Search

Background: Whether endometriosis affects the prognosis of ovarian clear cell carcinoma (OCCC) remains controversial despite the relationship between OCCC and endometriosis. A two-center cohort study and meta-analysis were performed to investigate the effect of endometriosis on the prognosis of OCCC., Methods: The study reviewed the clinicopathologic data of 109 patients with OCCC arising (n = 47) or not arising (n = 62) in endometriosis between 1997 and 2012 at two tertiary medical centers. Tumor response and survival were compared between the two groups. For further evaluation, PubMed, EmBase, and the Cochrane Library were searched, and a meta-analysis was conducted using 10 cohort studies published from March 1996 to May 2014, including the current cohort study., Results: Complete response did not differ between the patients with OCCC arising in endometriosis and those without endometriosis (77.5 vs. 87.3 %; P = 0.444). Early-stage disease and optimal debulking surgery were the only independent factors that reduced the risk of noncomplete response (adjusted odds ratios 0.203 and 0.038; 95 % confidence intervals [CIs] 0.045-0.920 and 0.006-0.226, respectively). Progression-free survival (PFS) and overall survival (OS) did not differ between the two groups. Early-stage disease and optimal debulking surgery were the only favorable factors that improved PFS (adjusted hazard ratios [HRs] 0.216 and 0.332; 95 % CIs 0.099-0.469 and 0.150-0.732, respectively) and OS (adjusted HRs 0.099 and 0.339; 95 % CIs 0.039-0.252 and 0.141-0.815, respectively). Furthermore, crude and subgroup meta-analyses showed no effect of endometriosis on PFS or OS in OCCC patients., Conclusion: Endometriosis may not affect the tumor response or the prognosis of OCCC patients.

Background: Success factors of laparoscopic nerve-sparing radical hysterectomy (LNRH) to preserve bladder function are little known despite its widespread use. Thus, we conducted a protocol-based prospective cohort study to evaluate clinicopathologic factors for preserving autonomic nerves and its impact on duration of postoperative catheterization (DPC)., Methods: From 2012 to 2014, 30 patients with stage IB1 to IIA2 cervical cancer were recruited prospectively to undergo LNRH. All procedures were performed on the left side of the patients by one gynecologic oncologist. Extent of resection and preservation of autonomic nerves were documented in the protocol during LNRH., Results: All patients received laparoscopic type C1 radical hysterectomy, where extent of resection and preservation of autonomic nerves were not different between the right and left sides. Stage IB1 disease was associated with the reduced risk of injury of the left junctions between the hypogastric and the splanchnic nerves; between the splanchnic nerve and the vesical branch of the pelvic plexus (S-V junction) (adjusted odds ratios, 0.06 and 0.06; 95 % confidence intervals, 0.01-0.92 and 0.01-0.48); the right S-V junction with marginal significance (adjusted odds ratio, 0.18; 95 % confidence interval, 0.03-1.06). Furthermore, bilateral preservation of autonomic nerves decreased DPC significantly when compared with failure or unilateral preservation (median, 6 days vs. 34 days or 57 days; P < 0.05)., Conclusions: LNRH has a higher likelihood of its success in stage IB1 than in stage IB2 to IIA disease. Moreover, preservation of bilateral autonomic nerves reduces DPC significantly in comparison with failure or unilateral preservation.

Background: Melanoma that involves the upper gastrointestinal (GI) tract is rare and studies relating to endoscopic and pathologic findings with clinical outcomes are lacking. We reviewed the gross and microscopic patterns of the upper GI tract in primary and metastatic melanoma, and examined their association with clinical outcomes., Methods: Twenty-nine cases of primary esophageal (n = 19) and metastatic gastric and/or duodenal melanoma (n = 10) that were detected during upper GI endoscopy between 1995 and 2011 were retrospectively analyzed., Results: Three types of gross patterns were recognized-nodular pattern in 7 cases, mass-forming pattern in 18 cases, and flat pigmented pattern in 4 cases. In primary esophageal melanoma, 13 patients (68.4 %) underwent surgery and 9 received palliative therapy. Of all cases, 22 patients (75.9 %) died of disease progression; the median overall survival period was 12 months (interquartile range [IQR] 4.5-24.5 months), and from recognition of upper GI tract melanoma the median overall survival period was 9 months (IQR 3.5-17.0 months). In primary esophageal cases, skin melanoma stage better discriminated the patients with good prognosis than the esophageal cancer stage. The flat pigmented gross pattern proved to be a good prognostic factor in primary and metastatic GI tract melanomas (p = 0.016 and p = 0.046, respectively)., Conclusions: Melanoma of the GI tract is a highly aggressive disease with a poor prognosis, both in primary and metastatic cases. However, in primary esophageal melanoma, careful inspection of the mucosa during endoscopic examination followed by surgical resection may result in extended survival.

