bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-Sentinel Lymph Node Metastases in Breast Cancer Patients with a Positive Sentinel Lymph Node: Validation of Five Nomograms and Development of a New Predictive Model
Authors: Lombardi Augusto , Maggi Stefano , Russo Marzia Lo , Scopinaro Francesco , Di Stefano Domenica , Pittau Maria Grazia , Tiberi Simone , Amanti Claudio 
Published: February 2018

Aims and Background Discordance of intraoperative analysis with definitive histology of the sentinel lymph node in breast cancer leads to completion axillary lymph node dissection, which only in 35–50% shows additional nodal metastases. The aim of the study was to identify individual patient risk for non-sentinel lymph node metastases by validating several statistical methods present in the recent literature and by developing a new tool with the final goal of avoiding unnecessary completion axillary lymph node dissection. Methods We retrospectively evaluated 593 primary breast cancer patients. Completion axillary lymph node dissection was performed in 139 with a positive sentinel lymph node. The predictive accuracy of five published nomograms (MSKCC, Tenon, Cambridge, Stanford and Gur) was measured by the area under the receiver operating characteristic curve. We then developed a new logistic regression model to compare performance. Our model was validated by the leave-one-out cross-validation method. Results In 53 cases (38%), we found at least one metastatic non-sentinel lymph node. All the selected nomograms showed values greater than the 0.70 threshold, and our model reported a value of 0.77 (confidence interval = 0.69–0.86 and error rate = 0.28) and 0.72 (confidence interval = 0.63–0.81, error rate = 0.28) after the validation. With a 5% cutoff value, sensitivity was 98% and specificity 9%, for a cutoff of 10%, 96% and 2%, respectively. Conclusions All the nomograms were good discriminators, but the alternative developed model showed the best predictive accuracy in this Italian breast cancer sample. We still confirm that these models, very accurate in the institution of origin, require a new validation if used on other populations of patients.
Effect of Endostatin on Preventing Postoperative Progression of Distant Metastasis in a Murine Lung Cancer Model
Authors: Wang He-Lan , Ning Tao , Li Mei , Lu Ze-Jun , Yan Xi , Peng Qian , Lei Na , Zhang Hui , Luo Feng 
Published: February 2018

Aims and Background The relapse and metastasis of cancer remain a predominant cause of death after surgical removal of the primary tumor. There is a positive linkage between the postoperative upregulation of systemic angiogenic activity and distant tumor metastasis. In the present study, we established a spontaneous metastasis model and investigated whether antiangiogenic therapy using endostatin could prevent the progression of distant metastasis after removal of the primary tumor. Methods Female C57BL/6 mice were implanted subcutaneously with 1 × 106 Lewis lung cancer cells. Twenty days after implantation of the cancer cells, the primary tumor was removed and the mice were randomly divided into three groups. The NS group received normal saline, the L-ES group received 3 mg/kg endostatin, and the H-ES group received 20 mg/kg endostatin intravenously daily for 10 days. The effect of endostatin on lung metastases and the survival time of the mice were observed. Flow cytometry and immunohistochemistry were carried out to assess the angiogenic activity. The serum endostatin levels in peripheral blood were measured using an enzyme-linked immunosorbent assay. Results The mean number of metastatic pulmonary nodules and the mean net lung weight in the NS, L-ES and H-ES groups was 10.2, 2.8 and 4.0, and 0.55g, 0.31g and 0.36g, respectively. The difference between the NS group and the endostatin-treated groups was statistically significant (P <0.05). The endostatin-treated mice showed prolonged overall survival (P <0.05). Compared with the NS group, the endostatin-treated groups had lower levels of circulating endothelial cells in peripheral blood and showed a decrease in microvessel density in the metastatic tumors, with a more marked reduction in the L-ES group (P <0.05). The systemic presence of endostatin was gradually increased with the continued administration of endostatin to the mice. Conclusions Antiangiogenic therapy with endostatin is effective in inhibiting the postoperative progression of distant metastasis.
Lifestyle and Breast Cancer Recurrences: The DIANA-5 Trial
Authors: Villarini Anna , Pasanisi Patrizia , Traina Adele , Mano Maria Piera , Bonanni Bernardo , Panico Salvatore , Scipioni Corrado , Galasso Rocco , Paduos Adriana , Simeoni Milena , Bellotti Elena , Barbero Maggiorino , Macellari Giorgio , Venturelli Elisabetta , Raimondi Milena , Bruno Eleonora , Gargano Giuliana , Fornaciari Giuseppe , Morelli Daniele , Seregni Ettore , Krogh Vittorio , Berrino Franco 
Published: February 2018

