A 72-year-old Japanese man was referred to a hospital because of urinary retention. Digital rectal examination revealed a stony, hard nodule in the prostate. A high level of serum PSA was not detected. Prostatic biopsy was performed, and pathological examination indicated adenocarcinoma of the prostate. He was referred to our hospital for treatment. Imaging examinations revealed no metastases (T4N0M0), so we re-evaluated the biopsy specimens. Immunohistochemical examination revealed prostatic small cell carcinoma. His levels of neuron-specific enolase (NSE) and pro-gastrin-releasing peptide (Pro-GRP) were high. We treated him with combination chemotherapy comprising irinotecan and cisplatin, and the treatment was effective. After four courses of the chemotherapy, levels of NSE and Pro-GRP had decreased, and the prostatic mass had decreased in size. Needle rebiopsy of the prostate demonstrated no evidence of malignancy. Adjuvant external beam radiation therapy was also performed. The patient iss till alive at 18 month after diagnosis with no evidence of relapse or metastasis of the disease.
Fifty-five clinical strains of Neisseria gonorrhoeae were examined for mutations in the gyrA and parC genes and for antimicrobial susceptibility profiles. The MICs of quinolones for 31 strains with alterations in GyrA were significantly higher than the MICs for 24 strains without such alterations. Eleven strains with alterations in both GyrA and ParC were significantly more resistant to fluoroquinolones than those with alterations in GyrA alone. The MICs of cephalosporins for these strains were also significantly higher than those for other strains.
Abstract Background: Transcription of the progesterone receptor (PgR) gene is regulated by estrogen in the breast tissue. PgR loss is considered to be a result in the reduction of estrogen receptor (ER) activity, due to either low circulating estrogen in some older women or a high growth factor signaling. Among the ER-positive breast cancer patients, PR-negative cases frequently have a higher resistance to endocrine therapy, and have a poorer prognosis. Therefore, we examined the clinical significance of ER+/PgR- tumors in luminal/HER2 negative breast cancer and its relationship to menopausal status. Methods: The sample for this study came from 1791 consecutive patients with HER2 negative primary breast cancer from January 2002 to March 2013. The ER and PgR expressions were evaluated using immunohistochemistry (IHC). 1586cases had ER+/PgR+ tumor, 205cases had ER+/PgR- tumor. The items examined were nuclear grade, Ki-67 index value, TP53, tumor size and number of lymph node involvement. The Ki-67 index value and TP53 were evaluated using IHC and the cut-off values were 20% and 50%, respectively. Recurrence free survival (RFS) and breast cancer-specific survival (BCSS) was calculated using the Kaplan-Meier method and evaluated by the log-rank test or generalized Wicoxon test in stage 1 and 2 breast cancer. Results: In terms of the distribution of ER and PgR status, ER+/PgR- were frequently seen in postmenopausal patients (13.7% vs 6.8%, respectively). Patients with ER+/PgR-and HER2 negative tumors had significantly smaller tumors, lower Ki-67 values, and a lower nuclear grade in the postmenopausal group compared with those in the premenopausal group. Moreover, RFS trended to be better in the postmenopausal group (p = 0.06), but there was no significant difference. BCSS was significantly higher in the postmenopausal cases (p = 0.001). On the other hand, in patients with ER+/PgR+ tumors, there was no significant difference in RFS and BCSS between the post- and pre-menopausal groups. Conclusion: The ER+/PgR- tumors were more commonly seen in postmenopausal patients. The biological characteristics of ER+/PgR- tumors were significantly different in terms of the Ki-67 index value, nuclear grade, and the prognosis (BCSS and RFS) between pre- and postmenopausal status. Moreover, the postmenopausal group had a more favorable biology and prognosis than the premenopausal group. Therefore, the findings in this study indicate that menopausal status is related to the biology and prognosis in patients with ER+/PgR- tumors. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-05-06.
