IMpassion132 double-blind randomised phase III trial of chemotherapy with or without atezolizumab for early relapsing unresectable locally advanced or metastatic triple-negative breast cancer.

BACKGROUND: Immune checkpoint inhibitors improve the efficacy of first-line chemotherapy for patients with programmed death-ligand 1 (PD-L1)-positive unresectable locally advanced/metastatic triple-negative breast cancer (aTNBC), but randomised data in rapidly relapsing aTNBC are scarce. PATIENTS AND METHODS: IMpassion132 (NCT03371017) enrolled patients with aTNBC relapsing <12 months after last chemotherapy dose (anthracycline and taxane required) or surgery for early TNBC. PD-L1 status was centrally assessed using SP142 before randomisation. Initially patients were enrolled irrespective of PD-L1 status. From August 2019, enrolment was restricted to PD-L1-positive (tumour immune cell ≥1%) aTNBC. Patients were randomised 1:1 to placebo or atezolizumab 1200 mg every 21 days with investigator-selected chemotherapy until disease progression or unacceptable toxicity. Stratification factors were chemotherapy regimen (carboplatin plus gemcitabine or capecitabine monotherapy), visceral (lung and/or liver) metastases and (initially) PD-L1 status. The primary endpoint was overall survival (OS), tested hierarchically in patients with PD-L1-positive tumours and then, if positive, in the modified intent-to-treat (mITT) population (all-comer patients randomised pre-August 2019). Secondary endpoints included progression-free survival (PFS), objective response rate (ORR) and safety. RESULTS: Among 354 patients with rapidly relapsing PD-L1-positive aTNBC, 68% had a disease-free interval of <6 months and 73% received carboplatin/gemcitabine. The OS hazard ratio was 0.93 (95% confidence interval 0.73-1.20, P = 0.59; median 11.2 months with placebo versus 12.1 months with atezolizumab). mITT and subgroup results were consistent. Median PFS was 4 months across treatment arms and populations. ORRs were 28% with placebo versus 40% with atezolizumab. Adverse events (predominantly haematological) were similar between arms and as expected with atezolizumab plus carboplatin/gemcitabine or capecitabine following recent chemotherapy exposure. CONCLUSIONS: OS, which is dismal in patients with TNBC relapsing within <12 months, was not improved by adding atezolizumab to chemotherapy. A biology-based definition of intrinsic resistance to immunotherapy in aTNBC is urgently needed to develop novel therapies for these patients in next-generation clinical trials.

Evaluation of orbital arteries with colour Doppler ultrasonography in patients with psoriasis.

AIM: To evaluate the blood flow in arteries of the orbit in patients with psoriasis. METHODS: In total, 30 patients with psoriasis and 30 healthy control subjects were recruited to the study. Standard ophthalmic evaluation, fundus examination and retrobulbar colour Doppler ultrasonography assessment were performed. The ophthalmic, posterior ciliary and central arteries were evaluated, and peak systolic blood flow velocity, end diastolic velocity, resistance index and pulsatility index were measured. Results of the measurements were compared between the two study groups. RESULTS: There were significant differences in blood flow parameters of the orbital arteries between the psoriasis group and the control group. CONCLUSIONS: The haemodynamics of the orbit might be affected in patients with psoriasis.

Variations of the celiac trunk and hepatic arteries: a study with 64-detector computed tomographic angiography.

OBJECTIVES: The aim of the present study was to evaluate variations in celiac trunk and hepatic artery with multi-detector computed tomography (MDCT). PATIENTS AND METHODS: Totally 820 patients who underwent angiography of the abdominal aorta were evaluated. Anatomical findings were grouped according to the Michels classification. RESULTS: Several variations and/or anomalies were noted in 33.2% of the patients (n=272). The most common abnormality was Michels type III (10.1%), followed by type V (7.3%), type II (4.7%) and others. Type X was not observed in our series. We have noted additional, previously unclassified variations in 12 cases (1.5%). CONCLUSIONS: Preoperative knowledge of variant anatomy may assist in the selection of treatment options and surgical planning, which in turn facilitates surgical dissection and helps avoiding iatrogenic injury. MDCT angiography allows detailed visualization of the vascular anatomy.