Aims and Background The DIANA (Diet and Androgens)-5 study is a multi-institutional randomized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles, associated with moderate physical activity, in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu. The intervention is expected to reduce serum insulin and sex hormones, which were associated with breast prognosis in previous studies. Methods Between 2008 and 2010, the study randomly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group, to be followed-up through 2015. General lifestyle recommendations for the prevention of cancer are given to both groups, and the intervention group is being offered a comprehensive lifestyle intervention, including cooking classes, conferences, common meals and exercise sessions. Adherence assessments occurred at baseline and at 12 months and are planned at 36 and 60 months. They include food frequency diaries, anthropometric measures, body fat distribution assessed with impedance scale, one week registration of physical activity with a multisensor arm-band monitor, metabolic and endocrine blood parameters. Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are validated through medical record verification. Results The randomized groups were comparable for age (51.8 years), proportion of ER-negative tumors (22%), axillary node metastasis (42%), reproductive variables, tobacco smoking, blood pressure, anthropometric measurements and hormonal and metabolic parameters. Conclusions DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences. We will assess evidence of effectiveness, first by comparing the incidence of additional breast cancer events (local or distant recurrence, second ipsilateral or contralateral cancer) in the intervention and in the control group, by an intention-to-treat analysis, and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score.
Radiotherapy for Inoperable Non-Small Cell Lung Cancer using Helical Tomotherapy
Authors: Monaco Alessia , Caruso Cristina , Giammarino Daniela , Cianciulli Michele , Pressello Maria Cristina , Donato Vittorio 
Published: February 2018

Aim To investigate the impact of tomotherapy on the dose delivered to the lungs and other normal tissues. Material and Methods From February 2008 to May 2009, 35 patients with stage IIIA/IIIB non-small cell lung cancer were treated with helical tomotherapy at the S. Camillo-Forlanini Hospital. For our study we selected 20 patients who underwent chemotherapy followed by sequential radiotherapy. The planning target volume was delineated using planning CT scan and FDG-PET. The mean prescribed radiation dose was 67.5 Gy delivered in 30 fractions at a dose of 2.25 Gy per fraction. Results Median follow-up was 12.3 months. All patients developed acute esophageal toxicity, 15 of RTOG grade 1 and 5 of RTOG grade 2. At first follow-up 15 patients presented stable disease or partial response, 4 patients presented complete response, and 1 patient presented disease progression. Conclusions Helical tomotherapy is useful to achieve dose-per-fraction escalation without increasing the treatment-related morbidity. Our results applying dose escalation were encouraging considering that we delivered doses that may be difficult to achieve with 3-dimensional treatments with no excessive complication rates.
Emotional Distress and Needs in Italian Cancer Patients: Prevalence and Associations with Socio-Demographic and Clinical Factors
Authors: Annunziata Maria Antonietta , Muzzatti Barbara , Bidoli Ettore , Veronesi Andrea 
Published: February 2018

Aims and Background Since emotional distress is a relevant psycho-social component of an oncological disease experience, its study is useful in multidisciplinary patient cancer care. In the present research, emotional distress together with needs during hospitalization were recorded and their associations with several socio-demographic and clinical variables were verified. Methods and Study Design Five hundred and forty-four consecutive oncological in-patients completed two self-assessment questionnaires concerning emotional distress and needs (i.e., Hospital Anxiety and Depression Scale, Needs Evaluation Questionnaire). Results 27.4% and 20.8% of the enrolled patients were probable cases, respectively, for anxiety and depression; when possible cases were included the percentages raised to 52.5% and 39.3%, respectively. Furthermore, 11.9% and 20.2% of participants were simultaneously probable and possible cases for both conditions. Few differences in anxiety and depression according to socio-demographic and clinical variables were demonstrated, whereas needs seemed to be more frequently associated to them. Finally, needs also seemed to be associated with both anxiety and depression, with possible and probable cases for anxiety and depression displaying more needs than non-cases. Conclusions The implications for both the quality of care and disease adjustment by cancer patients are discussed together with study limitations.
Differences in Stage and Treatment of Breast Cancer across Italy Point to Inequalities in access to and Availability of Proper Care
Authors: Minicozzi Pamela , Cirilli Claudia , Federico Massimo , Capocaccia Riccardo , Budroni Mario , Candela Pina , Falcini Fabio , Fusco Mario , Giacomin Adriano , La Rosa Francesco , Traina Adele , Tumino Rosario , Sant Milena 
Published: February 2018

