ECE-1 overexpression in head and neck cancer is associated with poor tumor differentiation and patient outcome.

BACKGROUND: Endothelin-converting enzyme-1 (ECE-1) primarily converts big endothelins (ETs) into active endothelin-1 (ET-1). However, the expression pattern and prognostication status of ECE-1 in head and neck cancer (HNC) are enigmatic. In this study, we investigated ECE-1 expression and assessed the roles of ECE-1 as a predictor for HNC differentiation and prognosis. MATERIALS AND METHODS: ECE-1 expressions were evaluated by immunohistochemical analysis using a tissue microarray (TMA) composed of 100 cases of head and neck squamous cell carcinoma. The correlation of ECE-1 expression with clinicopathologic variables and patient outcomes was analyzed. RESULTS: ECE-1 may be overexpressed in HNC carcinoma cells. Higher ECE-1 level was detected more frequently in moderately to poorly differentiated tumors and showed a lower differentiation category compared to the G1 cases (p = 0.015); this finding was further confirmed by an adjusted odds ratio (OR) of 4.071 (p = 0.042). Moreover, Kaplan-Meier survival analyses showed that a higher ECE-1 expression was associated with a poorer survival in patients with HNC (p < 0.0001). On multivariate Cox proportional hazards models analysis, ECE-1 of high expression proved to be an independent prognostic factor with a hazard ratio (HR) of 3.985 (p < 0.001). CONCLUSION: Our data provide the first evidence that overexpression of ECE-1 in HNC is a predictor of poor tumor differentiation and prognosis.

Vascularized lymph node transfer based on the hilar perforators improves the outcome in upper limb lymphedema.

BACKGROUND: Maintenance of the blood supply to the lymph nodes is necessary for survival and function. We report the outcome of vascularized lymph node transfer with hilar perforators compared with the conventional technique. PATIENTS: A total of 21 patients affected by early stage II upper limb lymphedema were included in this study. Of them, 11 patients received a free groin flap containing lymph nodes, and 10 patients received vascularized inguinal lymph nodes with hilar perforators. Mean follow-up was 46 and 40 months, respectively. Complications, secondary procedures, circumference of the limb, and subjective symptomatology were registered. The differences were evaluated statistically. RESULTS: The limb circumferences decreased significantly in the new group. The number of secondary procedures was significantly higher in the standard group. There were 2 cases of partial flap loss and donor site lymphorrhea in the standard group. In both the groups, visual analog scale scores improved after the operation. CONCLUSIONS: Transfer of vascularized inguinal lymph nodes based on the hilar perforators improves the outcomes in the treatment of early lymphedema of the upper extremity.

Optimizing outcome of charles procedure for chronic lower extremity lymphoedema.

BACKGROUND: The Charles procedure for late-stage lower limb lymphoedema (LLL) is often criticized for its unpredictable and poor results. We have adopted a systematic approach to optimize outcome of patients treated with this excisional surgery. METHODS: From June 2004 to March 2009 we performed the Charles procedure on 1 lower limb of 19 women and 8 men with late-stage LLL. Mean age and follow-up was 48 (range, 16.5-77.8) years and 21.6 (range, 1.5-48) months, respectively. RESULTS: Average inpatient stay was 27 (range, 11-54) days. After discharge, 16 (59.3%) patients underwent further minor surgery. The most frequent complication was a single, short episode of cellulitis, affecting 5 (18.5%) patients. Self-reported mobility was either the same or improved at 6 months, and appearance of their limbs satisfactory. CONCLUSIONS: The Charles procedure is an effective treatment for selected patients and by applying our systematic approach, a positive outcome can be achieved.