BACKGROUND AND OBJECTIVE:Prognosis of stage II colorectal cancer varies. Whether or not to perform adjuvant chemotherapy on patients with stage II colorectal cancer is controversial. This study was to explore the prognostic factors for the patients with stage II colorectal cancer and evaluate the effect and the necessity of adjuvant chemotherapy.METHODS:Between January 2000 and January 2005, 443 patients with stage II colorectal cancer receiving radical surgery at Sun Yat-sen University Cancer Center were retrospectively analyzed. The overall survival rate and survival curve were analyzed using the Kaplan-Meier method and the log-rank test. The univariate and multivariate prognostic analyses were performed by the Cox regression model. Patients with or without chemotherapy (Xelox/Folfox regimen) with high-risk factors were analyzed respectively.RESULTS:The median follow-up time was 59 months, and the 3-and 5-year survival rates were 88.4% and 82.5%, respectively. Univariate analysis showed that intestinal obstruction or perforation, diabetes mellitus, inadequate surgical margin, and the number of sampled nodes < 9 were poor prognostic factors. Patients with intestinal obstruction or perforation, the number of sampled nodes < 9 achieved higher 5-year survival (80% and 86%) undergoing adjuvant chemotherapy than those receiving surgery alone (67% and 64%).CONCLUSIONS:The prognosis of colorectal cancer patients with intestinal obstruction or perforation, diabetes mellitus, inadequate surgical margin, and the number of sampled nodes < 9 are relatively poor. Adjuvant chemotherapy is recommended to patients with intestinal obstruction, perforation or sampled nodes < 9.
第九届全国鼻咽癌会议于2009年7月31日-8月2日在昆明召开,内容涉及基础研究、流行病学研究和临床研究,其中鼻咽癌的细胞模型、临床分期、综合治疗及生存质量分析是这次会议报告的热点问题,受到全国各地鼻咽癌研究专家的关注.
BACKGROUND AND OBJECTIVE:Controlled-release oxycodone is an orally administered strong opioid analgesic for moderate to severe cancer pain. Sometimes, its oral administration has to be stopped because of continuous nausea, vomiting, conscious disturbance, or inability to swallow. This study was to investigate analgesic effect of vaginal administration of controlled-release oxycodone on cancer pain and observe adverse events to provide a new choice for female patients who can not tolerate the adverse events caused by oral administration.METHODS:Controlled-release oxycodone tablets were vaginally administered to 36 female patients with moderate to severe cancer pain. The initial dose was 10 mg every 12 h to patients who had never taken opioid analgesics; former dose continued to patients switching to vaginal route from oral route.RESULTS:Among the 36 patients, six had complete relief of cancer pain, 20 had significant relief, four had moderate relief, and four had slight relief, two had no relief. The relief rate of cancer pain was 83.3%. The mean time for onset of analgesic effect was 49 min; the mean duration of analgesic effect was 13.8 h. Main adverse event was vaginal burning sensation in nine (25.0%) patients. No patient discontinued vaginal administration because of adverse events.CONCLUSION:The vaginal administration of controlled-release oxycodone is a safe,effective and simple means of managing cancer pain in female patients who can not tolerate the adverse events caused by oral administration.
BACKGROUND AND OBJECTIVEAberrant expression of microRNAs (miRNAs) is involved in the development of breast cancer. This study was to explore differential expression of miRNAs between breast cancer cells and mammary epithelial cells, and to predict potential targets of the differentially expressed miRNAs.METHODSHuman breast cancer MCF-7 cells and normal human mammary epithelial HBL-100 cells were cultured. The total RNA was isolated and examined. The expression profiles of miRNAs in MCF-7 and HBL-100 cells were detected with a miRNA microarray chip and compared. Array results were confirmed by real-time polymerase chain reaction (PCR). Potential mRNA targets were predicted by MiRanda, TargetScan, PicTar, and DIANA-microT software.RESULTSThe purification of total RNA from MCF-7 and HBL-100 cells was relatively high. According to a microarray-based screening, 173 breast cancer-related miRNAs were identified. Of the 173 miRNAs, 113 were up-regulated and 60 were down-regulated in MCF-7 cells (P<0.01). Real-time PCR showed that mir-18a and mir-195 were highly expressed in MCF-7 cells. Sixty-eight potential target genes of mir-200b were predicted by informatics analysis.CONCLUSIONSThe miRNA expression profiles of breast cancer cells and mammary epithelial cells are obtained. Some miRNAs may be involved in the pathogenesis of breast cancer by regulating their target genes.
