Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment.

OBJECTIVE: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema. METHODS: 1250 sets of questionnaires consisting of WHO-DAS II, EORTC QLQ-C30, EORTC QLQ-BR23 and GHQ-30 were mailed to women who underwent a breast cancer surgery at the Lower Silesian Oncology Center in Poland between January 1998 and December 2005. RESULTS AND CONCLUSIONS: The response rate was 33.47%. 117 women were included into a lymphedema group and 211 into a group without this complication. Women with lymphedema were more disabled (overall disability (DAS) score 39.78 versus 34.67; p<0.001), reported symptoms from the upper extremity (shoulder or arm pain and difficulties in arm movement) and from the operated breast (pain and swelling) 2-3 times more often, experienced poorer quality of life (global quality of life (QOL) score 0.50 versus 0.57; p=0.005) and higher psychological distress (GHQ score 10.61 versus 8.01; p=0.007) in comparison to breast cancer survivors without lymphedema. The factors associated with higher DAS score, higher GHQ score and lower QOL score in women with lymphedema were as following: pain in the upper limb (mainly shoulder and arm), pain in operated breast, difficulties with arm movement, localization of lymphedema within the hand or in operated breast, a history of dermatolymphangitis and of receiving chemotherapy. Severity of lymphedema, younger age, BMI and localization of lymphedema within the dominant limb were not considerably related to worse outcomes in these women.

Influence of tamoxifen on cisplatin-sensitivity and estrogen receptors expression in ovarian carcinoma cell lines.

BACKGROUND: Tamoxifen, used in breast cancer treatment, competitively inhibits estrogen receptor (ER) and also demonstrates direct antiproliferative effect on cancer cells even in ER lacking cancer tissue. However its molecular mechanism of action is still unclear MATERIAL AND METHODS: We exposed on tamoxifen 11 ovarian cancer cell lines, including well-documented platinum-sensitive and platinum-resistant ones, and studied tamoxifen-, cisplatin-sensitivity and expression of ERalpha and beta. RESULTS: We observed: no correlation between TAM-sensitivity and ERalpha and ERbeta expressions, no correlation between TAM influence on cisplatin-sensitivity and ERalpha and ERbeta expressions, increase of ERbeta expression after TAM-exposure in 3 cell lines; decrease in the 1 line, no TAM-exposure influence on ERalpha expression and increase of 1050 for cisplatin after TAM-exposure in 5 (45%) cell lines. These results show ovarian cancer cells being affected by TAM have different platinum sensitivity CONCLUSIONS: Our data suggests that ovarian cancer cells platinum-sensitivity are not linked with ER expressions. We claim the necessity of seeking some TAM predicting factors, using DNA microarrays.

Mastectomy approach with Y-shaped incision: a technique designed for women with obesity.

OBJECTIVE: To evaluate the access to axilla, postoperative complications, and cosmetic results of the modified radical mastectomy with a Y-shaped approach especially designed for women with obesity. METHODS: One hundred seventeen consecutive women with obesity with infiltrating breast cancer were studied. All of them were not eligible for breast-conserving therapy and underwent modified radical mastectomy. Operation was performed using a surgical technique designed to improve the axillary clearance and to eliminate the lateral dog ear deformity. Two oblique incisions were added to the traditional transverse Stewart incision at the lateral part forming the Y-shaped approach. After lateral flap retraction, the axillary dissection was done. Before closing the wound, the triangular flap was advanced medially, whereas superior and inferior areas of redundant skin overlying the latissimus dorsi muscle were excised. RESULTS: No intraoperative complications were observed. In each case, the axillary dissection (with level 3 node clearance when needed) was performed with ease. The wound was healed by primary adhesion, giving an excellent cosmetic result without lateral dog ear deformity. Skin flap necrosis was found in 2 elderly patients. Wound hematoma and surgical site infection developed in 1 patient each. Necrosis of the apex of axillary triangle occurred in one woman with diabetes. These rare complications were managed successfully in all the cases. CONCLUSIONS: The Y-shaped approach for modified radical mastectomy is a simple and safe technique. It facilitates the wide access to axilla and improves cosmesis in women with obesity by eliminating lateral dog ear deformity.

