摘要:

AbstractA total of 128 surgically resected small hepatocellular carcinomas, measuring less than or equal to 3 cm in diameter, were studied by both macroscopic and histologic examinations. In 95 single nodular‐type tumors of the 128 lesions, eight tumors were associated with the cancerous areas of well differentiated hepatocellular carcinoma around the nodule. These surrounding cancerous areas went undetected by both the preoperative radiological examinations and the gross findings of resected specimens. Based on the immunohistochemical findings, the labeling index, both of the proliferating cell nuclear antigen (PCNA) and of the Ki‐67 in the surrounding cancerous areas, were lower than that of the main nodules but higher than in the nontumorous liver parenchyma in seven of eight cases. These results suggest that the main nodule was generated from the surrounding cancerous area, supporting the hypothesis of a stepwise progression of HCC. Even if the tumor seems to be a small and single nodular type, it is recommended that its surrounding areas should be closely examined and the surgical cutting margin should be made more than 1.0 cm away from the main nodule at hepatic resection. © 1995 Wiley‐Lis

ISSN:0022-4790    

DOI:10.1002/jso.2930600202

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThe objective of this study was to analyze the treatment and its results in breast cancer of the elderly. Special attention was given to the primary treatment with tamoxifen alone. We reviewed 210 patients over 70 years old with breast cancer treated between 1980 and 1992. Mean follow‐up time was 41 months. Tamoxifen was given as primary treatment in 34 patients without distant metastases; 147 patients without distant metastases underwent surgery. Local or regional recurrence occurred in 6% of the patients who had surgery. Local progressive disease was reported in 27% of those treated with tamoxifen (P<0.005). These patients had further surgery. There was no difference between the two groups in overall survival of patients and occurrence of metastases. We concluded that optimal treatment of breast cancer in the elderly should include surgery. Only patients with very limited life expectancy should receive tamoxifen alone. © 1995 Wiley‐Liss,

ISSN:0022-4790    

DOI:10.1002/jso.2930600203

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractA total gastrectomy was performed in 49 patients with early gastric cancer, and the effectiveness of this procedure was evaluated by reviewing the hospital files of the patients. The reasons for this total gastrectomy were as follows: (1) lymph node dissection for 22 patients, (2) surgeon's choice in reconstruction for 10 patients, (3) modification of the surgery from subtotal to total gastrectomy for seven patients, (4) synchronous multiple cancers for seven patients, and (5) cancer in a stomach remnant for three patients. Of 49 patients, 42 had the cancerous lesions in the upper portion of their stomachs. Lymph node involvement occurred in 5 patients, but not in the supra‐ or infrapyloric lymph nodes. Postoperative complications such as anastomotic leakage, reflux esophagitis and pancreatic fistula occurred in five, four, and two patients, respectively. Postoperative death, including two patients who died within 30 days after the surgery, occurred in 5 patients. Our study showed that total gastrectomy resulted in excessive unnecessary surgery in 39 out of 49 patients (79.6%). We conclude that a total gastrectomy should not be performed on patients with early gastric cancer except for synchronous multiple cancers and for cancers in a stomach remnant. © 1995 Wiley‐Liss,

ISSN:0022-4790    

DOI:10.1002/jso.2930600204

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractFifty‐two women with typical medullary breast carcinoma, diagnosed according to criteria of Ridolfi et al. [Cancer 40:1365–1385, 1977] are described. At the time of diagnosis, 90% of the patients were stages I and II. The primary tumor size was ≦ to 4 cm in 46 (88.5%) and>4 cm in 6 (11.5%) patients. Axillary lymph nodes were microscopically negative in 35 (67.3%) and positive in 17 (32.7%) patients. All 52 women underwent the Patey operation. Seventeen patients with microscopically positive axillary lymph nodes received postoperative irradiation. Of the 52 treated patients, 44 (84.6%) survived 10 years NED. The only prognostic factor was the microscopical axillary lymph nodes status. In the group of pNO patients, 97.1% survived 10 years NED, pN+ 58.8% only. The sole causes of unsuccessful treatment were distant metastases to lungs, hepar, and bones. Typical medullary carcinoma is a favorable histological type of breast carcinoma with very good prognosis for pNO patients. © 1995 Wiley‐L