BACKGROUND AND OBJECTIVE:Anaplastic T-cell lymphoma in children and adolescents is an aggressive malignant non-Hodgkin's lymphoma (NHL). The optimal treatment regimen needs to be investigated. This study was to evaluate the efficacy of modified B-NHL-BFM-90 protocol on anaplastic T-cell lymphoma in children and adolescents.METHODS:From October 2002 to January 2008, 18 untreated anaplastic T-cell lymphoma patients aged less than 16 years were enrolled, and treated with modified B-NHL-BFM-90 protocol including cyclophosphamide, vincristine, ifosfamide, etoposide, adriamycin, HD-methotrexate, vindesine, dexamethasone, cytarabine/HD-cytarabine. Intrathecal injection was given every course.RESULTS:Of the 18 patients, 15 (83.3%) achieved complete remission (CR), and three (16.7%) achieved partial remission (PR). The patients were followed up for 4-68 months (median, 31 months). The 3-year event-free survival (EFS) rates were (87.4+/-8.4)% for all patients, 100% for stage II patients, and (85.1+/-9.7)% for stage III/IV patients; 100% for low risk group, (88.9+/-10.5)% for moderate risk group, and (80.0+/-17.9)% for high risk group. Most patients suffered from grade 3-4 myelosuppression and recovered after active support care. One patient with stage IV disease received autologous peripheral blood stem cell transplantation (PBSCT) after CR and was still alive. Two patients had tumor relapsed and died at three and five months after off treatment, respectively.CONCLUSIONS:Modified B-NHL-BFM-90 protocol, with tolerable toxicity, is an effective treatment regimen for anaplastic T-cell lymphoma in children and adolescents. It should be used in experienced cancer centers and hematological units.
BACKGROUND AND OBJECTIVE:For early stage breast cancer with less than four metastatic axillary lymph nodes (ALN), indications for adjuvant radiotherapy are not well defined. This study was to investigate the risk factors for postmastectomy locoregional recurrence and survival in those patients. METHODS:In total 217 patients undergoing mastectomy in Sun Yat-sen University Cancer Center between March 1998 and March 2002 were retrospectively reviewed. Seventy-one patients were at pT1 stage, and 146 cases at pT2 stage. Two hundred and two patients received adjuvant chemotherapy, 51 received radiotherapy (RT), and 116 received endocrine therapy whose estrogen receptors (ER) or progesterone receptors (PR) were positive. RESULTS:The median follow-up time for these patients was 69 months. The 5-year actuarial locoregional recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were 85.2%, 81.8%, and 90.2%, respectively. Treatment failure was found in 44 patients, among whom 21 cases were diagnosed as locoregional recurrence. The 5-year actuarial OS was significantly lowered in patients with locoregional recurrence than in those without (61.9% vs. 93.6%, P<0.0001). Age younger than 35 years, pT2 tumor, and the rate of metastatic ALN>or=30% were risk factors for poor LRFS, DFS, and OS. When a scoring system was established consisting of these three prognostic factors, the 5-year actuarial LRFS in patients with varied scores were significantly different (P=0.0072). In the subgroup of 159 patients who received adjuvant chemotherapy of not less than five cycles, 35 patients who received adjuvant RT achieved significantly better survival rates than those who did not. CONCLUSION:Age younger than 35 years, pT2 tumor, and the rate of metastatic ALN>or=30% are risk factors for locoregional recurrence and survival in patients with early stage breast cancer who have one to three positive ALN. Adjuvant RT is recommended for those patients.
