Sensitivity to CPT-11 and platinum derivatives of stage I/II node-negative breast, lung, and gastric cancer with occult neoplastic cells in lymph node sinuses.

Tumor sensitivity to anticancer drugs such as CPT-11 and platinum derivatives was investigated by assessing Topo-1 and Bax/ERCC-1 expression in patients with stage I/II breast, lung, and gastric cancer who were positive for ONCs, and tumor sensitivity was compared between CPT-11 and platinum derivatives. In the recurrence group (RG) (n=5), immunohistochemistry revealed high expression of Topo-1 in 3 patients (60%) and low expression in 2 patients (40%), while the non-recurrence group (N-RG) (n=17) showed high Topo-1 expression in 3 patients (17.6%) and low expression in 14 patients (82.4%) (not significant; N.S.). High Bax expression combined with low ERCC-1 expression was observed in 2 patients (40%) from the RG and other patterns of expression were seen in 3 patients (60%), while high Bax/low ERCC-1 expression was observed in 3 patients (17.6%) from the N-RG and other patterns were found in 14 patients (82.4%) (N.S.). PCR analysis of Topo-1 expression in the RG (n=4) revealed high expression in 4 patients (100%), while the N-RG (n=5) showed high expression in 3 patients (60%) and low expression in 2 patients (40%) (N.S.). With respect to ERCC-1, PCR analysis of the RG (n=4) also revealed high expression in 4 patients (100%), while the N-RG (n=5) again showed high expression in 3 patients (60%) and low expression in 2 patients (40%) (N.S.). There were significant differences between the expression of high Topo-1 and low ERCC-1 in the RG (p<0.01). These results suggest that tumor sensitivity to CPT-11 may be higher than that for platinum derivatives in patients with node-negative stage I/II breast, lung, or gastric cancer who are positive for ONCs.

Sensitivity to CPT-11 and platinum derivatives of stage III/Dukes' C colorectal cancer with occult neoplastic cells in lymph node sinuses.

The sensitivity of LN metastases to anticancer drugs such as CPT-11 and platinum agents was investigated by assessing Topo-1 and Bax/ERCC-1 expression in patients who had stage III/Dukes' C colorectal cancer with ONCs. In the recurrence group (RG) (n=21), immunohistochemical expression of Topo-1 was high in 8 patients (38.1%), and low in 13 patients (61.9%), while the non-recurrence group (N-RG) (n=12) showed high expression in 1 patient (8.3%) and low expression in 11 patients (91.7%) (not significant; N.S.). Regarding the immunohistochemical expression of Bax/ERCC-1, high Bax/low ERCC-1 expression was observed in 6 patients (28.6%) from the RG and other patterns of expression were seen in 15 patients (71.4%), while high Bax/low ERCC-1 expression level was observed in 3 patients (25.0%) from the N-RG and other patterns were found in 9 patients (75.0%) (N.S.). PCR analysis of Topo-1 expression in the RG (n=13) revealed high expression in 10 patients (76.9%) and low expression in 3 patients (23.1%), while the N-RG (n=3) showed high expression in 3 patients (100%) and low expression in none (N.S.). With respect to ERCC-1, PCR analysis of the RG (n=13) revealed high expression in 6 patients (46.2%) and low expression in 7 patients (53.8%), while the N-RG (n=3) showed high expression in 2 patients (66.7%) and low expression in 1 patient (33.3%) (N.S.). These results suggest that tumor sensitivity to CPT-11 and platinum derivatives is similar in stage III colorectal cancer patients with ONCs.

Sensitivity to CPT-11 and platinum derivatives of stage II/Dukes' B colorectal cancer with occult neoplastic cells in lymph node sinuses.

