Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma?

OBJECTIVES: Controversy continues over the importance of lymph node (LN) status in treating and predicting recurrence in endometrial cancer. Several predictive models are available which use uterine factors to stratify risk groups. Our objective was to determine how LN status affects recurrence and survival compared to uterine factors alone. METHODS: A retrospective review was performed of patients undergoing complete surgical staging for clinical stage 1 endometrioid adenocarcinoma of the uterus. Patients were assessed based on PORTEC 1 high intermediate risk (H-IR) criteria (2 factors : age>60, grade 3, >50% DOI), GOG-99 H-IR criteria (age >70+1 factor, age 50-70+2 factors, any age +3 factors: grade 2 or 3, LVSI, >50% DOI), and PORTEC 2 criteria. Rates of nodal involvement, recurrence rates, PFS, and OS were compared. RESULTS: We identified 352 clinical stage I patients with positive LN in 24% (87). 175 patients met PORTEC 1 eligibility and 66 met H-IR criteria. Rates of LN positivity were similar among groups (18.4% vs 19.7%, p=0.83) but recurrence rates were dissimilar (7.4% vs 27.3%, p=0.0004). Only 93 met PORTEC 2 criteria for treatment with no association between LN status, recurrence, and eligibility. 188 patients met H-IR eligibility criteria for GOG-99 with LN positive and recurrence rates higher in the H-IR group compared to GOG-99 eligible (34.6% vs 16.3%, p=0.0004, 28.3% vs. 10.6%, p=0.0002). CONCLUSIONS: Patients with H-IR disease based on uterine characteristics alone have substantial risk of nodal involvement. Knowledge of LN status may better define risk, prognosis, and postoperative treatment.

A comment on ATPase driven streaming in a reconstituted contractile system.

The production of chemo-mechanical effects in a reconstituted system of purified muscle proteins had been studied. It was found that the "streaming" effects observed (by previous workers) in the circular slit of a stream cell were observed under conditions where the absence of artefacts could not be guaranteed. In particular, convective motion motion, due to small temperature gradients is shown to be present, resulting in streaming even in the absence of essential components of the system such as ATP. Temperature inhomogeneities of the order of only 0.1 K . mm-1 are sufficient to cause motion, and any future experiments on streaming must be thermally homogeneous to a greater accuracy than this if valid conclusions are to be drawn.

Lipid composition of gram-negative bacteria, sensitive and resistant to streptomycin.

Analyses of streptomycin-sensitive and -resistant gram-negative bacteria show that, contrary to previous reports, the development of antibiotic resistance is not accompanied by changes in membrane lipid or fatty acid composition.