[The effectiveness of population-based breast cancer screening programme]. / Skutecznosc populacyjnego programu wczesnego wykrywania raka piersi.

UNLABELLED: Well-organised mammography screening programme can significantly reduce the breast cancer mortality However, changes in mortality rates take a long time thus some early indicators are usually used to monitor the effectiveness of the programme. If these operational objectives are accomplished then the programme can replicate the mortality reduction achieved in randomised trials. THE AIM OF THIS STUDY: To evaluate the quality of breast cancer screening programme in the region of Lower Silesia during the first year of its operating. MATERIAL AND METHODS: Centrally organised breast cancer screening has been introduced since the beginning of the year 2007. This population-based programme is designed for women aged 50-69. Females undergoing treatment or being followed-up due to breast cancer are not invited. Screen-film two-view mammography without clinical examination is used as a screening test which is to be performed every two years. The second level diagnostic tools are breast clinical examination and additional imaging (mammography and ultrasound). Following further assessment women are referred to the examination at the routine round length of the programme, at the less interval (short-term recall) or biopsy procedures. Quality assessment was done via early indicators according to the European guidelines. RESULTS: The attendance rate was 41% (79,143 women screened within 192,613 eligible population for one year). Technical repeat rate, further assessment rate, and short-term recall rate were: 0.26%, 6.85%, and 0.91%, respectively. Pathologically confirmed breast cancer was revealed in 364 women giving the detection rate 4.59 for 1000. Cancer detection rate to expected incidence ratio was 3.35. CONCLUSIONS: Mammography service performed during the first year of breast cancer screening programme in the region of Lower Silesia conforms to quality assessment parameters recommended by the European guidelines at the acceptable level. The main problem at the start of this programme is too low coverage. Invitation process must be strongly intensified to improve long-term effectiveness and to significantly reduce breast cancer mortality.

Constitutive and dynamic phosphorylation and acetylation sites on NUCKS, a hypermodified nuclear protein, studied by quantitative proteomics.

Nuclear ubiquitous casein and cyclin-dependent kinases substrate (NUCKS) is a 27 kDa chromosomal protein of unknown function. Its amino acid composition as well as the structure of its DNA binding domain resembles that of high mobility group A (HMGA) proteins, chromosomal proteins known as modulators of chromatin conformation and regulators of transcription. Conformation and function of the HMGA proteins are regulated by phosphorylation and acetylation. So far 19 phosphorylation sites had been reported in NUCKS. In this study, we have identified all known and six additional phosphorylation sites, and also mapped multiple sites of acetylation, methylation and formylation. We measured cell cycle dependent changes of phosphorylation and acetylation of NUCKS in HeLa cells through stable isotope labeling by amino acids in cell culture (SILAC), using the dephosphorylated protein for normalization. We identified sites that were highly phosphorylated or dephosphorylated in mitotically arrested cells as well as sites that were constitutively phosphorylated. The extent of acetylation is reduced in mitotically and G1 arrested cells. Analysis of human cancer specimens revealed that in tissues the extent of acetylation, formylation and methylation is higher than in cultured cells. In breast cancer samples, seven acetylation, three methylation, and three formylation sites were mapped in NUCKS. Of the 243 amino acids, at least 36 can be modified with a total of 57 posttranslational modifications. Thus, NUCKS appears to have the highest ratio of modified to unmodified residues of any protein so far described.

Positive correlation between cyclooxygenase 2 and the expression of ABC transporters in non-small cell lung cancer.

