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Biomedical subjects

C Kamby

Publications and source records attributed to C Kamby.

At least 55 records · Page 3Linked to original sources
PubMed1989

Oestrogen receptor status of primary breast carcinomas and their metastases. Relation to pattern of spread and survival after recurrence.

Immunohistochemical antibody techniques for detection of oestrogen receptors (ER) were applied to formalin fixed, paraffin embedded sections from 62 primary breast cancers, the metastases of their original regional lymph nodes (29 cases), bone marrow carcinosis (43 cases) and liver metastases (20 cases). Forty per cent of the primary tumours and 31% of the regional lymph node metastases were ER positive; in contrast, less than 20% of liver and bone marrow metastases were ER positive. The ER status of regional lymph node metastases was concordant with that of the primary tumour in 90% of the cases. The concordance rate was 75% for liver metastases and 58% for bone metastases. Patients with ER positive primary tumours had recurrence significantly more often in bone; ER negative tumours recurred more often in the liver. The survival after recurrence (SAR) was significantly related to the ER status of the primary tumour and to that of the regional lymph node metastases. In contrast, the SAR was not associated with the ER status of bone marrow carcinosis or liver metastases. Cox analyses showed that age and ER status of the primary tumour were the most important independent prognostic factors compared to other clinical, therapeutic, pathoanatomical and biochemical features. The study supports the hypothesis that tumour cell clones with different ER content are selected and adapted to grow in various anatomical sites. Moreover, the ER status of the primary tumour seems to be more important for the prognosis than the ER status of bone and liver metastases.

Breast Neoplasms↗
PubMed1989

Body size and menopausal status in relation to the pattern of spread in recurrent breast cancer.

The prognosis and pattern of spread were related to body size and menopausal status in 863 patients with recurrent breast cancer. These patients were all enrolled in the adjuvant protocols of the Danish Breast Cancer Cooperative Group. The pattern of spread was illustrated by the number of metastases, the anatomical location of recurrence, and the rate of progression. Body size was estimated as height, weight, Quetelet index (QI), and body surface area (BSA). The body size was unassociated with both recurrence-free interval (RFI) and survival after recurrence (SAR). The groups of patients with different body size had both the same number and the same location of metastases. The tumour growth rates were estimated as clinical rates of progression (i.e. the time elapsed from a single distant metastasis until dissemination). The progression rate was unaffected by body size. Postmenopausal patients had a significantly shorter RFI and SAR compared to premenopausal patients. The number of metastatic sites, the anatomical location of metastases, and the rate of progression were similar in pre- and postmenopausal patients. The study could not confirm most findings from the literature which report a poor prognosis for patients with large body size. Moreover, the results do not suggest interactions between body size, menopausal status, and the clinical course of recurrent breast cancer.

Anthropometry↗
PubMed1989

Semiparametric Marshall-Olkin models applied to the occurrence of metastases at multiple sites after breast cancer.

It is noted that the bivariate exponential distribution introduced by Marshall and Olkin (1967, Journal of the American Statistical Association 62, 30-40) allows semiparametric generalizations along the lines of the Cox regression model for survival data. Partial likelihoods for the regression parameters may be derived (here illustrated by the use of the profile likelihood construction), and in most cases standard Cox regression model software may be applied for the analysis with minor modification of the input files. The study was initiated by data on occurrence of metastases from breast cancer. Metastases may occur at various sites, here grouped into ten categories, and simultaneous as well as consecutive occurrence at several sites in common. It is desired to identify and compare risk factors for development of metastases at each site, and we illustrate on some of these data that the above models may be useful for this purpose.

Biometry↗
PubMed1988

Metastatic pattern in recurrent breast cancer. Special reference to intrathoracic recurrences.

