Biomedical subjects

L Skoog

Publications and source records attributed to L Skoog.

At least 127 records · Page 7Linked to original sources

PubMed1989

Radiotherapy, chemotherapy, and tamoxifen as adjuncts to surgery in early breast cancer: a summary of three randomized trials.

The paper summarizes up-dated results of three randomized adjuvant trials from the Stockholm Breast Cancer Group. The objective of all studies included an evaluation of the role of megavoltage radiation in the primary management of patients with early breast cancer. The first trial was started in 1971 and included 960 pre- and postmenopausal patients with operable disease. The study compared adjuvant radiotherapy with surgery alone. All patients were treated with a modified radical mastectomy. There was a sustained improvement of the recurrence-free survival with radiotherapy (p less than 0.001). Among node positive cases radiation reduced the frequency of both loco-regional recurrence (p less than 0.001) and distant metastasis (p less than 0.01). This observation indicates that distant dissemination in subgroups of patients can originate from uncontrolled local deposits of tumor cells, for instance in the regional lymph nodes. No adverse effect from radiation on long-term survival was observed. The second study was started in 1976 and compared postmastectomy radiation with adjuvant chemotherapy in pre- and postmenopausal high-risk patients. At a mean follow-up of 6 1/2 years there was no significant difference in recurrence-free survival between the two treatments. However, postmenopausal patients fared better with radiotherapy (p less than 0.01). In this subgroup, radiation was more effective than adjuvant chemotherapy in reducing both distant metastases (p less than 0.01) and loco-regional recurrences (p less than 0.001). In the third trial--which only included postmenopausal patients--2 years of adjuvant tamoxifen was compared with no adjuvant endocrine treatment. The number of treatment failures was significantly reduced with tamoxifen (p less than 0.01) but there was no significant overall survival benefit. Subset analysis indicated that tamoxifen improved the recurrence-free survival among patients treated with adjuvant chemotherapy (p less than 0.01) but only to a level close to that achieved with radiotherapy alone. Addition of tamoxifen to radiotherapy failed to further increase the recurrence-free survival.

Aged↗

PubMed1989

The relationship between hormone receptor content and the effect of adjuvant tamoxifen in operable breast cancer.

The relationship between hormone receptor status and the effect of adjuvant tamoxifen in early breast cancer remains controversial. This article presents the results of a randomized trial of adjuvant tamoxifen (40 mg daily for 2 years) versus no adjuvant endocrine therapy in postmenopausal patients. During 1976 to 1984, 1,407 patients were included in the study. Of these, 427 (30%) had high-risk tumors (pN + or pT greater than 30 mm) and were included in a concurrent randomized comparison of postoperative radiotherapy versus adjuvant polychemotherapy. The mean follow-up time was 61/2 years. Tamoxifen improved the recurrence-free survival (RFS) (P less than .01), but the overall survival difference in favor of the tamoxifen-allocated patients was not significant. Data on estrogen (ER) and progesterone receptor (PgR) content were available in 750 patients. Their mean follow-up time was 41/2 years. The effect of tamoxifen was significantly related to ER level (P less than .01). No benefit with tamoxifen was observed among ER-negative patients. The relation to PgR level was of borderline significance (P = .06). Multivariate analysis indicated that most of the interaction between treatment and receptor content was explained by the interaction with ER (P less than .01). The PgR status appeared to modify the effect of tamoxifen among the ER-positive patients and the greatest effect was observed among patients who were positive for both receptors. However, the additional predictive information provided by the PgR assay did not help to identify an unresponsive subgroup of patients.

Aged↗

PubMed1989

Steroid receptor levels in breast cancer. Relationships with age and menopausal status.

The paper presents descriptive data concerning relationships between age, menopausal status and steroid receptor content in primary breast carcinoma. The study was based on 2,329 women with primary breast carcinoma diagnosed in Stockholm county during 1980-1983. Oestrogen (ER) and progesterone receptor (PgR) content was determined using the isoelectric focusing technique. All analyses were done in one laboratory. There was a gradual increase in mean ER values with age. Premenopausal patients had lower mean ER values than peri- and postmenopausal patients of the same age. In contrast, PgR levels were similar in different age-groups. This could be a result of an insufficient stimulation of the tumour cells via the ER pathway. It is also possible that the PgR stimulation is maximal already at ER values below those found in old patients. It is concluded that steroid receptor content measured with commonly used ligand assays may reflect both biological properties of the tumour cells as well as influences by nontumoural factors, e.g. the endogenous levels of sex hormones.

Adult↗

PubMed1989

Non-palpable invasive breast carcinomas from the Stockholm screening project.

