Publications by authors named "Eeva Salminen"

48 Publications

Are Breast Cancer Nomograms Still Valid to Predict the Need for Axillary Dissection?

Oncology 2021 10;99(6):397-401. Epub 2021 Mar 10.

Department of Oncology, University of Turku and Turku University Hospital, Turku, Finland.

Background: Nomograms can help in estimating the nodal status among clinically node-negative patients. Yet their validity in external cohorts over time is unknown. If the nodal stage can be estimated preoperatively, the need for axillary dissection can be decided.

Objectives: The aim of this study was to validate three existing nomograms predicting 4 or more axillary lymph node metastases.

Method: The risk for ≥4 lymph node metastases was calculated for n = 529 eligible breast cancer patients using the nomograms of Chagpar et al. [Ann Surg Oncol. 2007;14:670-7], Katz et al. [J Clin Oncol. 2008;26(13):2093-8], and Meretoja et al. [Breast Cancer Res Treat. 2013;138(3):817-27]. Discrimination and calibration were calculated for each nomogram to determine their validity.

Results: In this cohort, the AUC values for the Chagpar, Katz, and Meretoja models were 0.79 (95% CI 0.74-0.83), 0.87 (95% CI 0.83-0.91), and 0.82 (95% CI 0.76-0.86), respectively, showing good discrimination between patients with and without high nodal burdens.

Conclusion: This study presents support for the use of older breast cancer nomograms and confirms their current validity in an external population.
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http://dx.doi.org/10.1159/000514616DOI Listing
June 2021

Excess of Radiation Burden for Young Testicular Cancer Patients using Automatic Exposure Control and Contrast Agent on Whole-body Computed Tomography Imaging.

Radiol Oncol 2017 Jun 26;51(2):235-240. Epub 2017 Feb 26.

Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.

Background: The aim of the study was to assess patient dose from whole-body computed tomography (CT) in association with patient size, automatic exposure control (AEC) and intravenous (IV) contrast agent.

Patients And Methods: Sixty-five testicular cancer patients (mean age 28 years) underwent altogether 279 whole-body CT scans from April 2000 to April 2011. The mean number of repeated examinations was 4.3. The GE LightSpeed 16 equipped with AEC and the Siemens Plus 4 CT scanners were used for imaging. Whole-body scans were performed with (216) and without (63) IV contrast. The ImPACT software was used to determine the effective and organ doses.

Results: Patient doses were independent (p < 0.41) of patient size when the Plus 4 device (mean 7.4 mSv, SD 1.7 mSv) was used, but with the LightSpeed 16 AEC device, the dose (mean 14 mSv, SD 4.6 mSv) increased significantly (p < 0.001) with waist cirfumference. Imaging with the IV contrast agent caused significantly higher (13% Plus 4, 35% LightSpeed 16) exposure than non-contrast imaging (p < 0.001).

Conclusions: Great caution on the use of IV contrast agent and careful set-up of the AEC modulation parameters is recommended to avoid excessive radiation exposure on the whole-body CT imaging of young patients.
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http://dx.doi.org/10.1515/raon-2017-0012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5514665PMC
June 2017

The Sentinel Node with Isolated Breast Tumor Cells or Micrometastases. Benefits and Risks of Axillary Dissection.

Anticancer Res 2017 07;37(7):3757-3762

Department of Oncology and Radiotherapy, Turku University Hospital, University of Turku, Turku, Finland

Background/aim: Sentinel lymph node (SLN) biopsy has become the standard procedure to identify metastases in axillary nodes in breast cancer. Even after careful SLN examination additional micrometastases and isolated tumor cells (ITCs) are sometimes found, resulting in a need for delayed axillary lymph node dissection (ALND). This study was undertaken to assess prognostic factors identifying additional axillary lymph node (ALN) metastases at delayed ALND.

Patients And Methods: To define the impact of late ALND regarding their outcome, 162 breast cancer patients with 169 operated breasts treated between 2010 and 2012 were evaluated, with follow-up through 2016. Data were collected on the patients, histology and biologic profile of the cancer, lymph node involvement, recurrence of breast cancer and adverse effects of ALND.

Results: With thorough examination and immunohistochemical stainings twenty-nine of 168 SLN biopsies (28 patients, 17% of the patients) showed micrometastases or ITC, and a full ALND was performed at a later time. During these ALNDs 13 to 31 lymph nodes were removed. Additional ALN metastases were found in three (10%) patients. Two (7%) of the 28 patients with triple-negative cancer deceased of metastatic breast cancer. Three patients (11%) reported adverse effects of ALND requiring physiotherapy due to pain, stiffness, swelling or arm oedema. Tumor factors such as molecular subtype (p=0.002), tumor size (p=0.004), and proliferation index (Ki-67) (p=0.003) correlated with higher numbers of ALN metastases.

