Roger Terry

Four prognostic groups predict long-term survival from prostate cancer following radiotherapy alone on Radiation Therapy Oncology Group clinical trials.

PURPOSE Gleason score (GS), T stage, and pathologic lymph node status have been described as major independent predictors of death due to prostate cancer in men treated with external beam radiotherapy (XRT). In this analysis we combine these three factors to define prognostic subgroups that correlate with disease-specific survival (DSS) death from prostate cancer. METHODS AND MATERIALS Men entered on one of four Radiation Therapy Oncology Group (RTOG) Phase III randomized trials between 1975 and 1992, for clinically localized prostate cancer (CAP) (n = 1557), were selected for this analysis. Patients were included if: 1) they were evaluable, and eligible for the trial; 2) they received no hormonal therapy with their initial treatment; and 3) follow-up was available. For this study a DSS event was declared if: 1) death was certified as due to CAP; 2) death was due to complications of treatment; or 3) death was from unknown causes with active malignancy. The median follow-up for patients treated on early and late RTOG studies exceeded 11 and 6 years respectively. Subgroups were identified based on their pretreatment GS, T-stage, and lymph node such that patients with similar risk of dying from prostate cancer were combined. RESULTS By combining patients with similar DSS, four subgroups were identified. Risk Group 1 patients had a GS = 2-6, and T1-2Nx; Group 2: GS = 2-6, T3Nx; or GS = 2-6, N+, or GS = 7, T1-2Nx; Group 3: T3Nx, GS = 7; or N+, GS = 7, or T1-2Nx, GS = 8-10; and Group 4 patients were T3Nx, GS = 8-10, or N+, GS = 8-10. The 5-, 10-, and 15-year DSS was 96%, 86%, and 72%; 94%, 75%, and 61%; 83%, 62%, and 39%; and 64%, 34%, and 27% for Groups 1 through 4, respectively. CONCLUSIONS Recognition of these four risk groups provides a basis for estimating the long-term DSS for men treated with XRT alone and should facilitate the design of future prospective randomized trials.

LONG-TERM SURVIVAL AFTER RADIOTHERAPY ALONE: RADIATION THERAPY ONCOLOGY GROUP PROSTATE CANCER TRIALS

PURPOSE We assess the relative importance of the several pretreatment characteristics in predicting death from prostate cancer in patients treated with curative intent with external beam radiotherapy alone. MATERIALS AND METHODS Patients entered on 4 prospective phase III randomized trials conducted by the Radiation Therapy Oncology Group between 1975 and 1992 were selected for this analysis if they were deemed evaluable and eligible for the trial, they had received no hormonal therapy with initial treatment and followup information was available. A disease specific survival event was declared if death was certified as due to prostate cancer, complications of treatment or unknown causes with clinically active malignancy. Median followup for patients treated on early and late studies exceeded 11 and 6 years, respectively. RESULTS Most of the patients (1,557) had tumors clinically staged as T3 (59%), and 87 (36%) with clinically staged T1-2 tumors had pathologically positive lymph nodes. On multivariate analysis Gleason score, clinical stage and nodal status were associated with a less favorable overall and disease specific survival, whereas others factors, such as age and race, were not. A Gleason score of 8 to 10 was associated with a high risk of dying of prostate cancer in the first 5 years (risk ratio 20.0, p = 0.0001). The 10-year disease specific survival for patients with a Gleason score of 2 to 5, 6 to 7 and 8 to 10 was 87, 75 and 44%, respectively, following radiotherapy. Based on published reports these rates were higher than expected with observation alone. CONCLUSIONS In the first 10 years Gleason score was the single most important predictor of death. Gleason score should be incorporated into the current clinical staging system.

Presentation of malignant lymphoma in the rectum

Because of their rarity, rectal malignant lymphomas are generally included in the group of large intestine lymphomas. A study of eight cases of rectal lymphomas revealed distinctive clinicopathologic correlations. Using the Lukes‐Collins classification of malignant lymphomas, the authors interpreted all the cases as B‐cell lymphomas, supported by immunologic studies in four cases. Seven cases were classified diffuse follicular center cell (FCC) lymphomas; four as small cleaved FCC; and three as small noncleaved FCC. One case was interpreted as plasmacytoid lymphocytic lymphoma. Monoclonality was demonstrated by immunoperoxidase staining of cytoplasmic immunoglobulin in three cases and by immunologic surface marker studies in another case. The small noncleaved follicular center cell lymphomas presented as localized tumors (clinical Stage I), so‐called primary lymphomas. The small cleaved follicular center cell lymphomas, by contrast, were part of a generalized lymphomatous process in three of the four cases with demonstrated involvement of the gastrointestinal tract elsewhere in two cases.

