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Background: Insulin-like growth factor-1 receptor (IGF-1R), epidermal growth factor receptor (EGFR), and HER2 have been reported to regulate tumor growth by interfering with ...apoptosis, cell proliferation, angiogenesis, and metastasis. However, the clinical significance of these molecules in colorectal cancer (CRC) remains undetermined. To gain further insight, we evaluated the prognostic implications of these biomarkers in patients with CRC treated with fluoropyrimidines or irinotecan. Methods: The study group comprised 91 patients who underwent surgery at National Cancer Center Hospital and subsequently received fluoropyrimidines as 1st-line chemotherapy for recurrent or residual tumors. The expressions of IGF-1R, EGFR, and HER2 in surgically removed specimens of primary lesions were analyzed immunohistochemically to determine the prognostic significance of these biomarkers. Results: IGF-1R expression (defined as >10% membranous staining) was found in 81 tumors (89%), EGFR in 77 (85%), and HER2 in 3 (3%). IGF-1R expression significantly correlated with EGFR expression (P=0.038). Overexpression (defined as >50% membranous staining) of IGF-1R was found in 48 tumors (53%), EGFR in 57 (63%), and HER2 in 2 (2%). Overexpression of IGF-1R significantly correlated with shorter survival from the start of 1st-line chemotherapy (P=0.032). Overexpression of EGFR was a significant predictive factor for a clinical response to fluoropyrimidines (P=0.037) and tended to correlate with TTP in patients given irinotecan as 2nd-line therapy (P=0.087). A multivariate analysis of potential prognostic factors showed that IGF-1R expression and worse performance status were independent predictors of poor outcomes ( Table ). Conclusions: IGF-1R and EGFR were highly positive in patients with CRC. Overexpression of IGF-1R predicts a poor outcome, and overexpression of EGFR predicts a good clinical response to fluoropyrimidines.
Table: see text
No significant financial relationships to disclose.
A 54-year-old man was referred to our hospital because of petechiae and pancytopenia. Bone marrow aspiration showed a normocellular marrow with 92.4% promyelocytes. PML/RAR alpha mRNA was detected by ...reverse transcription polymerase chain reaction. On the basis of above data, a diagnosis of acute promyelocytic leukemia (APL) was made, and treatment with all-trans retinoic acid (ATRA) at a dose of 60 mg/day was begun. Fourteen days after the start of treatment, the patient developed paralytic ileus, accompanied by hyperleukocytosis, high fever, renal dysfunction and elevation of the serum FDP level. There was no evidence of infection. At this time, retinoic acid syndrome was suspected, and therefore steroid pulse therapy was started, which led to an improvement of the symptoms within four days. This case suggests that ATRA may have an adverse effect on the small intestine, causing paralytic ileus.
Abstract
Aim: To compare the survival by surgery (S group) to that by definitive chemoradiotherapy (CRT: R group) among patients with potentially resectable esophageal squamous cell carcinoma.
...Methods: From January 2003 to June 2012, 564 consecutive patients were reviewed. Overall survival (OS) was analyzed using Kaplan-Meier method and propensity-score adjusted Cox proportional hazard models. The variables included in propensity score model were age, gender, performance status (PS), histologic grade, primary cancer site, cT, cN, cM, serum albumin, and year of treatment (3 groups).
Results: Three hundreds forty-two patients was in S group and 222 patients was in R group. Of the S group, 243 had preoperative chemotherapy, 37 had postoperative chemotherapy, and 62 had no adjuvant therapy. All values in patient characteristics were significantly different between S and R groups except for gender (age ≥ 65 years, 42% vs. 58%; gender male, 85% vs. 88%; Cancer site Ut/Mt/Lt, 14/49/37% vs. 14/60/27%; PS 0/1, 28/72% vs. 37/63%; cT stage 1/2/3, 19/13/68% vs. 40/9/51%; cN stage 0/1/2/3, 22/57/21/0% vs. 36/41/22/1%; cStage 1/2/3/4, 10/29/51/9% vs. 27/23/36/14%). In both unadjusted and adjusted analysis, there were no significant differences in survival of patients with cT1 and cT2 stages individually between S and R groups (cT1, unadjusted hazard radio (uHR) 1.9, p = 0.15; adjusted hazard radio (aHR) 1.5, p = 0.38. cT2, uHR2.1, p = 0.20; aHR1.8, p = 0.39). The R group was associated with worse OS compared to S group in those with cT3 stage (uHR1.9, p = 0.001; aHR1.8, p = 0.003). While OS benefit of S group was detected for cStage III patients (uHR2.2, p < 0.001; aHR2.1, p = 0.002), there were no significant differences in survival of those with cStage I or II between 2 groups (cStage I, uHR2.3, p = 0.15; aHR1.9, p = 0.34. cStage II, uHR1.0, p = 0.96; aHR1.1, p = 0.87). Although patients with cStage IV in S group showed significantly better OS in unadjusted analysis, this survival benefit was not present after adjustment as well (cStage IV, uHR3.3 p = 0.019; aHR2.8, p = 0.08).
Conclusions: Our study indicated CRT is comparable survival to surgery based therapy for patients with esophageal squamous cell carcinoma except for patients with cT3 or cStage III.
Disclosure: All authors have declared no conflicts of interest.
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