Conclusion: Since most patients with micrometastases found in the primary operation showed no additional positive lymph nodes, completion ALND may not be required in patients with micrometastases or ITCs in the SLN. In our study, the predictive factors for additional ALN metastases were tumur size, molecular subtype and proliferation index. It is conceivable that the features of the primary tumor, rather than the amount of cancer cells in the SLN, might serve to identify patients in whom ALDN can be avoided.
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http://dx.doi.org/10.21873/anticanres.11750DOI Listing
July 2017

Cancer Death Risk Related to Radiation Exposure from Computed Tomography Scanning Among Testicular Cancer Patients.

Anticancer Res 2017 02;37(2):831-834

Finnish Cancer Registry, Helsinki, Finland.

Background: A study of the computed tomography (CT) imaging related effective doses and radiation-related cancer death risk.

Patients And Methods: Estimate effective doses were computed from CT scans of testicular cancer patients treated and followed-up in Turku University Hospital, South Western Finland. Association between effective doses from follow-up CT scans and radiation-induced cancer death was examined using United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) 2008 formula.

Results: Mean effective dose per CT abdomen was 9.32 (standard deviation, SD 3.89) mSv and for whole-body CT it was 14.24 (SD 6.84) mSv. During follow-up of 6 years, the patients were estimated to undergo 12 to 14 abdominal/whole-body CTs and the corresponding risk estimates were 0.11 and 1.14, respectively. The risk of estimated radiation-induced cancer deaths (RICD in %) computed for mean effective doses was lower in patients diagnosed at older age, being 0.61 for 10-19 years age and 0.04 for 40-49 years age at the diagnosis.

Conclusion: Patient radiation exposure in CT imaging is associated with the type of CT device and imaging protocols, which should be periodically updated and reviewed to minimize individual exposure. Using the UNSCEAR modelling 2 % risk for radiation related cancer death was attributed to diagnostic exposure of study patients. Age at the diagnosis was associated with CT imaging related radiation exposure. The highest exposure was estimated to the youngest patients.
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http://dx.doi.org/10.21873/anticanres.11385DOI Listing
February 2017

Symptom Assessment for Patients with Non-small Cell Lung Cancer Scheduled for Chemotherapy.

Anticancer Res 2016 Aug;36(8):4123-8

Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland Department of Oncology and Radiotherapy, University of Turku, Turku, Finland.

Aim: This study assessed the symptoms and health-related quality of life (HRQOL) of patients with advanced non-small cell lung cancer (NSCLC) and examined the symptom-associated characteristics.

Patients And Methods: The symptoms of 122 patients with NSCLC scheduled for chemotherapy before starting treatment were surveyed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire and Edmonton Symptom Assessment Scale (ESAS).

Results: The most prevalent symptoms were coughing (EORTC score 41.7), dyspnea (33.9), fatigue (31.9), insomnia (30.3) and pain (21.8). The mean EORTC score for global QoL was 56.9 (SD=23.5). Physical, cognitive and emotional functioning, insomnia, diarrhea, and dyspnea had a significant influence on the HRQOL (p<0.05). ESAS assessment correlated with these results and thus was an easy-to-use tool for symptom assessment (correlation coefficient range=0.546-0.865, p<0.0001 for all symptoms).

Conclusion: Patients with advanced NSCLC suffer from multiple symptoms influencing HRQOL. ESAS provides a symptom assessment tool that is as reliable as but simpler to use than the EORTC questionnaire.
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August 2016

End-of-life pain medication among cancer patients in hospice settings.

Anticancer Res 2014 Nov;34(11):6581-4

Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland

Unlabelled: Cancer pain management in a hospice setting was studied in the present article. Drug treatments were studied at five time points: at the time of transfer to hospice, at 2nd day, two weeks, and two months following transfer to hospice care, as well as one day before death.

Patients And Methods: Records of 138 consecutive cancer patients treated in hospice in 2010 were studied regarding the drugs given during their stay. The most common cancer was gastro-intestinal cancer (33%), followed by lung (16%) and breast cancer (11%). Data were collected from patients' records and coded in a validated manner for statistical analysis.

Results: The median length of stay in hospice was 14 days (range=2-376 days). Upon transfer, 63% of patients were administered regularly-dosed opioids, 76.8% during the second day at hospice, and 89.9% of the patients received opioids one day prior to death. A significant change was observed in the more frequent subcutaneous administration during hospice stay (p<0.0001). Break-through pain was recorded on the second day in hospice by 52 % of patients, and by 76% on the day prior to death.

Conclusion: Individual patients' needs determined the dose range, but this was not the case for administration route of strong opioids during hospice care.
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November 2014

Harnessing microbiome and probiotic research in sub-Saharan Africa: recommendations from an African workshop.

Microbiome 2014 16;2:12. Epub 2014 Apr 16.

International Livestock Research Institute, Nairobi, Kenya.

To augment capacity-building for microbiome and probiotic research in Africa, a workshop was held in Nairobi, Kenya, at which researchers discussed human, animal, insect, and agricultural microbiome and probiotics/prebiotics topics. Five recommendations were made to promote future basic and translational research that benefits Africans.
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http://dx.doi.org/10.1186/2049-2618-2-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3996947PMC
August 2014

Health-related quality of life during adjuvant radiotherapy in breast cancer.