The anatomical and temporal patterns of recurrence were studied in 401 patients with first recurrence of breast cancer. All patients underwent the same scheduled investigation program: history, physical examination, blood tests, bone scanning, bilateral iliac crest biopsy, radiologic bone survey, chest x-rays, and ultrasound scanning of the liver. The current article focuses on the diagnosis of intrathoracic (ITH) recurrence. Most patients recurred in a single site and 50% of the recurrences were diagnosed within the first 2 years from initial diagnosis. Chest x-ray revealed ITH recurrence in 27% (109 patients), and in 8% the lung, pleura, and/or mediastinum were the only signs of recurrence. Generally, the status of primary demographic, clinical, and pathoanatomical characteristics were not predictive as to the development of ITH recurrence, although patients with pleural recurrences often had centrally located primary tumors, locally advanced disease, and often received adjuvant radiotherapy. Clinical symptoms and signs of ITH recurrence were present in only one third of the patients, and the diagnostic specificity and sensitivity of serum lactate dehydrogenase were only 33% and 85%, respectively. Since ITH recurrences often are silent, and since recurrence in this site may have both prognostic and therapeutical implications, routine chest x-ray is indicated in all patients with first recurrence of breast cancer.

Breast Neoplasms↗
PubMed1988

Characteristics of patients with short and long survivals after detection of intracranial metastases from breast cancer.

The clinical course of 106 patients with brain metastases from breast cancer was retrospectively studied. Median time of survival after detection of intracranial metastases (SAR(ICM] was 14 weeks (95% confidence limits: 10-19 weeks), and 25% of the patients survived for more than 37 weeks, while only 17% survived for one year. The occurrence of clinical, pathoanatomical and therapeutical variables in these patients were analyzed in a subgroup of 57 patients, who survived for less than 16 weeks, and compared with a subgroup of 49 patients, who survived for more than 16 weeks after detection brain metastases. None of the variables studied were associated with either of the two prognostic groups. Patients with short SAR(ICM) had, however, a greater number of extra-cranial metastases at recurrence in the brain compared to patients with SAR(ICM) more than 16 weeks (p = 0.07). Patients with SAR(ICM) less than 16 weeks had a somewhat shorter recurrence-free interval (p = 0.22) and a significantly shorter time from primary diagnosis until detection of brain metastases (p = 0.04). Probably as a consequence of this, these patients had a shorter survival from primary diagnosis as well as from first recurrence. The findings may indicate that the differences in survival of patients with brain metastases are mainly due to differences in the rate of disease progression.

Adult↗
PubMed1988

Adjuvant systemic treatment and the pattern of recurrences in patients with breast cancer.

The aim was to analyze the impact of adjuvant systemic treatment (AST) on the anatomical distribution, the number, and the temporal relationship of the first metastases in 635 patients (pts) with breast cancer. These patients participated in the prospective studies of AST of the Danish Breast Cancer Cooperative Group (DBCG) 77-program. All patients had primary high-risk breast cancer (i.e. node positive or local invasion or tumor size greater than 5 cm). The initial treatment was mastectomy with axillary sampling, followed by postoperative radiotherapy. The types of AST and the number of patients with recurrence were: chemotherapy (CT), 134 pts; levamisole (LEV), 96 pts; tamoxifen (TAM), 154 pts. The pattern of recurrence in these patients was compared with the pattern of recurrence in 251 pts who did not receive AST (controls). Although CT reduced the total number of metastatic sites (P = 0.04), the incidence of liver metastases was increased compared to untreated controls (P = 0.02). The median number of metastatic sites was equal in TAM- and LEV-treated pts compared to controls. The incidence of lung metastases was increased in TAM-treated pts (P = 0.03), and LEV-treated pts had a decreased incidence of lymph node (P = 0.01) and pleural recurrences (P = 0.01) compared to controls. The results may suggest that mechanisms of clonal selection during the metastatic process involve differences in sensitivity to antineoplastic treatments of metastases at various anatomical locations.

Antineoplastic Agents↗
PubMed1988

Histological grade and steroid receptor content of primary breast cancer--impact on prognosis and possible modes of action.