Sixty-six non-palpable, invasive mammary adenocarcinomas from the Stockholm mammography screening project were studied with respect to histopathology. In 53 of these tumors estrogen receptor (ER) content was estimated and in 30 of them also the DNA distribution pattern. The tumors were predominantly of low or intermediate histological malignancy grade and ER-rich, whereas the distribution of DNA ploidy equalled that found in a non-selected tumor material. Only 2 tumors recurred during follow-up (median 51 months), indicating that non-palpable breast carcinomas represent a prognostically favourable subset in spite of a relatively high proportion of aneuploid tumors.

Adenocarcinoma↗

PubMed1988

Primary spindle-cell sarcomas of the breast: diagnosis by fine-needle aspiration.

Primary breast sarcomas (excluding cytosarcoma phyllodes and its sarcomatous recurrences) are rare neoplasms. Few have been described in the aspiration cytology literature. We report the cytologic features of two cases of stromal sarcoma (both with the pattern of malignant fibrous histiocytoma) and two cases of angiosarcoma. The dominant cytologic features included individual atypical spindle cells and fragments of collagenous stroma. Tumor giant cells were present in one stromal sarcoma. Features of possible significance in the diagnosis of angiosarcoma include obvious vessel formation by atypical spindle cells, bridging of adjacent tumor fragments by spindle cells, and microacinar structures lined by atypical spindle cells. The differential diagnostic considerations in spindle-cell breast aspirations are discussed.

Adult↗

PubMed1988

Clinical utility of fine-needle aspiration cytology of the thyroid.

Fine-needle aspiration cytology (FNAC) of the thyroid has radically changed the management of patients with thyroid disease. It is an inexpensive, safe, and rapid procedure that usually gives a definitive morphological diagnosis. It frequently eliminates the need for diagnostic surgery. FNAC should be the initial diagnostic test to evaluate any palpable thyroid lesion. This direct approach reduces the need for other time-consuming and expensive investigations. FNAC can also determine whether patients with hyper- or hypothyroidism have underlying thyroiditis.

Biopsy, Needle↗

PubMed1988

Hormone receptor analysis in endometrial cytologic samples collected with the Gynoscann device.

Eighteen patients underwent endometrial cytologic sampling using the Gynoscann instrument immediately before curettage. The material obtained was used for cytologic diagnosis and for measurements of estrogen receptors (ERs) and progesterone receptors (PRs). The material collected with the Gynoscann device provided conclusive cytologic diagnoses in 88% of the cases, as compared with the histologic classification of samples collected by curettage. The DNA content in the samples obtained by the Gynoscann device varied from 5 micrograms to 218 micrograms; this amount was sufficient for the analysis of both ER and PR. Thus, assays for steroid receptors may be performed on endometrial cytologic samples obtained by the Gynoscann; this method may be especially useful for cases in which it is difficult to take a surgical biopsy.

Adult↗

PubMed1987

The Stockholm trial on adjuvant tamoxifen in early breast cancer. Correlation between estrogen receptor level and treatment effect.

The paper presents interim results of an on-going randomized trial of adjuvant tamoxifen (40 mg daily for 2 years) versus no endocrine adjuvant therapy in postmenopausal women with early breast cancer. A total of 1407 patients were included in the study between November 1976 through June 1984. Estrogen receptor (ER) data were available on 1184 patients (84%). The median follow-up was 53 months. Adjuvant tamoxifen increased the recurrence-free interval (P less than 0.01) but had no significant effect on overall survival. Treatment failures were reduced by 25% (P less than 0.01) and deaths by 7% (P greater than 0.05). Tamoxifen mainly decreased the frequency of loco-regional recurrence whereas distant metastases were less affected. The treatment effect was independent of tumor stage but was significantly related to the estrogen receptor (ER) content of the primary tumor. Tamoxifen appeared ineffective among ER negative patients, and the greatest effect was seen among those with high levels of ER. The results indicate that the main mechanism of action of adjuvant tamoxifen is similar to that suggested in advanced disease, i.e. an interaction with the estrogen receptor.

Aged↗

PubMed1987

Loss of heterozygosity in human ductal breast tumors indicates a recessive mutation on chromosome 13.