Impact of systemic inflammatory markers in patients with ALK-positive non-small cell lung cancer treated with crizotinib.

OBJECTIVES: To evaluate the prognostic utility of inflammation-based prognostic scores in patients with ALK-positive metastatic or non-resectable non-small-cell lung cancer (NSCLC) treated with crizotinib. PATIENTS AND METHODS: A total of 82 patients with ALK-positive metastatic or non-resectable NSCLC who received ALK TKI crizotinib were included. Pre-treatment modified Glasgow prognostic score (mGPS), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated. Multivariable logistic regression and Cox proportional hazards models were used to assess the impact of pretreatment mGPS, PNI, and SII on overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). RESULTS: The ORR was 77.2%, while 1-year OS and PFS rates were 95.0% and 93.5%, respectively. The univariate analysis revealed significantly higher 1-year PFS (89.4 vs. 64.4%, p=0.043) and OS (92.0 vs. 83.3%, p=0.01) rates in patients with low (<934.7) vs. high (≥934.7) SII scores. Multivariate analysis revealed that PNI ≥0.09 was a significant determinant of poorer 1-year OS rates (hazard ratio [HR]: 2.46, 95% confidence interval [CI] 0.88-4.85, p=0.035). No significant difference was observed in survival rates according to gender, age, smoking status, prior lines of therapy, or mGPS scores, while higher mGPS scores (odds ratio [OR]: 0.1, 95%CI 0.16-1.04; p=0.009) and higher PNI scores (OR: 0.16, 95% CI 0.02-0.55; p=0.035) were associated with poorer ORR. CONCLUSION: Our findings indicate the prognostic significance of PNI and SII in terms of survival outcome and the impact of mGPS and PNI on treatment response in patients with ALK-positive NSCLC treated with crizotinib.

Gemcitabine and cisplatin combination chemotherapy in triple negative metastatic breast cancer previously treated with a taxane/anthracycline chemotherapy; multicenter experience.

This study was aimed to establish clinical efficacy and tolerability of gemcitabine and cisplatin combination in patients with metastatic triple negative breast cancer progressing after anthracycline and taxane based chemotherapies.Thirty-three patients who were given cisplatin and gemcitabine for triple negative and metastatic breast cancer were evaluated retrospectively. A total of 141 cycles were administered with a median 4 cycles per patient. Median follow-up time was 14 months (range, 2-36 months). Objective response rate was 27.3%. Total clinical benefit of the combination was 48.4%. The estimated median progression free survival and median overall survival were 5 months and 14 months, respectively. The most common Grade 3 and 4 toxicity were neutropenia and thrombocytopenia observed in 10 (27.7%) and 9 (24.9%) patients, respectively. The combination of the gemcitabine and cisplatin after taxane/anthracycline is well tolerated and seems to be effective with acceptable toxicity profile.

Promising therapeutic options in triple-negative breast cancer.

Triple-negative breast cancer (TNBC) has a greater risk of recurrence despite more aggressive therapy even in lowrisk category. TNBC is high grade, hormone receptor and HER-2 negative, it exhibits a high level of Ki-67 staining and expresses the epithelial growth factor receptor (EGFR). Because of its expression profile, treatment options are limited to cytotoxic chemotherapy. Molecular defects that give rise to BRCA1-associated breast cancer also occur in TNBC. Thus, the combination of poly-(ADP-ribose)-polymerase (PARP) inhibitors with drugs that cause DNA breakages, such as alkylating agents and topoisomerase I inhibitors, could theoretically potentiate the efficacy of each drug in patients with TNBC. Clinical trials with various targeted approaches alone or in combination with different chemotherapeutic agents are currently underway. In this review, current and future treatment approaches in TNBC with novel targeted agents are discussed.

The prevalence and significance of autoantibodies in patients with non-Hodgkin's lymphoma: are they correlated with clinicopathological features?