BACKGROUND AND OBJECTIVE:Pneumonectomy has been long term used as the standard surgical procedure for central type non-small cell lung cancer (NSCLC). Sleeve lobectomy has been performed in a small number of patients meeting the indications. This study was to compare the 5-year survival rate, operation related complications and mortality of sleeve lobectomy with pneumonectomy for NSCLC, and evaluate sleeve lobectomy in the surgical treatment for NSCLC.METHODS:Ninety-three patients with NSCLC undergoing sleeve lobectomy (group A) and 571 patients with NSCLC undergoing pneumonectomy (group B) from January 1997 to December 2007 in Sun Yat-sen University Cancer Center were reviewed. The 5-year survival rate, operation related complications and mortality between the two groups were analyzed.RESULTS:The overall 5-year survival for group A and group B were 42.0% and 31.5%, respectively (P=0.015). In the subgroup analysis, the 5-year survival of N0 (P=0.007) and N1 (P=0.025) patients were significant higher in group A than in group B, while the survival were not significantly different between N2 patients (P=0.073). The 5-year survival rates for bronchial and pulmonary arterial sleeve resection (the subset of group A) and pneumonectomy were not significantly different (P=0.092). There was no significant difference in local recurrences between the groups (P=0.821). The postoperative complication rates were 11.8% in group A and 20.7% in group B (P=0.046). There was no statistically significant difference in mortality between the two groups (P=0.259).CONCLUSION:The operative safety and long term efficacy of sleeve lobectomy are superior to pneumonectomy for NSCLC.
BACKGROUND AND OBJECTIVE:The mechanism of tumor tissues selectively uptake the photosensitizer in photodynamic therapy (PDT) is still unclear. This study was to investigate the affinity of tumor cells to the photosensitizer photofrin-II.METHODS:Ultraviolet spectrophotometer was applied to measure the absorption spectra of various cell culture media. The fluorescence spectrum of photofrin-II was determined by spectrofluorometer. The absorption and elimination condition of photofrin-II were detected in immortalized human esophageal epithelial cell line SHEE and its malignant transformation cell line SHEEC.RESULTS:The maximum excitation wavelength of fluorescence for photofrin-II was (395.0+/-0.5) nm, and the maximum emission wavelength of that was (634.1+/-0.5) nm. The laser at the wavelength of 630 nm used in this experiment could permeate various types of cell culture media. There was no significant difference in the absorption and elimination of photofrin-II between SHEE and SHEEC at the same concentration and time. The absorption of photofrin-II in SHEE and SHEEC increased with the increase in photofrin-II concentration and duration, and reached the platform at the concentration of 30 microg/mL and a time point of 150 min, respectively. The photofrin-II contents of SHEE and SHEEC showed a slight change after 15-30 min, and diminished rapidly after 30 min.CONCLUSION:High photosensitizer concentration in tumor tissues may be not correlated with the affinity of tumor cells.
BACKGROUND AND OBJECTIVEThe efficacy of standard chemotherapy regimen on aggressive non-Hodgkin's lymphoma (NHL) of certain pathologic types is unsatisfied. This study was to evaluate the safety and efficacy of modified Hyper-CVAD regimen on Chinese patients with aggressive NHL.METHODSClinical records of 31 NHL patients who received modified Hyper-CVAD regimen in Cancer Hospital of Chinese Academy of Medical Sciences from June 2004 to June 2008 were analyzed in terms of toxicity and response.RESULTSThe 31 patients totally received 91 cycles of regimen A and 41 cycles of regimen B with a median of 4 cycles (ranged 1-7 cycles). The major toxicity was myelosuppresion: the occurrence rates of neutropenia of grades III-IV, thrombocytopenia and febrile neutropenia were 49.5%, 3.3% and 12.1% during treatment of regimen A, and were 80.5%, 82.9% and 46.3% during treatment of regimen B. No treatment-related death was observed. The responses were assessable in 26 patients. The total response rate was 80.8%, and 12 patients achieved complete response (46.2%).CONCLUSIONModified Hyper-CVAD regimen is a promising regimen for the patients with intermediate and high grade NHL.