ISSN:0022-4790    

DOI:10.1002/jso.2930600205

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThe c‐met proto‐oncogene encodes the receptor to hepatocyte growth factor‐scatter factor (HGF‐SF), a mesenchyme‐derived cytokine with cell‐dissociating, invasion, and angiogenic properties. The expression of c‐met in breast cancer is the subject of controversy; 111 primary breast cancers were examined for LOH of c‐met by Southern blot electrophoresis. c‐met expression was measured in a further 40 patients with breast cancer and in 8 patients with benign breast disease by flow cytometry. LOH of c‐met was detected in only 4% of informative breast cancers. Expression of c‐met was significantly greater in patients with breast cancer than in those with benign breast disease (P<0.01, Mann‐Whitney). There was no correlation however between increased c‐met expression and clinicopatho‐logical prognostic variables. These results do not support the role of c‐met as a tumour suppressor gene in breast cancer but suggest increased receptor expression in malignant breast disease. The significance of this increased expression in breast cancer is the subject of further investig

ISSN:0022-4790    

DOI:10.1002/jso.2930600206

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractMalignant pleural mesothelioma (MPM) is a generally fatal disease with no standard treatment. There are encouraging reports using intraperitoneal chemotherapy to treat peritoneal mesotheliomas and intrapleural chemotherapy (IPC) to treat malignant pleural effusions. Our objective was to evaluate the efficacy of IPC after subtotal pleurectomy. Between 1988 and 1992, 20 consecutive patients with diffuse MPM limited to one hemithorax underwent subtotal pleurectomy. Thirteen patients with biopsy‐proven MPM known prior to thoracotomy were enrolled in a phase II combined modality protocol consisting of perioperative intrapleural cisplatin (100 mg/m2) and ara‐C (1,200 mg) after subtotal pleurectomy, followed by systemic cisplatin (50 mg/m2/week × 8) and mitomycin‐C (8 mg/m2, days 1 and 36). Seven patients with MPM could not be enrolled because their diagnosis was made post‐thoracotomy. These patients underwent subtotal pleurectomy with (n = 4) or without (n = 3) adjuvant radiation (4,500–5,000 cGy in 3 patients, 2,100 cGy in 1 patient). One of three patients who developed chemotherapy‐related nephrotoxicity died, the only treatment‐related mortality. All 3 patients requiring postoperative readmission received IPC. Significant morbidity did not occur in patients not receiving chemotherapy. Median survival and time to progression were significantly longer in patients not receiving IPC (21 vs. 9 months,P =0.04; 12 vs. 6 months,P= 0.01). In conclusion, intrapleural and postoperative systemic chemotherapy resulted in significant toxicity and did not improve survival in our patients who underwent subtotal pleurectomy for MPM. © 1995

ISSN:0022-4790    

DOI:10.1002/jso.2930600207

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThe prognostic significance of c‐erbB‐2 oncogene amplification or overexpression in relation to axillary lymph node metastasis is controversial. We investigated this question in 159 cases of operable breast cancer: 56 patients with node negative disease and 103 patients with pathological involvement of axillary lymph nodes. c‐erbB‐2 overexpression was assessed by immunohistochemistry using a polyclonal antibody raised against a synthetic peptide fragment of the oncoprotein. The overall incidence of c‐erbB‐2 overexpression was 35%. c‐erbB‐2 overexpression was significantly related to survival when all patients were considered (P =0.0124), and also for patients with positive axillary lymph nodes (P= 0.0026). c‐erbB‐2 overexpression had no influence on survival of node negative patients (P =0.7972). A multivariate survival analysis using the Cox proportional hazard model revealed thatnumberof involved lymph nodes, c‐erbB‐2 overexpression, ER status, and tumour size were independently related to prognosis (P =0.0000, 0.0012, 0.0112, and 0.0204, respectively). When an interaction term was introduced in the Cox model between c‐erbB‐2 overexpression and number of involved axillary lymph nodes, a statistically highly significant interaction between these two factors was observed (P = 0.0002), suggesting that the expression of prognostic power of c‐erbB‐2 overactivity is related to the number of involved axillary lymph nodes. The 159 patients were then subdivided into three groups: node negative (‐ve) (56); 1–6 node positive ( + ve) (55); and ≥7 node +ve (48). This cutoff criterion gave the most numerically equitable distribution of the 159 patients into three groups. The relative risk of death increased stepwise from 0.86 (95% CI 0.26–2.78) for node negative patients, to 1.95 (95% CJ 0.82–63) for 1–6 node positive patients, to 2.23 (95% Cl 1.15–4.35) for>7 node positive patients. Our results suggest that the prognostic influence of c‐erbB‐2 overexpression increases arithmatically with increasing number of invo