PURPOSE: It is well known that an association exists between the pathogenesis of lymphomas and autoimmune diseases. Autoantibodies are detected at higher frequency in lymphoproliferative diseases, but neither the precise role of the immune system nor the cause of this is comprehensively understood. In this study we evaluated the presence and significance of some autoantibodies for patients with non- Hodgkin's lymphoma (NHL). METHODS: 150 patients with NHL who had either newly diagnosed disease, or active disease being under chemotherapy or were disease-free during follow-up, were analyzed. The frequency of autoantibodies and the relationship between autoantibodies and several clinicopathological factors were evaluated. RESULTS: The majority of the patients (50%) had diffuse large B-cell lymphoma (DLBCL). Thirty-two patients (21.4%) were newly diagnosed, 81 (54%) had active disease and were receiving chemotherapy and 37 (24.6%) were disease-free and followed-up. Fifty-one patients (34%) had stage IV disease. Antinuclear antibodies (ANA) were found in 7 (4.7%) patients, perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) in 10 (6.7%), anti dsDNA in 1 (0.7%), anti ssDNA in 16 (10.7%), anti Jo-1 in 3 (2%), anti-scleroderma antibody (anti Scl-70) in 4 (2.7%), and rheumatoid factor (RF) in 85 (56.7%) patients. No c7horbar;ANCA positivity was found. The mean levels of anti Jo-1 (p=0.028), anti ssDNA (p=0.014), c-ANCA (p=0.015), ANA (p=0.026) and RF (p=0.046) were significantly higher in cases with DLBCL compared to patients with non-DLBCL. In addition, in patients with newly diagnosed NHL the mean levels of anti Scl- 70 (p=0.023), anti Jo-1 (p7equals;0.017), and RF (p=0.046) were significantly higher than the other patient groups. No significant correlation was detected between the presence of autoantibodies and other clinicopathological factors. CONCLUSION: Our results show that the frequency of autoantibodies is high in NHL patients, especially in DLBCL and newly diagnosed cases. Autoantibodies may be helpful for the diagnosis of autoimmune diseases, but regular and long follow-up is needed in NHL patients with high levels of autoantibodies.

Evaluation of pulmonary vein variations in the middle pulmonary lobe with 64-slice multidetector computed tomography.

PURPOSE: To evaluate the multi detector computed tomographic (CT) depiction of middle lobe vein variation of the right pulmonary vein and create a diagram for cardiologist and cardiovascular surgeons. MATERIALS AND METHODS: According to hospital records, between January 2009 and April 2010, 314 consecutive patients underwent pulmonary CT angiography (CTPA) and coronary CT angiography. The CT films from these patients were retrospectively analyzed. RESULTS: Under normal conditions, the middle pulmonary vein (MPV) drains into the left atrium either by the "direct" or "indirect" route. Direct (37 patients, 11.8%) drainage means that the MPV does not drain into the upper or lower pulmonary veins but instead drains directly into the right pulmonary vein system. In contrast, indirect (276 patients, 87.9%) drainage occurs when the MPV drains into the upper or lower pulmonary veins. In this study, 12 different variations in drainage patterns were found. CONCLUSION: Increasing the number of patients may have led to the identification of additional variants. However, clinically important variations are rarely seen. Correct mapping of the MPV is very important for cardiologists and for surgeons in order to provide the best treatment and avoid complications.

A retrospective analysis of women's chances to become pregnant after completion of chemotherapy: a single center experience.

PURPOSE: With the improvement in anticancer therapies, the survival of women with malignancies has increased and infertility may affect the quality of life of premenopausal women, who experience temporary or permanent amenorrhea due to chemotherapy. The aim of this study was to review the rate of pregnancies among women with malignancy previously treated with chemotherapy. METHODS: We retrospectively recorded 317 women younger than 40 years of age who were treated with chemotherapy (and a number of them with additional radiotherapy/RT) due to several malignancies between 2007-2010. The patients who got pregnant after stopping chemotherapy and during followup were analyzed. RESULTS: Among women with breast cancer (n=116), malignant lymphoma (n=85), ovarian cancer (n=26) and colon cancer (n=90), 20 got pregnant after a median 22.9 months (range 10.7-96.5) from the end of chemotherapy. Childbearing was uneventful and newborns were healthy. CONCLUSION: Women who had previously received chemotherapy for malignancy can get pregnant and deliver healthy newborns.

