Inka Treskova

Prognostic factors of breast cancer liver metastasis surgery

The current survival of patients with breast cancer liver metastases (BCLM) after systemic oncological treatment is between 22 to 27 months [1, 2]. The proper indication for surgical treatment of BCLM is still a matter of discussion [3, 4]. We evaluated the risk factors of surgical treatment of BCLM in 21 women with an average age of 50.9 ±8.9 years. The interval between the breast and the liver surgery was 4.0 ±2.8 years. Local recurrence was observed in 6 (28.6%) patients. The primary tumour was a ductal carcinoma in 12 (57.1%) cases, a lobular carcinoma in 6 (28.6%) cases and another type in 3 (14.3%) cases. The primary tumour was oestrogen receptor positive in 14 (66.7%) cases, and progesterone receptor positive in 10 (47.6%) cases. Both receptor types were positive in 15 (71.4%) and both were negative in 2 (9.5%) patients. Fourteen patients had a solitary BCLM, and 7 patients had more metastases. The average sum of BCLM diameters was 5.2 ±3.8 cm. Extra-hepatic metastases were present in 6 (28.6%) patients. We performed 11 (52.4%) liver resections and 10 (47.6%) radiofrequency ablations (RFA). In 3 patients, a lymphadenectomy of the hepato-duodenal ligament, because of the presence of positive lymph nodes, was performed. We studied the effects of patients’ age, time interval between the breast cancer and BCLM surgery, the type of surgical procedure, histopathological findings of the primary tumour, the number and overall diameter of BCLM, the presence of resectable extra-hepatic metastases, and local tumour recurrence after primary breast cancer surgery on patients’ overall (OS) and progression-free survival (PFS). n nThe 1-, 3- and 5-year OS for patients treated with resection or RFA was 89.6, 85.7 and 14.3%; and 79.6, 45.5 and 11.4%, respectively (NS). Younger patients (< 50) were at greater risk in terms of both OS (HR = 4.163, 95% CI: 1.146–15.118, and p < 0.02) and PFS (HR = 4.303, 95% CI: 1.056–17.531, and p < 0.01). An interval ≥ 4 years between the primary procedure and BCLM surgery had a protective effect in terms of OS (HR = 4.738, 95% CI: 1.287–17.441, and p < 0.01) and PFS (HR = 5.088, 95% CI: 1.496–17.303, and p < 0.005). Negative status of ER and PR in the primary tumour was a negative factor for PFS (HR = 21.475, 95% CI: 1.907–241.843, and p < 0.0003). The presence of extra-hepatic surgically resectable metastases had a negative impact on OS (HR = 5.078, 95% CI: 1.437–17.949, and p < 0.005). If the overall diameter of the BCLM was ≥ 3.5 cm, then PFS was significantly worse (HR = 9.999, 95% CI: 1.257–79.513, and p < 0.009). The other studied factors did not have any impact on OS or PFS (Table I). n n n nTable I n nPatients characteristic and prognostic factors n n n nThe surgical treatment of BCLM remains the method of choice in a selected group of patients. The short time interval between the breast and BCLM surgery, presence of extra-hepatic metastases, an overall large BCLM diameter, especially in younger patients, and negative status for both hormone receptors represent significant risk factors, and in such cases the decision to proceed with surgical treatment of BCLM should be weighed on an individual basis by a multi-disciplinary team.

Serious Complications of Intraosseous Access during Infant Resuscitation

We report on a 2.5-month-old infant with ischemia of the left leg and compartment following intraosseous needle application during resuscitation. Unfortunately, this event led to major limb amputation. The cause, mechanism, and prevention of this severe complication are discussed in this article.

Portal Vein Embolization (PVE) Versus PVE with Haematopoietic Stem Cell Application in Patients with Primarily Non-resectable Colorectal Liver Metastases

Background: Portal vein embolization (PVE) and PVE with autologous mesenchymal stem cell application (PVE–MSC) increases future liver remnant volume (FLRV). The aim of this study was to compare both methods from the aspect of FLRV growth, progression of colorectal liver metastases (CLM), CLM resectability and long-term results. Patients and Methods: Fifty-five patients with CLM and insufficient FLRV were included in the study. FLVR growth and CLM volume were evaluated using computed tomography. Liver resection was performed in patients with FLVR >30% of total liver volume. Results: In the PVE (N=27) group, FLRV growth was observed in 23 patients (85.2%) and in 100% of patients in the PVE–MSC (N=28) group (p<0.05). The rapidity of FLRV and CLM growth did not differ between groups. R0 resection was performed in 14 (51.8%) and 24 (85.7%) patients from the PVE and PVE–MSC (p<0.02) groups, respectively. The 3-year overall and progression-free survival rates were 85.75% and 9.3% in the PVE group and 68.7% and 17.1% in the PVE–MSC group, respectively (p<0.67 and p<0.84, respectively). Conclusion: PVE–MSC allows for more effective growth of FLRV and resectability of CLM compared to PVE. The two methods do not differ in their long-term results.

