Surgical technique for acute retrograde type A aortic dissection after zone 2 TEVAR for complicated type B dissection in a 63-year-old patient.

Patients suffering retrograde type A aortic dissection after TEVAR for type B dissection are at higher risk of mortality than their spontanous counterparts and the kind of optimal therapy remains obscure. We present a case of successful open surgical repair where distal open anastomosis was accomplished by cutting off the un-covered stent portion and suturing a vascular prosthesis to the dissected distal aortic arch including the covered stent part. The clinical course was regular. Immediate and radical repair in the aortic arch may be the adequate response in such instances.

Endoaneurysmorrhaphy for a Giant Inferobasal Left Ventricular Aneurysm Restoring Mitral Function.

Over the years, the surgery of ventricular postinfarction aneurysm has evolved from linear resection to endoaneurysmorrhaphy using a patch. Technically, several aims that include the restoration of ventricular shape and function, exclusion of dead space, minimization of the risk of thrombus formation and restoration of valve function are pursued. Herein is reported the case of a 58-year-old male with a giant inferobasal aneurysm involving the mitral valve apparatus who underwent successful endoaneurysmorrhaphy. Correct sizing of the patch proved to be the 'road to success' in this patient. The present case is the second reported instance of a giant ventricular aneurysm involving the mitral valve, with favorable outcome.

Comparison of different surgical techniques in 112 consecutive patients with aortic root operations: when should the valve be spared?

BACKGROUND AND AIM OF THE STUDY: The benefit of valve-sparing aortic root replacement compared to conventional aortic root replacement surgery remains unclear. METHODS: Between February 2009 and November 2010, a total of 112 patients underwent aortic root surgery at the Department of Cardiovascular and Thoracic Surgery, Heinrich-Heine-University, Dusseldorf, Germany. The valve-sparing technique was used when leaflets were grossly normal. In cases where the valve could not be saved, a prosthetic or biological substitute was used for the aortic root, according to existing guidelines. The patients were allocated to three groups: (i) valve-sparing aortic root replacement group using the David technique (VSR-David; n = 47); (ii) valve-replacing aortic root surgery with a prosthetic conduit using the Bentall-Kuchucus technique (VRR-Prosthetic; n = 31); and (iii) valve-replacing aortic root surgery with a biological stentless valve with the full root technique (VRR-Bio; n = 34). RESULTS: Intraoperative data revealed that, in the VSR-David group, the cardiopulmonary bypass and cross-clamp times were significantly longer (207 +/- 68 min and 140 +/- 38 min respectively; both p = 0.001). The VRR-Prosthetic patients were at highest risk (mean EuroSCORE 15.9%) compared to the VSR-David and VRR-Bio groups (10.8% and 10.4%, respectively). Postoperative analysis showed that patients in the VRR-Bio group had the lowest number of perioperative heart failures (p = 0.004). The perioperative 30-day mortality was significantly higher in the VRR-Prosthetic group (22.6%; p = 0.004). Transaortic flow velocities were significantly lower in the VSR-David group, followed by the VRR-Bio group and VRR-Prosthetic group (1.66 +/- 0.54, 1.98 +/- 0.45, and 2.29 +/- 0.39 m/s, respectively; p = 0.012). The univariate and multivariate analyses of perioperative risk factors showed that only open distal anastomosis was strongly associated with negative results, but not the valve-sparing technique. CONCLUSION: Aortic valve-sparing root replacement must be considered as an excellent alternative for young patients requiring aortic root replacement when a biological valve is clinically indicated. For patients aged >65 years, or with a decreased life expectancy, the full root technique with a stentless valve should be used, given its technical simplicity and excellent postoperative results.

Role of primary bacterial contamination of a pulmonary homograft for Ross operation: report of a case and review of the literature.

