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    <recommendedItem id="20100101_19_451"
                     title="Sentinel Nodes Predict Spread in Oral Cancer (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/HematologyOncology/OtherCancers/tb/18367?impressionId=1265754151448"
                     
      &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_330"
                     title="Immune Cells Point to Skin Cancer Risk after Transplants (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Nephrology/KidneyTransplantation/tb/18200?impressionId=1265754151448"
                     
      Monitoring two types of immune cells in kidney transplant recipients might identify patients with an increased risk of skin cancer, British investigators reported.&lt;br&gt;
&lt;br&gt;Increased levels of T-regulatory cells (Tregs) more than doubled the risk of squamous cell cancer of the skin. Decreased levels of natural killer (NK) cells were associated with more than a five-fold increased risk of skin cancer.&lt;br&gt;
&lt;br&gt;Both immune parameters had substantially greater predictive power than a history of squamous-cell skin cancer, according to an online report in the &lt;em&gt;Journal of the American Society of Nephrology&lt;/em&gt; by a team of Oxford University investigators.&lt;/p&gt;
&lt;p&gt;&quot;Squamous cell cancer of the skin affects about 30% of kidney transplant patients after 10 years of immunosuppression,&quot; Robert Carroll, MD, currently of Queen Elizabeth Hospital in Woodville, Australia, observed in a statement.&lt;/p&gt;
&lt;p&gt;&quot;A small number of patients develop multiple skin cancers per year, but there is no laboratory test to determine which transplant recipients will develop multiple skin cancers in the future.&quot;&lt;/p&gt;
&lt;p&gt;&quot;If a test can confirm high risk of skin cancer development, this may help clinicians to tailor immunosuppressive regimens for individual patients,&quot; he added.&lt;/p&gt;
&lt;p&gt;Long-term immunosuppression, such as that required for transplant recipients, confers an increased risk of squamous-cell skin cancer.&lt;/p&gt;
&lt;p&gt;Estimates of the magnitude have ranged as high as 200 times greater than the general population, the authors wrote. Additionally, 3% of organ transplant recipients require extensive plastic surgery each year as a result of skin cancer lesions.&lt;/p&gt;
&lt;p&gt;Age at transplantation and the immunosuppression dosage are the principal determinants of skin-cancer risk, and the dosage of immunosuppression also influences the risk of metastasis from squamous-cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;In the general population, cancer has been associated with increased levels of Tregs, including CDR&lt;sup&gt;+&lt;/sup&gt;CD25&lt;sup&gt;high&lt;/sup&gt;FOXP3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt;CD28&lt;sup&gt;-&lt;/sup&gt; cells. The same types of cells could play a role in the risk of skin cancer among organ transplant recipients, the authors wrote.&lt;/p&gt;
&lt;p&gt;Within the tumor microenvironment, Tregs may impair the antitumor activity of CD8&lt;sup&gt;+&lt;/sup&gt; and NK cell. However, in organ transplant recipients, Tregs help control or prevent rejections and may help improve long-term outcomes.&lt;/p&gt;
&lt;p&gt;Different immunosuppressive drugs affect Tregs differently, the authors continued. Sirolimus (Rapamune), for example, increases the number of FOXP3&lt;sup&gt;+&lt;/sup&gt; cells, whereas cyclosporine decreases Treg numbers.&lt;/p&gt;
&lt;p&gt;&quot;Tregs have not been assessed in relation to cancer after transplantation,&quot; the authors wrote. &quot;We therefore investigated the hypothesis that squamous-cell cancer in kidney transplant recipients would be associated with an increased number of Tregs.&quot;&lt;/p&gt;
&lt;p&gt;To examine the hypothesis, investigators phenotyped peripheral blood from 65 kidney transplant recipients with squamous skin cancer and 51 recipients without skin cancer, matched for age, sex, and duration of immunosuppression.&lt;/p&gt;
&lt;p&gt;They also quantified lymphocyte populations in skin cancer lesions from a subset of 25 patients and matched them with 25 other nontransplant patients with squamous cell cancer of the skin.&lt;/p&gt;
&lt;p&gt;The kidney transplant recipients had a median follow-up of 340 days. The investigators found that a concentration of &amp;gt;35 peripheral FOXP3&lt;sup&gt;+&lt;/sup&gt;CD4&lt;sup&gt;+&lt;/sup&gt;CD127&lt;sup&gt;low&lt;/sup&gt; regulatory T cells/&amp;#181;L was associated with a hazard ratio for squamous cell skin cancer of 2.48 (95% CI 1.04 to 5.98).&lt;/p&gt;
&lt;p&gt;An NK cell count &amp;lt;100 cells/&amp;#181;L was associated with a skin cancer hazard ratio of 5.6 (95% CI 1.31 to 24). A history of squamous cell cancer of the skin increased the risk of skin cancer recurrence by a third (HR 1.33, 95% CI 1.15 to 1.53).&lt;/p&gt;
&lt;p&gt;&quot;If similar immune phenotypes are predictive in other kidney transplant recipient populations, then immune phenotype method has the potential to inform immunosuppressive regimen manipulation in kidney transplant recipients at high risk for developing multiple squamous cell cancers,&quot; the authors concluded.&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 authors had no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_745"
                     title="Multiple Primary Melanomas Run in the Family"
                     score="-0.005"
                     href="