvant chemotherapy. Response evaluation was performed by clinical palpation, ultrasound and mammography.

RESULTSOnly 12 (8.5%) among the 141 patients presented with a stage I tumor. The tumor size determined by palpation was often larger than that by ultrasound before therapy (P < 0.01). Among patients with suspicions axillary nodes checked by ultrasound, 88.3% (53/60) of them had positive nodes by pathology before NAC, and 34.5% (10/29) of patients with negative nodes determined by ultrasound had positive nodes by pathology. In all the 141 patients, 21(14.9%) showed pathological complete remission in both the primary tumor and lymph node. For response evaluation, the false complete remission rate judged by clinical examination was 46.8% (22/47), and the false tumor residual rate by ultrasound was 84.0% (21/25). In 53.5% (23/43) of patients the response could not be assessed by mammography due to that the tumors were undistinguishable in size. The range of microcalcification was not reduced in 5 patients with a partial response of the tumor. 25 patients experienced needle puncture during therapy. Among them, in the 9 pathologically negative patients, only 3 achieved pCR, and the other 16 positive patients didn't achieve pCR.

CONCLUSIONUsing the puncture or sentinel lymph node biopsy, clinicians should pay enough emphasis on the pathological determination of the node status before chemotherapy. Clinicians will make a quite of false judgment of the tumor by clinical examination, ultrasound or mammography. They may use needle puncture during therapy to evaluate the response of neoadjuvant chemotherapy, and the result should be analyzed synthetically.

Adult ; Aged ; Aged, 80 and over ; Axilla ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Cohort Studies ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mammography ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging ; Remission Induction ; methods ; Retrospective Studies ; Sentinel Lymph Node Biopsy ; Ultrasonography

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Evaluation of scalene lymph node or contralateral mediastinum biopsy during mediastinoscopy for non-small cell lung cancer.

Hui YU ; Shi-yi ZHANG ; Xin WANG ; Ze-ming XIE ; Jun-ye WANG ; Yong LI ; Xuan XIE ; Jia-liang ZHOU ; Lan-jun ZHANG ; Jian-hua FU

Chinese Journal of Oncology.2009;31(10):780-782.

OBJECTIVETo explore the clinical indication of N3 lymph node biopsy during mediastinoscopy for non-small cell lung cancer (NSCLC).

METHODSCervical mediastinoscopy was performed in 89 patients with clinical stage I-IIIA non-small cell lung cancer prior to thoracotomy. Of those, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior mediastinotomy.

RESULTSNine patients were found to have lymph node metastasis (N3 disease) during mediastinosopy. Of those, 6 had contralateral mediastinal lymph node metastasis and 3 cases with right scalene lymph node metastasis. The incidence of N3 disease in the patients with adenocarcinoma, serum CEA > 5 ng/ml and multi-station mediastinal lymph node metastasis was significantly higher than that in those with non-adenocarcinoma, CEA < 5 ng/ml and ipsilateral uni-station mediastinal lymph nodes metastasis (P < 0.05).

CONCLUSIONBiopsy of scalene lymph node or contralateral mediastinal lymph node should be performed during mediastinoscopy in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA >5 ng/ml and ipsilateral multi-station mediastinal lymph nodes metastasis.

Adenocarcinoma ; blood ; pathology ; Adult ; Aged ; Biopsy ; Carcinoembryonic Antigen ; blood ; Carcinoma, Non-Small-Cell Lung ; blood ; pathology ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms ; blood ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Mediastinoscopy ; Mediastinum ; Middle Aged ; Neck Muscles ; Neoplasm Staging

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Association between Ephb4 gene polymorphism and non-small cell lung cancer.

Li-qin SHEN ; Xiao-chen WANG ; Jun ZHAO

Chinese Journal of Oncology.2009;31(10):778-779.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; genetics ; Female ; Genetic Predisposition to Disease ; Humans ; Lung Neoplasms ; genetics ; Male ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide ; Receptor, EphB4 ; genetics

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Correlation between PPARgamma and VEGF-C expression in extrahepatic cholangioadenocarcinoma (EHCAC) and their prognostic significance.

Wen-bin WANG ; Yue-hong LI ; Bing LIU ; Heng-shu WANG ; Ai-rong CUI ; Xiang-hong ZHNAG

Chinese Journal of Oncology.2009;31(10):773-777.

OBJECTIVETo evaluate the expression of vascular endothelial growth factor C (VEGF-C) and peroxisome proliferators-activated receptors (PPARgamma) in extrahepatic cholangioadenocarcinoma (EHCAC) and to elucidate its correlation with clinicopathological factors and their significance in prognosis.