Non-hodgkin lymphomas of the thyroid

Twenty-nine cases of non-Hodgkin lymphomas presenting in the thyroid were classified according to Rappaport and Lukes and Collins. In the Rappaport classification there were 19 histiocytic, three mixed, five nodular PDL and two undifferentiated lymphomas. According to Lukes and Collins, 21 cases were follicular center cell lymphomas, eight were immunoblastic sarcomas. Cases classified as histiocytic according to Rappaport fell into the immunoblastic sarcoma and large cleaved or non-cleaved follicular center cell lymphoma groups. Immunoperoxidase studies confirmed the B cell nature of some of these cases. Survival was dependent on clinical stage, but this appeared to reflect the predominant cell type. Thus, follicular center cell lymphomas of the large non-cleaved type presented predominantly in stage I, while immunoblastic sarcoma was mostly stage IV and tumors of the small cleaved follicular center cell (FCC) type had excellent survival despite a usual presentation in stage IV. It is concluded that probably only lymphomas of the large non-cleaved FCC type and immunoblastic sarcoma (IBS) occur as true primary thyroid tumors, while small cleaved FCC lymphomas most likely represent systemic disease when first presenting in the gland. The median survival for large non-cleaved lymphomas in stages I and II was 31.5 months compared to 5.5 months for stage IV IBS. Although strongly suggestive these correlations were not statistically significant. An association with severe chronic lymphocytic thyroiditis was observed in 22 cases, including all cases of immunoblastic sarcoma as well as nine of ten large non-cleaved follicular center cell tumors. The prognostic significance of the Lukes-Collins classification is discussed in relation to these examples of thyroid lymphoma.

Immunohistochemical localization of carcinoembryonic antigen (CEA), CEA-S, and nonspecific cross-reacting antigen (NCA) in carcinomas of lung.

Antisera to carcinoembryonic antigen (CEA), to a physicochemical subset of CEA, namely CEA‐S, and to nonspecific cross‐reacting antigen (NCA) were used for the immunohistochemical localization of these antigens in human bronchogenic carcinomas using a triple layer immunoperoxidase technique. The study is based on an analysis of tumors from 130 patients. CEA, CEA‐S, and NCA were all identified in the membrane and/or cytoplasm of neoplastic cells, and a good correlation between the antigens was observed in a majority of tumors. The presence or absence of these tumor‐associated glycoproteins appeared to be correlated with the histologic type of the tumors, especially in small cell anaplastic carcinoma and adenocarcinoma, and the degree of histologic differentiation of adenocarcinomas correlated positively with these tumor‐associated antigens. Data from this group of patients suggest that analysis of tissue CEA at the time of biopsy or surgical resection may facilitate a more objective interpretation of serial plasma CEA assays.

Abnormal bone and parathyroid histology in carcinoma patients with pseudohyperparathyroidism.

Postmortem bone and parathyroid gland histology in nine hypercalcemic cancer patients without bone metastases was compared to bone and parathyroid histology in ten normocalcemic patients. Parameters of parathyroid function, including serum immunoreactive parathyroid hormone, acid base status, serum phosphate, and nephrogenous cyclic AMP were measured in the hypercalcemic group and compared to normals and to patients with primary hyperparathyroidism. Bone histology in all nine hypercalcemic cancer patients showed increased osteoclastic bone resorption and increased fibrous connective tissue in the bone marrow. Parathyroid glands were of normal size in all nine patients but contained little or no fat, one criterion of parathyroid hyperplasia. In the normocalcemic cancer patients only 2/10 had minimally increased bone resorption while 7/10 had decreased or absent stromal fat in the parathyroid glands. Despite the hyperplastic appearance of the parathyroid glands, serum biochemical parameters in the hypercalcemic cancer patients indicate a state of suppressed parathyroid function suggesting that the osteoclastic bone resorption is related to a humoral substance elaborated by the tumors which is distinct from parathyroid hormone.

Prostatic urethral polyps in adults: histopathologic variations and clinical manifestations.

Abstract Prostatic urethral polyps in adults may be more frequent than suspected. They appear to be finger-like prostatic hyperplastic protrusions in the prostatic urethra. Different histologic forms described may be, in fact, variations of similar structures. The polyps are benign and do not require treatment if not symptomatic.