The clinical course of breast cancer was related to degree of anaplasia (DA) and steroid receptor (SR) content of primary tumours in 743 patients (pts) with clinical recurrence, initially enrolled in the DBCG-77 protocols. The oestrogen receptor (ER) and the progesterone receptor (PgR) content was known in 110 and 67 pts. The recurrence-free interval, survival after recurrence, and the overall survival were all prolonged in patients with well differentiated tumours or with high SR content. The tumour growth rates were estimated as clinical rates of progression (i.e., the time elapsed from a single distant metastasis until dissemination). The progression rate was prolonged in relatively well differentiated as well as in receptor rich tumours. The extent of dissemination, as indicated by the number of metastatic sites, was not associated with either DA or SR content. However, the anatomical distribution of metastases varied with both DA and SR content: signs of poor prognosis (high DA or low SR content) were associated with occurrence of visceral metastases. In contrast, SR rich tumours had a propensity for recurrence in bone. The results suggest that the impact on prognosis of the features examined here includes both variations in growth rate and metastatic pattern.

Breast Neoplasms↗
PubMed1988

The pattern of metastases in human breast cancer. Influence of systemic adjuvant therapy and impact on survival.

Of the 3,802 patients enrolled in the DBCG 77 protocols, 863 developed clinical recurrence within a median follow-up time of 4.9 years (range 2.0-7.0). More than 69% of these had their first recurrence confined to a single anatomical site and 12% had more than two metastatic sites. The most common sites were bone (35%), lung (23%), skin (22%), and regional lymph nodes (16%). The observation period after first recurrence was 3.6 years (range 0.8-6.4). Survival after recurrence was significantly related both to the location and the number of metastases. Patients who were given adjuvant chemotherapy (n = 134) had significantly fewer metastatic sites and significantly more frequent liver metastases than untreated patients (n = 50). Patients who received adjuvant tamoxifen (n = 154) had the same number of metastatic sites, but more often had lung metastases than untreated patients (n = 201). These results probably reflect that metastases in different anatomical locations differ with respect to sensitivity to antineoplastic treatments.

Antineoplastic Agents↗
PubMed1987

Clinical and radiologic characteristics of bone metastases in breast cancer.

Metastatic bone disease was evaluated in 380 consecutive patients at the time of first metastasis of breast cancer. Studies included radiographic examination, radionuclide examination, and bone marrow biopsy. Radiographs of the skeleton demonstrated metastases in 120 patients (32%), and in 40 of these patients (13%) the bone was the only site of metastases. The diagnostic efficiency was 82% for bone scanning, 80% for pain evaluation, 59% for s-calcium analyses, and 77% for s-alkaline phosphatase analyses. Bone scanning is an effective method to exclude metastatic bone disease (sensitivity: 96%). A positive scan, however, requires radiologic confirmation (specificity: 66%). Bone scanning of the skeleton should be the initial staging procedure in all patients with recurrent breast cancer with no clinical or biochemical signs of bone metastases. Bilateral posterior iliac crest bone marrow aspirations and bone biopsies were positive in 82 out of the 320 patients who underwent biopsy. The frequency of positive bone marrow biopsy was significantly correlated with both the site of radiographic metastases and with the total number of involved bone regions. Routine bone marrow biopsies are indicated in patients with a positive bone scan, but a negative x-ray examination. In these cases biopsies should be performed bilaterally.

Biopsy↗
PubMed1987

The presence of tumor cells in bone marrow at the time of first recurrence of breast cancer.

The occurrence of bone marrow carcinosis was investigated in 380 patients at the time of first recurrence of breast cancer. Results were related to results from radiographic bone survey, 99mTc MDP bone scintigraphy, clinical examination and serum alkaline phosphatase and serum calcium levels. Eighty-seven patients (23%) had tumor cells in the bone marrow. X-rays showed metastases in 78% of the patients with and in 16% of the patients without bone marrow carcinosis. The diagnostic efficiency of x-rays with bone marrow biopsy as the key diagnostic factor was 83%, and it was superior to that of other investigation methods. Bone tissue biopsies were positive alone in 15 patients (17%) and marrow aspirations were positive alone in seven patients (8%). Imprint preparations were positive alone in 7% of the patients and bone tissue biopsy in 5% of the patients. Heavy tumor infiltration (greater than or equal to 50%) of the bone marrow was associated with the occurrence of numerous regions of radiographically involved bone lesions and with histopathologic evidence of bone destruction. Furthermore, pronounced bone formation and marrow fibrosis were more commonly seen in patients with osteosclerotic bone metastases than in patients with osteolytic bone metastases. This study provides evidence that the primary soil of metastatic bone disease in human breast cancer is the bone marrow and that radiographic evidence of bone metastases is a result of an invasion and destruction of the bone tissue matrix by tumor cells from the marrow cavity.