ISSN:0022-4790    

DOI:10.1002/jso.2930600208

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractLocal application of growth factors promote wound healing and may find clinical application for use in high‐risk intestinal anastomoses such as that following anterior resection. Since viable tumour cells are present in the bowel lumen and circulation after curative colorectal cancer surgery, it is unclear what effect such factors may have on tumour recurrence. The aim of this study was to examine the effect of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) in a collagen suspension on perianastomotic tumour growth in an animal model. Significantly (P<0.05) more animals in the collagen treated groups developed anastomotic tumours. The area of tumour growth at the anastomosis was also significantly greater for the collagen (median 14.7 mm2) and collagen + EGF (median 10.8 mm2) groups compared with controls (median 0.78 mm2). We were unable to demonstrate any promotion of tumour by growth factors alone. Collagen promotes perianastomotic tumour growth in this model and is not a suitable vehicle for growth factor application in colorectal cancer surgery. © 1995 Wiley‐Liss,

ISSN:0022-4790    

DOI:10.1002/jso.2930600209

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractThis paper describes complications and patient management issues associated with hepatic arterial chemoembolization (HACE) and embolization (HAE) used to treat liver malignancies and characterizes patient survival based on histologic tumor type. We performed a retrospective review of all patients treated with HACE or HAE between January 1, 1988 and December 31, 1990. During the study period, 314 HACEs and HAEs were performed in 121 patients. Ninety‐six of the patients (79%) were treated for neoplasms metastatic to the liver. The morbidity rate following HACE and HAE in this study was 5.1%. The major complications included portal vein thrombosis, hepatic abscess, and liver failure. The treatment‐related mortality rate was 4.1%. Fever and ileus were the most common management problems following HACE or HAE. Median survival for patients with liver metastases varied according to histologic type, and median survival for patients with hepatocellular cancer was 306 days. Morbidity and mortality from HACE and HAE to treat liver tumors can be minimized by proper selection and careful management of patients. HACE or HAE alone was not curative in any of these 121 patients. An understanding of treatment‐related side effects is necessary to aid in the management of patients following HACE or HAE. © 1995 Wiley‐L

ISSN:0022-4790    

DOI:10.1002/jso.2930600210

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractRecurrent rectal or rectosigmoid cancer is a difficult therapeutic problem. A treatment program of external beam irradiation, surgery, and intraoperative irradiation has been used for 41 patients. The 5‐year actuarial local control and disease‐free survival of all 41 patients was 30% and 16%, respectively. Subset analysis demonstrated differences in outcome by extent of surgical resection. The 5‐year actuarial local control and disease‐free survival of 27 patients undergoing complete resection was 47% and 21%, respectively. By contrast, the outcome of 14 patients undergoing partial resection was poor, with a 5‐year actuarial local control and survival of 21% and 7%, respectively. Late complications included soft tissue or peripheral nerve injury, with many of these resolving within 4–18 months. Local control and disease‐free survival rates are favorable in comparison with the results achieved by aggressive surgery. Patients who achieve a gross total resection at intraoperative irradiation have a markedly better prognosis than that of patients with residual gross disease. © 1995 W

ISSN:0022-4790    

DOI:10.1002/jso.2930600211

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY