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Berlin Brandenburg


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  • Adenocarcinoma
Type of Medium
  • 1
    Language: English
    In: World journal of gastroenterology, 07 March 2013, Vol.19(9), pp.1424-37
    Description: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/T1b esophageal neoplasms. A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most important predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P 〈 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559), P 〈 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P 〈 0.001]. A significantly greater number of SCC patients were submitted to surgery (log-odds, ADC: -2.1206 ± 0.6249 vs SCC: 4.1356 ± 0.4038, P 〈 0.05). The odds for re-classification of tumor stage after endoscopic resection were 53% and 39% for ADC and SCC, respectively. Local tumor recurrence was best predicted by grade 3 differentiation and piecemeal resection, metachronous cancer development by the carcinoma in situ component, and lymph node positivity by lymphovascular invasion. With regard to surgically resected patients: Significant differences in patients with positive lymph nodes were observed between ADC and SCC [coefficient: 1.889569, 95%CI: (0.3945146, 3.384624), P 〈 0.01). In contrast, lymphovascular and microvascular invasion and grade 3 patients between histologic types were comparable, the respective rank order of the predictors of lymph node positivity was: Grade 3, lymphovascular invasion (L+), microvascular invasion (V+), submucosal (Sm) 3 invasion, Sm2 invasion and Sm1 invasion. Histologic type (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were Sm3 invasion and (V+). For ADC, the most important predictor was (L+). Local tumor recurrence is predicted by grade 3, metachronous cancer by the carcinoma in-situ component, and lymph node positivity by L+. T1b cancer should be treated with surgical resection.
    Keywords: Adenocarcinoma ; Controversies in Treatment ; Deep Third Submucosal Layer ; Dysplasia ; Endoscopic Gastrointestinal Surgery ; Endoscopic Gastrointestinal Surgical Procedures ; Endoscopic Resection ; Esophageal Cancer ; Lymph Node Dissection ; Lymphatic Invasion ; Middle Third Submucosal Layer ; Mucosal Infiltration ; Recurrent Tumor ; Squamous Cell Carcinoma ; Submucosal Involvement ; Submucosal Layer ; Superficial Esophageal Cancer ; Superficial Submucosal Layer ; Vascular Invasion ; Esophagoscopy ; Carcinoma -- Surgery ; Esophageal Neoplasms -- Surgery ; Esophagectomy -- Methods
    ISSN: 10079327
    E-ISSN: 2219-2840
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  • 2
    In: International Journal of Cancer, 01 July 2015, Vol.137(1), pp.230-237
    Description: Neoadjuvant multimodality treatment is frequently applied to improve the poor prognosis of locally advanced adenocarcinomas of the gastroesophageal junction. This study aimed to asses if serum microRNA profiles are useable as response indicators in this therapeutic setting. Fifty patients with locally advanced adenocarcinomas of the gastroesophageal junction were included in the study. All patients received neoadjuvant therapy and subsequently underwent surgical resection. Histomorphologic regression was defined as major histopathological response when resected specimens contained less than 10% vital residual tumor cells. Circulating RNA was isolated from pretherapeutic/post‐neoadjuvant blood serum samples. RNA from nine patients was applied to PCR microarray analyses Based on these findings possible predictive miRNA markers were validated by quantitative RT‐PCR analyses. Depending on the histomorphologic regression, a differential serum microRNA profile was identified by microarray analyses. Based on the divergent miRNA pattern, miR‐21, miR‐192, miR‐222, miR‐302c, miR‐381 and miR‐549 were selected for further validation. During neoadjuvant therapy, there was a significant increase of miR 222 and miR‐549. Although on an expanded patient cohort, the six microRNAs could not be validated as markers for therapy response, there was a significant correlation between a high miR‐192 and miR‐222 expression with a high T‐category as well as miR‐302c and miR‐222 expression significantly correlated with overall survival. Comprehensive miRNA profiling showed a differential microRNA expression pattern depending on the histomorphologic regression in the multimodality therapy of locally advanced adenocarcinomas of the gastroesophageal junction. Moreover, using single RT‐PCR analyses a prognostic impact of miR‐222 and miR‐302c was detected. What's New? Advanced esophageal cancer is increasingly treated through combinations of therapeutic approaches, including neoadjuvant therapies. But only certain subsets of patients benefit from multimodal strategies, which has created a need for tools capable of predicting patient response. Potential, non‐invasive predictive markers include miRNAs. From microarray analyses, the authors of the present study were able to identify differential serum miRNA profiles among patients with advanced esophageal adenocarcinoma who received neoadjuvant therapy. Of six miRNAs selected for validation, two were found to be of potential prognostic significance. The findings warrant further investigation of the markers in studies with larger patient populations.
    Keywords: DNA Microarrays – Analysis ; Antineoplastic Agents – Analysis ; Microrna – Analysis;
    ISSN: 0020-7136
    E-ISSN: 1097-0215
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  • 3
    Language: English
    In: The Annals of Thoracic Surgery, November 2013, Vol.96(5), pp.1840-1845
    Description: There is an increasing trend to include patients with esophageal carcinoma invading the muscularis propria (pT2) in neoadjuvant therapy regimens. But it is unclear which patients have prognostic benefit from this strategy. The aim of this study was to assess the prognosis and prognostic factors in patients with pT2 esophageal adenocarcinoma to further optimize treatment strategies. Included were patients with pT2 esophageal adenocarcinoma treated operatively at three centers specializing in upper gastrointestinal surgery. There were 159 patients (139 male) without induction therapy; median age was 64.5 years. Survival was analyzed by univariate and multivariate analysis. In 37% of patients (n = 59), no lymph node involvement (pN0) was detected. Overall 5-year survival rate for all patients was 37%; for pN0 patients it was 62%, and for patients with lymph node metastases (pN+) it was 24%. Median number of examined lymph nodes was 26. Extracapsular lymph node involvement (ELNI) was evident in 55 of 100 pN+ patients with a 5-year survival rate of 14%. Patients without ELNI had a 5-year survival rate of 36% (  = 0.041). Results were comparable in all participating hospitals. Thirty-day and 90-day mortality rates of the entire collective were 2.6% and 3.8%, respectively. Multivariate analysis of prognosis revealed the lymph node ratio ( 〈 0.001) and the pN-ELNI category (  = 0.005) as significant parameters (pN0 hazard ratio 1 [reference]; pN+ without ELNI hazard ratio 2.2, 95% confidence interval: 1.2 to 3.8); pN+ with ELNI hazard ratio 2.5, 95% confidence interval: 1.5 to 4.5). The prognosis of patients with esophageal adenocarcinoma invading the muscularis propria without lymph node metastasis is very good. However, in this study, about 30% had extracapsular lymph node involvement, which reflects particularly aggressive biological tumor behavior.
    Keywords: 7;
    ISSN: 0003-4975
    E-ISSN: 1552-6259
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  • 4
    Language: English
    In: Expert Review of Gastroenterology & Hepatology, 01 June 2011, Vol.5(3), pp.371-384
    Description: Objectives: Endoscopic local procedures are increasingly applied in patients with superficial esophageal cancer as an alternative to radical oncologic resection. The objective of this article is to determine the risk of nodal metastases in submucosal (sm) esophageal cancer, comparing the two...
    Keywords: Risk of Lymph Node Metastasis ; Sm1 ; Sm2 ; Sm3 ; Submucosal Depth of Tumor Infiltration ; Submucosal Esophageal Cancer ; Surgically Resected Specimens ; Medicine
    ISSN: 1747-4124
    E-ISSN: 1747-4132
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  • 5
    Language: English
    In: Annals of Surgical Oncology, 2013, Vol.20(7), pp.2428-2433
    ISSN: 1068-9265
    E-ISSN: 1534-4681
    Source: Springer Science & Business Media B.V.
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  • 6
    Language: English
    In: The Thoracic and cardiovascular surgeon, September 2013, Vol.61(6), pp.470-8
    Description: The aim of our study was to develop a prognostic index score for patients undergoing surgical resection for esophageal cancer that accurately determines survival with specific clinicopathological characteristics. Clinical, histological, and demographical variables of 475 patients were entered in an univariate and multivariate regression model, followed by individual calculation of the Prognostic Indicator Score and model validation via simulation. Significant variables included in the scoring system were number of positive lymph nodes, pT, pL, R, obesity, and American Society of Anesthesiologist classification. Survival probability and its associated hazard function was significantly different between the scores, with an increase of hazard ratio ranging from 2.56 (score 2) to 20 (score 6 or higher). Comparing histological cancer entities revealed statistical significance only between stage IIA versus IIB in squamous cell and stage IIIA versus IIIB in adenocarcinoma. According to our methodology, an individualized follow-up by each possible score might allow interdisciplinary selection of patients for treatments based on expected survival. This may represent a breakthrough in patient selection for currently available treatments and clinical studies.
    Keywords: Decision Support Techniques ; Esophagectomy ; Adenocarcinoma -- Surgery ; Carcinoma, Squamous Cell -- Surgery ; Esophageal Neoplasms -- Surgery
    ISSN: 01716425
    E-ISSN: 1439-1902
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  • 7
    In: Journal of Magnetic Resonance Imaging, June 2014, Vol.39(6), pp.1436-1442
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1002/jmri.24301/abstract Byline: Andre Lollert, Theodor Junginger, Carl Christoph Schimanski, Stefan Biesterfeld, Ines Gockel, Christoph Duber, Katja Oberholzer Purpose To evaluate correlations between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and clinicopathologic data as well as immunostaining of the markers of angiogenesis epidermal growth factor receptor (EGFR) and CXC-motif chemokine receptor 4 (CXCR4) in patients with rectal cancer. Materials and Methods Presurgical DCE-MRI was performed in 41 patients according to a standardized protocol. Two quantitative parameters (k.sub.21, A) were derived from a pharmacokinetic two-compartment model, and one semiquantitative parameter (TTP) was assessed. Standardized surgery and histopathologic examinations were performed in all patients. Immunostaining for EGFR and CXCR4 was performed and evaluated with a standardized scoring system. Results DCE-MRI parameter A correlated significantly with the N category (P = 0.048) and k.sub.21 with the occurrence of synchronous and metachronous distant metastases (P = 0.029). A trend was shown toward a correlation between k.sub.21 and EGFR expression (P = 0.107). A significant correlation was found between DCE-MRI parameter TTP and the expression of EGFR (P = 0.044). DCE-MRI data did not correlate with CXCR4 expression. Conclusion DCE-MRI is a noninvasive method which can characterize microcirculation in rectal cancer and correlates with EGFR expression. Given the relationship between the dynamic parameters and the clinicopathologic data, DCE-MRI data may constitute a prognostic indicator for lymph node and distant metastases in patients with rectal cancer. J. Magn. Reson. Imaging 2014;39:1436-1442. [c] 2013 Wiley Periodicals, Inc.
    Keywords: Rectal Cancer ; Dce‐Mri ; Tumor Microcirculation ; Egfr ; Cxcr4 ; Prognosis ; Histopathology ; Immunohistochemistry
    ISSN: 1053-1807
    E-ISSN: 1522-2586
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  • 8
    Language: English
    In: Anticancer research, August 2012, Vol.32(8), pp.3153-9
    Description: The expression of the human homologue of Drosophila tumour suppressor gene lgl (HUGL-1) in pancreatic cancer was retrospectively assessed in 97 patients with surgically treated pancreatic cancer in order to correlate the HUGL-1 profile with patients' survival. Immunohistochemistry was performed on 4-μm-thick paraffin sections from representative tumour blocks using a standard protocol. The expression of HUGL-1 was evaluated semiquantitatively as negative (0), weak (1), medium (2) or strong (3). The results were correlated with clinicopathological parameters and with patients' survival, considering an observation period of 17 (mean) ± 16 (SD) months. In normal and inflammatory tissue, a uniform and relatively strong staining was observed in ductal epithelium, ganglion cells and some acinar epithelia. The endocrine islets exhibited a weak positivity. Human pancreatic cancer revealed variable intensities of HUGL-1 expression. A total of 69 tumour specimens were classified as negative and 28 as positive. The HUGL-1 expression was not correlated with clinical variables (age, gender), staging or tumour grading. HUGL-1 positivity proved to be prognostically favourable (p=0.0241) conferring a higher survival rate, especially for patients who had survived more than 12 months. The presence of distant metastases (M1) at diagnosis had a weak significant influence on survival (p=0.0474). The other staging parameters (T, N, UICC stage), tumour grading and clinical variables (age, gender) gave no significant prognostic information. In a multivariate Cox model, only HUGL-1 expression passed the entry limits. Preservation of HUGL-1 expression in pancreatic adenocarcinoma is a good prognostic factor that contributes to a better overall survival.