BACKGROUND AND OBJECTIVE Modified BFM-90 regimen has significantly improved the outcome of lymphoblastic lymphoma in children and adolescents. Infection is the main side effect of this regimen, which may affect the treatment efficacy and prognosis without proper intervention. This study was to summarize the characteristics of the modified BFM-90 regimen related infection, and explore effective approaches to treat the infection. METHODS The infection rate, site, pathogen were reviewed for the infections of 104 children and adolescents suffering from lymphoblastic lymphoma at different phases of the modified BFM-90 regimen. The relationship between chemotherapy, bone marrow suppression and infection was analyzed. The value of procalcitonin (PCT) in identifying the infection type and the outcome of anti-infection treatment was evaluated. RESULTS The infection rates in reduction phases Ia, Ib and re-reduction phases IIa, IIb were 52.5%, 60.7% and 48.6%, 28.2%, respectively. The infection rate in consolidation chemotherapy for patients with low to intermediate risk and high risk were 17.2% and 100%, respectively. In total 302 infections occurred. One hundred and sixty-seven cases (55.3%) had documented infection sites, most of which happened to the respiratory tract. Ninety-five cases (31.5%) had documented pathogens, most of which were Gram-negative bacteria. Infections of 262 cases (86.8%) were secondary to bone marrow suppression. The sensitivity and specificity of PCT in diagnosing sepsis were 83.3% and 70.2%, but it failed to identify the infection type. After the anti-infection treatment, 296 cases were cured, four cases gave up further treatment due to financial difficulties, two cases died of sepsis. CONCLUSIONS Infections caused by modified BFM-90 regimen for lymphoblastic lymphoma in children and adolescents are closely correlated to bone marrow suppression. The positive diagnosis rate of the pathogen is too low to identify most of the infection type. The treatment still mainly depends on experience.
BACKGROUND AND OBJECTIVE:Gemcitabine is used as an effective drug for patients with advanced pancreatic cancer. Serum CA19-9 has been proven as the most sensitive and specific serum marker for pancreatic cancer. This study was to investigate the value of serum CA19-9 in evaluating treatment efficacy and predicting prognosis of patients with pancreatic cancer treated by gemcitabine-based chemotherapy. METHODS:Seventy-one patients with histologically confirmed, locally advanced or metastatic pancreatic adenocarcinoma, whose karnofsky's performance status (KPS) score was >or= 70 were treated with gemcitabine alone or with gemcitabine-based chemotherapy. CA19-9 was measured before and after chemotherapy. RESULTS:Ten out of 71 patients had normal baseline CA19-9 levels, and 61 patients had increased baseline CA19-9 levels. The overall survival of patients were similar between the two groups, which were 9.0 months and 7.9 months respectively (P=0.797). The median baseline CA19-9 level for patients who had increased CA19-9 was (682+/-558) U/mL before treatment. Patients whose pretreatment CA19-9 levels were <682 U/mL achieved better survival than those whose pretreatment CA19-9 levels were >or=682 U/mL (9.6 months vs. 5.1 months, p=0.001). In addition, patients with a pretreatment CA19-9 level of <682 U/mL also had a better tumor response (43.5% vs. 15.8%, p=0.051) and clinical benefit response (48.1% vs. 29.2%, P=0.125) than those whose pretreatment CA19-9 level was <682 U/mL, but the differences were not significant. Patients with a fall of >or=25% in the baseline CA19-9 level after chemotherapy achieved a longer median overall survival (10.2 months vs. 5.0 months, p<0.001), better tumor response (47.8% vs. 10.5%, p=0.002) and better clinical benefit response (69.2% vs. 8.0%, P=0.000) than those without a decrease of baseline CA19-9 or with a fall of <25%. Multivariate analysis revealed that the baseline CA19-9 level before chemotherapy, decreased percentage of the CA19-9 level after chemotherapy, and the differentiation degree of tumor cells were independent risk factors for patients whose baseline CA19-9 levels were increased. CONCLUSION:The level of pretreatment base-line CA19-9 and the decreased percentage of baseline CA19-9 level after chemotherapy are of predictive values for survival of patients with advanced pancreatic cancer undergoing gemcitabine-based chemotherapy and with an increased level of baseline CA19-9.