Adult↗
PubMed1987

Incidence and methodologic aspects of the occurrence of liver metastases in recurrent breast cancer.

The occurrence of liver metastases was evaluated by ultrasonic scanning and correlated with prognostic factors, pattern of metastases, clinical examination, biochemical liver function tests from serum, and liver biopsy specimens in 394 consecutive evaluable patients with first recurrence of breast cancer. Fifty-nine patients (15%) had a positive scan, and liver metastases were the only sign of recurrent disease in 11 of these patients. The presence of liver metastases was not associated with age, menopausal status, size of the primary tumor, regional lymph node status, or the length of the recurrence-free interval; but patients with liver metastases were significantly closer to the menopause than those without (P = 0.02). The diagnostic value of clinical examinations was comparable to that of serum bilirubin and serum aspartate aminotransferase (ASAT) analyses, but was significantly better than alkaline phosphatase (AP) and lactate dehydrogenase (LDH) analyses. Analysis of serum AP was not a valuable diagnostic tool in the diagnosis of liver metastases, since it was elevated in 58% of the patients with bone metastases, and since metastases in this site were found in one third of the patients without liver metastases. If all four tests were negative, liver metastases were excluded in 99% of the patients, and if more than two of the four tests were positive, liver metastases were found in 95%. Valid (greater than 80%) diagnosis of liver metastases by serum LDH or serum ASAT alone, required an elevation of three or five times the upper normal limits, respectively. Thirty-nine patients with positive ultrasonography results underwent biopsy. The ultrasonographic diagnosis could not be confirmed histologically in three patients (8%). If ultrasonic scanning had not been performed routinely, only one of 213 patients (0.5%) with soft tissue metastases would have been offered local therapy rather than systemic treatment. These data suggest that ultrasonic scanning of the liver should not be a routine diagnostic tool in examination of patients with first recurrence of breast cancer. However, whenever indicated by clinical signs or elevated blood tests, scanning should be performed to confirm the presence of liver metastases, particularly in patients entering therapeutical trials, since liver metastases demonstrated by ultrasound examinations may serve as a measurable parameter.

Aspartate Aminotransferases↗
PubMed1987

Stage and pattern of metastases in patients with breast cancer.

This study compares the pattern of metastases in 228 patients with initial stage I and 635 patients with initial stage II breast cancer. All these patients had recurrence within a median time of follow-up of 4.9 years (range 2.0-7.0 years). All patients were initially mastectomized, and staging was based on histopathological evaluation of mastectomy specimens. Patients with stage II disease received postoperative radiotherapy; 67% also received systemic adjuvant therapy. Locoregional recurrences were the most common sites of recurrence in stage I, whereas distant metastases occurred more often in stage II patients. Stage II patients had a significantly higher number of metastatic sites than stage I patients. Among patients with a single site of recurrence the frequency of local or regional recurrence was 62% in stage I patients compared to 16% in stage II patients. When correcting for this difference, which was ascribed to the effect of radiotherapy, the number and the distribution of metastatic sites were almost equal in stage I and II patients. The anatomical distribution of metastatic sites in different periods after mastectomy was almost the same in stage I and stage II patients; extraregional lymph node metastases, however, occurred earlier in stage II than in stage I patients. The recurrence-free interval, the survival after recurrence (SAR), and the overall survival were all significantly shorter for stage II than for stage I patients. The reduced SAR for patients with stage II disease hints that tumours of higher stages have a higher rate of progression. The progression time, however, was of the same duration in patients with initial stage I and II breast cancer. The prognostic significance of the classification of patients with breast cancer according to stage does not seem to discriminate tumours with different biological properties with regard to the rate as well as the pattern of dissemination. Postmastectomy follow-up of patients with stage I and II disease should therefore, follow the same guide-lines. Since the anatomical distribution of metastases was the same in different periods after mastectomy, the screening for recurrent disease should not be directed towards any specific sites in certain periods after initial diagnosis.