Aims and background Population-based cancer registry studies of patterns of care can help elucidate reasons for differences in breast cancer survival across Italy documented by previous studies. The aims of the present study were to investigate across-country variation in stage at presentation and standard care for breast cancer cases diagnosed in Italy in the early 2000s. Methods Samples of adult (≥15 years) women with breast cancer diagnosed in 2003–2005 were randomly selected in 9 Italian cancer registries. Logistic regression models were used to estimate the odds of receiving breast-conserving surgery plus radiotherapy (BCS + RT) in each cancer registry, age group, and disease stage category compared with the entire sample (reference); the z test was used to evaluate differences in proportions of stage at diagnosis, employment of chemotherapy in node-positive (N+) disease, and use of endocrine treatment in estrogen-receptor positive (ER+) and negative (ER-) tumors across Italy. Results Stage at diagnosis was earlier in northern/central registries than in southern areas. Compared with the reference, the odds of receiving BCS + RT was significantly lower in Trapani, Sassari and Naples (southern Italy) after adjusting for age and stage at diagnosis. Among N+ patients, 73% received adjuvant chemotherapy (range, 51% [Biella, northern Italy] to 87% [Ragusa, southern Italy]). Eighty percent of ER+ cancers (range, 50% [Biella, northern Italy] to 97% [Ragusa, southern Italy]) and 18% of ER-cancers (range, 6% [Modena, northern Italy] to 28% [Umbria, central Italy]) were treated with hormonal therapy. Conclusions Disparities in stage distributions and conservative surgery in breast cancer persist across Italy. On a positive note, we found lower variations in the use of systemic treatment between Italian regions.
Tamoxifen in Trimodal Therapy with Cytotoxic Drugs and Hyperthermia in Vivo Significantly Enhance Therapeutic Efficacy against B16-F10 Melanoma
Authors: Krpan Ana Misir , Ivankovic Sinisa , Krajina Zdenko , Ivankovic Dusica , Stojkovic Ranko 
Published: February 2018

Aims and background The aim of the study was to investigate whether use of the antiestrogen tamoxifen and heat treatment in combined therapy with the well-known anticancer drugs cisplatin, dacarbazine and cyclophosphamide enhances their therapeutic efficacy on mouse B16-F10 melanoma in vivo. The results of systemic melanoma therapy have been mostly disappointing. Therefore, there is still a great need for strategies that can improve existing chemotherapy options. Methods and study design. The tumor model for the investigation of antitumor activity was a mouse B16–F10 melanoma transplanted into the footpad of C57BL/6 Zgr/Hr mice. Drugs were given intraperitoneally 15 min before the application of local hyperthermia, and tumor growth and mouse survival were followed. Results Hyperthermia alone determined a significant delay of tumor growth, but mouse survival was not affected. In bimodal combinations with hyperthermia, all the tested antitumor drugs significantly increased both tumor growth delay and mouse survival. Tamoxifen alone did not show any inhibitory effect on B16–F10 melanoma in vivo. However, in the trimodal therapy with a particular drug and hyperthermia, it potentiated the inhibitory effects of the respective bimodal treatments, especially that of cyclophosphamide and hyperthermia. Conclusions Our results obtained on the mouse B16–F10 melanoma in vivo confirmed the enhanced therapeutic efficacy of the trimodal therapy tamoxifen, hyperthermia and anticancer drug combinations in melanoma treatment. Further studies should optimize the heat-drug time scheduling and drug doses that will result in the best possible therapeutic achievement for these trimodal therapy options.
Estimating All Cancers Incidence with the MIAMOD Model: A New Method to Include Multiple Tumors
Authors: Ventura Leonardo , Miccinesi Guido , Sacchettini Claudio , De Angelis Roberta 
Published: February 2018

Aims and background The MIAMOD method has been widely applied to derive regional and national cancer burden estimates. The method is based on a back-calculation approach using cancer-specific mortality and relative survival to derive expected incident and prevalent cases. Multiple tumors occurring in the same site for the same person (for example colon-colon) can be estimated just once. This has little effect on cancer-specific estimates, whereas it limits all cancers-combined estimates, where only cancer cases, rather than cancer diagnoses, can be accounted for by the method. The aim of this article is to present a specific strategy of application of the MIAMOD method to all cancers sites, which better approximates an estimate of ‘cancer diagnoses’. Methods The strategy consists of breaking down the estimation process in separate applications to the most frequent cancer sites and to a ‘remainder-site’, given by all malignant sites except the previous ones. The separate estimates are then summed up to derive the overall quantities for all cancers combined. Cancer-specific mortality in the years 1985–2004 in the Tuscany cancer registry area (about 1,200,000 inhabitants) and relative survival data in the same area and periods (end of follow-up, 31 December 2006) were used to produce the estimates, which were then tested using observed incidence data in the same area and period. Results The standard application of the MIAMOD method underestimates all cancer incidence for both sexes. The mean relative difference between observed and expected incident cases is –14.8% for males and –17.2% for females. With the alternative method, the same mean relative difference drops to –8.2% for males and –6.1% for females. Conclusions The study provides a strategy to reduce a structural limit of the MIAMOD method in estimating the total burden of cancer disease.
Predictive Value of Maspin and Ki-67 Expression in Transurethral Resection Specimens in Patients with T1 Bladder Cancer
Authors: Acikalin Demet , Oner Ulku , Can Cavit , Acikalin Mustafa F , Colak Ertugrul 
Published: February 2018