BACKGROUND: The primary method of treatment of non-small cell lung cancer (NSCLC) in stage IIIB and IV is chemotherapy. Previous data suggested a correlation between cyclooxygenase-2 (COX-2) expression and the multidrug-resistant phenotype of cancer cells. MATERIALS AND METHODS: In this prospective study, 32 patients with NSCLC in stage IIIB and IV from 1,078 patients were included. The expression of COX-2 as well as the expression of the ABC transporters MDR1/P-glycoprotein (MDR1/P-gp), BCRP and MRP1 were detected immunohistochemically. RESULTS: Univariate and multivariate analyses demonstrated no prognostic or predictive significance of these proteins. It was merely demonstrated that complete or partial response are favourable factors for prediction of longer progression-free survival time. However, a strong positive correlation between the expression of COX-2, MDR1/P-gp and BCRP was found in NSCLC. CONCLUSION: These data suggest no clinical impact for the expression of MDR1/P-gp, MRP1, BCRP or COX-2 in NSCLC, but a putative coregulation of COX-2 and MDRI/P-gp and BCRP in NSCLC.

Nuclear metallothionein expression correlates with cisplatin resistance of ovarian cancer cells and poor clinical outcome.

Elevated metallothionein (MT) expression in ovarian cancers treated with cisplatin-based schemes represents an unfavorable prognostic index. MT expression is significantly higher in tumor samples obtained after chemotherapy. The present study aimed at examining MT expression in ovarian carcinoma cells sensitive (A2780) or resistant (A2780RCIS) against platinum drug treatment as well as examining effects of exposure to cisplatin on MT expression. Subcellular expression of MT was evaluated also in samples originating from 73 ovarian tumors. Cisplatin-resistant A2780RCIS cells were exposed to increasing cisplatin concentrations, and the subcellular expression of MT was determined by immunocytochemistry. The studies demonstrated that cisplatin-resistant A2780RCIS cells exposed to cisplatin typically manifested a nuclear MT expression. The study demonstrated also that exposure to cisplatin was paralleled by growing MT expression in cell nuclei. The nuclear expression of MT was also found to be specific for ovarian cancers of poor clinical outcome. No relationship could be demonstrated between cytoplasmic expression of MT and clinical variables. Nuclear MT expression is induced by cisplatin and seems to protect DNA in the cells from toxic effects of the drug.

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum.

The aim of the study was to estimate the long-term results and the prognostic value of clinical and pathological factors following R0 anterior resection with total mesorectal excision (TME). Ninety-eight consecutive patients with histologically confirmed rectal cancer were studied prospectively with five-year follow-up. Survival was calculated using the Kaplan-Meier method and differences between curves were tested by the log-rank test. Multivariate analysis was performed using the Cox regression model. Recurrence-free survival (RFS) was 63.6%. Mean time of recurrence was 13.8 months (range 3-38). Local recurrence rate was 7.8% with the mean time of 12.7 months (range 3-25). In univariate analysis Dukes' stage (RFS for stage: A=93.2%; B=53.8%; C=26.3%) and preoperative CEA serum level (s-CEA) (for s-CEA5 ng/ml RFS=5.9%) significantly influenced survival (P<0.005 and P<0.00001). These parameters were also found to be independent prognostic factors in multivariate analysis (P<0.05 and P<0.00001). Survival was worse in older female patients with low-localised poorly differentiated tumors; however, those variables had not significant impact on prognosis. Neither symptom duration nor mucinous histology was significantly related to survival. Using TME technique a low local recurrence rate resulting in improved survival can be achieved. Apart from clinicopathological staging, elevated s-CEA can identify patients with poor prognosis. In addition to TME adjuvant therapy for this high-risk group should be considered.

Occurence of stromal myofibroblasts in the invasive ductal breast cancer tissue is an unfavourable prognostic factor.