Background: Most pancreatic ductal adenocarcinomas (PDACs) metastasize even after curative resection. Our goal was to investigate the important factors affecting metastasis and overall survival (OS)., Methods: We studied 88 PDACs with R0 resection and evaluated immunohistochemical markers on tissue microarrays to assess the expression levels of the following: EGFR, amphiregulin, VEGF, p-c-met, MMP2, MMP7, MMP9, CXCR3, and CXCR4., Results: The median OS in patients who had positive versus negative expression of AREG and MMP9 were 25 versus 16 months and 24 versus 13 months, respectively (P = 0.03, P = 0.006). However, the median OS in patients with positive versus negative expression of MMP2 was 22 versus 37 months (P = 0.04). Immunoprofiles also revealed that patients with positive expression of p-c-met or VEGF had significantly shorter distant metastasis-free survival. Adjuvant treatment, postoperative decrease of CA 19-9, angiolymphatic invasion, AREG, and MMP2 were independent prognostic factors affecting OS in multivariate analysis., Conclusions: Immunoprofiles revealed the groups with unfavorable tumor biology: negative expression of AREG and positive expression of MMP2. Also, high immunoreactivity of p-c-met or VEGF seemed to be associated with early distant organ metastasis in R0 resected PDACs; however, they still need to be further investigated. These results may give us useful insights in understanding the tumor biology and the patterns of PDAC dissemination.

Background: To determine the safe criteria for less radical trachelectomy to treat patients with early-stage cervical cancer., Methods: We reviewed medical records and pathologic slides of 65 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IB1 cervical cancer. The safe criteria for less radical trachelectomy were determined by using three factors such as tumor size ≤ 1 cm, stromal invasion ≤ 5 mm, and no lymphovascular space invasion (LVSI) for minimizing parametrial involvement, lymph node metastasis (LNM), and the need of adjuvant radiotherapy. The diagnostic values were investigated by calculating specificity, negative predictive value for no parametrial involvement, no LNM, and no need of adjuvant radiotherapy., Results: The median age was 32 years (range 22-44 years), and the median duration of follow-up was 26 months (range 2-103 months). Among seven single or combined factors for the safe criteria, (1) tumor size ≤ 1 cm, (2) tumor size ≤ 1 cm and stromal invasion ≤ 5 mm, (3) tumor size ≤ 1 cm and no LVSI, (4) tumor size ≤ 1 cm, stromal invasion ≤ 5 mm, and no LVSI did not show parametrial involvement, LNM, and the need of adjuvant radiotherapy. In particular, tumor size ≤ 1 cm showed the highest specificity (28.1-29.5%) and negative predictive value (100%). In spite of no difference in progression-free survival (PFS) between tumor size ≤ 1 cm and >1 cm (P = 0.22), tumor size ≤ 1 cm showed better PFS without disease recurrence than tumor size >1 cm (2-year PFS, 100% vs. 90%)., Conclusions: Less radical trachelectomy may be safe in patients with early-stage cervical cancer who have tumor size ≤ 1 cm.

Background: Our previous study indicated that gene expression profiling of intestinal metaplasia (IM) or spasmolytic polypeptide-expressing metaplasia (SPEM) can identify useful prognostic markers of early-stage gastric cancer, and seven metaplasia biomarkers (MUC13, CDH17, OLFM4, KRT20, LGALS4, MUC5AC, and REG4) were selectively expressed in 17-50% of gastric cancer tissues. We investigated whether the combined expression of these metaplasia biomarkers could predict the prognosis of advanced stage gastric cancer., Methods: The expression of seven metaplasia biomarkers was evaluated immunohistochemically using tissue microarrays comprised of 450 gastric cancer patients. The clinicopathologic correlations and the prognostic impact were analyzed according to the expression of multiple biomarkers., Results: MUC13, CDH17, LGALS4, and REG4 were significant prognostic biomarkers in univariate analysis. No expression of four markers was found in 56 cases (14.2%); 1 marker was seen in 67 cases (17%), 2 in 106 cases (27%), 3 in 101 cases (25.7%), and 4 in 63 cases (16%). Patients in which two or fewer proteins were expressed (group B) showed younger age, undifferentiated or diffuse type cancer, larger tumor size, larger number of metastatic lymph nodes, and more advanced stage than those in which three or more proteins were expressed (group A). In undifferentiated or stage II/III gastric cancer, the prognosis of group B was significantly poorer than that of group A by multivariate analysis., Conclusions: The combined loss of expression of multiple metaplasia biomarkers is considered an independent prognostic indicator in undifferentiated or stage II/III gastric cancer.