Qual Life Res 2014 May 8;23(4):1363-9. Epub 2013 Nov 8.

Department of Psychiatry, University of Turku, Turku, Finland,

Objective: In this study, health- related quality of life (HRQoL) and its determinants were assessed in breast cancer patients undergoing postoperative adjuvant radiotherapy. The aim was to improve our understanding of patient's situation at the end of adjuvant treatment, as the return to every day life approaches after breast cancer surgery and adjuvant chemo- and radiotherapy.

Methods: Health- related quality of life was measured by the 15D instrument. Self-administered questionnaires were distributed to patients undergoing postoperative radiotherapy. Out of 389 consecutive breast cancer patients, 273 comprised the final study group. The results were compared to 15D results for an age-standardized sample of the female general population in Finland (n = 3,335). Determinants of HRQoL were assessed by a multivariate model.

Results: In patients <53 years, but not in older patients, the total 15D score was lower than in age-standardized controls. Both younger and older patients differed significantly from the controls on specific 15D dimensions of sleeping, depression, distress, vitality, and sexual activity. When clinical and treatment variables were assessed by a multivariate model, depressive symptoms had a negative effect on HRQoL. Further, having undergone breast conserving surgery instead of mastectomy was associated with poorer HRQoL.

Conclusions: Impairment of HRQoL was observed during adjuvant radiotherapy in breast cancer. This finding calls for action to develop supportive and preventive means to smoothen the return to normal activities after completion of adjuvant treatment for breast cancer.
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http://dx.doi.org/10.1007/s11136-013-0554-yDOI Listing
May 2014

State of the art in research into the risk of low dose radiation exposure--findings of the fourth MELODI workshop.

J Radiol Prot 2013 Sep 27;33(3):589-603. Epub 2013 Jun 27.

STUK-Radiation and Nuclear Safety Authority, PO Box 14, 00881 Helsinki, Finland.

The fourth workshop of the Multidisciplinary European Low Dose Initiative (MELODI) was organised by STUK-Radiation and Nuclear Safety Authority of Finland. It took place from 12 to 14 September 2012 in Helsinki, Finland. The meeting was attended by 179 scientists and professionals engaged in radiation research and radiation protection. We summarise the major scientific findings of the workshop and the recommendations for updating the MELODI Strategic Research Agenda and Road Map for future low dose research activities.
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http://dx.doi.org/10.1088/0952-4746/33/3/589DOI Listing
September 2013

Opioids in pain management of mesothelioma and lung cancer patients.

Acta Oncol 2013 Jan 1;52(1):30-7. Epub 2012 Oct 1.

Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.

Background: Lung cancer and mesothelioma are malignant tumors with generally dismal prognosis and therefore palliative pain treatment constitutes a challenge for the clinician.

Objectives: The aim of this study was to compare the outcomes of pain treatment with opioids among mesothelioma and lung cancer patients treated for palliation and assess factors which confound to optimal treatment.

Patients And Methods: A sub-cohort of 373 lung cancer and 22 mesothelioma patients was identified in multi-center European Pharmacogenetic Opioid Study (EPOS) cohort. A nested case-control (1:4) setting was designed to estimate the pain and other covariates distinguishing 22 mesothelioma- (= cases) and 88 lung cancer patients (controls), analyzed using univariate- and multivariate conditional (fixed-effects) logistic regression models.

Results: The mean total daily dose of opioids varied from 30.0 to 960.0 mg (mean 275, median 160 mg, SD 293) in mesothelioma, and from 10 to 5072 mg (mean 414, median 175, SD 788) in lung cancer patients (p = 0.420). In both groups, pain was mostly experienced as moderate and severe and it was frequently accompanied by depression, poor sleep, anxiety and fatigue. Four mesothelioma patients (18%) and seven lung cancer patients (10%) experienced complete pain relief with opioids by self-assessment. Assessments of pain severity by the patients and their physicians deviated significantly in mesothelioma (p = 0.039 McNemar test), as well as in lung cancer (p = 0.0001). In conditional logistic regression, no significant differences were found in distribution of pain covariates between lung cancer and mesothelioma patients.

Conclusion: Pain perception by the patients was associated frequently with other symptoms and complete pain control with opioids was achieved only with minority of patients both with mesothelioma and advanced lung cancer. Adequate pain control requires continuous monitoring and tailoring the dose to patient's individual needs and tolerance, recognition of accompanying symptoms such as depression and poor sleep, and their management.
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http://dx.doi.org/10.3109/0284186X.2012.725944DOI Listing
January 2013

Breast cancer patients receiving postoperative radiotherapy: distress, depressive symptoms and unmet needs of psychosocial support.

Radiother Oncol 2011 Aug 11;100(2):299-303. Epub 2011 Feb 11.

Department of Psychiatry, University of Turku, Finland.

Background And Purpose: The diagnosis and treatment of breast cancer can cause considerable psychological consequences, which may remain unrecognized and untreated. In this study, the prevalence of depressive symptoms and distress, and unmet needs for psychosocial support were assessed among breast cancer patients receiving postoperative radiotherapy.