The genotypes at chromosomal loci defined by recombinant DNA probes revealing restriction fragment length polymorphisms were determined in constitutional and tumor tissue from 10 cases of ductal breast cancer: eight premenopausal females and two males. Somatic loss of constitutional heterozygosity was observed at loci on chromosome 13 in primary tumor tissue from three females and one male. In two cases, specific loss of heterozygosity at three distinct genetic loci along the length of the chromosome was observed. In another case, concurrent loss of alleles at loci on chromosomes 2, 13, 14, and 20 was detected, whereas a fourth case showed loss of heterozygosity for chromosomes 5 and 13. In each instance, the data were consistent with loss of one of the homologous chromosomes by mitotic nondisjunction. Analysis of loci on several other chromosomes showed retention of constitutional heterozygosity suggesting the relative specificity of the events. In contrast, similar analyses of other breast cancers, including comedocarcinoma, medullary carcinoma, and juvenile secretory carcinoma, showed no loss of alleles at loci on chromosome 13. These data indicate that the pathogenesis of ductal breast cancer may, in a substantial proportion of cases, involve unmasking of a recessive locus on chromosome 13 and suggest the involvement of such a locus in heritable forms of this disease.

Adult↗

PubMed1987

Relationship between certain radiographic and biologic characteristics in breast cancer.

The relationship between mammographic appearance of microcalcifications and tumor stage, malignancy grade, estrogen receptor (ER) content and nuclear DNA pattern was studied in 92 mammary carcinomas. The results indicate that no complementary prognostic guidance can be obtained from the radiographic appearance of a tumor apart from a high probability of a spiculated cancer being ER-rich. The finding of a relatively high proportion of aneuploid and ER-poor carcinomas among tumors with microcalcifications indicates that this radiographic characteristic might be associated with increased growth potential.

Adult↗

PubMed1987

Estrogen receptor levels and survival of breast cancer patients. A study on patients participating in randomized trials of adjuvant therapy.

A series of 1,022 patients taking part in clinical trials to compare postoperative radiation therapy with postoperative CMF chemotherapy, and postoperative tamoxifen with no adjuvant therapy, had their tumors analyzed for estrogen receptor content. Isoelectric focusing of the receptor in polyacrylamide gel was used for receptor assay and the results were related to tumor DNA content. The estrogen receptor content was significantly correlated to prolonged survival both for premenopausal and postmenopausal women. It was confirmed that postmenopausal women have increased median receptor values, and for this group values of more than approximately 0.3 fmol per microgram DNA were correlated to prolonged survival. For premenopausal women, a lower level of more than 0.1 fmol per microgram of DNA defined patients with prolonged survival. Lymph node involvement and receptor level were independent prognostic indicators. Patients randomized to tamoxifen or CMF tended to live longer as compared with control patients but this was not statistically significant. Moreover, there was no tendency for adjuvant tamoxifen to further increase the survival of patients with receptor-containing tumors as compared with control patients with similar receptor values.

Adult↗

PubMed1987

Factors associated with prognosis in human breast cancer. VII. A comparison between a Cuban and a Swedish study.

Prognosis in human breast cancer is important since therapeutic plans can be adjusted to individual probability of relapse. Comparative studies are not very frequent in literature. Prognostic factors are not assessed in the same way in different countries, thus contradictory results can be obtained. This paper summarizes the studies performed in two different populations of Swedish and Cuban patients. A group of prognostic factors was compared: age, tumor size, lymph node status, hormone receptors and DNA distribution. Some differences were obtained in these parameters and in short-term relapses. Lymph node status was more important in Swedish series, whereas ER content and DNA pattern were of more predictive value in the Cuban series. Biological interpretations of the results is suggested.

Adult↗

PubMed1986

Content of low density lipoprotein receptors in breast cancer tissue related to survival of patients.

The content of low density lipoprotein (LDL) receptors in tissue from primary breast cancers was determined and its prognostic information compared with that of variables of established prognostic importance. Frozen tumour specimens were selected, and tissue from 72 patients (32 of whom had died) were studied. The LDL receptor content showed an inverse correlation with the survival time. Analysis by a multivariate statistical method showed that the presence of axillary metastasis, content of receptors for oestrogen and LDL, diameter of the tumour, and DNA pattern were all of prognostic value with regard to patient survival. Improved methods of predicting survival time in patients with breast cancer may be of value in the choice of treatment for individual patients.

Adult↗

PubMed1986

A comparison of static cytofluorometry and flow cytometry for the estimation of ploidy and DNA replication in human breast cancer.

332 primary invasive breast carcinomas were analysed by static cytofluorometry and flow cytometry. The ploidy distributions were similar, and 54% of the tumors were judged DNA aneuploid by both methods. The coefficient of variation of the G0-G1 peaks ranged from 2.0 to 8% with both techniques, but the mean was somewhat lower with flow cytometry--4.1%, compared to 4.9% for the static measurements. The proportion of S-phase cells was possible to estimate from 80% of the flow histograms and 70% of the static histograms. S-phase was not estimated from the static histograms if less than 150 tumor cells were measured. With 160 tumors S-phase was measured by both methods. The range was 0 to 27% with the static measurements and 0.7 to 25% with flow cytometry. Corresponding mean values were 7.6% and 8.2%, which are similar to thymidine labeling index results with breast cancers reported in some studies. A close correlation was obtained (r = 0.927) comparing S-phase fractions estimated from aneuploid tumors with flow cytometry and static cytofluorometry if more than 200 cells were measured with the latter. The proportion of S-phase cells was significantly lower for the diploid tumors. We conclude that both techniques can be useful for the estimation of DNA ploidy and replication in human breast cancer.