Adult↗
PubMed1987

Ewing's sarcoma. A retrospective study of prognostic factors and treatment results.

A material of 87 consecutive patients with Ewing's sarcoma referred for treatment in the period 1962-1983 was retrospectively analysed. Thirteen patients had metastases at the time of diagnosis. Of the remainder, 71 received radiation therapy and 32 adjuvant chemotherapy. Survival rate was not influenced by age, sex or treatment delay. Metastatic disease predictably shortened survival (median 6 months vs. 23 months for localized disease). Tumour site did not significantly influence survival rate, although pelvic localization was associated with a slightly shorter median survival. Both pain and objective impairment of movement at presentation correlated to a poorer prognosis, possibly because of larger tumours or soft tissue extension. Adjuvant chemotherapy prolonged recurrence-free survival from a median of 6 months to 16 months, but survival was not improved significantly. Local failure occurred in about 40 per cent, regardless of radiation dose and tumour site. At the time of evaluation, 13 patients (15%) were alive with no evidence of disease and a median follow-up time of 68 months (range 16-196). So far, 2 patients have developed secondary malignancies in irradiated areas (one malignant fibrous histiocytoma and one osteogenic sarcoma).

Adolescent↗
PubMed1986

Aggressive fibromatosis. Report of two cases with rare clinicopathological manifestations.

Two cases of aggressive fibromatosis are described, one with tricentric origin and with the first tumor originating in the hand, the other with malignant transformation into a myxoid fibrosarcoma, grade III. The primary treatment of aggressive fibromatosis should be wide excision, and the follow-up should be long, taking into account the possibility of multicentricity and the risk of malignant transformation.

Adolescent↗
PubMed1986

Metastatic pattern and response to endocrine therapy in human breast cancer.

The effect of endocrine therapy in 465 postmenopausal patients with advanced breast cancer who entered four consecutive, randomized trials has been related to the site of the metastases. Patients received either tamoxifen (T) alone or T in combination with medroxyprogesterone acetate, diethylstilbestrol, halotestin, or aminoglutethimide. The overall response rate was 40%. Responses were most frequently seen in patients with metastases in soft tissue, and the duration of response to endocrine therapy in these patients was longer than for those with metastases in bone or viscera (p less than 0.00001). In addition, the response rate was inversely correlated with the number of main metastatic sites in patients with soft tissue metastases, whereas the response rate was not associated with the number of metastatic sites in patients with metastases in bone and viscera. Survival after first recurrence was significantly longer in responding patients with soft tissue lesions compared to those with recurrence in bone or viscera. In contrast, survival after first recurrence was identical in patients with nonresponding disease, irrespective of dominant site of metastases. The outcome of endocrine therapy depends partially upon the dominant site of metastases. This may reflect a difference in biological characteristics of human breast cancer tumor cells that metastasize to different sites.

Aminoglutethimide↗
PubMed1986

Fine needle aspiration and Tru-Cut biopsy in the diagnosis of soft tissue metastases in breast cancer.

Soft tissue is a common site of the first recurrence in patients with breast cancer, and soft tissue lesions are often used to assess the efficacy of systemic therapy. It is therefore desirable to obtain histological/cytological verification of such lesions. It is our experience that FNA and TCB in psycho-social respects are superior to a surgical biopsy. Using a surgical biopsy as the key-diagnosis we have compared the diagnostic value of Fine-Needle Aspiration (FNA), Tru-Cut Biopsy (TCB) and clinical evaluation. The FNA was found to be significantly better than TCB in establishing the diagnosis. The diagnostic specificity and sensitivity for FNA was 1.0 and 0.65, while the corresponding figures for TCB and the clinical diagnosis were 1.0 and 0.36 and 0.76 and 0.33, respectively. Since no false positive results were obtained by use of FNA, this procedure seems to be a sufficient diagnostic procedure. However, in case of a negative outcome of the FNA, the diagnosis must be obtained by a surgical biopsy.

Adult↗