Clinicopathological significance of decreased galectin-3 expression and the long-term prognosis in patients with breast cancer.

PURPOSE: Galectin-3 expression is modulated in cancer cells, and that finding has led to the recognition of galectin-3 as a diagnostic or prognostic marker for various cancers, including breast cancer. This study investigated the correlation between galectin-3 expression and the clinicopathological features in patients with breast cancer, in order to determine the relevance and role of galectin-3 in breast cancer progression. METHODS: Galectin-3 expression was investigated immunohistochemically in 116 patients with breast cancer, and a statistical analysis was performed. RESULTS: Galectin-3 expression in breast cancer was significantly associated with tumor vascular invasion. However, galectin-3 expression was not associated with Ki-67 expression, which reflects tumor proliferation. Disease-free survival and long-term overall survival were significantly shorter for patients with reduced galectin-3 expression. CONCLUSIONS: This study demonstrated that the galectin-3 expression was associated with tumor vascular invasion and metastasis, suggesting that galectin-3 plays a critical role in tumor progression via an invasive mechanism but not via proliferation in breast cancer. Furthermore, reduced expression of galectin-3 is useful for predicting a long-term poor prognosis in patients with breast cancer.

Cell to cell interaction in clusters enhances thermosensitivity in HT29 human colon cancer cells.

BACKGROUND/AIMS: Tumor cells at high density are considered to be resistant to hyperthermia. Our objective in this study was to investigate hyperthermia sensitivity of clusters, cancer cell aggregation, compared with that of monolayer cells. METHODOLOGY: Colon carcinoma cells HT29 were cultured on poly 2-hydroxyethyl methacrylate-coated dishes for 7 days and the clusters were selected by a 40µm pore filter. To detect the cell reproductive potential, a colony formation assay was performed in HT29 cells from a monolayer and from clusters after exposure to cis-diamino-dichloroplatinum, fluorouracil and/or hyperthermia. Western blotting was used to analyze the induction of heat shock protein expression by hyperthermia. RESULTS: Histological findings of the clusters less than 400µm in diameter showed dividing cells and no secondary central necrosis. Cluster cells were more sensitive to hyperthermia than monolayer cells (p<0.0001). However, cluster formation induced cis-diamino-dichloroplatinum resistance (p<0.0001). The enhancement of hyperthermia sensitivity in clusters was not observed when the cells were heated after dispersion to single cells (p<0.0001). No difference of heat-induced HSP70/72 and HSP27 expression between cluster cells and monolayer cells was found. CONCLUSIONS: Cluster formation induced hyperthermia sensitivity, and cell-to-cell interaction in the clusters might enhance hyperthermia sensitivity.

Accuracy of intraoperative macroscopic diagnosis of sentinel node metastases in breast cancer: is accurate prediction possible?

BACKGROUND: Accurate intraoperative diagnosis of sentinel lymph node (SLN) metastases enables the selection of patients who require axillary lymph node dissection, thus avoiding an additional operation. In this study we investigated the accuracy of intraoperative macroscopic diagnosis of SLN metastases in patients with breast cancer. METHODS: SLNs from 276 breast cancer patients with clinically negative nodes were analyzed by macroscopic examination. The results of intraoperative macroscopic diagnosis were compared with those of frozen section analysis. RESULTS: The sensitivity, specificity, overall accuracy, and false negative rate of SLN biopsy in the assessment of node status were 82.1%, 100%, 96.4%, and 17.9%, respectively, for frozen section analysis, and 57.1%, 95.5%, 87.7%, and 42.9%, respectively, for macroscopic evaluation. Even in patients with node metastasis >7 mm, the false negative rate of macroscopic evaluation was 11.1%. CONCLUSIONS: Our results suggest that macroscopic diagnosis is less effective in predicting lymph node status in breast cancer than frozen section analysis. These findings imply that intraoperative macroscopic evaluation of sentinel nodes is never predictive of the final pathology.

The efficacy of prophylactic administration of SBT/ABPC for preventing surgical site infection in elderly patients undergoing colorectal surgery.

