Role of prognostic factors in the therapeutic strategy of primary gastric non Hodgkins lymphomas.
Colucci G. Naglieri E. Maiello E. Marzullo F. Caruso ML. Leo S. Pellecchia A. Cramarossa A. Timurian A. Prete F.
Oncology Institute, Bari, Italy.
PURPOSE: To evaluate retrospectively in 64 gastric non-Hodgkin lymphoma (G-NHL) patients the role of some prognostic factors in the therapeutic strategy of this disease. PATIENTS AND METHODS: Sixty-four primary G-NHL patients (39 males and 25 females; median age: 57 years) were retrospectively evaluated. Treatment consisted of surgery alone (S) in 7 patients, chemotherapy alone (CT) in 15, CT + radiotherapy (RT) in 2, S + RT in 2, S + CT in 19, S + CT + RT in 16. Three patients had no treatment. Forty-four patients received sub-total gastrectomy (21) or total gastrectomy (23), and 20 were not submitted to surgery. RESULTS: After a median follow-up of 106 months (range 48-201), the four-year disease free survival (DFS) was 56% and overall survival (OS) was 59%. In the univariate analysis, tumor invasion depth (p = 0.007), stage (IIE1 vs IIE2: p = 0.007; I-IIE1 vs IIE2-IV: p = 0.0000009) and treatment (in stage IE-IIE1: p = n.s.; in stage IIE2-IV: p = 0.002) were significantly different. In the multivariate Cox regression model, stage was the only significant variable negatively influencing survival. CONCLUSIONS: Our study confirms the prognostic value of both the depth of invasion and the disease stage. In patients with early disease stages and disease localized to the gastric wall, a conservative approach can be recommended. No difference was found between the sub-total and total gastrectomy but surgery retains its fundamental role for G-NHL, even in advanced disease. Prospective trials are needed to confirm these results.
[Hepatic steatosis: clinical-statistical study of patients diagnosed by histological or ultrasonographic methods]
Grassi M. Spada S. Conti R. Loria C. Satta MC. Messini F. Raffa S.
Istituto di Idrologia Medica, Universita La Sapienza, Roma, Italia.
PURPOSE: This study wants to document eziopathogenetic factors and clinical, instrumental and hystological characters that associate to the various types of hepatic steatosis. PATIENTS AND METHODS: In this retrospective study have been examined two different groups of randomized patients. The "Group 1" comprehended 70 patients with hystologic diagnosis of hepatic steatosis (steatohepatitis--SH--60%; steatosis--SE--40%). The "Group 2" comprehended 70 patients with ultrasonographic pattern of fatty liver (slight degree: 70%; severe degree: 30%). RESULTS: Analysis of results relative to the "Group 1" showed the role of HCV-infection in etiopathogenesis of the SH, significantly greater than in SE (76.2% vs 25%; p < 0.0001). SE is often associated with exogenous noxae (alcoholism: 28.6%; use of long-term medications: 14.3%) or metabolic disorders (hyperglycemia 28.6%, hyperlipidemia 42.8%, obesity 25%). Haven't seen differences of clinical data or serum liver tests between SE and SH. Histological features that predicted the development of cirrhosis and/or fibrosis are more frequent in SH (SH: 40.4% vs SE: 10.7%; p < 0.01). The analysis of "Group 2" hasn't shown differences of clinical data or serum liver tests between slight and severe degree. CONCLUSIONS: Analysis of results relative to the two groups of patients ones has shown that SE and SH are thick asymptomatics and associated at hepatomegaly and at increase of ALT, AST, gamma GT. The increase of ALT and/or AST leads to search for the markers of HBV and HCV; when they are positive, hepatobiopsy is necessary for the diagnosis of possible SH or evolutive state to liver cirrhosis.
[Long-term survival after hepatectomy for metastatic liver cancer originating from colorectal carcinoma: presentation of two clinical cases]
Paoletti G. Amodio A.
Istituto Regina Elena per lo Studio e la Cura dei Tumori, Roma, Italia.
We report two case histories of long surviving patients after resection of liver methastases from colorectal cancer. In the first case the patient underwent a right hepatectomy to resect a 3 cm-lesion revealed by a CT scan three years after surgery for a rectal adenocarcinoma. Subsequently, she received two cycles of 5-day continuous infusion of fluorouracil. Four years and 11 months after hepatectomy, the patient is alive and free of disease. The second patient underwent resection of a large hepatic methastasis 3 months after left emicolectomy. The lesion substituted almost completely the right lobe and extended to the IV segment of the left lobe of the liver. After hepatectomy, the patient had a disease-free survival longer than 10 years, until a chest X-ray and a CT scan revealed a primary right lung cancer (citologically, adenocarcinoma) with a methastasis in the left lung. Surgical resection represents the only potentially curative therapy for hepatic methastases from colorectal cancer. Recent data about patient selection for hepatic methastasectomy are presented, and the opportunity of postoperative chemotherapy is discussed.