Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations.

BACKGROUND: The benefits of preoperative chemotherapy and radiation for esophageal carcinoma are under investigation. A pilot study was undertaken to determine if pathologic assessment of tumor regression correlated with disease free survival. METHODS: Ninety-three resected specimens from patients treated with cis-dichloro-diamino cisplatin and irradiation before surgery were examined on semiserial sections. Patients selected for surgery were all Status 1 according to the World Health Organization (WHO) classification. Histologic typing was based on the WHO classification. Tumor regression grade (TRG) was quantitated in five grades: TRG 1 (complete regression) showed absence of residual cancer and fibrosis extending through the different layers of the esophageal wall; TRG 2 was characterized by the presence of rare residual cancer cells scattered through the fibrosis; TRG 3 was characterized by an increase in the number of residual cancer cells, but fibrosis still predominated; TRG 4 showed residual cancer outgrowing fibrosis; and TRG 5 was characterized by absence of regressive changes. Survival curves were estimated according to the Kaplan-Meier method. A quantification of the relationship between treatment failure and confounding variables (age, tumor location, tumor size, esophageal wall involvement by residual cancer and/or regressive changes, histology, treatment, adequacy of surgery, pathologic lymph node status, and tumor regression grade) was done using Cox's proportional hazards model. RESULTS: Forty-two percent of specimens were TGR 1-2; 20%, TGR 3; and 33%, TGR 4-5. Univariate analysis found that tumor size, pathologic lymph node status, tumor regression grade, and esophageal wall involvement were highly correlated with disease free survival (P < 0.05). After multivariate analysis, only tumor regression (i.e., TRG 1-3 versus TRG 4-5) remained a significant (P < 0.001) predictor of disease free survival. CONCLUSIONS: This study highlights the importance of tumor regression in the survival of patients with esophageal carcinoma treated with preoperative chemoradiotherapy. These findings suggest that tumor regression grade should be considered when evaluating therapeutic results.

Prognostic factors in soft tissue sarcomas. A multivariate analysis of 109 cases.

Prognostic factors were evaluated in 109 soft tissue sarcomas of the extremities, walls of the trunk, head, and neck. All lesions were graded according to the systems proposed by the National Cancer Institute (NCI) and the French Federation of Cancer Centers (FNCLCC), and a correlation was found between tumor grade and prognosis. Univariate analysis selected the following variables as unfavorable prognostic factors: invasive tumor margins, extra-compartmental status, deep tumors, tumor diameters over 5 cm, inadequate excision, presence of necrosis, high mitotic count, histologically undifferentiated tumors, and blood vessel invasion. These variables were found to be interdependent. Multivariate analysis selected quality of surgery as the most important variable for predicting local recurrences. The factors selected with regard to overall and metastasis-free survival were tumor size, tumor margins, necrosis, and adequacy of excision. These results permitted classification of patients into four prognostic groups: two with good and two with bad prognosis. Five-year survival for the four groups was 100%, 83%, 53%, and 0%; 5-year metastatic rates were 0%, 12%, 67%, and 100%. Similar groups were obtained when the variables of tumor margins and size were combined with an adaptation of the NCI grading (low-grade tumors/high-grade tumors without necrosis/high-grade tumors with necrosis). Comparative analysis showed that patients with tumors of the same histologic grade or type were not necessarily classed in the same prognostic groups. A better clinicopathologic correlation was obtained using a combination of prognostic factors than with histologic grading or typing alone.

[Relation between the HLA system and the development of asbestosis fibrosis in a group of workers exposed to asbestos]. / Etude des relations entre le système HLA et l'apparition d'une fibrose asbestosique dans un groupe de travailleurs exposés à l'aminate.

The various studies which have dealt up to the present with a possible relationship between asbestosis and HLA groups have led to differing conclusions. The present study evaluated this relationship by comparison of 57 workers with asbestosis confirmed radiologically (minimum S1 type opacities) and functionally (VC and/or DuaCO less than 88%) with 58 controls from the same population. In a second phase, statistical analysis involved the combination of these cases with those reported in the literature, estimating the mean relative risk and, for each gene, the heterogeneity of the results thus collected. No relation was found between class I (A and B) HLA antigens and asbestosis. The authors suggest extension of this study to class II (DR) and III (components of complement) antigens and to seek possible links between combinations of antigens and the development of asbestosis.

Clinical usefulness of a bone mineral measurement method on the femoral shaft.

An improved version of a previously described photon absorptiometry method for measuring the bone mineral content of the femoral shaft is presented. The study included 267 healthy persons, who served as control subjects, and 31 osteoporotic and 3 osteomalacic female patients. A monoenergetic source of 241Am was used and a fully automatic apparatus designed. The examinations were recorded with an independent microcomputer and secondarily processed by the nuclear unit central computer. The guidelines of Cameron and West were used to perform various calculations from the initial absorption curve, and the clinical usefulness of these was tested. On the one hand, cortical bone density (CBD) and bone linear attenuation coefficient (BLAC) were found adequately to differentiate between osteoporotics and controls, but we defined a discriminative function (F) which allowed even better separation between the two groups. On the other hand, bone index (BI) was found to be the best parameter to follow an individual patient during therapy. These results underline the usefulness of these calculations for detecting and monitoring the progress of pathological states.

[Comparison of data of respiratory function tests and pulmonary radiology images. Apropos of 106 subjects exposed to asbestos]. / Comparaison entre les données de l'exploration fonctionnelle respiratoire et les images radiologiques pulmonaires. A propos de 106 sujets exposés a l'amiante.

We have compared X-ray and lung function data in 106 asbestos workers with diverse, yet most often prolonged and important, exposure times. Based on the international B.I.T. classification, we have found a significant link between VC and type, density, opacity extent and presence of pleural thickening. The same relationship is found with alveolo-arterial ductance. On the whole, however, it is difficult to determine lung function condition with X-ray. Thus, certain criteria concerning function should be considered as well as radiography.