Prognostic significance of type IV collagen and laminin immunoreactivity in urothelial carcinomas of the bladder

Article Abstract:

The invasion of surrounding tissue by a developing carcinoma is an important event in the development of cancer, and survival statistics confirm that if a cancer is surgically removed prior to invasion the prognosis is more favorable. During the process of invasion, carcinoma cells secrete enzymes that attack protein components of the basement membrane, which would otherwise act as a protective barrier under an epithelial cancer. In the past, it has been difficult to directly visualize this process under the microscope, as there were no specific stains to selectively dye the basement membrane. However, the availability of antibodies to the protein components of basement membrane now makes such visualization practical. An investigation was undertaken to characterize the changes that occur in the basement membrane during cancer invasion and to determine if these changes may be of prognostic value. Using immunological methods, researchers examined the basement membrane of 125 surgical specimens of bladder cancer. While the researchers anticipated that the basement membrane would be intact in noninvasive cancers and destroyed in regions of invasion, examination of the microscopic slides revealed that the true situation is more complicated. Basement membrane is not absent in regions of cancer invasion, which probably reflects the fact that basement membrane is not a static entity, but rather a dynamic substance that is being laid down by reactive cells even as it is being enzymatically destroyed by the invading cancer cells. However, it was possible to show that areas of absent or patchy basement membrane correlated well with the stage of the cancer. Furthermore, it was found that survival was better among patients with intact basement membrane than among those in whom the patchy or absent areas could be seen. However, analysis showed that the correlation between survival and cancer stage is strong, and beyond being a marker for stage, the information about basement membrane did not provide any useful prognostic information. The authors point out, though, that when the stage of the tumor is ambiguous, immunohistochemical staining with basement membrane antibodies may provide a useful microscopic technique. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Physiological aspects, Development and progression, Cancer invasiveness, Membrane, Basement, Basement membrane

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Association of disease-free survival and percent of ideal dose in adjuvant breast chemotherapy

Article Abstract:

It is not uncommon for a cancer patient to fail to receive the full dose of chemotherapy that was originally intended. Often, this happens because an adverse effect requires a reduction in the dose or premature termination of the cycle of chemotherapy. The patient may die before chemotherapy is completed. Some studies have shown that the closer a patient comes to receiving the ''ideal'' dose, that is, the dose originally specified, the more likely he/she will achieve long-term survival. There are tremendous difficulties, however, in the analysis of this kind of data. To start with, virtually all such studies are retrospective, analyzing events that have already taken place. Consequently, these studies rarely permit the analysis of cause and effect, and they may not reach any reliable conclusion because of the absence of random sampling. For example, the patients who are in poorer health may be more likely to suffer vomiting and thus receive lower doses of chemotherapy. If these patients have a poorer outcome, is it related to reduced chemotherapy or poorer health status from the outset? The authors of the present article discuss some of the methodological difficulties researchers face when trying to determine if the percentage of ideal dose received has a significant impact on the prognosis of breast cancer. They then applied careful statistical analysis to the cases of 256 women with Stage II and Stage III breast cancer. It was found that the closer a woman was to having received 100 percent of the ideal dose of chemotherapy, the better her chances for survival. However, in a detailed attempt to eliminate the sources of sampling bias in the data analysis, they demonstrated that this apparent effect was due entirely to the presence of women receiving lower doses of chemotherapy who suffered a relapse within the first two years. When these women were excluded from the analysis, the relationship between chemotherapy dose and survival was no longer present. The authors caution that a cause and effect relationship cannot be inferred from this finding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Medical research, Breast cancer, Chemotherapy

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Prognostic factors for survival of patients with advanced urothelial tumors treated with methotrexate, vinblastine, doxorubicin, and cisplatin chemotherapy

Article Abstract:

A study was conducted to determine which factors best predict the outcome of cases of advanced cancer of the urothelial lining of the urinary tract. A total of 132 patients participated; the analysis of the first 92 patients was used to construct a prognostic model, and the other 40 patients were analyzed to confirm the validity of the model. The patients were treated with a combination of chemotherapeutic agents including methotrexate, vinblastine, doxorubicin, and cisplatin. One hundred of the patients are now dead, and the median survival time for the first 92 patients was 12.1 months. A Cox regression analysis revealed that a normal level of the enzyme alkaline phosphatase in the blood was a significant predictor of better survival. Also significant was the Karnofsky performance score, which is an indicator of overall disability of cancer patients; patients with high performance scores are doing better. The findings also revealed that patients over 60 years of age were likely to survive longer than younger patients, but the authors raise the question of whether only more robust elderly patients were referred to the study, thus biasing the results. Normal hemoglobin levels at the time of diagnosis were also associated with an improved prognosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

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