Is there any correlation among adiponectin levels in serum, tumor tissue and normal tissue of the same patients wih breast cancer?

PURPOSE: Adiponectin is secreted from adipose tissue and is characterized by hyperinsulinemia which is related with obesity. Although serum adiponectin levels in patients with breast cancer have been studied previously, adiponectin levels in the serum, tumor and normal tissue of the same patients have not been simultaneously investigated. The aim of this study was thus to evaluate the relationship among serum, tumor and normal tissue adiponectin levels in patients with breast cancer. METHODS: Fifty-three patients with breast cancer who were operated at the Dr. Lutfi Kirdar Kartal Education and Research Hospital, Department of Surgery, between February 2008 and June 2008, were analyzed. Their serum adiponectin levels, tumor tissue and normal breast tissue adiponectin levels were compared. The correlation between postoperative histopathological parameters, insulin resistance parameters and adiponectin levels was also examined. RESULTS: The mean adiponectin levels in tumor tissue, normal breast tissue and serum were 56 ± 9.6 ng/ml, 56 ± 10 ng/ml and 43.5 ± 3.1 ng/ml, respectively. The serum adiponectin levels were inversely correlated with tumor tissue adiponectin levels (p=0.001, r=-0.43). When tumor tissue adiponectin levels were increased, serum adiponectin levels were decreased. O n the other hand, there was a positive correlation between normal breast tissue adiponectin levels and tumor tissue adiponectin levels (p=0.0001, r= 0.850). The tumor tissue adiponectin level was inversely correlated with tumor stage (p=0.037 , r= -0.29). Moreover, in early-stage and low grade tumors, both tumor tissue and normal tissue adiponectin levels were high compared with those of advanced stage or high grade tumors (p=0.027, r= -0.32 and p=0.004, r= -0.408, respectively). In the subgroup analyses, no significant relationship was found between insulin resistance parameters and adiponectin levels (p>0.05). CONCLUSION: Our results indicate that serum adiponectin levels were inversely correlated with tumor tissue adiponectin levels, but no relationship between normal breast tissue and tumor tissue adiponectin levels was demonstrated. Adiponectin levels in breast tumor tissue increase while serum adiponectin levels decrease. Adiponectin might play an important role in the prevention of tumor progression by decreasing tissue neovascularization.

Tissue leptin levels in patients with breast cancer.

PURPOSE: High leptin serum levels, overexpression of leptin and its two main receptor isoforms, OBR-L and OBR-S, have been documented in breast cancer patients. In the present study, the relationship between tissue leptin levels and breast cancer was evaluated. METHODS: Thirty-three normal breast tissue samples and 33 breast cancer tissue samples from 33 patients with breast cancer were evaluated. The association of tissue leptin levels and important prognostic factors related to breast cancer was analyzed. RESULTS: Mean tissue leptin levels in breast cancer tissue samples (5.02 + or - 1.06 pg/ml) were significantly higher than those found in normal breast tissue (2.02 + or - 0.83 pg/ml; p=0.01). No correlation was found in tissue leptin levels and menopausal status, hormone receptor and HER-2/neu status, lymph node involvement, and histopathologic features. CONCLUSION: High leptin levels were significantly higher in breast cancer tissue compared with normal tissue. No special correlation was found between tissue leptin levels and different clinicopathological characteristics.

Is there a cut-off value for standardized uptake values in positron emission tomography for predicting response to treatment and survival in patients with advanced non-small cell lung cancer? Single center experience.