BACKGROUND: Numerous experimental studies have described the capacity of myofibroblasts to stimulate mammary cancer cells in a paracrine manner. Until now, the prognostic significance of myofibroblasts present in breast cancer has not been examined. PATIENTS AND METHODS: In paraffin sections, originating from 45 patients with primary invasive breast cancer, immunohistochemical reactions were performed using antibodies directed against smooth muscle actin, Ki-67, VEGF, bFGF and UPA. RESULTS: The cases with higher content of myofibroblasts in the tumour tissue manifested higher grade, more pronounced expression of Ki-67, VEGF and bFGF and shorter overall survival and relapse-free survival. CONCLUSION: The present study for the first time documents the unfavourable prognostic significance of myofibroblasts in tissues of invasive ductal mammary carcinomas.

Hepatitis C virus infection and locally advanced splenic marginal zone lymphoma.

Splenic marginal zone lymphoma (SMZL) is a rare malignant B-cell neoplasm, usually with an indolent clinical course and favorable prognosis. Treatment options include chemotherapy, surgery, radiation and immunotherapy. In some recent studies an increased incidence of hepatitis C virus (HCV) infection in patients with SMZL was reported and its possible role in lymphomagenesis was emphasized. A 66-year-old woman with twelve-year history of HCV infection was admitted due to locally advanced abdominal tumor involving the spleen and the left part of the diaphragm. Transaminase serum levels were not elevated. Neither peripheral lymphadenopathy nor bone marrow pathology was found. Absolute blood lymphocyte, erythrocyte and platelet counts were normal. A splenectomy with partial diaphragm resection in one block was performed. Recovery was uneventful. Pathologic examination with immunohistochemistry revealed SMZL and confirmed a neoplastic infiltration of the resected diaphragm. Following surgery, chemotherapy (CHOP regimen) and immunotherapy (anti-CD20 antibody) were given. At the last follow-up 15 months after surgery, the patient was free of any symptoms of lymphoma. Surgical resection of even locally advanced SMZL with involvement of adjacent tissues can be performed as a diagnostic and therapeutic procedure. Splenectomy is especially indicated in symptomatic patients without other sites of the disease. HCV infection may result in increased risk of SMZL due to the induction of B-cell lymphoproliferation. Because of possible lymphoma regression following anti-viral therapy, a systematic screening for HCV in patients with SMZL seems to be valuable and helpful for treatment planning.

Sphincter-preserving R0 total mesorectal excision with resection of internal genitalia combined with pre- or postoperative chemoradiation for T4 rectal cancer in females.

AIM: To evaluate the impact of chemoradiation admi-nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter-preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log-rank test. The association between chemoradiation and other variables was evaluated with the Fisher's exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors locatedor=1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P<0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.

[Postoperative complications of curative treatment for rectal cancer in males with sphincter-preserving total mesorectal excision]. / Powiklania leczenia u mezczyzn raka odbytnicy metoda calkowitego wyciecia mezorektum z zaoszczedzeniem zwieraczy.

UNLABELLED: Cancer of the rectum is an important problem for public health in Poland due to increasing incidence rate and still not satisfying treatment outcomes. Surgical management remains the mainstay of therapy. Because of introduction of the total mesorectal excision technique (TME) better locoregional control can be achieved. The value of the treatment method for clinical practice is associated with oncological effectiveness but it is also related to the risk of mortality and morbidity. THE AIM OF THIS STUDY: To assess the risk of mortality and morbidity of the curative anterior resection with TME in male patients and to evaluate the association between the incidence of postoperative complications and patient-, tumour- and treatment-related variables. MATERIAL AND METHODS: Consecutive 65 patients with histologically confirmed rectal cancer operated on with sphincter-saving TME method were studied prospectively RO resection was achieved in all cases. All anastomoses were constructed with end to end double-stapling technique. Adjuvant therapy was administered for 54% patients (in stages UICC II i III). 19% of patients received preoperative radiation with high-dose fractions to 25 Gy (5 x 5 Gy) and postoperative chemotherapy with 5-fluorouracil and leucovorin in six courses. In 35% of patients combined adjuvant radiotherapy to the total dose 50.4 Gy and chemotherapy scheduled as above was used. RESULTS: There was no postoperative mortality. Early complications were noticed in 23% of patients: in 9.2% prolonged wound healing caused by superficial infection, in 6.9% anastomosis leakage (surgical treatment was performed in one patient), in 4.6% prolonged bowel paralysis, in 2.3% acute postoperative bleeding requiring relaparotomy. Late complications occurred in 16% of patients: in 6.9% anterior resection syndrome with bowel dysfunction (in one case defunctioning stoma was constructed), in 4.6% bladder dysfunction (nycturia with dysuria and urinary incontinence in 2.3% each), in 2.3% moderate benign anastomosis stricture and also in 2.3% complete sexual impotence. In patients with postoperative complications following factors were present: older age (> 75 years), obesity (BMI > 30), diabetes, preoperative radiotherapy and ultra low site of tumour (< 6 cm from the anal verge). CONCLUSIONS: Anterior resection with TME technique is a safe procedure in male patients. The incidence of early and late postoperative complications seems to be acceptable especially considering the oncological advantages of this method. The risk of morbidity increases in older patients with obesity, diabetes, ultra low-sited tumours and after preoperative radiation therapy