Material And Methods: Out of 389 consecutive patients, 276 responded and comprised the final study group. Depressive symptoms were assessed with the Beck Depression Inventory. Distress was measured with the Distress Thermometer. Hospital records of the patients were examined for additional information.

Results: Nearly one third of patients (32.1%) displayed depressive symptoms, and more than a quarter of patients (28.4%) experienced distress. Younger age (p=0.001) and negative hormone receptor status (p=0.008) were independent factors associated with distress. One quarter of the patients expressed an unmet need for psychosocial support, which was independently associated with depressive symptoms and/or distress (p=0.001) and younger age (p=0.006).

Conclusions: During radiotherapy for breast cancer, the staff should have awareness of the higher risk of depression and distress in their patients and should consider screening tools to recognise distress and depressive symptoms. Special attention should be paid to younger patients.
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http://dx.doi.org/10.1016/j.radonc.2011.01.014DOI Listing
August 2011

International Conference on Advances in Radiation Oncology (ICARO): outcomes of an IAEA meeting.

Radiat Oncol 2011 Feb 4;6:11. Epub 2011 Feb 4.

STUK, Finnish Radiation and Nuclear Safety Authority and Department of Radiation Oncology Turku University Hospital, Finland.

The IAEA held the International Conference on Advances in Radiation Oncology (ICARO) in Vienna on 27-29 April 2009. The Conference dealt with the issues and requirements posed by the transition from conventional radiotherapy to advanced modern technologies, including staffing, training, treatment planning and delivery, quality assurance (QA) and the optimal use of available resources. The current role of advanced technologies (defined as 3-dimensional and/or image guided treatment with photons or particles) in current clinical practice and future scenarios were discussed.ICARO was organized by the IAEA at the request of the Member States and co-sponsored and supported by other international organizations to assess advances in technologies in radiation oncology in the face of economic challenges that most countries confront. Participants submitted research contributions, which were reviewed by a scientific committee and presented via 46 lectures and 103 posters. There were 327 participants from 70 Member States as well as participants from industry and government. The ICARO meeting provided an independent forum for the interaction of participants from developed and developing countries on current and developing issues related to radiation oncology.
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http://dx.doi.org/10.1186/1748-717X-6-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042948PMC
February 2011

Relationship between COX-2 and cell cycle-regulatory proteins in patients with esophageal squamous cell carcinoma.

World J Gastroenterol 2010 Dec;16(47):5975-81

Department of Oncology, The People's Hospital of Taizhou, Taizhou Medical School, Yangzhou and Nantong University, No. 210, Yingchun Road, Taizhou 225300, Jiangsu Province, China.

Aim: To investigate the correlation between cyclooxygenase-2 (COX-2) and cell cycle-regulatory proteins in patients with esophageal squamous cell carcinoma (ESCC).

Methods: One hundred and two surgically obtained specimens of ESCC were randomly collected. All specimens were obtained from patients who had not received chemo- or radiotherapy prior to surgical resection. Twenty-eight specimens of normal squamous epithelium served as controls. The expression of COX-2, Ki-67, cyclin A and p27 was examined by immunohistochemistry. The Pearson test was used to analyze the relationship between groups.

Results: The protein level of COX-2, Ki-67 and cyclin A was significantly higher in ESCC than in normal squamous epithelium (74.7 ± 61.2 vs 30.2 ± 43.4, 64.0 ± 51.6 vs 11.6 ± 2.3, 44.2 ± 32.2 vs 11.7 ± 5.0, respectively, all P < 0.01). In contrast, the protein level of p27 was significantly lower in ESCC than in normal squamous epithelium (182.0 ± 69.0 vs 266.4 ± 28.0, P < 0.01). In ESCC, COX-2 expression was correlated with T stage, the score of T1-T2 stage was lower than that of T3-T4 stage (55.0 ± 42.3 vs 83.0 ± 66.5, P < 0.05), and Ki-67, cyclin A and p27 expressions were correlated with the tumor differentiation (43.8 ± 31.7 vs 98.4 ± 84.8, 32.0 ± 19.0 vs 54.1 ± 53.7, 206.2 ± 61.5 vs 123.5 ± 68.3, respectively, all P < 0.01). COX-2 expression was positively correlated to Ki-67, cyclin A and negatively correlated to p27 expression in ESCC (r = 0.270, 0.233 and -0.311, respectively, all P < 0.05).

Conclusion: The expression of COX-2 is correlated with tumor cell invasion and is closely related to the cell proliferation in patients with ESCC.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3007117PMC
http://dx.doi.org/10.3748/wjg.v16.i47.5975DOI Listing
December 2010

Prognostic evaluation of COX-2 expression in renal cell carcinoma.

Anticancer Res 2010 Jul;30(7):3023-30

Department of Oncology and Radiotherapy, Turku University Hospital, PL 52, FIN-20521 Turku, Finland.