METHODSThe expressions of PPARgamma and VEGF-C were detected by immunohistochemistry in 69 cases of EHCAC, 12 cases of non-tumor bile duct epithelium, and their relationship to clinicopathological parameters and follow-up were analyzed.

RESULTSThe positive rate of PPARgamma expression in 69 cases of EHCAC was 59.4%, significantly higher than that in 12 cases of non-tumor bile duct epithelium (0%), (P < 0.01). The positive rate of VEGF-C in 69 cases of EHCAC was 84.1%, also significantly higher than 16.7% in 12 cases of benign bile duct epithelium (P < 0.05). PPARgamma expression was associated with clinical TNM stage and lymph node metastasis. VEGF-C expression was associated with lymph node metastasis. Cox analysis results showed that portal vein and/or hepatic artery invasion, lymph node metastasis and VEGF-C expression were independent prognostic factors of EHCAC (P < 0.05).

CONCLUSIONPPARgamma expression may play an important role during tumorigenesis of extrahepatic cholangioadenocarcinoma. The expressions of PPARgamma and VEGF-C are significantly correlated with the clinicopathological characteristics and biological behavior of EHCAC. Expression of VEGF-C is an independent prognosis factors in EHCAC. The detection of PPARgamma and VEGF-C is valuable for evaluation of prognosis of EHCAC.

Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms ; metabolism ; pathology ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; metabolism ; pathology ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; PPAR gamma ; metabolism ; Proportional Hazards Models ; Survival Rate ; Vascular Endothelial Growth Factor C ; metabolism

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Value of thallium-201 scintigraphy in assessment of neoadjuvant chemotherapy for osteosarcoma.

Zhong-ke HUANG ; Cen LOU ; Xiang-qian FANG

Chinese Journal of Oncology.2009;31(10):769-772.

OBJECTIVETo investigate the significance of Tl-201 scintigraphy for assessment of neoadjuvant chemotherapy for osteosarcoma.

METHODSThirty-four cases with osteosarcoma were enrolled into this study. The Tl-201 scintigraphy features including uptake ratio(UR) and size ratio(SR) were obtained in both early and delay imaging stages before and after chemotherapy. The responses of chemotherapy were classified into three grades according to the percentage of tumor necrosis in the specimens: necrosis < 50% as grade 1, necrosis of 50% approximately 90% as grade 2, diffuse necrosis > 90% as grade 3. The alteration ratio (AR) and SR were calculated according to tumor necrosis ratio (TNR).

RESULTSOf the 6 patients with grade 1 response, the mean alteration ratios were 3.19% +/- 8.40% and -26.29% +/- 63.61% in early and delay imaging stages, respectively. Among the 18 patients with grade 2 response, the mean alteration ratios were 40.07% +/- 11.95% and 39.30% +/- 9.87%, respectively. Of the 10 patients with grade 3 response, the mean alteration ratios were 78.32% +/- 8.33% and 63.26% +/- 6.06% in early and delay imaging stages, respectively. The results of liner regression analysis of TNR of the surgical specimens showed a significantly positive correlation (r = 0.71) between AR and TNR. The lesion size was reduced in 18 cases, but unchanged in 8 and increased in 8. The liner regression analysis results showed a negative correlation between SR and TNR.

CONCLUSIONThe alteration ratio changes significantly after neoadjuvant chemotherapy and has a significantly positive correlation with tumor necrosis ratio. Thallium-201 scintigraphy is helpful in the evaluation of neoadjuvant chemotherapy for osteosarcoma.

Adolescent ; Adult ; Bone Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Child ; Female ; Femoral Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Humans ; Male ; Neoadjuvant Therapy ; Osteosarcoma ; diagnostic imaging ; drug therapy ; pathology ; Radionuclide Imaging ; Thallium Radioisotopes ; Treatment Outcome ; Tumor Burden ; Young Adult

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Prognostic significance of metastatic lymph node ratio in colorectal cancer.

Yang ZHAO ; De-chuan LI ; Rong-can LOU ; Wei-ping CHEN ; Gui-ping CHEN ; Yong-tian FAN

Chinese Journal of Oncology.2009;31(10):764-768.

OBJECTIVETo investigate the prognostic significance of metastatic lymph node ratio in patients with colorectal cancer.

METHODSThe clinicopathological data of 303 surgically treated patients with colorectal cancer were retrospectively analyzed. Spearman correlation analysis was used to determine the correlation coefficient. The survival was analyzed using Kaplan-Meier method, and the survival difference was assessed by Log-rank test. Multivariate analysis was performed using Cox proportional hazard regression model in forward stepwise regression. Receiver working characteristic curve was used to compare the accuracy of the metastatic lymph nodes ratio in predicting the death of patients at 5 years postoperatively with that of the number of metastatic lymph nodes.