In a 43-year-old female, Ross operation was performed with annular reinforcement of the autograft and a cryo-fixed homograft that proved to be contaminated with enterobacter cloacae and klebsiella pneumoniae at the time of operation. Clinical course was unremarkable, perhaps due to effective antibiotic prophylaxis and treatment. In the literature, little is known about intraoperative bacterial contamination and early endocarditis. The authors report what they believe is the second reported case. Particular resistibilities of homograft and autograft might make early endocarditis unlikely.

Monitoring of loss of heterozygosity in serum microsatellite DNA among patients with gastrointestinal stromal tumors indicates tumor recurrence.

BACKGROUND: Patients with gastrointestinal stromal tumors (GIST) harbor increased levels of circulating tumor DNA in their peripheral blood. In the current study, the aim was to investigate whether the frequency of loss of heterozygosity (LOH) on cell-free DNA in blood may reflect tumor stage and recurrent disease of these patients. MATERIALS AND METHODS: Serum DNA and follow-up samples of 92 patients suffering from recurrent GIST were analyzed by a PCR-based fluorescence microsatellite analysis using a panel of 12 polymorphic markers. The data were correlated with established risk factors, and patients were followed-up over 4 y. RESULTS: Microsatellite analysis demonstrated a positive LOH score on cell-free DNA of 30/92 patients. A significant correlation with recurrence in CT imaging showed that a positive LOH score (n ≥ 2) was detected in 58% (11/19) of patients with recurrent disease (P = 0.030, χ(2) test), but only in 25% of patients were clinically free of recurrence. No prognostic significance of a positive LOH score was observed after a median observation time of 48 mo. CONCLUSION: Our findings show that LOH on circulating serum DNA correlates with the tumor status and is a frequent event in GIST patients with recurrent disease.

Delayed sternal closure (DSC) after cardiac surgery: outcome and prognostic markers.

BACKGROUND: Maintenance of an open sternotomy (OS) after a complicated cardiac operation is an adjunct in the treatment of the severely impaired heart. The purpose of this retrospective study was to evaluate the incidence, survival, and predictors of poor outcome for open chest management (OCM) with delayed sternal closure (DSC) at our department. METHODS: Prolonged open chest (OC) was used in 179 of 5122 cardiac surgery patients between 2004 and 2008 (3.5%). We wanted to determine indications, mortality, postoperative complications, and predictors of outcome. RESULTS: The incidence of OS was 3.5%, with 1.3% for isolated CABG, 2.4% for isolated valve, and 6.4% for combined procedures. Indications for OS were: hemodynamic compromise (110), intractable bleeding (19), arrhythmia (14), and cardiac edema or tamponade (36). 127 of the 179 patients with DSC (71%) survived. 52 patients died: 20 before DSC and 32 after this procedure. Mortality could be related to the indication for OS: With the indication "low cardiac output syndrome" (LCOS) the mortality was 34.5%, for bleeding it was 26.3%, for arrhythmias, 21.4%, and for tamponade on closure it was 16.7%. After DSC, deep sternal wound infection occurred in nine patients (5%), superficial infection in 4.7% of patients. There were 16 patients with postoperative stroke (8.9%) and 24 patients with need for dialysis (13.4%). Predictors of mortality by univariate analysis were VAD insertion, new onset of hemodialysis, reoperation for bleeding, mean length of duration of OS (survivors 3.4 days, nonsurvivors 6.5 days), and longer duration of high-dose inotropic therapy. CONCLUSION: This study shows that OCM with DSC is a beneficial, therapeutic option in patients with postoperative LCOS, significant hemorrhage or intractable arrhythmias. However, patients with reoperation for bleeding, need for VAD, and particularly a prolonged delay before sternal closure continued to have a poor outcome.

Complementary use of fluorescence and magnetic resonance imaging of metastatic esophageal cancer in a novel orthotopic mouse model.