BACKGROUND/AIMS: Colorectal surgery presents a high risk of surgical site infections (SSI). SSI and prolonged hospital stay were associated with being aged 75 years or older. We investigated the efficacy of sulbactam sodium/ampicillin sodium (SBT/ABPC), which is a combination drug of ampicillin and beta-lactamase inhibitor, as a prophylactic drug against SSI in elderly patients undergoing colorectal surgery. METHODOLOGY: From July 2003 to November 2005, a total of 181 patients underwent colorectal surgery. Of these patients, 43 who were older than 75 years were compared with 138 who were younger. Patients were given SBT/ABPC as follows: Before anesthetic induction at surgery, 1.5 g of SBT/ABPC was administrated by intravenous drip infusion, and further doses were continued at 12-hour intervals for 2 days. We assessed SSI, postoperative stay, type of surgery, duration of operation, and amount of bleeding. RESULTS: The result was that SSI was found in none of the patients. There was no significant difference in rate of SSI and postoperative hospital stay between the two groups. Adverse reactions due to SBT/ABPC such as apparent skin symptoms or gastrointestinal symptoms were not observed. CONCLUSIONS: SBT/ABPC for elderly patients would be effective to prevent SSI in colorectal operations and could be used safely.

The efficacy of prophylactic administration of SBT/ABPC for preventing surgical site infection in elderly patients undergoing colorectal surgery.

BACKGROUND/AIMS: Colorectal surgery presents a high risk of surgical site infections (SSI). SSI and prolonged hospital stay were associated with being aged 75 yrs or older. The present study investigated the efficacy of sulbactam sodium/ampicillin sodium (SBT/ABPC), which is a combination drug of ampicillin and beta-lactamase inhibitor, as a prophylactic drug against SSI in elderly patient underwent colorectal surgery. METHODOLOGY: From July 2003 to November 2005, a total of 181 patients underwent colorectal surgery. Of these patients, 43 older than 75 yrs were compared with 138 who were younger. Patients were given SBT/ABPC as follows: Before anesthetic induction at surgery, 1.5 g of SBT/ABPC was administrated by intravenous drip infusion, and further doses were continued at 12-hour intervals for 2 days. We assessed SSI, postoperative stay, type of surgery, duration of operation, and amount of bleeding. RESULTS: The result was that SSI was found in none of the patients. There was no significant difference in rate of SSI and postoperative hospital stay between the two groups. Adverse reactions due to SBT/ABPC such as apparent skin symptoms or gastrointestinal symptoms were not observed. CONCLUSION: SBT/ABPC for elderly patients would be effective to prevent SSI in colorectal operations and could be used safely.

Endoscopy-assisted subcutaneous mastectomy and immediate breast reconstruction for breast cancer: advantage of the posterior approach.

In the past few years, endoscopic surgery has been applied to breast surgery to minimize the wound. We have performed endoscopic-assisted subcutaneous mastectomy and immediate breast reconstruction (EASM-IBR) since 2002. In later cases of EASM-IBR, we used a posterior approach to the breast tissue. EASM-IBR was performed in 21 cases. Ten patients underwent EASM by the advanced skin flap method, and 11 patients underwent EASM by the posterior approach. Surgical duration was 251 and 216 minutes, respectively. Intraoperative blood loss was 294 and 238 ml, respectively. Surgical duration tended to be shorter, and there was less bleeding with the posterior approach than with the advanced skin flap method. In the posterior approach, breast tissue is fully retracted through the wound as the dissection advances. It is a useful method for video-assisted surgery.

Anxiety in outpatients receiving chemotherapy for solid cancer.

BACKGROUND/AIMS: We conducted this prospective study to assess the anxiety in outpatients receiving chemotherapy for solid cancers. METHODOLOGY: Patients were eligible if they were receiving chemotherapy for solid cancer in an outpatient setting, had a life expectancy of more than 6 months, and were able to complete self-administered questionnaires. The State-Trait Anxiety Inventory (STAI) was used to measure the anxiety levels. RESULTS: From January to December 2004, 119 patients were recruited, and, of these, 114 completed the questionnaires. Their median age was 60.6 years, and the male-to-female ratio was 1.04:1. Of the 114 patients, 36 had breast cancer, 35, colorectal cancer, 23, gastric cancer, 8, esophageal cancer, 5, non-small-cell cancer, 4, pancreatic cancer, and 3, liver cancer. The state- and trait-anxiety levels were higher for women (p=0.019). Age did not influence the trait-anxiety level, but the state-anxiety levels of younger patients were higher. The periods of chemotherapy raised the state and trait-anxiety levels (p=0.023 and 0.015, respectively). No statistically significant differences were observed according to the type of cancer. CONCLUSIONS: The anxiety levels of outpatients with solid cancer receiving chemotherapy were significantly high. Having access to such information will help oncologists provide appropriate support to their patients.