Aims and background To evaluate the clinical significance of maspin and Ki-67 expression in patients with newly diagnosed T1 bladder cancer. Methods and study design Maspin and Ki-67 expression was investigated by immunohistochemistry from paraffin-embedded tissues of 68 patients undergoing transurethral resection for bladder cancer. Clinicopathological data were retrospectively reviewed from available charts and pathological reports. Maspin and Ki-67 expression levels were classified according to the staining percentage. Cases in which at least 5% of the tumor cells stained for maspin were scored as positive. Ki-67 labeling index was considered to be positive when samples demonstrated >10% reactivity. Results Maspin expression was found as an independent predictor of recurrence and progression (P <0.05). Patients with negative maspin expression were 2.191 times more likely to relapse than patients with positive maspin expression. Patients with negative maspin expression were 4.345 times more likely to progress than patients with positive maspin expression. Furthermore, the maspin-negative group was found to have shorter recurrence and progression-free survival (P <0.05). No significant association was found between maspin subcellular localization pattern and recurrence-free, progression-free or overall survival (P >0.05). There was no correlation between Ki-67 expression and tumor recurrence, progression or tumor-related death (P >0.05). Chi-square tests showed a significant relationship between Ki-67 expression and tumor size and tumor grade (P <0.05). Conclusions Our findings suggested that the evaluation of maspin expression in stage T1 bladder tumors is a useful prognostic marker for predicting the tumor behavior.
Association of Thymidylate Synthase and Hypoxia Inducible Factor-1alpha DNA Polymorphisms with Pancreatic Cancer
Authors: Ruiz-Tovar Jaime , Fernandez-Contreras Maria Encarnación , Martín-Perez Elena , Gamallo Carlos 
Published: February 2018

Background Thymidylate synthase and hypoxia inducible factor-1α play a central role in the control of tumor progression. In the present study, we investigated the effect of three DNA polymorphisms within the thymidylate synthase gene and two within hypoxia inducible factor-1α on the prognosis of pancreatic cancer. Patients and methods A retrospective study was performed in 59 patients diagnosed with invasive ductal adenocarcinoma of the pancreas and 159 healthy volunteers. The studied DNA polymorphisms were a variable tandem repeat of 28 bp (rs45445694), a G/C single nucleotide polymorphism (rs34743033), and a deletion of 6 bp (ins1494del 6bp; rs34489327) within the thymidylate synthase gene and C1772T and G1790A single nucleotide polymorphisms within hypoxia inducible factor-1α (rs11549465 and rs11549467, respectively). Variable tandem repeats were determined by specific polymerase chain reaction, whereas thymidylate synthase single nucleotide polymorphism G/C, ins1494del 6pb, and hypoxia inducible factor-1α polymorphisms were identified by polymerase chain reaction and RFLP. Thymidylate synthase and hypoxia inducible factor-1α genotype distributions in patients and healthy volunteers were determined. The impact of the polymorphisms on clinico-pathological variables, including survival, was also studied. Results The frequency of carriers of the variant del6bp allele was significantly higher among patients (70.0% vs 51.0% of healthy donors, P = 0.02); 42% of male patients were homozygous 2R/2R vs 13.6% of females (P = 0.03), but differences regarding gender were not observed among healthy volunteers. Concerning hypoxia inducible factor-1α C1772T and G1790A single nucleotide polymorphisms, the rates of variant T/T and A/A homozygous genotypes were significantly elevated among patients (18.6% vs 5.3%, P = 0.001, and 5.1% vs none, P = 0.021 respectively). Conclusions In our study, the variant del14946bp allele within the thymidylate synthase gene, and TT and AA genotypes of C1772T and G1790A hypoxia inducible factor-1α single nucleotide polymorphisms were associated with the development of pancreatic cancer. The 2R/2R genotype of variable tandem repeat thymidylate synthase polymorphism might be a risk factor for pancreatic cancer in males.
Batwing Mastopexy as Oncoplastic Surgical Approach to Periareolar Tumors in Upper Quadrants
Authors: Matkowski Rafal , Szynglarewicz Bartlomiej , Kasprzak Piotr , Forgacz Jozef , Skalik Robert , Zietek Marcin , Kornafel Danuta 
Published: February 2018

Aims and background Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position. Methods and study design A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter. Results There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant. Conclusions BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.