OBJECTIVE:The aim of the study was to assess the mortality and morbidity following extended anterior resection with excision of internal female genitalia combined with pre- or postoperative chemoradiotherapy in women with extensive rectal cancer. METHOD:The study included a consecutive series of 21 women with T4 adenocarcinoma of the rectum infiltrating the reproductive organs treated with curative intent between 1997 and 2003. All patients had an extended anterior sphincter preserving resection of the rectum (total mesorectal excision) and hysterectomy with or without posterior vaginal wall excision. In all patients, surgery was combined with adjuvant radiochemotherapy. Ten patients received preoperative radiotherapy (50.4 Gy) concurrently with two courses of chemotherapy [fluorouracil with folinic acid (FA)] followed by surgery within 6-8 weeks and subsequently four courses of postoperative chemotherapy. Eleven received postoperative chemoradiotherapy (50.4 Gy plus fluorouracil with FA). RESULTS:There was no postoperative mortality. Postoperative complications were observed in 57% patients (early in 14% and late in 52%). These included: anterior resection syndrome with anorectal dysfunction in 52% (requiring proximal diversion in 5%), urinary complications in 24% (complete incontinence requiring a permanent catheter in 5%). In addition, postoperative acute bleeding requiring relaparotomy, delayed wound healing caused by superficial infection, anastomotic leakage, prolonged bowel paralysis, benign rectovaginal fistula and anastomotic stricture occurred (5% each). The risk of postoperative morbidity (52%) was similar for patients with or without preoperative radiochemotherapy. CONCLUSION:Despite this aggressive therapeutic approach, most postoperative complications were transient or could be treated. Preoperative radiochemotherapy did not increase the risk of morbidity.

11024 Background: There is no definitive conclusion regarding the importance of T cell- dependent immune mechanisms and the tumor progression in breast cancer. Anti-tumor effects are mediated through the induction of CD8+ T cell response against specific antigen. The aim of the study was to assess the prognostic role of CD8 expression in patients with breast cancer. Methods: Tissue samples were obtained from 88 breast cancer patients (median age 62 years; range: 29 to 79 years). All patients presented with operable disease (AJCC stage I: n=34; 38.64%; stage II: n=29; 32.95%, stage III: n=25; 28.41%) and had ductal histology. Forty three (48.86%) women had pathologically confirmed axillary lymph node involvement. Patients were treated with surgery followed by standard adjuvant chemotherapy (n=59, 67.04%), hormonal therapy (n=57; 64.77%) and radiotherapy (n=38; 43.18%). The expression of CD8 was evaluated in tumor samples using mouse monoclonal antibody. Overall, CD8 expression was found in 84 (95.46%) tumors: in 11 (12.50%) mild, in 34 (38.64%) moderate and in 39 (44.32%) strong expression was seen. Results: Statistical analysis showed correlation (Pearson’s correlation coefficient = 0.32, p<0.05) between expression of CD8 in tumor cells and involvement of axillary lymph nodes. During 48 months of follow-up 12 patients relapsed (11 with distant metastases, 1 local reccurence). Nine of 12 women with disease recurrence (81.8%) had strong expression of CD8 in primary tumor, which was statistically significant (Pearson’s correlation coefficient = 0.31, p<0.05). Conclusions: The presence of CD8+ cells correlates with lymph node involvement and unfavourable prognosis. These results suggest that immune response has an influence on behaviour of breast cancer tumors. The analysis of tumor-infiltrating immune cells may therefore be a valuable prognostic tool and a marker of lymph node involvement. No significant financial relationships to disclose.

22166 Background: Vascular endothelial growth factor (VEGF) expression has been reported to have independent prognostic significance and is associated with inferior survival in breast cancer. Since blood biomarkers are minimally invasive, relatively easy to evaluate, and there are several reports suggesting that soluble VEGF might be potential markers of angiogenesis we investigated the differences of serum VEGF A165 in various pathological types of breast cancer and benign breast tumors. Methods: Serum VEGF A165 levels were measured preoperatively in 295 patients with breast tumors using immunohistochemical method (ELISA). Patients were divided into four groups according to histological type of breast pathology. Ductal cancer was diagnosed in 202 patients, lobular in 60, ductal carcinoma in situ (DCIS) in 10 and benign tumors in 23 women. Results: Serum VEGF A165 levels ranged from 156 pg/ml to 1,850 pg/ml. In patients with ductal cancer mean level was 640.6 pg/ml, median 553.3 pg/ml, in lobular cancer respectively 611.1pg/ml and 596.8pg/ml, in DCIS - 748.4pg/ml and 628.7pg/ml, in benign tumors 633.8pg/ml and 569.3pg/ml. Statistical analysis (T-Student test) does not show statistically significant differences between serum levels of VEGF in those four groups. Conclusions: VEGF A serum levels are similar in breast invasive cancer and non malignant tumors. Despite the VEGF role of as a key mediator of normal and pathological angiogenesis, serum VEGF levels can't be a marker of invasive cancer. We observed that in patients with DCIS VEGF A serum levels were higher than in individuals with invasive cancer or benign tumors however these differences were not statistically significant (p=0,15, and p=0,19) and the group of patients with DCIS was small. However, to elucidate this issue studies in larger patient population need to be performed. No significant financial relationships to disclose.