Second-line combination chemotherapy of oral S-1 with cisplatin and irinotecan for colorectal cancer resistant to 5-FU.

BACKGROUND/AIMS: A phase I clinical trial has been planned to determine the recommended dose and to assess the safety and efficacy of combination chemotherapy of S-1 with cisplatin and irinotecan (SCI regimen) as a second-line treatment in 5-fluorouracil (5-FU) resistant colorectal cancer (CRC). METHODOLOGY: Patients with unresectable recurrent or metastatic CRC were enrolled in this study for second-line treatment. On an outpatient basis, the patients received a treatment SCI regimen comprising S-1 oral administration for 28 days followed by withdrawal for 2 weeks, plus cisplatin and irinotecan were administered on days 1, 8, 15 and 22 by intravenous injection. These courses were repeated every 6 weeks. Starting doses were 70 mg/m2 S-1, 6 mg/m2 Cisplatin, and 60 mg/m2 Irinotecan. RESULTS: A total of 29 patients was enrolled. Dose-limiting toxicities were fatigue, nausea, and leucopenia. Twenty-three patients at recommended dose were evaluable for treatment response. The response rate was 21.7% (5 partial responses, 13 stable diseases, and 5 progressive diseases). The median progression-free survival rate was 4.3 months; the median survival time was 9.6 months. CONCLUSIONS: The SCI regimen is feasible in an outpatient setting and should be considered as second-line chemotherapy for patients with 5-FU resistant CRC.

Oral regimen consisting of UFT/UZEL for elderly patients with colorectal cancer.

BACKGROUND/AIMS: A clinical trial has been planned to assess the safety and efficacy of oral administration of UFT and leucovorin (UZEL) in elderly patients with advanced colorectal cancer (CRC). METHODOLOGY: Twenty-six patients with advanced CRC who were over 70 years and considered ineligible for combination chemotherapy received oral UFT 300 mg/day and UZEL 75mg/day were administered orally for 28 days followed by a 7-day rest period. Treatment was repeated every 5 weeks until disease progression. RESULTS: A total of 106 cycles of UFT/UZEL were administered (median, four cycles; range, one to twelve cycles). UFT/UZEL was well tolerated. The response rate was 11% (3 partial responses, 16 stable diseases, and 7 progressive diseases). The median progression-free survival rate was 3.9 months and the median survival time was 9.8 months. Treatment-related grade 3 and 4 adverse events were not observed. CONCLUSIONS: Oral regimen consisting of UFT/ UZEL is effective and well tolerated in elderly patients with advanced CRC who are considered ineligible for combination chemotherapy.

Implication of an Intramammary Sentinel Lymph Node in Breast Cancer: Is This a True Sentinel Node? A Case Report.

BACKGROUND: Intramammary lymph nodes (ILN) are often diagnosed by final histological examination. Recently, sentinel lymph node biopsy (SLNB) has been developed as a new standard in the treatment of breast cancer. However, reports describing intramammary sentinel nodes (ISLNs) are relatively rare, and the clinical significance of metastases in ISLNs is still unclear. CASE REPORT: We herein report a patient with breast cancer with an ISLN that was detected prior to surgery. In the current case, the ISLN contained foci of carcinoma, but the axillary SLNs (aSLN) did not contain such foci. Previous reports related to ISLNs and aSLNs, including our case, are reviewed. Interestingly, there was no case with negative ISLNs and positive aSLNs. CONCLUSIONS: The current and previous cases have shown that axillary lymph node dissection (ALDN) might rely on the aSLN status but not on the ISLN status. The effect on the prognosis or clinical significance in cases with positive ISLNs has not been fully elucidated. Cases of ISLNs found by SLN navigation are discussed in relation to their clinical significance.