RESULTSThe MLR was not correlated with the total number of dissected lymph nodes (Spearman correlation coefficient: -0.099, P > 0.05), but the positive rate of metastatic lymph nodes did (correlation coefficient: 0.107, P < 0.05). Kaplan-Meier survival analysis revealed that the MLR significantly influenced the postoperative survival time (Log-rank chi(2) = 42.878, P < 0.01), even in the patients with less than 12 resected lymph nodes. The 5-year survival rates for rN0, rN1, rN2 and rN3 were 90.9%, 68.9%, 54.7% and 39.4%, respectively. There was a significant difference between the different stages (P < 0.01). Cox proportional hazard regression model analysis showed that the metastatic lymph node ratio was an independent prognostic factor. (EXP(B) = 7.809, P < 0.01). There was no significant difference between metastatic lymph node ratio and the number of metastatic lymph nodes in predicting the death of patients at 5 years postoperatively based on the area under the receiver working characteristic curve.

CONCLUSIONThe metastatic lymph node ratio in colorectal cancer patients is not correlated with the total number of dissected lymph nodes. The metastatic lymph node ratio is a major independent prognostic factor for patients with colorectal cancer. The ability of metastatic lymph node ratio in predicting the death of colorectal cancer patients at 5 years postoperatively is the same as that of the number of metastatic lymph nodes.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colonic Neoplasms ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Proportional Hazards Models ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Young Adult

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Case-control study of risk factors in cholangiocarcinoma.

Lian-yuan TAO ; Xiao-dong HE ; Lei CAI ; Wei LIU ; Wen-juan JI ; Lei ZHAO ; Shuang-min ZHANG

Chinese Journal of Oncology.2009;31(10):759-763.

OBJECTIVETo investigate the risk factors of intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC).

METHODSThe clinicopathological data of 190 patients with cholangiocarcinomas (61 ICC and 129 ECC) diagnosed and treated in the Peking Union Medical College Hospital between 1998 and 2008 were collected. The clinicopathological data of 380 matched healthy controls were also collected. The information about liver diseases, family history, diabetes, smoking and drinking were recorded and analyzed.

RESULTSThe positive rate of HBsAg(+) and anti-HBc(+), HBsAg(-) and anti-HBc(+) and the incidence of choledocholithiasis or hepatolithiasis in ICC patients were 27.9%, 50.8% and 14.8%, respectively. The incidence of diabetes mellitus, cholecystolithiasis, choledocholithiasis or hepatolithiasis and previous cholecystectomy in ECC patients were 18.6%, 15.5%, 18.6% and 13.2%, respectively. The incidences of all above mentioned factors in the ICC or ECC patients were significantly higher than that in the controls (P < 0.05). Compared with the patients with ECC, the ICC patients had a significantly higher cirrhosis rate (P < 0.05).

CONCLUSIONOur study results show that choledocholithiasis or hepatolithiasis, liver cirrhosis and chronic HBV infection are possible risk factors for intrahepatic cholangiocarcinoma, while choledocholithiasis or hepatolithiasis, diabetes mellitus, cholecystolithiasis, history of cholecystectomy are risk factors for extrahepatic cholangiocarcinoma.

Bile Duct Neoplasms ; etiology ; virology ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Case-Control Studies ; Cholangiocarcinoma ; etiology ; virology ; Cholecystectomy ; Cholecystolithiasis ; complications ; Diabetes Complications ; complications ; Female ; Hepatitis B ; complications ; Hepatitis C ; complications ; Humans ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

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Correlation between aneuploidy of chromosome 17, over-expression of TP53 and TOPIIalpha, and the clinicopathological features and diagnosis of gastric adenocarcinoma.

Hai-zhen LU ; Yu-peng WU ; Wei LUO ; Ya-ling HAN ; Yan CAI ; Xin XU ; Jing LIANG ; Shang-mei LIU ; Ming-rong WANG

Chinese Journal of Oncology.2009;31(10):754-758.

OBJECTIVEThe purpose of this study was to investigate the markers which can be used in auxiliary diagnosis of gastric adenocarcinoma (GAC), and their correlation with their clinicopathological features.

METHODS122 surgical specimens including 99 gastric adenocarcinoma (GAC), 18 adjacent mucosa and 5 distal normal mucosa were collected, and analyzed by in situ hybridization (FISH). The centromere probe cen17, specific for chromosome 17, which was reported to be frequently amplified in GAC, was selected for the FISH analysis. The clinicopathological features of the 99 GAC cases were reviewed, and the level of TP53 and TOPIIalpha gene expression, located in chromosome 17, was detected using tissue micro-array (TMA), compared with that of corresponding adjacent normal mucosa. Data were analyzed with SPSS 11.5 for Windows.