AIMS:To present the experiences of the Regional Comprehensive Cancer Center in Wroclaw with abdominosacral resection (ASR) carried out in low-rectal cancer patients.METHODS:Rectal cancer patients (n=294) were operated on by the same surgical team using the standardized TME technique between May 5, 1998 and February 23, 2001. Depending on the distance from the anal verge, the primary tumor was removed by means of standard abdominal resection (AR-mid- and upper-rectal cancers) or abdominosacral resection (ASR-low-rectal cancers). The patients who underwent the different operative procedures were comparable in terms of distributions of age, gender, tumor infiltration depth and regional lymph node involvement with no significant statistical difference between the groups.RESULTS:Ninety-seven cases were excluded from the analysis of survival based on exclusion criteria defined. Consequently, 197 cases were left for further analysis, including 154 patients operated on by AR and 43 who underwent ASR. AR and ASR patients did not differ significantly in terms of postoperative morbidity (11% and 14%, respectively), observed (57.1% vs. 60.4%) and relative 5-year survivals (74.3% vs. 73.2%) and the cumulative 5-year local recurrence rate (5.8% vs. 4.7%).CONCLUSION:The combined use of the modern TME technique and the "historical" abdominosacral excision of the rectum seems to give new, potentially attractive perspectives for successful surgical treatment of low-rectal cancers.

HistopathologyVolume 51, Issue 1 p. 125-127 Unfavourable prognostic significance of S100P expression in ovarian cancers P Surowiak, P Surowiak Institute of Pathology, Charité Campus Mitte, Berlin, Germany Department of Histology and Embryology, University School of Medicine Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorA Maciejczyk, A Maciejczyk Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorV Materna, V Materna Institute of Pathology, Charité Campus Mitte, Berlin, GermanySearch for more papers by this authorM Drag-Zalesińska, M Drag-Zalesińska Department of Histology and Embryology, University School of MedicineSearch for more papers by this authorA Wojnar, A Wojnar Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorM Pudelko, M Pudelko Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorW Kędzia, W Kędzia Department of Obstetrics and GynaecologySearch for more papers by this authorM Spaczyński, M Spaczyński Department of Obstetrics and GynaecologySearch for more papers by this authorM Dietel, M Dietel Institute of Pathology, Charité Campus Mitte, Berlin, GermanySearch for more papers by this authorM Zabel, M Zabel Department of Histology and Embryology, University School of Medicine Department of Histology and Embryology, University School of Medicine, Poznań, PolandSearch for more papers by this authorH Lage, H Lage Institute of Pathology, Charité Campus Mitte, Berlin, GermanySearch for more papers by this author P Surowiak, P Surowiak Institute of Pathology, Charité Campus Mitte, Berlin, Germany Department of Histology and Embryology, University School of Medicine Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorA Maciejczyk, A Maciejczyk Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorV Materna, V Materna Institute of Pathology, Charité Campus Mitte, Berlin, GermanySearch for more papers by this authorM Drag-Zalesińska, M Drag-Zalesińska Department of Histology and Embryology, University School of MedicineSearch for more papers by this authorA Wojnar, A Wojnar Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorM Pudelko, M Pudelko Lower Silesian Centre of Oncology, WrocławSearch for more papers by this authorW Kędzia, W Kędzia Department of Obstetrics and GynaecologySearch for more papers by this authorM Spaczyński, M Spaczyński Department of Obstetrics and GynaecologySearch for more papers by this authorM Dietel, M Dietel Institute of Pathology, Charité Campus Mitte, Berlin, GermanySearch for more papers by this authorM Zabel, M Zabel Department of Histology and Embryology, University School of Medicine Department of Histology and Embryology, University School of Medicine, Poznań, PolandSearch for more papers by this authorH Lage, H Lage Institute of Pathology, Charité Campus Mitte, Berlin, GermanySearch for more papers by this author First published: 31 May 2007 https://doi.org/10.1111/j.1365-2559.2007.02714.xCitations: 14Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Györffy B, Surowiak P, Kiesslich O et al. Resistance prediction profile for eleven anticancer agents at clinical concentrations based on the gene expression pattern of thirty cell lines. Int. J. Cancer 2006; 118; 1699– 1712. 2 Jiang F, Shults K, Flye L et al. S100P is selectively upregulated in tumor cell lines challenged with DNA cross-linking agents. Leuk. Res. 2005; 10; 1181– 1190. 3 Bertram J, Palfner K, Hiddemann W, Kneba M. Elevated expression of S100P, CAPL and MAGE 3 in doxorubicin-resistant cell lines: comparison of mRNA differential display reverse transcription-polymerase chain reaction and subtractive suppressive hybridization for the analysis of differential gene expression. Anicancer Drugs 1998; 9; 311– 317. 4 Arumugam T, Simeone DM, Schmidt AM, Logsdon CD. S100P stimulates cell proliferation and survival via receptor for activated glycation end products (RAGE). J. Biol. Chem. 2004; 279; 5059– 5065. 5 Surowiak P, Materna V, Denkert C et al. Significance of cyclooxygenase 2 and MDR1/P-glycoprotein coexpression in ovarian cancers. Cancer Lett. 2006; 235; 272– 280. 6 Remmele W, Stegner HE. [Recommendation for uniform definition of an immunoreactive score (IRS) for immunohistochemical estrogen receptor detection (ER-ICA) in breast cancer tissue][in German]. Pathologe 1987; 8; 138– 140. Citing Literature Volume51, Issue1July 2007Pages 125-127 ReferencesRelatedInformation