[The results of breast conserving treatment in breast cancer]. / Wyniki leczenia oszczedzajacego chorych na raka sutka.

UNLABELLED: The aim of the work was to assess the results of breast conserving treatment (BCT) in early breast cancer in patients treated in Lower Silesian Oncology Centre. MATERIAL AND METHODS: Analysis of data from 167 women treated between 1997 and June 2003 with BCT and adjuvant therapy was performed. RESULTS: Only in 14 patients (8.3%) failure of treatment was observed. In 7 cases (4.8%) there was local recurrence, all of them underwent mastectomy m. Patey and they are all alive without disease symptoms. In 6 women (3.6%) dissemination of cancer was observed. Death of 5 patients (3%) between 21 and 68 months from operation took place. In Cox-Mantel test only dependency between N status and dissemination (p < 0.05) was noted. Better results of treatment were connected with estrogen receptor (ER) overexpression. Our results do not differ from data published by leading oncology centers around the world.

CD24 expression is specific for tamoxifen-resistant ductal breast cancer cases.

BACKGROUND: In breast cancer, the expression of CD24 represents a poorly recognised unfavourable prognostic factor. CD24 has been described to be potentially down-regulated by estrogen receptor alpha (ER). The present study was aimed at examining the predictive value of CD24 expression in tamoxifen-treated breast cancer cases. MATERIALS AND METHODS: Sixty patients with primary invasive ductal breast cancers with post-operative tamoxifen treatment were enrolled in the study. Immmunohistochemical reactions were performed using monoclonal antibodies directed against CD24 and ER. RESULTS: Cases demonstrating cytoplasmic-membranous expression of CD24 (CD24c-m) proved to be characterised by a significantly lower expression of ER as compared to CD24c-m-negative cases. A multivariate progression analysis based on the Cox proportional hazard model demonstrated that CD24c-m expression is an independent prognostic factor for poor overall survival. CONCLUSION: The data from the present study suggested that CD24c-m expression is specific for tamoxifen-resistant breast cancer cases. CD24 should be subjected to comprehensive studies as a marker of resistance to tamoxifen treatment.

Stromal myofibroblasts in breast cancer: relations between their occurrence, tumor grade and expression of some tumour markers.