We describe the development of an aggressive orthotopic metastatic model of esophageal cancer, which is visualized in real time with combined magnetic resonance imaging (MRI) and fluorescence imaging. The aim of the study was to describe the development of a novel model of metastatic tumor disease of esophageal carcinoma and use this model to evaluate fluorescence and MRI in early detection of local and metastatic disease. The human esophageal adenocarcinoma cell line PT1590 was stably transfected with green fluorescent protein (GFP). Nude mice were orthotopically implanted with PT1590-GFP cells. Orthotopic tumor growth as well as metastatic spread was examined by fluorescence imaging and high-resolution MRI at defined intervals after orthotopic implantation. Highly aggressive novel fluorescent cell lines were isolated from metastatic tissues and put into culture. After implantation of these cells, 100% of the animals developed orthotopic primary tumors. In 83% of animals, metastatic spread to liver, lung and lymph nodes was observed. Primary tumor growth could be visualized with fluorescence imaging and with MRI with high correlation between the 2 methods. Fluorescence imaging allows fast, sensitive, and economical imaging of the primary and metastatic tumor without anesthesia. With MRI, anatomical structures are visualized more precisely and tumors can be more accurately localized to specific organs. This model should prove highly useful to understand esophageal carcinoma and to identify novel therapeutics for this treatment-resistant disease.

Impact of mitral valve repair in patients with mitral regurgitation undergoing coronary artery bypass grafting.

BACKGROUND: The benefit of concomitant mitral valve correction (replacement or reconstruction, MVR) and coronary artery bypass grafting (CABG) in patients with coronary artery disease and mitral regurgitation (MR) remains unclear. PATIENTS AND METHODS: 298 consecutive patients underwent CABG alone (n=196) or CABG+ MVR (n=102) between January 2003 and April 2008. Clinical data were collected and MR graded according to preoperative echocardiographic studies. Four severity grades of MR were determined and patients assigned accordingly. Echocardiographic follow-up was performed postoperatively to assess heart and valve function. Multivariate logistic regression analysis was performed for perioperative morbidity and mortality. RESULTS: Patients were comparable within the groups regarding age, gender, NYHA-class, ejection fraction and number of graft vessels. Perioperative mortality (10.8% vs. 5.1%, P < 0.05) and degree of MR were higher among CABG+MVR patients. Among patients with moderate to severe or severe MR, postoperative echocardiography showed an improvement of mitral regurgitation in 95% of CABG+MVR and in 64% of CABG only patients. In patients with mild or moderate MR, improvement rates of both groups were similar (74% and 69%, respectively). Postoperatively, ejection fraction increased in both groups (CABG+MVR: 31.3 +/- 8.5 to 36.4 +/- 11.2; CABG only: 29.9 +/- 6.1 to 33.3 +/- 8.1, P > 0.05). Significant predictors for peri-operative mortality were renal insufficiency, older age and NYHA class III/IV. CONCLUSIONS: For reduction of ischaemic MR, CABG+MVR is preferable in patients with moderate to severe or severe MR. Combined CABG+MVR procedures cannot be recommended for patients with a particular risk profile because of disproportionately high peri-operative mortality.

Haeme oxygenase-1 promoter polymorphism is an independent prognostic marker of gastrointestinal stromal tumour.

AIMS: Gastrointestinal stromal tumours (GISTs) display genetic alterations on chromosome 22. GTn repeat (GTn) length polymorphism in the promoter of haeme oxygenase-1 gene (HMOX-1) is located on chromosome 22 and associated with malignant growth. The aim was to investigate the role of HMOX-1 promoter polymorphism in GIST patients. METHODS AND RESULTS: Tumour and corresponding healthy tissue DNA of 44 patients who underwent surgical resection of GIST were analysed by polymerase chain reaction, capillary electrophoresis and DNA sequencing. GTn polymorphism was classified into short (S) and long (L) allele. There was no difference detected in GTn genotype between tumour and healthy tissue DNA. Short GTn allele (SGTn) was significantly associated with metastatic disease, higher tumour recurrence rates and high risk GIST (consensus criteria 2001). Furthermore, SGTn allele carriers had significantly shorter disease-free and overall survival (log rank test, P < 0.0001). On multivariate Cox regression analysis, GTn polymorphism was identified as an independent prognostic factor for survival (P = 0.001). CONCLUSIONS: HMOX-1 promoter GTn polymorphism is a potential prognostic marker and may help to allocate patients to different risk groups, customized therapy and follow-up. Haeme oxygenase-1 could represent an important candidate gene in the pathogenesis and growth of GIST.