BACKGROUND AND OBJECTIVE Ovarian cancer is one of the most common causes of death among gynecological malignancies. This study was to investigate the prognostic factors for ovarian cancer using the Cox regression model. METHODS Data of 103 patients, initially operated at Shaanxi Tumor Hospital from 1999 to 2004, were retrospectively analyzed. All patients were operated by experienced surgeons, and underwent adjuvant chemotherapy afterwards. Follow-up lasted for 100 months. The Kaplan-Meier survival curves, long-rank test and the Cox regression model were used for analysis. RESULTS The one-, three- and five-year survival rates of patients with ovarian cancer were 87.7%, 50.8% and 31.1%, respectively. Univariate analysis and the Cox regression model showed that clinical stage, differentiation, residual tumor size and chemotherapy course were the major prognostic factors of ovarian cancer. CONCLUSION Sufficient removal of the ovarian cancer at the early stage, residual tumor of less than 2 cm in diameter and sufficient adjuvant chemotherapy after surgery could improve the survival rate of ovarian cancer.
BACKGROUND AND OBJECTIVE B7-H1, a member of B7 family, is expressed in tumor cells and has emerged as an important immune modulator capable of suppressing host immunity by inhibiting T cells function. This study was to probe into the correlation between the expression level of B7-H1 protein in pancreatic carcinoma tissues and clinicopathological characteristics and prognosis. METHODS The expression of B7-H1 was measured in 40 cases of pancreatic carcinoma tissues and 10 cases of normal corresponding paracarcinoma tissues by immunohistochemistry. The relationship between the expression level of B7-H1 and clinicopathological characteristics and survival was analyzed. RESULTS The positive rate of B7-H1 was significantly higher in the tumor tissues [45.00% (18/40)] than in the normal corresponding paracarcinoma tissues [0(0/10)] (P<0.05); moreover, B7-H1 expression was significantly associated with the staging of tumor and preoperative serum CA19-9 level (P<0.05). The multivariate cox proportional hazards regression analysis of prognostic factors for overall survival and relapse-free survival showed that the expression of B7-H1 was an independent factor for poor prognosis. CONCLUSION B7-H1 protein was expressed in human pancreatic carcinoma tissues, and was associated with the prognosis.
BACKGROUND AND OBJECTIVE Ewing's sarcoma family of tumor (ESFT) is aggressive. The optimal therapy modality for ESFT is still to be found. This study was to explore the clinical characteristics and therapy for ESFT. METHODS Ninety-two cases of ESFT were collected from January 1995 to April 2008 in Sun Yat-sen University Cancer Center and analyzed retrospectively. RESULT Of 92 cases, 23 were Ewing's sarcoma of bone, 21 extraosseous Ewing's sarcoma, 43 peripheral primitive neuroectodermal tumor, and 5 Askin tumor. Median follow-up time was 31.5 months (range, 10-137 months). Thirty-eight patients received multidisciplinary therapy and 19 single model therapy in non-metastasis group. Three-year overall survival (OS) and event-free survival (EFS) were significantly different between non-metastatic multidisciplinary therapy group and non-metastatic single model group (63% vs. 20%, 46% vs. 18%, respectively, P<0.001). The patients who received surgery plus chemotherapy and plus radiation or not had longer survival than those treated with chemotherapy plus radiation in non-metastatic multidisciplinary therapy group (Chi2=7.591, 9.212; P=0.006, 0.002). CAV/IE alternative regimen was superior to other regimens in event-free survival, but not in overall survival (Chi2=6.950, 3.530; P=0.008, 0.06). Cox regression analysis suggested therapy model and response to treatment were independent prognostic factors for ESFT. CONCLUSIONS Our studying showed multidisciplinary therapy could significantly improve non-metastatic ESFT patients' survival. Chemotherapy plus surgery and plus radiation or not were superior to chemotherapy plus radiation in local control for the non-metastatic ESFT. Therapy model and response were independent prognostic factors.