Among 13 patients with recurrent colorectal cancer (recurrence group: RG), immunohistochemical expression of Topo-1 was high in 4 patients (30.8%) and low in 9 patients (69.2%), while the non-recurrence group (N-RG) (n=8) showed high expression in 1 patient (12.5%) and low expression in 7 patients (87.5%) (NS). Regarding immunohistochemical expression of Bax/ERCC-1, high Bax/low ERCC-1 expression was observed in 6 patients (46.2%) from the RG and other patterns of expression were seen in 7 patients (53.8%), while high Bax/low ERCC-1 expression was observed in 4 patients (50.0%) from the N-RG and other patterns were found in 4 patients (50.0%) (NS). PCR analysis of Topo-1 expression revealed high expression in 9 patients (75.0%) from the RG (n=12) and low expression in 3 patients (25.0%), while the N-RG (n=8) showed high expression in all 8 patients (100.0%) and low expression in none (NS). With respect to ERCC-1, PCR analysis revealed high expression in 7 patients (58.3%) from the RG (n=12) and low expression in 5 patients (41.7%), while the N-RG (n=8) showed high expression in 1 patient (12.5%) and low expression in 7 patients (87.5%) (p<0.05). These results suggest that tumor sensitivity to CPT-11 and platinum derivatives is similar in stage II colorectal cancer patients with ONCs.

Local recurrence and occult neoplastic cells in the extranodal fat of dissected lymph nodes in patients with curatively resected primary colorectal cancer.

This study was designed to examine the relationship between occult neoplastic cells (ONCs) inside and outside harvested lymph nodes (intranodal/extranodal ONCs) and local recurrence in 30 patients who underwent curative resection of primary colorectal cancer. Among 10 patients with colon cancer (Dukes' A=1, Dukes' B=6 and Dukes' C=3), intranodal ONCs were positive in 1 patient (10.0%) and negative in 9 patients (90.0%), while extranodal ONCs were negative in all 10 patients (100.0%). There were no significant differences between the detection of intranodal or extranodal ONCs. Among 20 patients with rectal cancer (Dukes' A=4, Dukes' B=2 and Dukes' C=14), intranodal ONCs were positive in 5 (25.0%) and negative in 15 (75.0%), while extranodal ONCs were positive in 3 (15.0%) and negative in 17 (85.0%). There were no significant differences between the detection of intranodal or extranodal ONCs. These results suggest that patients with rectal cancer and extranodal ONCs should be followed-up carefully as a high-risk group for pelvic local recurrence. However, the prevalence of extranodal and intranodal ONCs was almost similar.

A liver-derived immunosuppressive factor is an arginase: identification and mechanism of immunosuppression.

We found a substance in culture medium of neonatal pig liver fragments, which suppresses an immune response monitored by (3)H-thymidine incorporation using phytohemagglutinin (PHA)-stimulated lymphocytes. We named it as an immunosuppressive factor (ISF). To purify ISF, ammonium sulfate fractionation, DE52, SP-Sephadex, hydroxyapatite, blue Sepharose, heparin Sepharose and Superdex gel filtration columns were used. Using these purification procedures, ISF was purified 1,254-fold, with 9.2% recovery, from the culture medium of neonatal pig liver fragments, and was identified as arginase by its biochemical characteristics including molecular size, amino acid sequences of digested peptides and expression of arginase activity. The addition of ISF caused to decrease in arginine concentration in culture medium and at the same time DNA synthesis was suppressed dose-dependently, both of which were recovered by the addition of NOHA (N(G)-hydroxy-L-arginine), an arginase inhibitor. In addition, the depletion of arginine in culture medium also led to the inhibition of DNA synthesis. These results led us to the conclusion that immunosuppressive effect of ISF was due to arginase activity that decreased arginine concentration in culture medium, not to another function of ISF.

Predicting recurrence and metastasis of primary esophageal cancer with or without lymph node metastasis.