Clinical value of loss of heterozygosity in serum microsatellite DNA of patients with gastrointestinal stromal tumors.

GOALS: To study the role of loss of heterozygosity (LOH) in serum microsatellite DNA of patients with gastrointestinal stromal tumors (GIST). BACKGROUND: In GIST, tumor markers from peripheral blood are missing. STUDY: Seventy-eight patients (59 GIST, 13 leiomyomas, 2 leiomyosarcomas, and 4 schwannomas) underwent resection at our institute between 1985 and 2006. Thirty-three preoperative sera (26 GIST and 7 non-GIST) and 62 postoperative sera (47 GIST and 15 non-GIST) were available and tested for alterations in 12 representative microsatellite loci on chromosomes 22, 17, 13, 9, and 3, using fluorescence-based automated capillary electrophoresis by ABI Prism. Survival was calculated with Kaplan-Meier plots. RESULTS: Seventeen out of 26 GIST patients had a positive preoperative serum LOH score (> or =2 LOH, sensitivity 65.4%), and 6 out of 7 non-GIST patients had a negative score (< or =1 LOH, specificity 85.7%, P=0.030, Fisher exact test). Serum LOH in GIST were strongly correlated with Fletcher risk groups (P=0.016, chi test). All metastasized GIST (7/7) showed > or =2 LOH preoperatively. Postoperative sensitivity and specificity of LOH analysis for prediction of relapse in 47 GIST was 75.0% and 64.1%, respectively. After a median observation time of 51.3 months (95% confidence interval, 39.4-61.4), LOH in serum significantly predicted overall survival (P=0.007, log-rank test). CONCLUSIONS: LOH serum analysis in GIST may play a role as a noninvasive, differential diagnostic, prognostic, and monitoring marker in the clinical routine.

Subset of esophageal adenocarcinoma expresses adhesion molecule l1 in contrast to squamous cell carcinoma.

BACKGROUND: Esophageal adenocarcinoma is currently the most rapidly increasing cancer in Western populations. L1 (CD171), a neural cell adhesion molecule, has an essential function in tumor progression and has been shown to be expressed in the proliferating cells of the intestinal crypts in mice. The aim of the current study was to determine L1 expression in esophageal cancer and to evaluate whether L1 could serve as a potential marker and therapeutic target for this tumor type. MATERIALS AND METHODS: L1 expression was assessed on a tissue microarray with 257 surgically resected esophageal cancer samples by immunohistochemistry with a monoclonal antibody (Clone UJ127). L1 expression was correlated with clinicopathological data. RESULTS: L1 was detected in 22 (9%) of 257 esophageal cases, whereas 235 (91%) were L1 negative. Nineteen (86%) of the 22 L1-positive cases were adenocarcinoma. Cross table analysis showed a significant association between L1 expression and adenocarcinoma subtype (p<0.001), but not squamous cell carcinoma. CONCLUSION: L1 expression in a subgroup of esophageal cancer is specifically prevalent in adenocarcinoma. Data suggest L1 as a potential target for biological therapy in L1-positive esophageal adenocarcinoma patients.

Repeated surgery improves survival in recurrent gastrointestinal stromal tumors: a retrospective analysis of 144 patients.