BACKGROUND AND OBJECTIVE:Sporadic Burkitt's lymphoma (sBL) is uncommon and its relation to Epstein-Barr virus (EBV) is unknown in China. This study was to investigate the clinical presentation, morphologic features, immunophenotype and EBV infection status of sBL in Guangzhou district, a prevalent area of EBV infection.METHODS:The clinical data of 21 sBL patients were reviewed. A panel of immunohistochemical staining was performed and EBV-encoded small RNAs (EBERs) in situ hybridization was applied to identify EBV infection.RESULTS:From January 2000 to October 2007, 21 cases(0.87%) of sBL were confirmed among 2416 cases of non-Hodgkin's lymphoma(NHL) in Sun Yat-sen University Cancer Center. Male to female ratio was 4.25 (17/4). The median age was 23 years. Of the 21 patients, 19 (90.48%) had lymph node(s) involvement; 16 (76.19%) had multiple sites involvement; 12 (57.14%) were at advanced stages (III/IV). The 2-year survival rate of 15 patients who received chemotherapy or resection plus chemotherapy was 56.00%. Twenty cases showed the prototypic morphology of sBL, and one was the variant of sBL with plasmacytoid differentiation. The main immunophenotype of these 21 sBLs was sIgM+/CD20+/CD10+/Bcl-6+/Bcl-2-[or Bcl-6+(>95%)/Bcl-2+(<10%)]/TdT-/Ki-67+ 100%. Of 20 detectable cases, 11 showed CD5 expression in a few (3%-20%) tumor cells. P53 was overexpressed in ten cases (47.62%). Six cases (28.57%) had EBV infection, with EBNA1 and EBERs expression, but not LMP1. There were no significant differences in morphology and immunophenotype between EBV-positive and EBV-negative cases.CONCLUSIONS:sBL is uncommon in Guangzhou district, mainly seen in boys and young men. Most patients had lymph node(s) involvement, showing similar morphology and immunophenotype as that of endemic BL. Type I EBV latent infection is associated with 28.57% of cases.
BACKGROUND AND OBJECTIVE:Clinical trials on docetaxel plus cisplatin (DDP) (TP regimen) in treating nasopharyngeal carcinoma (NPC) are still uncertain due to limited samples. This study was to compare the short-term efficacy and toxicity of induction chemotherapy with TP regimen followed by concurrent chemoradiotherapy with TP regimen versus DDP in treating locally advanced NPC. METHODS:Fifty-seven patients with stage T3-4N2-3M0 NPC diagnosed pathologically from December 2005 to December 2006 were randomized into TP group (30 patients) and DDP group (27 patients). Both groups received TP regimen as induction chemotherapy with docetaxel (70 mg/m(2)) on Day 1 and DDP (80 mg/m(2)) on Day 2, repeating every 21 days for 2 cycles. For concurrent chemotherapy, TP group were administered docetaxel (60 mg/m(2)) on Day 1 and DDP (80 mg/m(2)) on Day 2; DDP group were administered DDP (80 mg/m(2)) on Day 1. Both schedules were repeated every 21 days for 2 cycles. Linear accelerator was used as radioactive source. Irradiation field was designed with CT-simulation and conventional fractions. RESULTS:The 57 patients received 111 cycles of induction chemotherapy, and 53 of them received 103 cycles of concurrent chemotherapy; four patients ceased induction chemotherapy and three ceased concurrent chemotherapy. All patients completed radiotherapy. The major toxicity of induction chemotherapy was hematologic toxicity; the main toxicities of concurrent chemoradiotherapy were hematologic toxicity and mucositis. The occurrence rates of Grade 3-4 leucopenia and Grade 3-4 neutropenia were significantly higher in TP group than in DDP groups (p <0.05). In concurrent chemoradiotherapy, the application rate of granulocyte colony stimulating factor (G-CSF) was significantly higher in TP group than in DDP group (100% vs. 72.0%, p<0.05). After concurrent chemoradiotherapy, the complete remission (CR) rates of the nasopharynx and regional lymph nodes were 93.3% and 92.9% in TP group, and were 96.3% and 91.3% in DDP group (p>0.05). CONCLUSIONS:The short-term efficacy of induction chemotherapy with TP regimen followed by concurrent chemoradiotherapy with TP regimen on locally advanced NPC is similar to that of TP regimen followed by concurrent chemoradiotherapy with DDP. The toxicity of the former schedule is severer than that of the latter, but it is tolerable with the use of G-CSF. The long-term efficacy of induction chemotherapy with TP regimen followed by concurrent chemoradiotherapy with TP regimen need to be further studied.
