To compare the results, complications, and hospital charges associated with laparoscopy versus laparotomy in second-look operations for epithelial ovarian cancer. We conducted a retrospective chart review of 109 patients with invasive epithelial ovarian cancer who underwent a second-look operation between July 1, 1992, and June 30, 1995. Thirty-one patients (28.4%) underwent laparoscopy, 70 patients (64.2%) underwent laparotomy, and eight patients (7.3%) underwent both procedures at the same operation. The majority of patients (60.6%) presented with stage IIIC disease. Persistent ovarian cancer was found in 65 of 109 (59.6%) patients, including 17 of 31 (54.8%) evaluated by laparoscopy, 43 of 70 (61.4%) by laparotomy, and five of eight (62.5%) by both procedures. Significantly lower mean blood loss was noted in patients undergoing laparoscopy (27 mL) compared with laparotomy (208 mL) (P < .01). In addition, the mean operating time for laparoscopy (129 minutes) was significantly shorter than that for laparotomy (153 minutes) (P < .01), and mean hospital stay was shorter for patients undergoing laparoscopy (1.6 days) compared with laparotomy (6.8 days) (P < .01). All intraoperative and immediate postoperative complications were noted in patients who underwent laparotomy. There was no difference in day of surgery charges between the two procedures; however, total hospital charges were significantly lower for patients undergoing laparoscopy ($9448) compared with laparotomy ($17,969) (P < .01). With a median follow-up of 22.0 months, recurrence after negative second-look surgery was noted in four of 27 (14.8%) patients evaluated by laparotomy and two of 14 (14.3%) patients evaluated by laparoscopy. Laparoscopy may be an acceptable alternative to second-look laparotomy for interval evaluation of epithelial ovarian cancer. Second-look laparoscopy probably results in less morbidity, shorter operating time, shorter hospital stay, and lower total hospital charges. These results require confirmation in a randomized clinical trial.
IFN-α in der adjuvanten Therapie des malignen Melanoms ist eine häufig verwandte Behandlungsform. Die vielfältigen Wirkmechanismen beruhen unter anderem auf der Inhibition der Tumorzellproliferation, Verstärkung der Phagozytose und Verstärkung der spezifischen Zytotoxizität. IFN-α-Therapie kann hierbei zur Induktion bzw. Modulation von sekundären Zytokinen führen, welche selbst Teil der therapeutischen Wirkung sind, oder aber für das breite Nebenwirkungsspektrum verantwortlich sein können. Zentraler Punkt unserer Analysen war daher, weiterführende Aussagen über das Immungeschehen unter längerfristiger IFN-α-Therapie zu erhalten. Patienten mit malignem Melanom im Stadium II und III wurden vor Therapiebeginn mit IFN-α-2b, nach 4 Wochen und nachfolgend jeweils nach 3 Monaten Serumproben entnommen. Insgesamt konnten bei 20 Patienten insgesamt 80 Serumproben analysiert werden. Hierbei wurden die Konzentrationen von IL-2, hsIL-2R, TNF-α, beta-2 Mikroglobulin (B2M) und IL-10 mittels ELISA bestimmt. Die medianen Werte für das gesamte Kollektiv lagen für IL-2 bei 5,0 pg/ml (range 0–76,2), für IL-10 bei 2,64 pg/ml (range 0,37–13,2), für TNF-α bei 22,5 pg/ml (range 0–196,5) und für B2M bei 3,15mg/L (range 0,070–7,74). Für 13 Patienten liegen aktuell Verläufe unter Therapie vor. Das immunsuppressive IL-10 zeigt im Verlauf bei mehreren Patienten eine Rückläufigkeit. Bei fast allen Patienten zeigte sich für B2M ein Anstieg, was als biologischer Marker der IFN-Aktivität dient. Eine Abnahme der Serumwerte zeigte IL-2, dies allerdings bei ansteigenden hsIL-2R-Werten. Für die Hälfte der Patienten zeigte TNF-α einen ansteigenden Verlauf, was sowohl für einen therapeutischen Effekt, als auch für toxische Effekte verantwortlich sein kann. Auch nach längerer IFN-Therapie kommt es somit zu anhaltenden Modulationen von immunologisch relevanten Zytokinen.