PURPOSE:To assess the prognostic significance of clinicopathological factors, especially histological parameters of new Jass classification, following sphincter-sparing total mesorectal excision (TME) for high-risk rectal cancer.MATERIAL AND METHODS:Forty-five consecutive patients treated with curative intent in 1998-1999 due to rectal cancer in Dukes stage B and C were studied prospectively. All of them underwent anterior resection with TME technique. Prognostic value was evaluated by the impact on five-year recurrence-free survival (RFS) in uni- and multivariate analysis. Only factors significant in univariate analysis entered the multivariate regression model. P value <0.05 was stated as a significance limit.RESULTS:Regarding traditional clinico-pathological factors patient age, tumor site, differentiation grade, mucinous histology and the extent of direct tumor penetration did not significantly affect survival rates. Only the lymph nodes status was associated with prognosis with statistical importance (negative vs positive, RFS: 53.8 +/- 10.0% vs 26.3 +/- 10.4%, respectively). Considering the additional parameters of Jass classification the character of invasive margin of the tumor did not reveal the important predictive value although the lymphocytic tumor infiltration was significantly related to patient outcome (presence vs absence, RFS: 63.6 +/- 15.2% vs 37.5 +/- 8.7%, respectively). In multivariate analysis the only one statistically important and independent predictive parameter was the lymph nodes status.CONCLUSIONS:Lymph nodes metastases remain the most important prognostic factor after anterior resection with TME for Dukes B and C rectal cancer. From variables included into Jass classification the absence of lymphocytic infiltration of the tumor can be helpful to identify patients with enhanced risk of oncological relapse.

Determination of oestrogen receptor alpha (ER) represents at present the most important predictive factor in breast cancers. Data of ours and of other authors suggest that promising predictive/prognostic factors may also include pS2, metallothionein (MT) and CD24. Present study aimed at determining prognostic and predictive value of immunohistochemical determination of ER, pS2, MT, and CD24 expression in sections originating from 104 patients with breast cancer. An univariate and multivariate analysis was performed. Both univariate and multivariate analyses demonstrated that cytoplasmic-membranous expression of CD24 (CD24c-m) represents a strong unfavourable prognostic factor in the entire group and in most of the subgroups of patients. In several subgroups of the patients also a prognostic value was demonstrated of elevated expression of pS2 and of membranous expression of CD24. Our studies demonstrated that all patients with good prognostic factors (higher ER and pS2 expressions, lower MT expression, CD24c-m negativity) survived total period of observation (103 months). The study documented that cytoplasmic-membranous expression of CD24 represented an extremely strong unfavourable prognostic factor in breast cancer. Examination of the entire panel of the studied proteins permitted to select a group of patients of an exceptionally good prognosis.