Age,smoking and overweight contribute to the development of intestinal metaplasia of the cardia

AIM:To assess the role of Helicobacter pylori(H.pylori),gastroesophageal reflux disease(GERD),age,smoking and body weight on the development of intestinal metaplasia of the gastric cardia(IMC).METHODS:Two hundred and seventeen patients scheduled for esophagogastroduodenoscopy were enrolled in this study.Endoscopic biopsies from the esophagus,gastroesophageal junction and stomach were evaluated for inflammation,the presence of H.pylori and intestinal metaplasia.The correlation of these factors with the presence of IMC was assessed using logistic regression.RESULTS:IMC was observed in 42% of the patients.Patient age,smoking habit and body mass index(BMI) were found as potential contributors to IMC.The risk of developing IMC can be predicted in theory by combining these factors according to the following formula:Risk of IMC = a + s-2B where a = 2,…6 decade of age,s = 0 for non-smokers or ex-smokers,1 for < 10 cigarettes/d,2 for > 10 cigarettes/d and B = 0 for BMI < 25 kg/m2(BMI < 27 kg/m2 in females),1 for BMI > 25 kg/m2(BMI > 27 kg/m2 in females).Among potential factors associated with IMC,H.pylori had borderline signif icance(P = 0.07),while GERD showed no signif icance.CONCLUSION:Age,smoking and BMI are potential factors associated with IMC,while H.pylori and GERD show no significant association.IMC can be predicted in theory by logistic regression analysis.

The Prognostic Value of Minimally Involved Melanoma Sentinel Lymph Nodes

Background: Sentinel node (SLN) status is the most important prognostic factor for early-stage melanoma patients. It will influence follow-up and may change therapy. Positive SLNs present different degrees of involvement so that subgroups of patients may have minimal SLN invasion. The aim of this study was to evaluate survival in subgroups with minimally involved SLNs and to compare them to negative SLN patients. Method: SLN biopsy was performed in 499 consecutive clinically N0 patients between 1997 and 2008. Following updated recommendations from the Melanoma Group of the European Organization of Research and Treatment of Cancer, degrees of SLN involvement were fully reassessed for two anatomopathological parameters: tumour burden according to Rotterdam criteria (1.0 mm) and microanatomic location according to Dewar (subcapsular, combined subcapsular and parenchymal, parenchymal, multifocal, or extensive). Minimally involved SLNs were defined as those with tumor burden <0.1 mm and/or subcapsular metastasis location. Kaplan-Meier and multivariable logistic regression analyses were performed. Results: Out of 499 clinically N0 patients, positive SLNs were found in 123 patients (24.7 percent). With a median follow-up of 52 months (range: 9 - 146), five-year disease-free (DFS), disease-specific survival (DSS) and overall survival (OS) were 88.1, 93.9 and 89.9 percent for negative SLN patients, respectively. In minimally involved SLNs, there were 21 with tumour burden <0.1 mm, and 52 with subcapsular metastasis. Five-year DFS, DSS and OS in these sub-groups were 79.6, 86.6 and 86.6 percent, then 57.3, 69.8 and 67.8 percent respectively. DFS univariable analysis of these sub-groups compared to negative SLNs showed: (HR1.89, 95 percent CI 0.75 - 4.79;p 0.175) and (HR 3.92, 95 percent CI 2.29 - 6.71;p < 0.0001) respectively. Minimally involved sub-groups were not predictive for NSLN negativity. Conclusion: Rotterdam’s tumour burden stratification is an easy and useful prognostic factor of melanoma survival. There was a trend showing that patients with SLN tumour burden <0.1 mm have a lower survival compared to SLN negative patients. One might suggest that patients with minimally involved SLNs may not be managed similarly to negative SLN patients. Subcapsular metastasis subgroup according to the microanatomic location has statistically significant worst survival.