PURPOSE: Recurrence of a gastrointestinal stromal tumor (GIST) may require multimodal therapy and the role of repeated surgery in this concept is unclear. PATIENTS AND METHODS: A consecutive series of GIST patients treated by surgery, imatinib therapy or both was retrospectively reviewed, and long-term survival was studied by Kaplan-Meier analysis. RESULTS: Institutional primary surgeries before 1999 necessitated reclassification of the histopathological sections and 58/78 patients were classified as having true GIST. In primary surgeries, liver metastases were observed in GIST (6/58) but not in sarcoma/schwannoma patients (0/20), and exulceration of the primary tumor did not correlate with adverse outcome. Additionally, 86 patients were seen on an outpatient basis or were treated for recurrence at our institution, thus a total of 144 GIST patients were seen at our institution between 1994 and 2007 for either primary or secondary tumor manifestation. After 2003, 19/144 GISTs recurred and were treated by targeted therapy with imatinib. The patients showed better overall survival than historic controls. Imatinib therapy enhanced re-resectability due to tumor downsizing, and re-resection (n = 16) improved survival significantly (p = 0.046, log-rank test). CONCLUSION: A multimodal approach including targeted therapy and repeated surgery in the long-term management of recurrent GIST improves survival.

Short tandem repeat polymorphism in exon 4 of esophageal cancer related gene 2 predicts relapse of oral squamous cell carcinoma.

Short tandem repeat (STR) polymorphisms in exon 4 of esophageal cancer related gene 2 (ECRG2) are a prognostic marker for squamous cell carcinoma (SCC) of the esophagus. The aim of the present study was to correlate these STRs with clinical outcome of the similar tumor type oral squamous cell carcinoma (OSCC). DNA of 81 patients that underwent complete surgical resection of OSCC was analyzed for STRs TCA3/TCA3, TCA3/TCA4 and TCA4/TCA4 in exon 4 of ECRG2 by PCR, capillary electrophoresis and DNA sequencing. ECRG2 STR TCA3/TCA3 were found in 45 (56%), TCA3/TCA4 in 33 (41%) and TCA4/TCA4 in 3 (3%) patients. TCA3/TCA3 was significantly associated with reduced relapse-free survival of OSCC, compared with TCA3/TCA4 and TCA4/TCA4 genotypes (P<0.05; log-rank test). TCA3/TCA3 STR was independent prognostic factor determined by multivariate Cox regression analysis (p<0.05). STR polymorphism TCA3/TCA3 in exon 4 of ECRG2 is associated with poor relapse-free survival in surgically completely resected OSCC patients and might be a potential prognostic marker.

Determination of microvessel density by quantitative real-time PCR in esophageal cancer: correlation with histologic methods, angiogenic growth factor expression, and lymph node metastasis.

PURPOSE: Angiogenesis and lymphangiogenesis are important steps in tumor growth and dissemination and are of prognostic importance in solid tumors. The determination of microvessel density (MVD) by immunohistology is subject to considerable variability between different laboratories and observers. We compared MVD determination by immunohistology and quantitative real-time PCR and correlated the results with clinical variables. EXPERIMENTAL DESIGN: The expression of endothelial antigens vascular endothelial cadherin (CD144), P1H12 (CD146), tie-2, and VEGFR-2, and lymphatic endothelial markers VEGFR-3, Prox, and LYVE was assessed by quantitative PCR (qPCR) in primary surgical samples. The expression of angiogenetic growth factors VEGF-A, VEGF-C, VEGF-D, angiopoietin-1, and angiopoietin-2 was quantified by PCR and correlated with MVD and clinical variables. RESULTS: The expression of endothelial antigens vascular endothelial cadherin (CD144), P1H12 (CD146), tie-2, and VEGFR-2 correlated with each other in 54 samples of primary esophageal cancer (P < 0.0001 for all comparisons). MVD determined immunohistologically by CD31 staining in a subgroup of 35 patients correlated significantly with the qPCR method. The expression of angiogenetic growth factors VEGF-A, VEGF-C, VEGF-D, angiopoietin-1, and angiopoietin-2 was significantly associated with MVD (P < 0.0001 for all comparisons). Analysis of the expression of lymphendothelial markers VEGFR-3, Prox, and LYVE revealed concordant results, indicating that quantification of lymphendothelial cells is possible by qPCR. The presence of lymph node metastasis on surgical specimens was significantly correlated with MVD (P < 0.003), VEGFR-2 (P < 0.048), and VEGF-C (P < 0.042) expression. CONCLUSIONS: These results indicate that quantification of MVD by qPCR in surgical samples of esophageal carcinoma yields similar results with immunohistology. Interestingly, the extent of angiogenesis and lymphangiogenesis was not related in individual tumor samples. Lymph node metastases could be predicted by MVD and VEGF-C expression.