Aneuploidy↗

PubMed1986

Receptors for EGF and oestradiol and thymidinekinase activity in different histological subgroups of human mammary carcinomas.

The cellular content of receptors for epidermal growth factor (EGF) was measured in different histological subgroups of human mammary carcinomas. EGF receptors were detected in 36% of the ductal and all the medullary carcinomas. In contrast lobular and pure colloid tumours did not contain measurable amounts of the receptor. The receptor was found both among tumours with an euploid and aneuploid DNA pattern. The EGF receptor is thus found in carcinomas with a varying degree of differentiation as judged by the cellular DNA pattern. There was no correlation between the proliferative activity of the tumours as measured by thymidinekinase activity and the amount of EGF receptors in the tumour. Tumours with detectable EGF receptor often had low levels of oestrogen receptor. This finding could only partly be explained by the menstrual status of the patients.

Breast Neoplasms↗

PubMed1986

Comparison between histologic type, estrogen receptor, and nuclear DNA content in mammary carcinoma.

Histological specimens from 80 invasive breast carcinomas comprising typical cases of 16 ductal, nine papillary, 14 comedo, 13 colloid (mucous), 15 lobular, and 13 medullary carcinomas were examined with respect to nuclear DNA and estrogen receptor content. In agreement with previous studies, ductal carcinomas were found to exhibit different types of nuclear DNA distribution patterns, i.e., tumors with DNA values in the normal diploid or tetraploid regions indicative of good prognosis (euploid tumors) or those with values exceeding the normal tetraploid region indicative of poor prognosis (aneuploid tumors). The majority of the papillary and colloid tumors were euploid, while comedocarcinomas in general had aneuploid profiles. These findings are in agreement with expected survival within these patient groups. In lobular breast carcinomas, the correlation between the DNA distribution patterns and expected patient survival was less obvious; and in medullary carcinomas where the vast majority of the tumors showed aneuploid DNA profiles, the correlation to expected patient survival was low. Thus, lobular carcinoma in general seems to have a worse prognosis than is expected from nuclear DNA analysis, whereas medullary carcinomas in general seem to carry a better prognosis than indicated from DNA measurements. In agreement with earlier reports there was a good correlation between nuclear DNA content of the tumor cells and cytosol estrogen receptor values, i.e., euploid tumors in general exhibited relatively high receptor levels, whereas aneuploid tumors had low or unmeasurable estrogen receptor levels.

Breast Neoplasms↗

PubMed1986

Enzyme markers in acute myeloid leukaemia.

The levels of TdT, AdA, 5'-N, 20 alpha-SDH and TK1 were analyzed in different FAB subgroups of AML. AdA, 5'-N, 20 alpha-SDH and TK1 showed large variations both within and between the different subgroups. It therefore seems unlikely that measurements of these enzymes will be able to aid morphological subclassification of AML. Neither could analysis of these enzymes give prognostic information. TdT was detectable in 46% of AML but the levels were only 1/10-1/100 of those found in ALL. The enzyme was detected in leukaemic granulocytopoietic cells while leukaemic cells of monocytic origin were negative in all but 1 case. In addition, increased TdT activity was positively correlated to the length of survival.

20-Hydroxysteroid Dehydrogenases↗

PubMed1986

Proliferative index, cytosol estrogen receptor and axillary node status as prognostic predictors in human mammary carcinoma.

The predictive value of tumor cell estrogen receptor (ER) content, DNA ploidy, proliferative index (PI) and lymph node involvement was examined in 210 women operated on for primary breast cancer in 1979. At a minimum follow-up of 60 months the highest relapse free survival was observed in patients whose tumours had ER greater than 0.30 fmole/micrograms DNA (ER rich) and PI less than 5% (PI low). Subclassification of tumors in euploid and aneuploid groups gave no prognostic information. When examined by axillary node status (no nodal involvement - involved nodes) both ER and PI contributed prognostic information. Multivariate analysis using Cox proportional hazards model showed that nodal involvement was the strongest predictor of recurrence (p = 0.0007). However, ER and PI contributed significant independent prognostic information (p = 0.048 and p = 0.038), respectively.

Adult↗