PURPOSE: Positron emission tomography (PET) is an important imaging technique for the diagnosis and staging of patients with non-small cell lung cancer (NSCLC). In this study, we evaluated the standardized uptake values (SUV) of PET in NSCLC patients to determine whether there was a cut-off value for predicting response to treatment and survival. METHODS: We retrospectively analyzed 149 patients with locally advanced NSCLC. All the patients were staged by PET-computerized tomography (CT) after diagnosis. 18fluoro-2-deoxyribose (FDG) was used as the PET tracer. Univariate and multivariate analyses were performed to detect whether any prognostic factors were related to response to treatment. RESULTS: The median patient age was 60 years and the median follow-up time 10.3 months. One-year progression-free survival (PFS) and overall survival (OS) rates were 31% and 58.7%, respectively. The median OS was 15.4 months. Stage, sex and response to treatment were important factors for OS and PFS. We defined a cut-off value for SUVmax (the highest standardized uptake value for all cross sectional areas) as 10.8 by using ROC analysis. Multivariate analysis identified response to treatment as the most significant (p<0.05) prognostic factor for OS. Logistic regression analysis showed that SUVmax and weight loss were important for response to treatment. CONCLUSION: Multivariate analysis indicated that whilst response to treatment was an important factor for predicting survival, the SUVmax was also significant for determining response to therapy and a cut-off value for SUVmax was defined as 10.8.

Primary peritoneal spindle cell sarcoma presented with massive ascites: a case report.

Soft tissue sarcomas (STSs) are a heterogeneous group of rare neoplasms originating from the embryonic mesoderm and mesenchymal cells. Primary peritoneal sarcomas have been reported as leiomyosarcoma, liposarcoma and carcinosarcoma. However, primary peritoneal spindle cell sarcoma has never been reported in the literature. Herein, we report on a 38-year-old woman with massive ascites diagnosed as primary peritoneal spindle cell sarcoma. Following doxorubicin and ifosfamide chemotherapy, her symptoms improved and ascites regressed. Other primary peritoneal sarcomas rarely cause massive ascites. We suggest that in patients presenting with massive exudative ascites associated with malignancy, primary peritoneal sarcomas should be also considered in the differential diagnosis.

Pertuzumab, trastuzumab and taxane-based treatment for visceral organ metastatic, trastuzumab-naïve breast cancer: real-life practice outcomes.

PURPOSE: In this study, we aimed to describe the real-life practice outcomes of pertuzumab-trastuzumab-taxane (PTT) combination in visceral organ metastatic, trastuzumab-naive breast cancer (BC) patients. METHODS: This study was conducted by Turkish Oncology Group and included 317 patients' data from 36 centers. RESULTS: Median age was 51 (22-82). Median PFS was 28.5 months, while median OS was 40.3 months. Patients with brain metastases (n: 13, 4.1%) had worse PFS (16.8 m vs. 28.5 m; p = 0.002) and OS (26.7 m vs. 40.3 m; p = 0.009). Patients older than 65 years of age (n: 42, 13.2%) had significantly lower OS results (19.8 m vs. 40.3 m; p = 0.01). Two hundred sixty-eight patients (86.7%) received docetaxel while 37 patients (11.7%) received paclitaxel. PFS and OS were similar between taxane groups. In eight patients (2.5%), 5-40% ejection fraction decrement from baseline was detected without any clinical sign of heart failure. CONCLUSIONS: Our RLP trial included only visceral metastatic, trastuzumab-naïve BC patients including cases with brain involvement who received PTT combination in the first-line treatment. Regardless of negative prognostic characteristics, our results are in parallel with pivotal trial. Further strategies for brain metastasis should be developed to improve outcomes despite encouraging results with PTT treatment. Taxane selection can be personalized and endocrine maintenance may further improve outcomes after taxanes were discontinued. To our knowledge, this is the largest scale real-life clinical practice study of pertuzumab-trastuzumab-taxane therapy to date.

Determining predominating histologic component in malignant mixed müllerian tumors: is it worth it?