In order to answer the question whether the Fc portion of the IgE molecule in patients with atopic dermatitis is altered by somatic replacement mutations, we amplified and sequenced the respective C epsilon 2 and C epsilon 3 domain genes. Five patients with atopic dermatitis and 6 non-atopic individuals were studied. Neither within the C epsilon 2 nor the C epsilon 3 domain could any common nucleotide substitutions be detected. Therefore, the conclusion can be drawn that, in patients with atopic dermatitis, there are no protein sequence differences within the Fc part of the IgE which could be responsible for distinct functional features with regard to Fc epsilon-receptor binding and signal transduction or could account for the frequent occurrence of anti-IgE autoantibodies in these individuals.
Abstract Background Nodal staging with sentinel node biopsy (SNB) and completion lymph node dissection (CLND) provides prognostic information to patients with melanoma and their physicians. It is not known whether the timing of CLND is associated with survival outcome and/or CLND tumour load. This study investigated whether CLND timing is associated with CLND tumour load, disease-free survival (DFS) and/or melanoma-specific survival (MSS). Methods A retrospective cohort of patients with SNB-positive melanoma from nine European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group centres undergoing surgery between 1993 and 2009 were examined. Patients were selected based on availability of CLND and follow-up data. The CLND interval was defined as the number of days between diagnosis and CLND. Patient and tumour characteristics were collected. Five-year DFS and MSS rates were calculated. Cox and logistic regression analysis were performed, adjusting for known prognostic/predictive indicators. Results A total of 784 patients were included in the study. Their median age was 51 (i.q.r. 40–62) years, and 418 patients (53·3 per cent) were men. Median Breslow thickness was 3·0 (i.q.r. 2·0–5·0) mm, and 148 patients (18·9 per cent) had a residual tumour load. Median CLND interval was 84 (i.q.r. 65–105) days. Five-year DFS and MSS rates were not significantly different for patients operated on with a median CLND interval of less than 84 days and those with an interval of at least 84 days (DFS: 54·2 versus 53·3 per cent respectively; MSS: 66·9 versus 65·1 per cent). In a multivariable Cox model, CLND interval was not a significant prognostic indicator. CLND interval was negatively correlated with identification of positive non-sentinel nodes, but following adjustment for known risk factors this effect was no longer found. Conclusion The time interval between diagnosis of melanoma and CLND did not influence CLND tumour load, DFS or MSS.
8550 Background: Ultrasound (US) guided fine needle aspiration cytology (FNAC) prior to the surgical sentinel node (SN) procedure has recently been proven to have an increased accuracy due to the introduction of new US morphology criteria. This study reports on a larger dataset, increased follow-up and analyzed US-FNAC versus the validated Memorial Sloan Kettering Cancer Center (MSKCC) Nomogram (Wong et al., 2005). Methods: Prior to SN-biopsy patients (pts) underwent lymphoscintigraphy followed by US-exam. US images were prospectively scored for predetermined morphologic criteria. FNAC was performed in all suspicious US. All pts underwent a SN biopsy. Sensitivity (sens), specificity (spec) and negative/positive predictive value (NPV and PPV) and Hazard Ratios (HR) were calculated for prognostic factors and correlated with survival. Multivariate analyses were performed and compared to the nomogram. Results: Since 2001 over 1000 consecutive pts have been included into a prospective database. Median Breslow thickness was 1.6 mm, 56% were male, mean follow-up 33 months for all pts, 56 months for the first 400 pts., ulceration present in 24%. SN positivity rate was 20%(n=202). Sens and spec. of US-FNAC was 106/196(54%) and 768/779(99%). PPV and NPV were 91% and 90%. Peripheral perfusion showed a sens of 69% and PPV of 56%. Balloon shaped lymph nodes had a sens of 25% and PPV of 94%. 5-ys overall survival (OS) was 55% for US-FNAC positive vs. 92% for US-FNAC neg compared to 65% vs. 93% for SN histological pos and neg pts. There was no increase in late relapses for the first 400 pts (194 at risk at 5 yrs). The MSKCC nomogram accurately predicted SN involvement in this external dataset. Multivariate analysis for OS demonstrated that both the MSKCC Nomogram (HR 3.2, (1.5 – 6.8) P=0.002) and US-FNAC (HR 4.6 (2.6 – 8.2) P<0.001) were independent prognostic factors for OS. Conclusions: This large dataset has validated previous results on the accuracy of US-FNAC performed with new morphology criteria and the MSKCC- nomogram. US-FNAC and MSKCC are independent prognostic factors for OS. US-FNAC might be able to improve the accuracy of the nomogram, a follow-up study will address this.