Background: Prognosis of renal cell carcinoma (RCC) differs within the same stage and grade. Our aim was to investigate the incidence of COX-2 in primary RCC tumors at different stages according to the occurrence of metastasis, and the impact of this biomarker on the survival of RCC patients.

Patients And Methods: The cytoplasmic/membranous COX-2 protein expression was examined by immunohistochemistry in RCC tumors from 102 patients. The patients were divided into those with: no metastasis during 7.5 years' follow-up (nm), no metastasis at the time of nephrectomy but who later developed metastases (lm), and those with metastasis at presentation (pm). The immunoreactivity of COX-2 was classified as none (absent/weak intensity in fewer than 10% of the cancer cells), low (weak intensity in over 10% of the cancer cells) or high immunostaining (strong intensity in the majority of the cancer cells). In addition p53 and Ki-67 immunostaining was also assessed in tumors.

Results: Percentages of COX-2 reaction were (no/low/high): 78/16/7 in the nm, 53/28/19 in the lm, 92/8/0 in the pm groups (p=0.014). Median metastasis-free survival was shorter in lm patients with COX-2-negative tumors when compared to those with COX-2-positive ones (15 vs. 46 months; p=0.020). Median overall survival was shorter in pm/lm patients with COX-2-negative tumors when compared to those with COX-2-positive ones (28 vs. 94 months; p=0.027), and with COX-2-negative/Ki-67-positive tumors when compared to COX-2-positive/Ki-67-negative ones (19 vs. 97 months; p=0.004). Findings for patients with COX-2-negative/p53-positive tumors were similar, with shorter survival compared to those with COX-2-positive/p53-negative ones (19 vs. 97; p=0.006).

Conclusion: COX-2 protein expression is associated with slow development of metastases, and favourable prognosis in metastatic RCC.
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July 2010

Expression of thymidylate synthase and glutathione-s-transferase pi in patients with esophageal squamous cell carcinoma.

World J Gastroenterol 2009 Sep;15(34):4316-21

Department of Oncology and Pathology, The People's Hospital of Taizhou, Taizhou Medical School, Yangzhou & Nantong University, Taizhou 225300, Jiangsu Province, China.

Aim: To investigate the expression of thymidylate synthase (TS) and glutathione-s-transferase pi (GST-pi) in esophageal squamous cell carcinoma and their association with the clinicopathologic characteristics.

Methods: Immunohistochemical methods were used to detect the expression of TS and GST-pi in surgically resected formalin-fixed, paraffin-embedded esophageal squamous cell carcinoma (ESCC) tissue sections from 102 patients (median age, 58 years) and in 28 normal esophageal mucosa (NEM) samples. The relationship between TS and GST-pi expression and clinicopathologic factors was examined.

Results: The expression of TS and GST-pi was not statistically significantly associated with age of the patients, tumor size, lymph node metastasis, depth of invasion or tumor stage. TS staining was positive in 17.86% of normal esophageal mucosa and in 42.16% of ESCC samples (P < 0.05). The expression level of TS was not only significantly lower in well-differentiated (21.88%) than in poorly-differentiated carcinomas (51.43%, P < 0.05), but was also significantly higher in samples from male patients (46.51%) than from female patients (18.75%, P < 0.05). GST-pi was positively stained in 78.57% of normal esophageal mucosa and in 53.92% of ESCC samples (P < 0.05). The expression level of GST-pi was also significantly higher in well-differentiated carcinomas (65.63%) than in poorly-differentiated carcinomas (35.00%, P < 0.05).

Conclusion: The expression of TS and of GST-pi may be used as molecular markers for the characterization of ESCC. Poorly-differentiated cells showed increased expression of TS and reduced expression of GST-pi.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744189PMC
http://dx.doi.org/10.3748/wjg.15.4316DOI Listing
September 2009

Twinning partnerships through International Atomic Energy Agency (IAEA) to improve radiotherapy in common paediatric cancers in low- and mid-income countries.

Radiother Oncol 2009 Nov 10;93(2):368-71. Epub 2009 Sep 10.

Applied Radiation Biology and Radiotherapy, Division of Human Health, IAEA and Department of Radiotherapy and Oncology, University of Turku, Finland.

Purpose: The article summarises the current use of radiotherapy (RT) in childhood cancer and suggests methods to improve current practice in regions where outcomes of paediatric cancer patients are inferior to those of high-income countries.

Methods And Materials: The International Atomic Energy Agency (IAEA) is supporting low- and mid-income countries (LMICs) in upgrading cancer care where nuclear applications, particularly RT, are used. A consensus meeting of experts was invited to advise IAEA on the needs for RT in paediatric cancer patients. The current indications for RT were reviewed, together with regional differences in access, practice and outcome.

Results: Regional variations in the use of evidence-based multidisciplinary care including RT were associated with varying outcomes of paediatric cancer patients. The contribution of modern and investigational technology to these differences is uncertain and should be determined in clinical trials. Adequate resources are required to support children through the acute phase of treatment and to permit early recognition and management of late effects. An IAEA sponsored project for prospective data collection to assess the current and future status of radiation treatment in childhood cancer in LMICs has commenced.