Malignant mixed müllerian tumors (MMMT) are highly aggressive tumors, usually diagnosed in advanced stage. Cases of MMMT derive from either ovary or uterus. In our study, we investigated the role of carcinomatous and sarcomatous component on response to chemotherapy and disease outcome. We retrospectively analyzed 25 patients with MMMT who were treated in our outpatient clinic from 1998 to 2003. All the paraffin specimens were reevaluated according to the histopathologic features (primary site and percentages of carcinomatous and sarcomatous component) and the effect of predominant histologic type on response to treatment. Primary tumor sites were ovary and endometrium in 36% and 64% of patients, respectively. Ten of 25 patients (40%) were treated with a combination chemotherapy regimen of cisplatin-ifosfamide (PI) and 7 patients (28%) were treated with paclitaxel-carboplatin (PC) protocol. Despite chemotherapy, 17.6% of patients had progressive disease. The remaining 13 patients (54.2%) responded to chemotherapy. Response rates of patients treated with PC (100%) were remarkably higher than the response rates of patients treated with PI (66.6%). Moreover, patients with predominating carcinomatous component had a higher response rate (87.5%) than patients with predominating sarcomatous component (66.6%). MMMT are highly chemoresponsive tumors, irrespective of primary site. One of the best predictors to response is the histologic pattern. Predominating histopathologic feature (carcinoma or sarcoma) should be taken into consideration in predicting the response and planning the chemotherapy regimen.

Cutaneous anthrax in Eastern Turkey: a review of 85 cases.

BACKGROUND: Anthrax is a zoonotic disease diminishing worldwide. Although a very rare disease in developed countries, anthrax is still endemic in developing countries. AIM: To evaluate the clinical history and features, treatment and outcome of our patients with anthrax and emphasize the importance of the disease in our region. METHOD: In this study, the records of all patients diagnosed with cutaneous anthrax admitted to Yüzüncü Yil University Medical Faculty between March 2002 and March 2007, were reviewed, and data on age, gender, occupation, clinical symptoms and findings, location and type of lesions, clinical history, laboratory findings, treatment and outcome were recorded. RESULTS: There were 85 patients [46 (54.1%) male, 39 (45.9%) female; mean age 30.6 years, range 6-72]. All the patients had a history of contact with infected animals or animal products. The infectious agent was found using direct examination of Gram-stained smears from 17 patients (20%), and Bacillus anthracis was isolated from vesicle fluid cultures from 11 patients (12.9%). Diagnosis was based on clinical findings in the remaining 57 patients (67.1%). All patients, except for two with respiratory tract obstruction, made a full recovery. CONCLUSION: Anthrax continues to be an endemic disease in Turkey, and should be considered in patients with a relevant contact history having a painless ulcer and vesicular skin lesions surrounded by a zone of oedema. Gram staining and simple culture methods are useful aids to diagnosis, but diagnosis may have to be based on clinical grounds in the majority of patients.

The importance of paraoxonase 1 activity, nitric oxide and lipid peroxidation in hepatosteatosis.

This study evaluated the changes in oxidative status in hepatosteatosis patients in terms of lipid peroxidation, nitric oxide (NO) and paraoxonase 1 (PON1) activity. A total of 49 patients with hepatosteatosis (29 males and 20 females, mean age 47.2 +/- 3.6 years) and 25 healthy subjects (15 males and 10 females, mean age 46.1 +/- 3.2 years) were enrolled in the study. Serum PON1 was measured spectrophotometrically, malondialdehyde (MDA), an end-product of lipid peroxidation, was determined using the thiobarbituric acid method, and NO was assessed using the Griess reaction. Lipid and other biochemical parameters were determined by routine laboratory methods. PON1 activity and NO levels were significantly decreased and MDA levels significantly increased in hepatosteatosis patients compared with healthy subjects. PON1 activity was correlated with MDA level and NO level. In conclusion, oxidative stress seems significantly to suppress PON1 synthesis in hepatosteatosis patients. In addition, oxidative stress and oxidant-antioxidant imbalance may be part of the cytotoxic mechanisms leading to liver cell injury.

Brain MRI and MR Spectroscopy Findings in Children with Nutritional Vitamin B12 Deficiency.