We studied 42 patients, consisting of 11 stage I/II patients who were node-negative (LN-) and 31 stage II/III patients who were node-positive (LN+). In the LN- patients, detection of occult neoplastic cells (ONCs) in lymph nodes had a sensitivity of 0.0% (0/5), a false-positive (FP) rate of 33.3% (2/6), a specificity of 66.7% (4/6), a false-negative (FN) rate of 100% (5/5), a positive predictive value (PPV) of 0.0% (0/2), and a negative predictive value (NPV) of 44.4% (4/9). In the LN+ patients, the sensitivity of ONCs was 25.0% (5/20), FP rate was 36.4% (4/11), specificity was 63.6% (7/11), FN rate was 75.0% (15/20), PPV was 55.6% (5/9), and NPV was 31.8% (7/22). In LN- patients, positivity for at least 2 of the 3 high-risk criteria had a sensitivity of 20.0% (1/5), FP rate of 16.7% (1/6), specificity of 83.3% (5/6), FN rate of 80.0% (4/5), PPV of 50.0% (1/2), and NPV of 55.6% (5/9). In LN+ patients, these criteria had a sensitivity of 75.0% (15/20), FP rate of 9.1% (1/11), specificity of 90.9% (10/11), FN rate of 25.0% (5/20), PPV of 93.8% (15/16), and NPV of 66.7% (10/15). These results suggest that the high-risk criteria may be useful for predicting recurrence or metastasis in stage II/III lymph node-positive patients with esophageal cancer.

Recurrence and 5-FU sensitivity of stage I/II node-negative breast, lung, or gastric cancer with occult neoplastic cells in lymph node sinuses.

This study was designed to examine the relationship between the presence of occult neoplastic cells (ONCs) in lymph nodes (LNs) and survival in 238 patients with stage I/II LN-negative cancer of the breast, lung, or stomach. In addition, immunohistochemistry for TS and DPD was used to compare the 5-FU sensitivity of the primary tumor in ONC (+) patients. The 5-year relapse-free survival (RFS) rate of 215 ONC (-) patients and 23 ONC (+) patients was 95.2 and 82.6%, respectively (p=0.0107). The 5-year overall survival (OS) rate of the ONC (-) and (+) patients was 97.4 and 77.4%, respectively (p=0.0000). The 6 ONC (+) patients with recurrence showed high and low TS expression in 33.3% (2/6) and 66.7% (4/6), respectively, while high and low DPD expression was observed in 16.7% (1/6) and 83.3% (5/6), respectively. In the 17 ONC (+) patients without recurrence, the corresponding values were 64.7% (11/17), 35.3% (6/17), 29.4% (5/17), and 70.6% (12/17). Patients with a combination of high TS and low DPD expression accounted for 33.3% (2/6) of the ONC (+) patients with recurrence and 52.9% (9/17) of those without recurrence, showing no significant difference between the two groups. These results suggest that ONCs are associated with a lower survival rate and that ONC (+) patients are unlikely to respond to 5-FU+LV therapy.

Alternating hepatic arterial infusion and systemic chemotherapy for stage IV colorectal cancer with synchronous liver metastasis.

Among 41 patients with synchronous liver metastases of colorectal cancer, 15 patients underwent synchronous resection of their liver metastases and achieved a median survival time (MST) of 1,441 days (versus 748 days for the 26 patients without resection, p=0.038), a median relapse-free survival time of 652 days (MST not reached), and a recurrence rate in the residual liver of 20% (3/15 patients). The alternating hepatic arterial infusion and systemic chemotherapy showed partial response (PR) in 6 cases, stable disease (SD) in 8 cases, and progressive disease (PD) in 1 case (n=15/26). They had an objective response rate of 40% (6/15), tumor control rate (>/= SD) of 93.3% (14/15), one-year progression-free survival rate of 35.7%, 50% time to progression of 270 days, one-year survival rate of 76.2%, and two-year survival rate of 50.8% (MST not reached). Grade 3 leucopenia was observed in 2/15 patients (13.3%). These results suggest that the present alternating therapy may become a standard regimen for patients in whom synchronous resection of liver metastases is impossible and patients who have stage IV colorectal cancer with a risk of recurrence in the remnant liver and/or at extrahepatic sites such as the lungs.

Prospective study on the recurrence/metastasis of stage II/III colorectal cancer and gastric cancer associated with occult neoplastic cells in lymph node sinuses: three-year interim results.