It is suggested that tumour stromal myofibroblasts exert an unfavourable effect on the biology of breast cancer. We are aware of only a single study which examined relationships between manifestation of myofibroblasts in the stroma of breast cancer and clinicopathological data of the patients. The present study was aimed at estimation of the effect exerted by myofibroblasts present in the tumour stroma on principal pathological parameters and on expression of Ki67, P53 and HER-2 proteins in the group of the most frequent breast cancers, the ductal cancers. In paraffin sections of 60 ductal breast cancers (20 cases in G1, 20 in G2 and 20 in G3), immunohistochemical reactions were performed to detect expression of smooth muscle actin (SMA) in order to visualize myofibroblasts, Ki67, P53 and HER-2. The studies demonstrated that the most numerous myofibroblasts were present in G3 cases and they were the least frequent in G1 cases (P = 0.02). Positive correlations were observed between the presence of myofibroblasts in tumour stroma and expression of Ki67 and HER-2 in breast cancer cells in the entire group (P < 0.001 and P = 0.001, respectively), in G2 cases (P = 0.003 and P = 0.03) and in G3 cases (P = 0.01 and P = 0.03). Considering that the higher grade, Ki67 and HER-2 are thought to represent unfavourable prognostic factors, the elevated content of myofibroblasts in tumour stroma is probably typical for cases with worse prognosis.

Relationship between the expression of cyclooxygenase 2 and MDR1/P-glycoprotein in invasive breast cancers and their prognostic significance.

INTRODUCTION: Recent reports suggest that expression of the cyclooxygenase 2 (COX-2) enzyme may up-regulate expression of MDR1/P-glycoprotein (MDR1/P-gp), an exponent of resistance to cytostatic drugs. The present study aimed at examining the relationship between the expression of COX-2 and of MDR1/P-gp in a group of breast cancer cases. METHODS: Immunohistochemical reactions were performed using monoclonal antibodies against COX-2 and MDR1/P-gp on samples originating from 104 cases of primary invasive breast cancer. RESULTS: COX-2-positive cases were shown to demonstrate higher expression of MDR1/P-gp (P < 0.0001). The studies also demonstrate that COX-2 expression was typical for cases of a higher grade (P = 0.01), a shorter overall survival time (P < 0.0001) and a shorter progression-free time (P < 0.0001). In the case of MDR1/P-gp, its higher expression characterised cases of a higher grade (P < 0001), with lymph node involvement (P < 0001), and shorter overall survival (P < 0.0001) and progression-free time (P < 0.0001). CONCLUSION: Our studies confirmed the unfavourable prognostic significance of COX-2 and MDR1/P-gp. We also document a relationship between COX-2 and MDR1/P-gp, which suggests that COX-2 inhibitors should be investigated in trials as a treatment supplementary to chemotherapy of breast cancers.

Differences in oestrogen and progesterone receptors, HER-2, p53 expression and proliferation in ductal breast cancers in relation to histopathological grade.

In case of breast cancer the grade of differentiation and expression of oestrogen and progesterone receptors falls within the first category of prognostic factors according to the College of American Pathologists. HER-2, p53 and Ki67 belong to the second category and their significance still awaits confirmation. The aim of the present study was to examine the relationship between the intensity of expression of oestrogen receptors (ER), progesterone receptors (PgR), HER-2, p53 and Ki67 in cells of ductal breast cancer of G1, G2 or G3 differentiation grade. In paraffin sections of 60 ductal breast cancers (20 cases in G1, 20 in G2 and 20 in G3), immunocytochemical reactions were performed to detect the expression of ER, PgR, HER-2, p53 and Ki67. Following a semi-quantitative appraisal of the preparations under examination, appropriate statistical tests were used to document significant relationships. We noted significant positive correlations between ER and PgR (the entire group studied, G1-3, and the G1 group), HER-2 and p53 (G2) and between p53 and Ki67 expression (G2). Significant negative correlations were found between ER and p53 (G1-3), PgR and p53 (G1-3, G1, G3) and between PgR and Ki67 (G1-3, G2). The studies performed demonstrated distinct relationships between the expression intensity of various proteins in tumour cells in relation to the grade of differentiation of the tumour. We also showed that a parallel determination of ER, PgR and p53 expression may carry high predictive value as to response to tamoxifen treatment.

[The relationship of the expression of proliferetron--related antigens Ki67 and PCNA in the cells of ductal breast cancer with the differentiation grade]. / Porównanie ekspresji antygenów proliferacyjnych Ki67 i PCNA w komórkach raka przewodowego gruczolu sutkowego w zaleznosci od stopnia zróznicowania guza.

