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    <recommendedItem id="20100101_19_451"
                     title="Sentinel Nodes Predict Spread in Oral Cancer (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18367?impressionId=1265756131598"
                     
      &lt;p&gt;In early oral squamous cell carcinoma, a sentinel node biopsy correctly predicted an absence of lymphatic metastasis in all but 4% of patients, researchers said.&lt;/p&gt;
&lt;p&gt;For T1 and T2 lesions that were clinically node-negative, the procedure  --  combined with additional sectioning and immunohistochemistry  --  yielded a negative predictive value of 96%, according to Francisco Civantos Jr., MD, of the University of Miami, and colleagues.&lt;/p&gt;
&lt;p&gt;For T1 lesions, the value was 100%, while for T2 cancers it was 94%, the researchers reported online in the &lt;em&gt;Journal of Clinical Oncology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The finding may position the procedure as an intermediate option between watchful waiting and selective neck dissection, the researchers said, asserting that it&apos;s now &quot;reasonable&quot; to conduct a head-to-head trial of sentinel node biopsy and neck dissection.&lt;/p&gt;
&lt;p&gt;The procedure has significantly increased the sensitivity for detecting lymphatic metastasis in melanoma and breast cancer patients, Civantos and colleagues noted.&lt;/p&gt;
&lt;p&gt;But in oral cancer, many surgeons prefer a completion neck dissection, they added, despite the &quot;measurable morbidity&quot; that&apos;s associated with the procedure. On the other hand, because of that morbidity, other specialists prefer watchful waiting and elective neck irradiation.&lt;/p&gt;
&lt;p&gt;To investigate the issue, Civantos and colleagues conducted a multicenter trial in which patients with early invasive oral cancers were treated with both procedures  --  a sentinel node biopsy, followed by completion selective neck dissection.&lt;/p&gt;
&lt;p&gt;The primary goal was to see if a negative hematoxylin and eosin finding on the sentinel node biopsy accurately predicted the negativity of the other cervical lymph nodes removed in the neck dissection.&lt;/p&gt;
&lt;p&gt;All told, 140 patients qualified and had the dual procedures, the researchers reported.&lt;/p&gt;
&lt;p&gt;The sentinel nodes were identified using a radioactive gamma probe. The primary tumor was removed transorally, followed by the sentinel node biopsy through a small incision within the area of the planned incision for the neck dissection.&lt;/p&gt;
&lt;p&gt;Staining of the sentinel nodes at the various trial sites resulted in 106 that were negative. Of those, 100 were also negative by hematoxylin and eosin staining of the neck dissection specimens.&lt;/p&gt;
&lt;p&gt;That yielded a negative predictive value of 94%, the researchers said.&lt;/p&gt;
&lt;p&gt;Additional step sectioning and immunohistochemistry at a central pathology lab increased the negative predictive value to 96%, they said.&lt;/p&gt;
&lt;p&gt;Both findings were significant, they reported, with a one-sided &lt;em&gt;P&lt;/em&gt;-value of &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001.&lt;/p&gt;
&lt;p&gt;One limitation of the study, the researchers noted, is that the dual procedures may have interfered with each other, in that sentinel lymph biopsy might have changed the way the neck dissection was performed or the other way around.&lt;/p&gt;
&lt;p&gt;But that &quot;may actually lead to underestimation of the accuracy of this technique,&quot; they said, since the neck dissections were guided by information gleaned from nuclear imaging and the gamma probe used in the sentinel node procedure.&lt;/p&gt;
&lt;p&gt;The study was also limited, the researchers said, because many surgeons involved were only moderately experienced and none was experienced &quot;at levels currently considered appropriate for surgeons caring for breast cancer or melanoma.&quot;&lt;/p&gt;
&lt;p&gt;Nonetheless, they said, the negative predictive value found in the study was &quot;higher than anticipated for a multi-institutional setting with relatively inexperienced surgeons.&quot;&lt;/p&gt;
&lt;p&gt;They added that only a clinical trial in which outcomes after a negative sentinel node biopsy are simply observed for several years would yield a true negative predictive value for the procedure.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;Civantos reported no conflicts.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_440"