This study was designed to prospectively examine whether the presence of occult neoplastic cells (ONCs) in lymph nodes or positive high-risk (HR) criteria were related to the survival of patients with stage II/III colorectal cancer or gastric cancer. The 3-year relapse-free survival (3Y-RFS) rate was calculated for 79 patients who were registered during a 2-year period. The 3Y-RFS rate was 80.5% in patients without ONCs (n=54) and 84.3% in patients with ONCs (n=25; p=0.9089). Among patients who had stage II/III colorectal cancer, it was 89.0% (n=47) and 76.2% (n=15), respectively (p=0.4131). For patients with stage III colorectal cancer alone, it was 80.8% (n=24) and 62.5% (n=9), respectively (p=0.4006). The 3Y-RFS rate was respectively 88.1% and 77.6% for the HR patients (n=31) and low-risk (LR) patients (n=48) with stage II/III colorectal cancer or gastric cancer (p=0.5545). It was respectively 92.3% and 84.3% for the HR patients (n=20) and LR patients (n=42) with stage II/III colorectal cancer (p=0.5073). Also, the rate was respectively 80% and 76.2% for the HR patients (n=7) and LR patients (n=26) with stage III colorectal cancer alone (p=0.9506). These results indicate that the 3Y-RFS rate is lower in ONC-positive patients with stage II/III colorectal cancer, suggesting that ONCs may have an influence on survival.

Long-term survival and tumor 5-FU sensitivity in patients with stage IV colorectal cancer and peritoneal dissemination.

Among 125 patients with peritoneal dissemination (P1-3) of colorectal cancer, including those with other synchronous metastases, the 5-year overall survival (OS) rate was 13.3% for P1 patients (n=30), 12.8% for P2 patients (n=39), and 1.8% for P3 patients (n=56) (P1 vs. P2, p=N.S.; P2 vs. P3, p=0.02; P1 vs. P3, p=0.001), while the median survival time (MST) was 12.0, 14.1, and 3.1 months, respectively. The 5-year OS rates for patients who had peritoneal dissemination without other metastases were 17.6% (n=17), 12.5% (n=19), and 3.4% (n=28) (P1 vs. P2, p=N.S.; P2 vs. P3, p=N.S.; P1 vs. P3, p=0.039), while the MST was 25.1, 15.1, and 12.5 months, respectively. In the P3 short survival group (SSG; n=13), TS expression was high in 7.7% (1/13) and low in 92.3% (12/13) of tumors, while DPD expression was high in 38.5% (5/13) and low in 61.5% (8/13) of tumors. In the P3 long survival group (LSG; n=15), the corresponding values were 80.0% (12/15), 20.0% (3/15), 33.3% (5/15), and 66.7% (10/15). High TS and low DPD expression was found in only 7.7% (1/13) of the SSG tumors vs. 46.7% (7/15) of the LSG tumors (p=0.028). These results suggest that the prognosis of stage IV colorectal cancer with P3 peritoneal dissemination is extremely poor. In addition, patients fitting the SSG criteria are unlikely to respond to treatment with 5-FU+LV, and may need combination chemotherapy using CPT-11 and/or L-OHP.

Recurrence and 5-FU sensitivity of stage III/Dukes' C colorectal cancer with occult neoplastic cells in lymph node sinuses.

In 72 patients without occult neoplastic cells (ONCs) in their lymph node sinuses, the 5-year relapse-free survival (RFS) rate and overall survival (OS) rate were 71.3% and 69.2%, respectively. In 33 patients with ONCs, the 5-year RFS rate and OS rate were 33.9% and 31.3%, respectively. There was a marked difference of survival between the two groups (p=0.0001 and p=0.0003). The metastatic lymph nodes of the 33 ONC-positive patients had high and low levels of thymidilate synthase (TS) expression in 38.1% (8/21) and 61.9% (13/21) of the recurrence group (n=21), respectively, while high and low levels of dihydropyrimidine dehydrogenase (DPD) expression were found in 38.1% (8/21) and 61.9% (13/21), respectively. In the non-recurrence group (n=12), high and low levels of TS or DPD expression were detected in 58.3% (7/12) and 41.7% (5/12) versus 16.7% (2/12) and 83.3% (10/12), respectively. Patients with high TS and low DPD expression accounted for 9.5% (2/21) of the recurrence group and 50.0% (6/12) of the non-recurrence group (p<0.01). These results suggest that ONCs are clearly associated with the 5-year RFS and OS rates. Unlike the non-recurrence group, the recurrence group of ONC-positive patients with Dukes' C colorectal cancer is unlikely to respond well to treatment with 5-FU plus LV and require combination chemotherapy based on CPT-11 and/or L-OHP.