    Keywords: Adenocarcinoma -- Pathology ; Cytoskeletal Proteins -- Genetics ; Pancreatic Neoplasms -- Pathology
    E-ISSN: 1791-7530
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 9
    Language: English
    In: The American surgeon, February 2012, Vol.78(2), pp.195-206
    Description: The objective of this study was to establish a prediction model of lymph node status in T1b esophageal carcinoma and define the best squamous and adenocarcinoma predictors. The literature lacks a satisfactory level of evidence of T1b esophageal cancer management. We performed an analysis pooling the effects of outcomes of 2098 patients enrolled into 37 retrospective studies using "neural networks" as data mining techniques. The percentages for lymph node, lymphatic (L+), and vascular (V+) invasion in Sm1 esophageal cancers were 24, 46, and 20 per cent, respectively. The same parameters apply to Sm2 with 34, 63, and 38 per cent as opposed to Sm3 with 51, 69, and 47 per cent. The respective number of patients with well, moderate, and poor histologic differentiation totaled 267, 752, and 582. The rank order of the predictors of lymph node positivity was, respectively: Grade III, (L+), (V+), Sm3 invasion, Sm2 invasion, and Sm1 invasion. Histologic-type squamous and adenocarcinoma (ADC/SCC) was not included in the model. The best predictors for SCC lymph node positivity were sm3 invasion and (V+). As concerns ADC, the most important predictor was (L+). Submucosal esophageal cancer should be managed with surgical resection. However, this is subject to the histologic type and presence of specific predictors that could well alter the perspective of multimodality management.
    Keywords: Disease Management ; Neural Networks (Computer) ; Adenocarcinoma -- Secondary ; Carcinoma, Squamous Cell -- Secondary ; Esophageal Neoplasms -- Pathology
    ISSN: 00031348
    E-ISSN: 1555-9823
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  • 10
    Language: English
    In: Journal of Cancer Research and Clinical Oncology, 2013, Vol.139(11), pp.1961-1962
    Description: BACKGROUNDCytoreductive surgery (CS) combined with intraperitoneal chemotherapy (IPC) is a multimodal approach to the treatment of peritoneal metastases (PM) of lower gastrointestinal origin. This study examines patient outcomes and critically evaluates its patterns of recurrences relative to the site of metastatic origin. METHODSPatients treated with CS/IPC from 2000 to 2012 where PM arose from a primary tumour of the appendix, colon and rectum were identified from a prospective database for retrospective evaluation. The primary endpoints were survival (overall and disease-free), and secondary end points include patterns of recurrence and prognostic factors associated with overall outcomes. RESULTSTwo hundred and eleven patients were followed up for a median of 23.3 months (range 1–156). Overall median survival was 46.8 months, and the 1-, 3-, 5-year survival rates were 87, 56 and 42 %, respectively. The 5-year survival of patients with appendiceal, colonic and rectal PM was 55, 33 and 20 %, respectively. Tumour origin was the only independent prognostic factor associated with overall survival (p = 0.03). Recurrences were more common in patients of colorectal origin over appendiceal origin (p\0.001) and were more likely to be of a systemic nature (p = 0.05). CONCLUSIONCS/IPC provides an option for improved survival in patients with PM of lower gastrointestinal origin and appears to be most promising in patients with disease of appendiceal origin.
    Keywords: Adenocarcinoma–Drug Therapy ; Aged–Pathology ; Appendiceal Neoplasms–Surgery ; Colonic Neoplasms–Drug Therapy ; Combined Modality Therapy–Pathology ; Disease-Free Survival–Surgery ; Female–Drug Therapy ; Humans–Pathology ; Intestinal Neoplasms–Surgery ; Male–Drug Therapy ; Middle Aged–Pathology ; Peritoneal Neoplasms–Surgery ; Rectal Neoplasms–Therapy ; Retrospective Studies–Drug Therapy ; Survival Rate–Secondary ; Survival Rate–Surgery ; Survival Rate–Therapy ; Survival Rate–Drug Therapy ; Survival Rate–Pathology ; Survival Rate–Surgery;
    ISSN: 0171-5216
    E-ISSN: 1432-1335
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