Predictive factors of complete response to neoadjuvant chemoradiotherapy in patients with rectal cancer.

PURPOSE: Pathological complete response (pCR) after neoadjuvant chemoradiotherapy is a favorable prognosticator in rectal cancer patients. We investigated whether the biological features of the primary tumor affect pCR. MATERIALS AND METHODS: Forty-six patients treated with capecitabine-oxaliplatin and pelvic conformal radiotherapy were considered. Forty-three patients underwent surgery, and the pathologic response was scored according to the tumor regression grade (TRG) scale. Epidermal growth factor receptor (EGFR), vascular endothelial growth factor, poly(adenosine diphosphate-ribose) polymerase-1, X-ray cross-complimenting, thymidylate synthase (TS) and Ki67 expression were evaluated by immunohistochemistry on rectal biopsies obtained before chemoradiotherapy, and scored as the percentage of positive cells. Cutoffs were selected based on ROC analysis. The correlation between the biological factors and the TRG coded as TRG1 (pCR) versus TRG ≥2 (no pCR) was assessed by the χ(2) test and logistic regression analysis. RESULTS: Low EGFR (p = 0.007), high TS (p = 0.002), and high Ki67 (p = 0.05) were strongly associated with pCR. Upon univariate analysis, TRG significantly affected disease-free survival (p = 0.03). CONCLUSIONS: pCR was significantly associated with high TS, high Ki67 and low EGFR expression. Patients with pCR have a significantly lower incidence of relapse.

Cutaneous needle track seeding of mesothelioma diagnosed by fine needle aspiration cytology: a case report.

BACKGROUND: Diagnostic and therapeutic procedures for mesothelioma require surgical biopsy or the usage of different-sized needles. Thoracic wall involvement along the surgical or needle tracks has been reported. CASE: A 57-year-old woman who had suffered from non-Hodgkin's lymphoma complained of dyspnea and left pleural effusion. The patient had been treated with chemotherapy and radiotherapy and was in remission since then. Thoracentesis was performed using a 22-gauge needle; the cytologic diagnosis was malignant pleural mesothelioma. Within 2 weeks from thoracentesis, the patient complained of an erythematous swelling in her left chest wall, in the area of the needle track. Fine needle aspiration cytology (FNAC) of the swelling was performed using a 23-gauge needle; 2 smears and a cell block were prepared. Smears showed neoplastic cells in sheets and papillary configuration with the features of mesothelial lineage. Immunocytochemistry showed positivity for calretinin and vimentin. Cytologic slides of the former effusion showed an overlapping of the cytologic and immunocytochemical features. A diagnosis of chest wall involvement from mesothelioma was established and histologically confirmed. CONCLUSION: Chest wall infiltration is a definite risk in the management of pleural mesothelioma, and FNAC is a useful procedure for a timely diagnosis of this ominous complication.

Microvascular density and endothelial area correlate with Ki-67 proliferative index in surgically-treated pancreatic ductal adenocarcinoma patients.

Previous experimental and clinical data have indicated that tumour cell proliferation is associated with angiogenesis; in addition, an increased microvascular density (MVD) of tumours has been associated with poor prognosis in solid and haematological malignancies. However, limited data exists regarding the association between tumour cell proliferation and angiogenesis in primary tumour tissue from pancreatic ductal adenocarcinoma (PDAC) patients; therefore, the present study aimed to investigate this association. A series of 31 PDAC patients with stage Tumour (T)2-3 Node (N)0-1 Metastasis (M)0 were recruited into the present study and subsequently underwent surgery. PDAC tissue and adjacent normal tissue (ANT), resected during surgery, were evaluated using immunohistochemistry and image analysis methods to determine MVD, endothelial area (EA) and Ki-67 expression, which is an indicator of cell proliferation rate. The results demonstrated a correlation between the above parameters with each other as well as the main clinico-pathological features of PDAC. Significant differences were identified in MVD, EA and Ki-67 proliferation index between PDAC and ANT. It was demonstrated that MVD, EA and Ki-67 proliferation index were significantly correlated with each other in tumour tissue (r=0.69-0.81; P=0.001-0.003). However, no other significant correlations were identified. These data therefore suggested that angiogenesis and cell proliferation rate were significantly increased in PDAC compared with ANT, which provides a biological basis for the potential use of novel combinations of angiogenesis inhibitors and anti-proliferative chemotherapeutic drugs in the treatment of PDAC.