RESULTSThe statistical results of FISH and TMA showed that 58.6% of cen17 in tumor tissues were aneuploid, and 45.5% of TP53 and 84.7% of TOPIIalpha were over-expressed in GAC samples, significantly higher than those in non-tumor gastric mucosa (0, 12.1% and 14.1%, respectively) (P = 0.000). 58 GAC tissues were aneuploid of cen17, including 26 cases TP53-positive and 49 cases TOPIIalpha-positive. The expression of TP53 in non-tumor gastric mucosa with dysplasia was significantly higher than that in the mucosa without dysplasia (P = 0.009). Aneuploidy of cen17 was more frequent in grade 1 or 2 than in grade 3 GAC (P < 0.05). Higher frequency of aneuploidy of cen17 was also observed in the gastric cardia than in pylorus (P < 0.05), while no correlation was found between aneuploidy of cen17 and age, sex of patients, lymph node metastasis, and clinical stage of tumors. Over-expression of TP53 protein was associated with the size of tumors (P < 0.05). In addition, a negative correlation was observed between over-expression of TOPIIalpha and lymph node metastasis (LNM) as well as TNM classification (P < 0.05).

CONCLUSIONDetection of aneuploidy of cen17 as well as over-expression of TP53 and TOPIIalpha may be helpful in the diagnosis and prognostic prediction of gastric adenocarcinoma.

Adenocarcinoma ; genetics ; metabolism ; pathology ; Adult ; Aged ; Aged, 80 and over ; Aneuploidy ; Antigens, Neoplasm ; metabolism ; Chromosomes, Human, Pair 17 ; genetics ; DNA Topoisomerases, Type II ; metabolism ; DNA-Binding Proteins ; metabolism ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Stomach Neoplasms ; genetics ; metabolism ; pathology ; Tumor Suppressor Protein p53 ; metabolism ; Young Adult

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Effects of survivin in tamoxifen-induced inhibition of proliferation and enhancement of apoptosis in hepatoma Hep22 cells.

Ren-Hua GUO ; Tong-Shan WANG ; Lian-Ke LIU

Chinese Journal of Oncology.2009;31(10):752-753.

Antineoplastic Agents, Hormonal ; pharmacology ; Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Proliferation ; drug effects ; Hep G2 Cells ; Humans ; Inhibitor of Apoptosis Proteins ; Microtubule-Associated Proteins ; metabolism ; Tamoxifen ; pharmacology

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Combination with SN-38 on human colon cancer LoVo cells.

Yan WANG ; Jian-ming XU ; Qin-zhi XU ; Ping-kun ZHOU ; San-tai SONG

Chinese Journal of Oncology.2009;31(10):746-851.

OBJECTIVETo observe the anti-proliferation effect of bevacizumab and SN-38 (active metabolite of irinotecan), and investigate the possible mechanisms of these two agents.

METHODSHuman colon cancer LoVo cells were cultured under hypoxic conditions. Inhibition of cell proliferation was evaluated by MTT assay. The drug modulation on HIF-1alpha, VEGF, ERK and AKT were assessed by the following assays. The mRNA expression of HIF-1alpha and VEGF were measured by RT-PCR. The protein expression of HIF-1alpha, ERK and AKT were evaluated by Western blot analysis, and VEGF by ELISA assay.

RESULTSAmong different combination schedules, Bevacizumab given after SN-38 show most synergistic anti-proliferation effect. Under hypoxic conditions, the expression of HIF-1alpha and VEGF increased as time accumulated, Bevacizumab combined with SN-38 almost completely inhibited the expression of HIF-1alpha and VEGF. Moreover, the MAP kinase pathway was involved in the drug modulation of HIF-1alpha and VEGF.

CONCLUSIONThese findings suggest the anti-proliferation effect of bevacizumab and SN-38 was schedule-dependent, and the synergistic effect of Bevacizumab and SN-38 was related to drug modulation of the HIF-1alpha and MAP kinase pathway.

Antibodies, Monoclonal ; pharmacology ; Antibodies, Monoclonal, Humanized ; Antineoplastic Agents, Phytogenic ; pharmacology ; Bevacizumab ; Camptothecin ; analogs & derivatives ; pharmacology ; Cell Hypoxia ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Colonic Neoplasms ; metabolism ; pathology ; Drug Synergism ; Extracellular Signal-Regulated MAP Kinases ; metabolism ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; metabolism ; RNA, Messenger ; metabolism ; Signal Transduction ; Time Factors ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

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