                     title="Soft Drinks Linked to Pancreatic Cancer Risk (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18354?impressionId=1265756131598"
                     
      &lt;p&gt;Regular consumers of sugary soft drinks are at higher risk for pancreatic cancer than fruit juice drinkers or the general population, a new Singaporean study has found.&lt;/p&gt;
&lt;p&gt;Chinese men and women living in Singapore who drank two or more soft drinks per week were 87% more likely to contract pancreatic cancer after the researchers adjusted for factors such as smoking (95% CI 1.10 to 3.15), according to the report published Feb. 8 in &lt;em&gt;Cancer Epidemiology, Biomarkers &amp;amp; Prevention.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&quot;In this large prospective cohort of Chinese men and women in Singapore, those who reported regular soft drink consumption were at increased risk of pancreatic cancer when compared with those who largely abstained,&quot; Mark Pereira, PhD, of the School of Public Health at the University of Minnesota, and colleagues wrote. &quot;There was no association between consumption of juice and risk of pancreatic cancer.&quot;&lt;/p&gt;
&lt;p&gt;While pancreatic cancer is relatively rare, it is one of the most deadly cancers, with less than 5% of patients surviving five years after diagnosis. Although rates have generally plateaued in the U.S., they continue to climb in some Asian countries, including Singapore.&lt;/p&gt;
&lt;p&gt;&quot;This increase may reflect demographic and socioeconomic shifts as well as a transition towards a more westernized lifestyle and diet,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Research has shown that insulin promotes pancreatic cancer cell growth, and some researchers think sugary foods could result in blood sugar and insulin fluctuations that expose the pancreas to high concentrations of insulin.&lt;/p&gt;
&lt;p&gt;While fruit juices contain sugar, soft drinks are the major sources of added sugar in the U.S. diet and major contributors to hyperglycemia and hyperinsulinemia.&lt;/p&gt;
&lt;p&gt;Pereira and colleagues followed 60,524 men and women who enrolled in the Singapore Chinese Health Study between April 1993 and December 1998 and were followed for 14 years.&lt;/p&gt;
&lt;p&gt;At enrollment, the participants completed a 146-question food frequency questionnaire, which contained three items related to soft drinks and juice. The questions asked the participants how much, if any, they drank of soft drinks such as Coca-Cola and 7-Up, orange juice, and other fruit and vegetable juices.&lt;/p&gt;
&lt;p&gt;The dietary data was later cross-referenced with records from the Singapore Cancer Registry and the Singapore Registry of Births and Deaths, to determine which of the participants had died of pancreatic cancer and whether it might be related to their soft drink or juice consumption.&lt;/p&gt;
&lt;p&gt;Overall, researchers found that 140 participants had contracted pancreatic cancer.&lt;/p&gt;
&lt;p&gt;The results were largely consistent with three of four previous U.S. studies on the links between pancreatic cancer and soft drinks. Three of the U.S. studies found an association between soft drinks and cancer.&lt;/p&gt;
&lt;p&gt;The author acknowledged that soft drink consumers are more likely than abstainers to participate in other unhealthy behaviors, including smoking and overeating, which makes it difficult to determine that soft drink consumption is an independent risk factor for pancreatic cancer.&lt;/p&gt;
&lt;p&gt;For instance, smokers in their study were at higher risk for pancreatic cancer. &quot;We could not rule out the possibility of residual confounding by factors associated with the habit of drinking soft drinks or other unascertained factors such as waist circumference,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They also noted that the study was limited in statistical power because pancreatic cancer is rare, which limited the sample size of cancer cases. &quot;Also, because we were unable to collect repeated dietary measurements in this study, we were unable to account for changes in consumption of soft drinks and juices,&quot; they wrote, &quot;especially when the diagnosis of diabetes occurred after the baseline interview.&quot;&lt;/p&gt;
&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by the National Cancer Institute.&lt;/p&gt;&lt;p&gt;The authors reported no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_514"
                     title="AASLD: Lighter Patients with Liver Cancer Fare Better"
                     score="-0.006"
                     href="