BACKGROUND AND OBJECTIVECurrently, the serum immunoglobulin A against Epstein-Barr virus capsid antigen (EBV-VCA/IgA) is one of the most commonly used markers for diagnosis of nasopharyngeal carcinoma (NPC). However, its value for prognostic implication in NPC patients is unclear. This study was to evaluate the relationship between pretreatment titers of EBV-VCA/IgA and NPC patients' survival.METHODSThe clinicopathologic data of 317 NPC patients treated in Sun Yat-sen University Cancer Center between 1990 and 2003 were retrieved from the registration system of cancer incidence and mortality of Sihui city, Guangdong province. The correlation of pretreatment EBV-VCA/IgA titers to the survival of these patients was analyzed.RESULTSPretreatment VCA/IgA titer was significantly higher in stage III-IV NPC patients than in stage I-II patients (p = 0.01). The survival time was significantly shorter in the 170 patients with higher EBV-VCA/IgA titers (>or= 1:160) than in the 147 patients with lower EBV-VCA/IgA titers ( < 1:160). The 5-year survival rate was 65% in low EBV-VCA/IgA titer group and 43% in high titer group (p = 0.01). Multivariate analyses showed that clinical stage, sex, the year of treatment, and pretreatment serum EBV-VCA/IgA titer were all independent prognostic factors of NPC.CONCLUSIONPretreatment serum EBV-VCA/IgA titer may be used as an independent prognostic marker of NPC.
Poorly differentiated nasopharyngeal carcinoma (NPC) is a major malignancy in certain areas of Asia. It exists also in Africa, notably among largely Arab populations in North Africa, and in "hotspots" in East Africa among "native" Africans. This article deals with the latter, as studied and defined in depth during the 1960s and 70s by the Irish-born surgeon, Peter Clifford. Through his published works, he has influenced and helped define the field of head and neck cancer as it exists in Kenya. He also did pioneering work on the African childhood malignancy, Burkitt's lymphoma (BL). Both BL and NPC have been ultimately shown to be associated with the human herpes Epstein-Barr virus (EBV). This article is written as a tribute to Peter Clifford, focusing on his work on NPC, where he first defined the disease "hotspots" in the Kenyan Highlands, studied how best to treat the malignancy in the absence of radiotherapy, looked at possible NPC predisposing factors in the Kenyan setting, and ultimately addressed how the cancer cells interact with EBV. Peter Clifford's pioneering work was cut short by accident. Although outside East Africa he remains largely an 'unsung hero' in the field, his influence has been great. It begs to be re-addressed and reconsidered.
BACKGROUND AND OBJECTIVE:Extramammary Paget's disease (EMPD) of the scrotum with sweat gland adenocarcinoma is a rare malignant tumor. This study was to summarize the clinicopathologic characteristics of scrotum Paget's disease with underlying sweat gland adenocarcinoma, and analyze the treatment outcome.METHODS:Clinical data of six scrotum Paget's disease patients with sweat gland adenocarcinoma, treated in Sun Yat-sen University Cancer Center from 1964 to 2004, were analyzed with literature review.RESULTS:The typical manifestation of scrotum Paget's disease with sweat gland adenocarcinoma was eczematoid-like skin changes. All patients underwent primary lesion resection plus uni-inguinal lymphadenectomy, one patient underwent rectus abdominis pedicle flap transplantation. Three patients died of tumor at 15, 26, 38 months after operation, respectively. Other three patients were followed up for 48, 50, 55 months, respectively, and were alive without tumor.CONCLUSION:The primary lesion resection plus uni-inguinal lymphadenectomy is the major treatment for scrotum Paget's disease with underlying sweat gland adenocarcinoma.