Abstract Introduction: The Ki-67 index value is a prognostic factor in primary breast cancer and is a proliferation marker that also distinguishes between luminal type A and type B breast cancer. Moreover, change in Ki-67 index value due to treatment and recurrence is considered to be important in treating breast cancer. The evaluative procedure in this study was on two levels; first, we examined whether the baseline Ki-67 value at the primary tumor is useful as a prognostic factor after recurrence, and second, we looked at the changes in the values after recurrence. Patients and Methods: Immunohistochemical (IHC) analysis of the Ki-67 index was performed on 4701 patients with primary breast cancer from 1987 until March 2013 at Kumamoto City Hospital. Out of these patients, there were 666 consecutive cases with recurrence after primary surgery. The fraction of proliferating cells (positive for Ki-67) was based on a count of at least 500 tumor cells in the area including the hot spot, and the Ki-67 values were divided into 2 or 3 groups; <20% and ≥20% (and ≥50%). Items examined were ER, PgR, HER2, tumor size, nodal status at primary tumor, and recurrent site (soft tissue, bone and viscera) and disease-free interval (DFI). Cox's proportional hazard model was used to perform a univariate and multivariate analyses of the factors related to overall survival (OS) after recurrence. The median follow-up period was 65.9 months in the remaining survival group. In 101 recurrent cases from whom the recurrent lesion was resected, the change in biological markers (Ki-67, ER and PgR) were evaluated. Results: The median Ki-67 value at baseline was 20% in all the cases and 27% in the recurrent cases. In terms of recurrent site, the values were low (23%) in patients with bone metastasis, whereas patients with liver or brain metastasis showed higher values (38% and 53%, respectively). Moreover, DFI was inversely correlated with Ki-67 values. Univariate and multivariate analyses were performed to identify the prognostic factors for OS after recurrence. The significant factors included tumor size, lymph node status, ER, PgR, DFI, recurrent site, and the Ki-67 index value. Among these factors, a multivariate analysis revealed that the Ki-67 index value at primary tumor was an independent significant factor. The hormone receptor positive rate from the primary tumor to recurrence decreased from 67.3% to 63.4% and 64.4% to 50% for ER and PgR, respectively. The Ki-67 index value increased significantly from a mean of 28.9% at primary tumor to 35.7% at relapse. Furthermore, the Ki-67 index value at primary tumor was a significant prognostic factor for OS after recurrence in this cohort. Conclusion: The Ki-67 value at primary tumor was a significant prognostic factor for OS after recurrence. The Ki-67 index value increased significantly after recurrence. It is therefore important to take the Ki-67 index into consideration in the treatment and follow-up of breast cancer patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-14.
In this study, we aimed to determine the utility of cytoreductive nephrectomy (CN) in real-world clinical practice and investigate whether CN contributes to improved oncological outcomes in patients with metastatic renal cell carcinoma (mRCC). This retrospective multicenter cohort study enrolled patients with mRCC who received systemic therapy at six institutions between May 2005 and May 2023. The patients were divided into those who did not undergo CN (Group I) and those who underwent CN (Group II). The primary endpoints were oncological outcomes, including cancer-specific survival (CSS) and progression-free survival (PFS). Altogether, 137 patients with mRCC were included in this study. The median CSS was 14 months in Group I and 32 months in Group II (p < 0.001). Additionally, the median PFS in Groups I and II was 5 and 13 months, respectively (p = 0.006). A multivariate analysis showed that CN was an independent prognostic factor for CSS and PFS. Hence, CN is a potential treatment modality that can improve oncological outcomes in patients with mRCC.
The Ki-67 index is an important biomarker for indicating the proliferation of cancer cells and is considered to be an effective prognostic factor for breast cancer. However, a standard cut-off point for the Ki-67 index has not yet been established. Therefore, the aim of this retrospective study was to determine an optimal cut-off point in order to establish it as a more accurate prognostic factor. Immunohistochemical analysis of the Ki-67 index was performed on 4329 patients with primary breast cancer from August 1987 to March 2012. Out of this sample, there were 3186 consecutive cases from September 1997 with simultaneous evaluations of ER, PgR and HER2 status. Cox's proportional hazard model was used to perform univariate and multivariate analyses of the factors related to OS. The hazard ratios (HR) and the p values were then compared to determine the optimal cut-off point for the Ki-67 index. The median Ki-67 index value was 20.5% (mean value 26.2%). The univariate analysis revealed that there was a statistically significant negative correlation with DFS and OS and the multivariate analysis revealed that the Ki-67 index value was a significant factor for DFS and OS. The top seven cut-off points were then carefully chosen based on the results of the univariate analysis using the lowest p-values and the highest HR as the main selection criteria. The multivariate analysis of the factors for OS showed that the cut-off point of 20% had the highest HR in all of the cases. However, the cutoff point of 20% was only a significant factor for OS in the Luminal/HER2- subtype. There was no correlation between the Ki-67 index value and OS in any of the other subtypes. These data indicate that the optimal cut-off point of 20% is the most effective prognostic factor for Luminal/HER2- breast cancer.