L1 is associated with favorable outcome in neuroblastomas in contrast to adult tumors.

BACKGROUND: Neuroblastoma is the most common solid tumor in childhood with unconventional clinical behavior. L1, a neuronal cell adhesion molecule, is associated with poor survival in malignant adult tumors. The aim of the current study was to determine expression of L1 in pediatric neuroblastoma. METHODS: L1 expression was assessed on a tissue microarray with 66 surgically resected neuroblastoma samples by immunohistochemistry with a monoclonal antibody and peroxidase method. Additionally, mRNA expression was analyzed by reverse transcriptase-polymerase chain reaction with L1-specific primers. Data were correlated survival data by log rank test and Cox regression multivariate analysis. RESULTS: L1 was detected in 57 (86%) of 66 neuroblastomas, whereas 9 (14%) were L1 negative. Median survival of all children was 72 months. Analysis with Kaplan-Meier method revealed a surprising and contrary finding to adult tumor entities: an association of L1 positivity with better event-free and overall survival (P < .001 and P < .01 by log rank test). Multivariate Cox regression analysis showed an independent prognostic impact of L1 negativity for event-free and overall survival of the children (P < .05). CONCLUSIONS: In contrast to adult tumor entities, where L1 is associated with aggressive clinical behavior, our data show that L1 predicts good outcome in children with neuroblastoma. This novel finding suggests an inverse role of L1 in neuroblastoma. Future studies might focus on the molecular basis of the varying effect of L1 in different tumors.

Thy-1 as a potential novel diagnostic marker for gastrointestinal stromal tumors.

PURPOSE: Only few immunohistochemical markers besides c-kit exist for gastrointestinal stromal tumors (GISTs). Thy-1, a cell-surface glycoprotein, is a marker for several types of stem cells and particularly for neuronal precursor cells. The aim of this study was to determine Thy-1 expression in GISTs. MATERIALS AND METHODS: Fifty-seven surgically resected and paraffin-embedded GIST samples were analyzed by immunohistochemistry with peroxidase method for Thy-1 molecule. RESULTS: Thy-1 was detected in the majority of 57 GIST samples (54 out of 57 patients, 95%). All samples were c-kit positive and 90% were CD34 positive. All three Thy-1 negative samples were CD34 positive, had a low proliferative index (Ki-67

Midkine as a prognostic marker for gastrointestinal stromal tumors.

PURPOSE: Midkine (MK), a heparin-binding growth factor, has an important role in cancer progression. The outcome of patients with gastrointestinal stromal tumors (GISTs) is correlated with tumor size and mitotic count. The aim of this study was to determine MK expression in GISTs. METHODS: Midkine was detected in 31 (55%) of 57 surgically resected GISTs by immunohistochemistry with a rabbit antibody against MK and peroxidase method. RESULTS: A significant worse outcome of MK-positive patients was found (P < 0.05; log rank test). Multivariate Cox regression analysis showed an independent prognostic impact (relative risk for overall survival 3.64; P < 0.05). Interestingly, MK expression was significantly associated with mitotic rate (P < 0.05; Chi-squared test), but not with tumor size (P = 0.97). CONCLUSIONS: Taken together, MK is a prognostic marker for GIST patients. MK might also be a useful peripheral tumor marker since it can be detected in peripheral serum. Future studies should involve higher GIST patient numbers including tumor and serum samples for detection of MK.

Microsatellite analysis in serum DNA as a diagnostic tool for distinction of patients with unknown pancreatic masses.

