Medical oncology
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Diabetes mellitus is associated with a poorer outcome in patients with hepatocellular carcinoma. The impact of diabetes mellitus on the treatment of hepatocellular carcinoma, especially chemotherapy, is uncertain. Intra-arterial chemotherapy is one of the therapeutic options of unrespectable hepatocellular carcinoma. ⋯ The median time to progression was significantly longer in non-diabetics compared with the diabetic counterpart (a median of 206 days vs. 88 days, P=0.02). In the hepatocellular carcinoma cell line, Hep G2, insulin rather than glucose was more important for promoting cell proliferation and enhancing the drug resistance of cisplatin or fluorouracil. Our study showed that intra-arterial chemotherapy for unrespectable hepatocellular carcinoma was less effective in diabetic patients than the non-diabetic counterpart in terms of the progression-free rate and time to disease progression survival.
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A systematic review of randomized controlled trials (RCTs) was conducted to evaluate whether patients benefit from the suction drainage after axillary lymph node dissection (ALND) in breast cancer surgery. RCTs of drainage versus no drainage after ALND in women with breast cancer were retrieved from PubMed, EMBASE, Cochrane Library and Chinese Biomedical database. Two authors independently assessed the quality of included trials and extracted data. ⋯ The study demonstrated that insertion of a drain in the axilla after breast cancer surgery resulted in a statistically significant reduction in the rate of seroma (OR = 0.36, 95% CI, 0.16 to 0.81, P = 0.01), the volume of aspiration (MD = -100.10, 95% CI, -174.36 to -25.85, P = 0.008), or the frequency of seroma aspiration (MD = -1.03, 95% CI, -1.35 to -0.71, P < 0.00001), but prolonged the length of hospital stay (MD = 1.52, 95% CI, 0.36 to 2.68, P = 0.01). There was no statistically significant difference in the incidence of wound infection (OR = 0.67, 95% CI, 0.34 to 1.32, P = 0.25) between drainage group and no drainage group. Based on the current evidence, insertion of a drain in the axilla following ALND in breast cancer surgery effectively decreased seroma formation, volume of aspiration as well as the frequency of seroma aspiration without increasing the incidence of wound infection, but extending their stay in hospital.
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Comparative Study
Cardiac risk associated with the receipt of anthracycline and trastuzumab in a large nationwide cohort of older women with breast cancer, 1998-2005.
To determine the risk of cardiotoxicities in association with trastuzumab with/without anthracycline-containing chemotherapy in a large nationwide population-based cohort of patients with breast cancer. We studied 47,806 women with breast cancer ages ≥ 65 in 1998-2005 from 16 cancer registries in the Surveillance, Epidemiology and End Results (SEER)-Medicare data and 16,092 cases matched with equal number of controls on the propensity of receiving chemotherapy or trastuzumab. Cumulative incidence of congestive heart failure in year-1 was 5.5% for patients receiving anthracycline and trastuzumab and 3.2% for those receiving anthracycline without trastuzumab. ⋯ Compared to those without chemotherapy and trastuzumab, patients treated with anthracycline-containing chemotherapy and no trastuzumab were 19% significantly more likely to develop congestive heart failure (hazard ratio = 1.19, 95% CI = 1.05-1.34), whereas those receiving trastuzumab without anthracycline and those receiving both trastuzumab and anthracycline were 1.97 and 2.37 times more likely to develop congestive heart failure after adjusting for patient and tumor characteristics. Concurrent or sequential use of anthracycline and trastuzumab was associated with a greater risk of congestive heart failure and cardiomyopathy. Carefully monitoring cardiac functions in patients receiving anthracycline and trastuzumab is warranted.
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The detection and diagnosis of small-sized (2 cm or less) non-small cell lung cancer (NSCLC) has increased with the development of computed tomography (CT). Over 80% of 5-year survival rate has been reported in surgically treated peripheral lung cancer. There are systematic mediastinal and hilar lymph node involvement pleural invasion and intrapulmonary metastasis even with tumor diameter less than 2 cm. ⋯ There are systematic mediastinal and hilar lymph node involvement even with tumor diameter less than 2 cm. The results of the present study suggested that systematic lymph node dissection is necessary even for cases with tumor diameter less than 2 cm. However, if the tumor is within 1.0 cm in diameter with obvious GGO showing on chest CT scan, these are good candidates for partial resection without mediastinal lymph node dissection.
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This study was to investigate whether the expressions of DNA repair genes ERCC1 (excision repair cross complementing 1), RRM1 (ribonucleotide reductase subunit M1) and BRCA1 (breast cancer 1) affected clinical outcome in patients with NSCLC. Patients with stage IIIb/IV NSCLC were given platinum-based chemotherapy. Messenger RNA expression levels of ERCC1, BRCA1 and RRM1 were determined by real-time polymerase chain reaction with TaqMan probes in the tumor. ⋯ A significant relationship was observed between the expression of ERCC1 and BRCA1 and TTP (6.5 vs. 5.1 months, P=0.001, 5.2 vs. 6.5, P=0.019, respectively). High expression of BRCA1 was associated with better survival in the anti-tubulin-containing regimen subgroup (8.7 vs. 13.0, P=0.035). ERCC1, RRM1 and BRCA1 are promising predictive and prognostic biomarkers in advanced non-small cell lung cancer.