Conclusion: RT remains an essential component of the multidisciplinary management of many paediatric cancers. Excessive variations in outcome are inappropriate and call for action on harmonising training programmes and compliance with evidence-based recommendations. Training projects targeting paediatric cancer care are being implemented and clinical studies comparing new technologies against evidence-based approaches are needed to achieve this goal. The IAEA has an important role in these activities and has commenced prospective data collection in 13 LMICs to monitor trends in treatment techniques and outcomes.
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http://dx.doi.org/10.1016/j.radonc.2009.08.018DOI Listing
November 2009

Effect of a low dose of sea buckthorn berries on circulating concentrations of cholesterol, triacylglycerols, and flavonols in healthy adults.

Eur J Nutr 2009 Aug 14;48(5):277-82. Epub 2009 Mar 14.

Department of Biochemistry and Food Chemistry, University of Turku, 20014, Turku, Finland.

Background: Epidemiological studies indicate beneficial effects of flavonoids on cardiovascular disease (CVD) risk.

Aim Of The Study: To study the effect of flavonoid-rich sea buckthorn berry (SBB) on circulating lipid markers associated with CVD risk and plasma flavonol concentration. Also investigated was whether changes in the circulating flavonol concentrations correlate with the SBB induced changes in C-reactive protein (CRP) concentration observed previously.

Subjects And Methods: In all 229 healthy participants completed the randomized double-blind study and consumed daily 28 g of SBB or placebo for 3 months. Fasting blood samples for the analysis of lipid markers and flavonols were obtained at the beginning and end of the study.

Results: Compared to the placebo, the consumption of SBB increased the plasma concentration of the flavonols quercetin and isorhamnetin significantly [treatment differences 3.0 ng/ml (P = 0.03) and 3.9 ng/ml (P < 0.01), respectively]. The increase of kaempferol concentration was not significant [treatment difference 0.7 ng/ml (P = 0.08)]. SBB did not affect the serum total, HDL, LDL cholesterol, or the serum triacylglycerol concentrations. There was no correlation between the changes in flavonol and CRP concentrations of participants.

Conclusions: The consumption of SBB significantly increased the fasting plasma concentration of quercetin and isorhamnetin indicating that it is a good dietary source of flavonols. However, this did not convert to affecting the circulating concentrations of lipid markers in healthy, normolipidemic adults having healthy diets.
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http://dx.doi.org/10.1007/s00394-009-0011-4DOI Listing
August 2009

Qualitative and quantitative analyses of the bifidobacterial microbiota in the colonic mucosa of patients with colorectal cancer, diverticulitis and inflammatory bowel disease.

World J Gastroenterol 2007 Aug;13(29):3985-9

Instituto de Productos Lacteos de Asturias (IPLA-CSIC). Ctra. Infiesto s/n, 33300, Villaviciosa, Asturias, Spain.

Aim: To characterize the bifidobacterial microbiota of the colonic mucosa in patients with colon cancer, inflammatory bowel disease or diverticuitis.

Methods: A sample of the distal colonic mucosa was taken during surgery from a total of 34 patients, twenty-one with diagnosed colorectal cancer, nine with diverticulitis and four with inflammatory bowel disease, requiring surgery for their condition. Bacterial DNA was extracted from the resected mucosal samples and bifidobacterial mucosa-associated microbiota was qualitatively and quantitatively determined by means of qualitative and quantitative PCR.

Results: Bifidobacteria were found in 100% of the samples from patients with diverticulitis or IBD and a 76% of those suffering colon cancer. The species B. longum and B. bifidum were the most widely found, followed by B. animalis, B. catenulatum and B. adolescentis. B. breve, B. dentium and B. angulatum were not detected in any sample. A significantly higher occurrence of B. longum was observed in patients with diverticulitis than in those with colon cancer or IBD (100%, 62% and 75%, respectively, P < 0.05). Similar results were obtained for B. animalis (56%, 0% and 25%, P < 0.05), while B. adolescentis was only found in the mucosa from patients with colon cancer (5 out of 21, 24%). At the quantitative level, patients with colon cancer or IBD showed lower counts of total Bifidobacterium (4.94 and 5.91 vs 6.96 log cells/sample, respectively, P < 0.05) and of the species B. longum (4.05 and 4.79 vs 6.76, P < 0.05) than those with diverticulitis.

Conclusion: Aberrancies in mucosa associated microbiota are present in different intestinal diseases. This may indicate a role of the microbiota in the pathogenesis of these diseases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171173PMC
http://dx.doi.org/10.3748/wjg.v13.i29.3985DOI Listing
August 2007

[Not Available].

Duodecim 2007 ;123(7):841-5

TYKS:n lastenpsykiatrian klinikka, PL 52, 20520 Turku.

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April 2008

[Not Available].

Duodecim 2007 ;123(7):825-8

TYKS:n syöpätautien klinikka, PL 52, 20521 Turku.

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April 2008

[Not Available].