INTRODUCTION: Our aim in this study was to analyze the findings of brain magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of children with vitamin B12 deficiency. METHODS: This study included 14 cases. The findings of brain MRI and MRS in all cases were investigated. Four patients had been followed up and mean follow-up time 71.8 (59-85) day. RESULTS: Eight patients of the cases (57 %) had at least one abnormal MRI finding. The most commonly found MRI findings were thinning of the corpus callosum and brain atrophy, respectively. The mean ratio of NAA/Cr and Cho/Cr were measured in MRS, with values of 1.31 ± 0.17 and 1.04 ± 0.27, respectively. In two of three patients with abnormal MRI studies at presentation, subsequent MRI showed improvement while one patient remained unchanged. An increase in the ratios of metabolites were found in one case with control MRS. There was no lactate peak. CONCLUSION: Brain MRI was abnormal in more than half of the cases of children with vitamin B12 deficiency. Our radiologic findings similar with literature. There was no identifiable lactate peak. B12 deficiency could be the cause of the thinning of the corpus callosum and brain atrophy in the children that were given a brain MRI.

Prognostic importance of RASSF2 expression in patients with gastric cancer who had undergone radical gastrectomy.

BACKGROUND: Although Ras-association domain family of gene 2 (RASSF2) has been shown to undergo promoter methylation at high frequency in some cancer types and in brain metastases, its clinical utility as a useful prognostic molecular marker remains unclear in gastric cancer. METHODS: Prognostic significance of RASSF2 expression was retrospectively analysed by immunohistochemically in 105 patients with gastric cancer who underwent curative gastrectomy. RESULTS: Low RASSF2 expression was detected in 58 (55 %) patients, whereas 47 patients (45 %) had high RASSF2 expression. Lymph node involvement, pT stage, TNM stage, vascular invasion, perineural invasion and the presence of recurrence were found to be significantly related to RASSF2 expression levels. Low PRL-3 expression was closely correlated with lymph node metastasis (p = 0.001), advanced pT stage (p = 0.021), advanced TNM stage (p < 0.001), the presence of vascular invasion (p < 0.001), perineural invasion (p = 0.018) and high prevalence of recurrence (p = 0.003) compared with high RASSF2 expression. The median disease-free survival (DFS) time for patients with low RASSF2 expression was significantly worse than that of patients with high RASSF2 expression (10.2 vs. 50.6 months, p < 0.001). In addition, patients with high RASSF2 expression had the higher overall survival (OS) interval compared to patients with low RASSF2 expression (NR vs. 14.9 months, p < 0.001). In the multivariate analysis, the rate of RASSF2 expression levels was an independent prognostic factor, for DFS [p < 0.001, HR 0.12 (0.10-0.88)] and OS [p < 0.001, HR 0.10 (0.04-0.46)], as were pT stage and TNM stage, respectively. CONCLUSIONS: RASSF2 may be an important molecular marker for carcinogenesis, prognosis and progression in gastric cancer, but the potential value of RASSF2 expression as a useful molecular marker in gastric cancer progression should be evaluated, comprehensively. It would be possible to develop treatments targeting RASSF2 and advance new treatment strategies for gastric cancer.

Serum uric acid as a surrogate marker of favorable response to bevacizumab treatment in patients with metastatic colon cancer.

Bevacizumab is a monoclonal antibody which is a vascular endothelial growth factor inhibitor. It obscures vascularization of tumor tissue and damages intratumoral microcirculation. The damaged intratumoral microcirculation leads to tissue hypoxia and results in increase of uric acid level. The main aim of our study was to investigate the relationship between uric acid change and response to bevacizumab therapy. This study included a total of 158 patients with metastatic colorectal cancer who had received bevacizumab therapy. The number of male patients was 100 (63.3 %) while female patients number was 58 (37.7 %). The median age was 61 (29-83). There was relationship between increase of uric acid level of third month uric acid level and stable disease (p < 0.001). There was a significant overall survival increased in the group with increased uric acid level (p < 0.001). The decline of CEA level was related to uric acid level (p < 0.022). In conclusion, this study is the first showing significant increases of serum uric acid in patients with metastatic colorectal cancer who favorably responded to chemotherapy with bevacizumab. But further studies are justified to test whether monitoring uric acid levels might predict clinical outcomes of patients with metastatic colorectal cancer.