Perioperative Tumour Marker Levels as Prognostic Factors for Surgical Treatment of Breast Cancer Liver Metastases

Background/Aim: The results of surgical treatment of breast cancer liver metastases (BCLM) remain suboptimal. The search for perioperative prognostic factors could help determine high risk groups of patients. The aim of study was to evaluate the significance of tumour markers (TM) on long-term treatment results. Patients and Methods: Liver surgery was carried out in 32 women for BCLM. The perioperative serum levels of CEA, CA19-9, TPA, TPS, CYFRA 21-1 and TK were determined. Results: Preoperative levels of CA19-9 were significant for overall survival (OS)(p<0.05) and recurrence-free survival (RFS) (p<0.01). TPA, TPS and CYFRA 21-1 levels were significant for OS (p<0.05; p<0.04; p<0.05). Postoperative levels of CEA, TPS and CYFRA 21-1 were significant for RFS (p<0.04; p<0.01; p<0.02), while CA19-9 postoperative levels were significant for OS and RFS (p<0.03; p<0.01). Conclusion: Perioperative TM serum levels may represent prognostic indicators reflecting the results of surgical treatment of BCLM.

OPG, OPN, EGF and VEGF Levels at Individual Breslow Score Stages in Malignant Melanoma

Background/Aim: Melanoma represents one of the most aggressive forms of cancer. With the rapid increases in the incidence of melanoma in the United States, Australia and Europe over the last decades, melanoma has been considered an epidemic cancer in these areas. The aim of our study was to evaluate the utility of osteoprotegerin (OPG), osteopontin (OPN), epidermal growth factor (EGF) and vascular endothelial growth factor VEGF for the diagnosis and prognosis of melanoma. Patients and Methods: Overall, 322 individuals were assessed: 183 melanoma patients and 139 healthy individuals. Melanoma patients were divided into four subgroups according to the Breslow score. OPN, OPG, EGF, and VEGF were determined in each plasma sample. Results: The serum levels of the following biomarkers were statistically significantly higher in the melanoma group compared to the control group: OPG and, OPN (p<0.0001), EGF (p=0.0379). In the first stage, OPG (p=0.0236) and OPN (p=0.0327) showed a statistically significant increase. Concerning positive and negative sentinel node metastases a statistically significant change was observed in: OPN (p<0.0001), EGF (p=0.0114), VEGF (p=0.0114). Conclusion: OPG and OPN are promising biomarkers of early-stage melanoma. EGF and VEGF appear to be prognostic biomarkers.

Prognostic value of tumor markers in malignant melanoma

Scientific objectives The incidence of melanomas has been increasing over the past decades. According to WHO statistics 132 000 melanoma skin cancers occur currently each year globally, as an ozone levels have been depleting, the next incidence increase of melanomas is estimated. The melanoma is highly metabolically active tumor that releases number of molecules. This study evaluated the dynamics of tumor markers and their relation to prognosis of melanoma patients.

P2-15-06: Breast Cancer Liver Metastases – Possibilities and Limits of Surgical Treatment.

Background Breast cancer liver metastases (BCLM) are often considered as a sign of a systemic disease with little hope of therapeutic success. The aim of study was to assess the possibilities and determine the limits of the surgical treatment of BCLM. Method : 646 patients were operated for malignant and benign lesions of the liver between 1999 and 2010. Liver surgery for BCLM was performed in 21 women of the average age of 48.5 years (33-71). The average time from the primary surgery for breast cancer till BCLM diagnosis was 4.7 years (2 months - 9 years). BCLM were solitary in 17 and in four cases multiple. Patient selection for liver surgery was based on sufficient future remnant liver volume, the absence of systemic non-resectable tumor dissemination and response to chemotherapy. The authors performed six right-sided hepatectomy, four segmentectomies, three left lobectomies, one metastasectomy, six radiofrequency ablations (RFA), one combined procedure -liver resection and RFA. Histological examination revealed ductal carcinoma in fourteen and lobular carcinoma in seven cases. All patients were treated with the curative adjuvant chemotherapy after surgery. The data were statistically evaluated by statistical software Statistica 9.0. Results : 30 - days mortality rate was 0%. One patient had a complicated hepatectomy with iatrogenic bile duct injury. According to statistical analysis the probability of patients survival twelve, resp. thirty months after surgery was 100, resp. 66.7% and the probability of the tumor relapse anywhere in the body was at the same time intervals 0, resp. 71. 5%. Conclusion : Liver surgery combined with the adjuvant chemotherapy are a therapeutic methods of choice for highly selected patients with metastases limited to the liver and objective response to neoadjuvant chemotherapy. The study was supported by the research projects IGA MZ NS 9727 and IGA MZ NS 102 40. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-06.