Authors:
Eeva Salminen

Duodecim 2007 ;123(2):191-2; author reply 192

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April 2008

The association of immunoreactive p53 and Ki-67 with T-stage, grade, occurrence of metastases and survival in renal cell carcinoma.

Anticancer Res 2006 Sep-Oct;26(5B):3825-33

Department of Oncology and Radiotherapy, Turku University Hospital, PL 52, FIN-20521 Turku, Finland.

Background: The aim of this study was to clarify the association of p53 and Ki-67 protein expressions with tumor characteristics and survival in renal cell carcinoma (RCC).

Materials And Methods: One hundred and seventeen patients were included in the study, 101 (86%) with conventional RCC according to the Heidelberg classification. Patients were divided into three groups with either primary metastases (pm), later metastases (lm), or no metastases (nm) during 7.5 years follow-up. Paraffin-embedded tissues were examined by immunohistochemistry utilizing anti-p53 and anti-Ki-67 antibodies, with a positive reaction cut-off of 10%.

Results: In conventional RCC, there was more Ki-67 positivity in high T(tumor)-stage compared to low T-stage (p = 0.036) and in pm patients compared to nm patients (p = 0.007); p53 was not associated with T-stage or metastatic category. Coexpression of p53/Ki-67 was more common in pm patients than in lm patients, but was not observed in nm patients (p = 0.001). In the pm/lm group, p53 and Ki-67 expressions were associated with decreased survival (log-rank, p = 0.030 and p = 0.031, respectively). In lm patients, high T-stage (T3, T4) was associated with metastases-free survival (p = 0.034) and overall survival (p = 0.006).

Conclusion: p53 and Ki-67 expressions are associated with aggressive tumor phenotype and decreased survival in metastatic RCC. Ki-67 alone was a stronger prognostic marker than p53 for development of metastases. Double positivity for p53 and Ki-67 expression in RCC patients seems to indicate a high metastatic probability.
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December 2006

Probiotic supplementation reduces a biomarker for increased risk of liver cancer in young men from Southern China.

Am J Clin Nutr 2006 May;83(5):1199-203

Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland.

Background: In vitro and in vivo studies suggest that selected strains of probiotic bacteria can form tight complexes with aflatoxin B(1) and other carcinogens.

Objective: The aim of the present study was to determine whether administration of probiotic bacteria could block the intestinal absorption of aflatoxin B(1) and thereby lead to reduced urinary excretion of aflatoxin B(1)-N(7)-guanine (AFB-N(7)-guanine), a marker for a biologically effective dose of aflatoxin exposure. Elevated urinary excretion of this aflatoxin-DNA adduct is associated with an increased risk of liver cancer.

Design: Ninety healthy young men from Guangzhou, China, were randomly assigned to 2 groups; one group received a mixture of Lactobacillus rhamnosus LC705 and Propionibacterium freudenreichii subsp. shermanii strains 2 times/d for 5 wk, and the other group received a placebo preparation. The subjects provided 4 urine samples: at baseline, at 3 and 5 wk after starting the supplementation, and at the end of the 5-wk postintervention period.

Results: The percentage of samples with negative AFB-N(7)-guanine values tended to be higher in the probiotic group than in the placebo group during the 5-wk intervention period (odds ratio: 2.63, P = 0.052), and a statistically significant decrease in the concentration of urinary AFB-N(7)-guanine was observed in the probiotic group. The reduction was 36% at week 3 and 55% at week 5. The geometric means for the probiotic and placebo groups were 0.24 and 0.49 ng AFB-N(7)-guanine/mL, respectively, during the intervention period (P = 0.005).

Conclusion: A probiotic supplement reduces the biologically effective dose of aflatoxin exposure and may thereby offer an effective dietary approach to decrease the risk of liver cancer.
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http://dx.doi.org/10.1093/ajcn/83.5.1199DOI Listing
May 2006

Impact of radiotherapy in the risk of esophageal cancer as subsequent primary cancer after breast cancer.

Int J Radiat Oncol Biol Phys 2006 Jul 19;65(3):699-704. Epub 2006 Apr 19.

Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland.

Purpose: To assess the risk of esophageal cancer as second cancer among breast-cancer patients treated with radiotherapy.

Methods And Materials: The records of the Finnish Cancer Registry from 1953 to 2000 were used to assess the risk of esophageal cancer as second cancer among 75,849 breast-cancer patients. Patients were treated with surgery (n = 33,672), radiotherapy (n = 35,057), chemotherapy and radiotherapy (n = 4673), or chemotherapy (n = 2,447). The risk of a new primary cancer was expressed as standardized incidence ratio (SIR), defined as the ratio of observed to expected cases.

Results: By the end of 2000, the number of observed cases esophageal cancers was 80 vs. 72 expected cases (standardized incidence ratio (SIR) = 1.1, 95% Confidence Interval (CI) = 0.9 to 1.5). Among patients followed for 15 years and treated with radiotherapy, the SIR for esophageal cancer was 2.3 (95% CI = 1.4 to 5.4). No increase in risk was seen for patients treated without radiotherapy. The risk of esophageal cancer was increased among patients diagnosed during 1953 to 1974, although age at the treatment did not have marked effect on the risk estimate.