Recurrence and 5-FU sensitivity of stage II/Dukes' B colorectal cancer with occult neoplastic cells in lymph node sinuses.

In 103 patients without occult neoplastic cells (ONCs) in the lymph node sinuses, the 5-year relapse-free survival (RFS) rate and overall survival (OS) rate were 90.2% and 91.8%, respectively. In 21 patients with ONCs, the 5-year RFS and OS rates were 34.9% and 62.3%, respectively. There were marked differences of survival between the two groups (p=0.0000 and p=0.0003). In the primary tumors of the 21 ONC-positive patients, high and low TS levels were found in 46.2% (6/13) and 53.8% (7/13) of the recurrence group (n=13), respectively. High and low DPD levels were found in 23.1% (3/13) and 76.9% (10/13), respectively. In the non-recurrence group (n=8), high and low TS or DPD levels were found in 75.0% (6/8) and 25.0% (2/8) versus 12.5% (1/8) and 87.5% (7/8), respectively. The percentage of patients with high TS and low DPD levels was 23.1% (3/13) in the recurrence group and 62.5% (5/8) in the non-recurrence group (p=0.07). These results suggest that the presence of ONCs had a clear association with the 5-year RFS and OS rates. The recurrence group of ONC-positive patients with stage II/Dukes' B colorectal cancer was unlikely to be highly responsive to 5-FU-based treatment, thus requiring multi-combination chemotherapy using CPT-11 and/or L-OHP.

Recurrence and 5-FU sensitivity of stage II/III node-positive gastric cancer with occult neoplastic cells in lymph node sinuses.

The 5-year overall survival (OS) rates for patients without occult neoplastic cells (ONCs) were 43.0% in stage II (n=15), 52.2% in stage III (n=23), and 48.5% for stages II and III combined (n=38). For ONC-positive patients, the 5-year OS rates were 44.4% in stage II (n=7; p=0.88322), 11.3% in stage III (n=30; p=0.0006), and 17.5% for stages II and III combined (n=37; p=0.0019). Among the ONC(+) recurrence group (75.7%, 28/37), 42.9% (12/28) showed high TS expression in metastatic lymph nodes and 57.1% (16/28) showed low TS expression. In the case of DPD expression, 32.1% (9/28) showed high expression and 67.9% (19/28) showed low expression. Among the ONC(+) non-recurrence group (24.3%, 9/37), 66.7% (6/9) showed high TS expression and 33.3% (3/9) showed low TS expression, while high and low DPD expression was seen in 22.2% (2/9) and 77.8% (7/9), respectively. A combination of high TS and low DPD expression was found in 32.1% (9/28) of the recurrence group vs. 66.7% (6/9) of the non-recurrence group (p=0.070). These results suggest that ONCs are associated with OS. Unlike the non-recurrence group, the ONC(+) patients with recurrence of stage II/III node-positive gastric cancer are unlikely to respond to treatment with 5-FU + LV and may need combination chemotherapy based on L-OHP and/or CPT-11.

Is temporary loop colostomy of the right transverse colon appropriate for complete obstruction by colorectal cancer?

We experienced 12 consecutive cases of complete bowel obstruction due to primary colorectal cancer. Among these patients, temporary loop colostomy (loop C) was performed within the resection zone for the primary tumor in 10 cases, and Hartmann's operation was performed in two cases. The loop C was located in the sigmoid colon in five cases and on the left side of the transverse colon in five cases. The interval until radical resection was from 13 to 35 days (mean: 20 days), the duration of surgery was from 2 h 5 min to 4 h 55 min (mean: 4 h 7 min), and the length of resected bowel ranged from 22.5 cm to 51.2 cm (mean: 29.8 cm). Mild wound infection was observed in two cases. Dukes' clinical stage was as follows: A in 0 case, B in 5 cases, C in 6 cases and D (distant metastasis) in 1 case. We have achieved good results over the past two years without performing standard loop C on the right side of the transverse colon.