Background: According to the AJCC/UICC TNM classification, T mesocolon invasion in AGC is classified as T2b or T3 according to the presence or the absence of serosa invasion. However, many authors have considered T mesocolon invasion in AGC as T4. This study was performed to evaluate the appropriate T stage for T mesocolon invasion in AGC., Materials and Methods: From 1996 to 2008, 90 patients underwent curative gastrectomy with T mesocolon excision at the authors' institute under the suspicion of T mesocolon invasion based on surgical findings and without pathologic invasion to any other organ. Histopathologic findings were reviewed to determine whether tumors had invaded the T mesocolon. Survival data of AGC patients registered in the SNUH database (N = 9998, from 1986 to 2007) was used as reference data for comparative purposes., Results: A total of 27 patients (30%) had proven histopathological invasion of the T mesocolon, and a significant difference in survival rates was found between these 27 and the remaining 63 (P = .012). As compared with the SNUH database population, the survival rate of T mesocolon invasion patients differed from those of T2b (P < .001) and T3 (P = .043) patients, but was similar to that of T4 patients (P = .218). Furthermore, for N1 stage patients, the survival rate differed from those of T2b (P = .001) and T3 (P = .046) patients, but was similar to that of T4 patients (P = .744)., Conclusions: The T stage of T mesocolon invasion in AGC should be revised to AJCC/UICC stage T4, because the survival rate of T mesocolon invasion AGC is lower than that of stage T2b or T3.

Background: The characteristics of invasive type-intraductal papillary mucinous neoplasm (invasive IPMN) have not been fully explored due to limited reports. Furthermore, a straightforward method is needed to describe its aggressiveness. The purpose of this study was to investigate prognostic factors and to examine the clinical significance of percentage pancreatic volume occupied by the invasive component in invasive IPMN., Methods: Of 217 patients who underwent surgical resection with a diagnosis of IPMN between 2001 and 2008, 41 had invasive IPMC. We serially sectioned pancreatic parenchyma at 5-7-mm intervals. Whole slides were reviewed by a pancreas-biliary tract special pathologist, who determined the percentage pancreatic volumes occupied by the invasive components (IC%) in whole IPMN lesions., Results: By multivariate analysis, perineural invasion, metastasis, AJCC stage, and invasive component percentage (IC%) significantly predicted prognosis. IC% was found to be significantly associated with survival. Patients with an IC% <10 had a 3-year survival rate (YSR) of 100%, whereas patients with an IC% >50% had a 3 YSR of 36.5% and those with an IC% of 10-50% had a 3 YSR of 71.4% (p = 0.041)., Conclusions: In addition to conventional prognostic factors, such as AJCC stage and perineural invasion, the percentage of pancreatic volume occupied by the invasive component (IC%) appears to be an important prognostic factor in invasive IPMN. The concept of IC% is straightforward, semiquantitative, and objective, and offers a means of determining tumor aggressiveness; hence, it could be a means of classifying invasive IPMN.

Background: Although the honeycomb microcystic type is common and typical for a serous cystic tumor (SCT), clinical and radiological features are diverse. Systematic classification of SCT subtypes is not well established. The purpose of this study was to classify the subtypes of SCT and to clarify its clinical and pathological characteristics., Methods: Clinical data from 52 patients with a pathologically confirmed SCT were prospectively collected using a standard data form. According to cyst size and multiplicity, on gross and radiological evaluation, the cysts were classified as microcystic when they were smaller than 2 cm, and macrocystic when larger than 2 cm. The microcystic tumors were subdivided into honeycomb and solid types, while the macrocystic tumors into unilocular and multilocular types based on the number of cysts., Results: There were 22 cases with microcystic SCTs that were subclassified into the honeycomb (n = 21) and solid types (n = 1), while 30 cases were macrocystic type and were subclassified into multilocular (n = 16) and unilocular types (n = 14). There were no differences between four subtypes with regard to gender, tumor location, and size. The preoperative diagnostic accuracy of the unilocular macrocystic SCT was only 35.7%, while that of honeycomb microcystic SCT and multilocular macrocystic SCT were 81% and 87.5%, respectively (P = 0.005)., Conclusion: Microcystic SCTs and multilocular macrocystic SCTs can be accurately diagnosed preoperatively; therefore conservative treatment and observation are possible in some cases. However, the unilocular macrocystic SCT is difficult to differentiate from the other pancreatic cystic tumors with malignant potential, therefore resection must be considered.