Conclusion: Increased risk of second cancer in the esophagus was observed for breast-cancer patients in Finland, especially among patients with over 15 years of follow-up and treated in the earliest period, which may relate to the type of radiotherapy.
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http://dx.doi.org/10.1016/j.ijrobp.2006.01.017DOI Listing
July 2006

[Hematuria of a young man].

Authors:
Eeva Salminen

Duodecim 2006 ;122(2):185-6

TY ja TYKS: n syöpätautien klinikka, Turku.

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August 2006

IAEA's role in the global management of cancer-focus on upgrading radiotherapy services.

Acta Oncol 2005 ;44(8):816-24

Division of Human Health, International Atomic Energy Agency, Wagramerstrasse 5, A-1400, Wien, Austria.

The International Atomic Energy Agency (IAEA) is an intergovernmental organization composed by 138 Member States within the United Nations. It has a mandate to seek to accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world. Within the IAEA structure, the Division of Human Health contributes to the enhancement of the capabilities in Member States to address needs related to prevention, diagnosis and treatment of health problems through the development and application of nuclear and radiation techniques within a framework of quality assurance. In view of the increasing cancer incidence rates in developing countries the activities in improving management of cancer have become increasingly important. This review will outline the IAEA's role in cancer management focusing on activities related to improving radiotherapy worldwide.
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http://dx.doi.org/10.1080/02841860500341355DOI Listing
May 2006

Serum tartrate-resistant acid phosphatase 5b (TRACP 5b) as a marker of skeletal changes in prostate cancer.

Acta Oncol 2005 ;44(7):742-7

Department of Oncology, Turku University Hospital, Finland.

Skeletal metastases are a significant problem in prostate cancer (PC). The patients are also exposed to treatment-related skeletal changes. This cross-sectional study evaluated a marker of bone resorption, TRACP 5b in relation to the standard analyte total alkaline phosphatase (tALP) as a marker of skeletal changes. Serum levels of TRACP 5b, tALP and PSA were measured in 130 prostate cancer patients. Comparison was made between patients with (BM+, n = 25) and without (BM-, n = 105) skeletal metastases, and between those treated with (n = 64) or without (n = 66) androgen deprivation (AD). Sensitivities and specificities were calculated for each marker and diagnostic accuracy was evaluated by ROC curve analysis. ROC curves indicated the superior accuracy of tALP, whereas TRACP 5b and PSA were comparable. With tALP the best combination of sensitivity (96%) and specificity of (91%) was reached at a cut-off point 224 U/L, the corresponding values were for TRACP 5b sensitivity (76%), specificity (89%) with a cut-off point 4.89 U/L, and for PSA sensitivity (65%), specificity (81%) at 23 ng/L for skeletal metastases. Patients treated with AD showed with increasing duration an increase in TRACP 5b values. TRACP 5b was less specific than tALP as a marker of skeletal metastases. TRACP 5b may have a role in the diagnostics of skeletal changes in PC with a focus on treatment-related skeletal changes.
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http://dx.doi.org/10.1080/02841860500327586DOI Listing
February 2006

Increased proliferation activity measured by immunoreactive Ki67 is associated with survival improvement in rectal/recto sigmoid cancer.

World J Gastroenterol 2005 Jun;11(21):3245-9

Department of Oncology and Radiotherapy, POB 52, Fin-20510 Turku, Finland.

Aim: To assess the expression of Ki67 as prognosticator in rectal/recto sigmoid cancer.

Methods: Samples from 146 patients with rectal and recto sigmoid cancer were studied for expression of Ki67 and its prognostic significance in comparison with clinico-pathological predictors of survival. Formalin-fixed, paraffin-embedded tissues from 6 (4.1%) patients with T1, 26 (17.8%) with T2, 94 (64.4%) with T3, and 20 (13.7%) with T4 tumors were studied. Ki67 expression was determined immunohistochemically. Samples were divided according to mean value into high (>40%) and low (< or =40%) expression. Areas of extensive proliferation (>50%) were defined as "hot spot" areas.

Results: Hot spot areas were present in samples regardless of histopathological grade. Lower TNM and Dukes stage and higher expression of Ki67 and presence of Ki67 hot spot areas in histopathological samples were associated with better survival, whereas no association was observed with histopathological grade (P = 0.78). In Cox multivariate regression analysis, significant prognostic factors were Dukes stage (P<0.001), presence of lymph node metastases (P = 0.015), age (P = 0.035) and presence of Ki67 hot spot areas (P = 0.044).

Conclusion: Proliferative activity as measured by Ki67 in rectal cancer is associated with survival improvement compared with patients with low Ki67. Areas of prognostically significant increased proliferation were found independently of histopathological tumor grade.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316056PMC
http://dx.doi.org/10.3748/wjg.v11.i21.3245DOI Listing
June 2005