Improvement of 10-year survival by Japanese radical lymph node dissection in patients with Dukes' B and C colorectal cancer: a 17-year retrospective study.

This study investigated whether the Japanese radical lymph node dissection (J-LND) method was useful for improving the survival and outcome in patients undergoing surgical resection of primary colorectal cancer. The subjects were 434 patients with primary colorectal cancer treated over 17 years. The 10-year survival (10-YS), the number of retrieved and metastatic lymph nodes (LN), the extent of lymph node dissection (D0-D3), and the extent of lymph node metastasis (n0-n4) were compared with Dukes' classification by the Kaplan-Meier curves, log-rank test and multivariate analysis. Patients with a D number larger than their n number (D>n group) were defined as being treated according to J-LND principles, while those with a D number equal to their n number were used as controls (D=n group). Among Dukes' B patients, there was a significant difference of 10-YS between those with retrieval of > or =17 LN or < or =16 LN (p=0.0106). Among Dukes' C patients, a significant difference of 10-YS was observed between those with 1 metastatic node or > or =3 metastatic LN (p=0.0401). A significant difference of 10-YS was also noted between Dukes' C patients with D>n or D=n (p=0.0282). Multivariate analysis showed that retrieval of < or =16 LN (HR=9.051) and intramural invasion (se,si/a2,ai; HR=6.313) were independent determinants of 10-YS in Dukes' B patients, while D=n (HR=2.354) and > or =3 metastatic LN (HR=2.210) were independent determinants in Dukes' C patients. These results suggest that the J-LND method should be performed to retrieve at least 17 nodes when serosal dimpling of the primary tumor is observed during surgery. Effective post-operative adjuvant therapy, such as combination chemotherapy and/or radiotherapy, should be provided for Dukes' C patients with D=n and/or > or =3 metastatic nodes on histopathological examination.

Selection criteria for high risk and low risk groups of recurrence and metastasis in patients with primary colorectal cancer.

Among 371 patients with primary colorectal cancer, 54 patients suffered from recurrence/metastasis (recurrence group) and 317 survived without recurrence for at least 5 years (non-recurrence group). The clinicopathological characteristics of the 2 groups were compared and occult neoplastic cells (ONCs) in the lymph node sinuses were detected by cytokeratin immunohistochemistry. There were significant differences of the following factors: venous invasion (v-) vs. (v+) for Dukes' A patients (p=0.0315); harvested lymph nodes (LN) or=15 for Dukes' B patients (p=0.0388); (v-) vs. (v+) (p=0.0059), lymphatic invasion (ly-) vs. (ly+) (p=0.0435) for Dukes' A and B patients combined; D>n vs. D=n (p=0.0033), depth of tumor invasion or=se/a2 (p=0.0329) for Dukes' C patients. When the detection of >or=3 ONCs was defined as positive, the sensitivity, specificity, PPV, and NPV were respectively 77%, 100%, 100% and 71% in Dukes' B patients, as well as 75%, 72%, 73% and 74% in Dukes' C patients. The high-risk groups for recurrence/metastasis were identified by the following criteria: (v+) and (ly+), or=se/a2, and ONCs (+) of those with >or=2 factors for Dukes' C patients (selection rate; approximately 21.2-37.5%). These factors seem to be appropriate for separating patients into high-risk and low-risk groups of colorectal cancer recurrence/metastasis.

Predicting recurrence and metastasis of stage II/Dukes' B colorectal cancer without lymph node metastasis.

This study was designed to compare the prediction of recurrence based on detection of occult neoplastic cells (ONCs) in lymph nodes or by using high-risk criteria for recurrence/metastasis in patients with Dukes' B colorectal cancer. Prediction of recurrence based on the detection of ONCs had a sensitivity of 59.1% (13/22), a false-positive rate of 7.8% (8/102), a specificity of 92.2% (94/102), and a negative predictive value (NPV) of 91.3% (94/103). Prediction of recurrence based on positivity for at least 2 of the 3 high-risk criteria had a sensitivity of 90.9% (20/22), a false-positive rate of 49.0% (50/102), a specificity of 51.0% (52/102), and an NPV of 96.3% (52/54). Among the 21 patients in whom ONCs were detected, prediction of recurrence based on the presence of all 3 high-risk criteria including ONCs had a sensitivity of 84.6% (11/13) and a positive predictive value (PPV) of 78.6% (11/14). These results suggest that colorectal cancer is unlikely to recur in patients without ONCs, while recurrence is likely in patients who fulfill 2 or more of the high-risk criteria. Accordingly, a combination of these parameters may be useful for the early prediction of recurrence/metastasis to assist in the choice of postoperative systemic chemotherapy.