OBJECTIVES: Ki67 and PCNA proteins are characteristic for cells in mitotic cycle and represent unfavourable prognostic indices. Intensity of the proteins expression directly correlates with grade of tumour differentiation. They belong to the second category of prognostic factors in breast cancer according to the College of American Pathologists. DESIGN: Present study aimed at examining the relationship between intensity of expression of proliferation-related antigens--Ki67 and PCNA in cells of ductal breast cancer of G1, G2 or G3 differentiation grade. MATERIALS AND METHODS: In paraffin sections of 60 ductal breast cancers, immunocytochemical reactions were performed to detect expression of Ki67 and PCNA. Following semiquantitative appraisal of studied preparations, appropriate statistical tests were used to document statistical relationships. RESULTS: Intensity of Ki67 expression was most pronounced in G3 group and least pronounced in G1 group (ANOVA rang Kruskal-Wallis, p=0.00001). In the case of PCNA we did not show any differences. Only in the G1 we showed a positive correlation between expression intensity of studied antigens (Spearmans rang correlation, r=0.67, p=0.024). CONCLUSIONS: The study showed that Ki67 and not PCNA correlates with morphologic features of proliferation.

[Prognostic value of Jass classification of rectal cancer compared to original Dukes system]. / Skutecznosc prognostyczna klasyfikacji raka odbytnicy wedlug Jassa w porównaniu z klasycznym systemem Dukesa.

UNLABELLED: The aim of this study was to assess the prognostic value of Jass and Dukes classification of rectal cancer. MATERIAL AND METHOD: The impact of these staging systems on five-year disease-free survival has been estimated in univariate and multivariate analysis for the group of ninety-two curatively treated patients. RESULTS: In univariate analysis a relationship between survival and stage of disease has been found with a high degree of statistical significance for both Jass (I: 89.3 +/- 5.9; II: 54.2 +/- 10.2, p< 0.005; III: 14.3 +/- 9.4, p< 0.001; IV: 12.0 +/- 6.5, p < 0.001) and Dukes (A: 88.1 +/- 6.4; B: 41.0 +/- .9, p < 0.001; C: 15.4 +/- 7.1, p < 0.001) classifications. Cox regression model has identified Jass system as the best predictor of prognosis (II: p < 0.05; III: p < 0.001; IV: p < 0.001) and has shown the lack of significance for Dukes classification. In multivariate analysis of specific pathological features constituting Jass scale a significant and independent influence on survival (p < 0.05) has been noticed for the depth of penetration through the bowel wall, type of tumour growth and lymphocytic infiltration but not for the number of positive lymph nodes. CONCLUSION: Jass classification of rectal cancer is a prognostically effective modification of Dukes system as the result of addition of histological parameters significantly affects the prognosis.

Vertebroplasty with methacrylate bone cement and radiotherapy in the treatment of spinal metastases with epidural spinal cord compression. Preliminary report.

Background. The choice of treatment method for metastases to the spine remains an unresolved and controversial question. The major complication in disseminated neoplastic disease compression of the spine and nervous elements. Vertebroplasty performed jointly with palliative radiotherapy has been proposed as a procedure to treat metastases complicated by cancer infiltrations in the vicinity of the spine. Material and methods. We examined 21 patients treated since May 2004. Vertebroplasty was performed by surgery using acrylic cement, followed by palliative radiotherapy. Results. Outcome was assessed by clinical examination, neurological evaluation, and other methods, such as X-ray, CT scan, and MRI. All patients showed prompt relief of pain and substantial improvement in mobility. No complications or side effects were observed in connection with the joint palliative treatment. Conclusions. Vertebroplasty is an effective method and works to help stabilize spinal fractures. Satisfactory results were obtained using palliative treatment. The use of acrylic cement made it possible to perform radiotherapy safely with an optimum margin of healthy tissues, which enhances treatment. These initial results point to the need for further clinical collaboration between neurosurgeon and radiotherapist.