The clinical distinction between cancer and chronic pancreatitis is difficult in patients with pancreatic masses. To test whether detection of aberrant serum DNA could assist in this important differential diagnosis, we tested a panel of 12 microsatellitemarkers from chromosomes 17p, 17q, 13q, 9p, 5q, and 2p in the blood of 35 pancreatic cancer patients, 22 patients with chronic pancreatitis, and 20 healthy individuals. An average of 2.8 loss of heterozygosity (LOH) was found in 32 of 35 cancer patients of whom 30 (86%) had 2 or more LOH. LOH was also found in 7 of 22 pancreatitis patients but all these patients had only 1 LOH. No LOH was detected in healthy donors of comparable age. These data suggest that LOH analysis may be a substantial help for diagnosing pancreatic masses. An extension of the panel, perhaps in combination with a better selection of markers may further improve this assay.

P53 is an independent prognostic factor for survival in thyroid cancer.

BACKGROUND: p53 has been reported to be of prognostic importance in different types of cancer. Immunohistochemical measurement of p53 antigen activity could be a prognostic marker for aggressiveness and survival in thyroid cancer. Different types of antibodies have been used to detect p53 in previous studies without direct comparison to each other. PATIENTS AND METHODS: A series of 54 patients with thyroid cancer who had undergone thyroidectomy between 1993 and 1998 is reported. All samples were chosen retrospectively and classified by routine histopathology, followed by immunohistopathological examination with three different types of antibodies (PAb1801, CM1 and DO-7) with the peroxidase method. Survival data was generated. RESULTS: The mean time of follow-up was 9.0 years. Eighteen patients died. Twenty-three (42.6%) samples were positive for p53 using the antibody PAb1801, 17 (31.5%) with using CM1 and only 4 (7.4%) cases with DO-7. Statistical analysis determined that the size (p = 0.02) and classification of the tumor (p < 0.001), the age of the patients (p = 0.036), the presence of lymph node metastasis (p = 0.024) and positive staining for p53 (p < 0.001) were prognostic factors for overall survival by Kaplan-Meier method. Multivariate analysis revealed overexpression of p53 to be an independent significant prognostic factor of survival. CONCLUSION: PAb1801 is the most sensitive antibody for detection of p53 protein in this type of cancer, and p53 is a prognostic factor for survival in thyroid cancer. This may provide further information for prognosis and aggressiveness of thyroid cancer.

Short tandem repeat polymorphisms of exon 4 in Kazal-type gene ECRG2 in pancreatic carcinoma and chronic pancreatitis.

BACKGROUND: Short tandem repeat (STR) polymorphisms in exon 4 of the Kazal-type esophageal cancer related gene (ECRG2) have been reported to be associated with esophageal carcinoma. Kazal-type genes are associated with cancer and pancreatic disease. The aim of the present study was to examine whether ECRG2 STR polymorphisms are associated with pancreatic carcinoma and chronic pancreatitis. MATERIALS AND METHODS: A total of 209 surgically treated patients were analyzed, 92 with pancreatic adenocarcinoma and 117 with chronic pancreatitis. We retrospectively analyzed genomic DNA from peripheral blood leukocytes for STR TCA3/TCA3, TCA3/TCA4 and TCA4/TCA4 in the noncoding region of exon 4 of ECRG2. Associations between STRs and survival of cancer patients were investigated using log-rank test. RESULTS: ECRG2 STR of highest incidence was TCA3/TCA3 [47 (51%) in pancreatic carcinoma; 59 (50%) in pancreatitis patients], followed by the TCA3/TCA4 [37 (40%); 54 (46%)] and TCA4/TCA4 [8 (9%); 4 (4%)] genotypes. No correlation in frequency of STRs comparing chronic pancreatitis and pancreatic cancer was determined using the Chi-squared test (p = 0.23). STR polymorphisms were not significantly associated with reduced tumor-specific or overall survival (p > 0.05; log-rank test). CONCLUSION: The data show that ECRG2 STR polymorphism TCA3/TCA3 in exon 4 is the most prevalent polymorphism found in pancreatic adenocarcinoma and chronic pancreatitis detected in peripheral blood. None of the polymorphisms was associated with poor clinical outcome in pancreatic cancer patients.