Predicting the recurrence/metastasis of stage I and II breast cancer without lymph node metastasis.

Prediction of the recurrence of primary breast cancer was attempted by detection of occult neoplastic cells (ONCs) in lymph nodes or by using the high-risk criteria for recurrence/metastasis of gastric and colorectal cancer. The subjects were 70 patients with stage I or II node-negative primary breast cancer. Prediction of recurrence using ONCs had a sensitivity of 60.0% (3/5) and a false-negative rate of 40.0% (2/5) in the recurrence group, while the specificity was 96.9% (63/65) and the false-positive rate was 3.1% (2/65) in the non-recurrence group. The accuracy of ONCs was 78.5%. Prediction of recurrence based on positivity for at least 2 of the high-risk criteria showed a sensitivity of 60.0% (3/5) and a false-negative rate of 40.0% (2/5) in the recurrence group, while the specificity was 95.4% (62/65) and the false-positive rate was 4.6% (3/65) in the non-recurrence group. The accuracy of the high-risk criteria was 77.7%. These results suggest that ONCs show the same accuracy as the high-risk criteria for predicting recurrence/metastasis of stage I and II node-negative breast cancer with a high specificity.

Predicting recurrence and metastasis of stage III/Dukes' C colorectal cancer with lymph node metastasis.

This study was designed to compare the prediction of recurrence based on detection of occult neoplastic cells (ONCs) in lymph nodes or using specific criteria to identify patients at high risk of recurrence/metastasis among 105 patients with Dukes' C colorectal cancer. Prediction of recurrence based on the detection of ONCs had a sensitivity of 50.0% (22/44), specificity of 80.3% (49/61), and an accuracy of 65.2%. Prediction of recurrence based on positivity for at least 2 of the 3 high-risk criteria had a sensitivity of 54.5% (24/44), specificity of 83.6% (51/61), and an accuracy of 69.1%. Among the 34 patients with ONCs, prediction of recurrence based on positivity for all 3 high-risk criteria had a sensitivity of 27.3% (6/22), specificity of 91.7% (11/12), an accuracy of 59.5%, and a positive predictive value (PPV) of 85.7% (6/7). These results suggest that the predictive value of ONCs and the high-risk criteria was similar, and that recurrence is likely to occur in patients who fulfill < or =2 of the high-risk criteria. Accordingly, combined use of these parameters may be more effective for the early prediction of recurrence/metastasis to assist in the choice of postoperative systemic chemotherapy.

Predicting recurrence and metastasis of Dukes' A primary colorectal cancer with or without proper muscle invasion.

This study compared the prediction of recurrence based on detection of occult neoplastic cells (ONCs) in lymph nodes or using 3 criteria to identify high-risk patients among 72 patients who had Dukes' A colorectal cancer with or without proper muscle invasion. Predicting recurrence based on the detection of ONCs had a sensitivity of 40.0% (2/5) and a false-negative rate of 60.0% (3/5), while there was a specificity of 97.0% (65/67) and false-positive rate of 3.0% (2/67), resulting in an accuracy of 68.5%, PPV of 50.0% (2/4), and NPV of 95.6% (65/68). Predicting recurrence based on the presence of at least 2 of the 3 high-risk criteria showed a sensitivity of 60.0% (3/5) and a false-negative rate of 40.0% (2/5), while it had a specificity of 74.6% (50/67) and a false-positive rate of 25.4% (17/67), resulting in an accuracy of 67.3%, PPV of 15.0% (3/20), and NPV of 96.2% (50/52). These results suggest that a prediction based on ONCs was similar to use of the high-risk criteria, with both methods having a high specificity for recurrence/metastasis of Dukes' A colorectal cancer.