These types of studies have been greatly advanced by the emergence of gene array and tissue microarray technologies. Here, Parker and colleagues out of the Mayo Clinic report on the utility of survivin expression as a marker of prognosis in clear cell RCC. Survivin is an anti-apoptotic protein that demonstrates nuclear expression and was identified as being overexpressed in RCC as a consequence of genomic profiling studies.

Survivin expression was evaluated using computer assisted immunohistochemical analysis in 312 patients with clear cell RCC in a tissue microarray. Of these, 97 (31.3%) demonstrated increased expression of survivin. Overexpression of survivin in this study was classified as ? 2% of cells examined demonstrating increased expression. Increased expression of survivin was associated with increased tumor size, more advanced tumor stage, increased tumor grade, the presence of coagulative necrosis, the presence of lymph node and distant metastases, and the presence of a venous tumor thrombus. Patients who had overexpression of survivin had an increase risk of death from RCC with a relative risk ratio (RR) of 5.3. The 5 year cancer specific survival for patients with survivin overexpression was 43% versus 87.2% in those without survivin overexpression. In a multivariate analysis that controlled for performance status, TNM stage, grade, and the Mayo SSIGN score, overexpression of survivin remained an independent risk factor for death from RCC. In a subset analysis of 273 patients with localized RCC, increased expression of survivin was associated with an increased risk of cancer progression following nephrectomy, with an RR of 3.9.

This study suggests that expression of the anti-apoptotic protein survivin is associated with a worse outcome in clear cell RCC. One criticism is the definition of overexpression of the protein, which in this study was greater than or equal to 2% of cells evaluated. Mean expression was only 2.3% for the entire population. One wonders of the biologic relevance and utility of a tissue marker that is not found in 98% of the cells in a given tumor.

Cancer 107(1): 37-45, 2006 - UroToday

UroToday

"Increased Breast Calcifications in Women With ESRD on Dialysis: Implications for Breast Cancer Screening," American Journal of Kidney Disease: Mario Castellanos of the Staten Island University Hospital and colleagues compared the mammograms of 45 women who were on hemodialysis with a control group of 86 age-matched women with normal kidney function (Reuters Health, 8/21). Researchers reported a "statistically significan[t] increase" in the total number of breast calcifications in the group with decreased kidney function, compared with the control group (American Journal of Kidney Diseases, 8/21). Among women in the dialysis group, 84.4% developed breast calcifications, compared with 59.0% of women in the control group, the study finds. The researchers concluded, "Every woman on dialysis therapy should be referred for screening mammography, and the physician taking care of these patients should be aware of the slightly increased risk for workup and possibly resultant psychological stress after screening dialysis patients" (Reuters Health, 8/21). "Tobacco Control Policies: Do They Make a Difference for Low SES Women and Girls?" Journal of Epidemiology and Community Health: Policies that aim to reduce secondhand smoke exposure have been less effective for girls and women of lower economic status than for people of higher economic statues, the report finds. The American Legacy Foundation in the report finds that tobacco control polices have led to a reduction in secondhand smoke exposure for many U.S. residents, and policies such as higher prices have helped to reduce smoking among lower-income women. The report also says women who do not complete high school or who have "blue-collar" jobs are less likely than other women to live in homes without smoke, CQ HealthBeat reports (Abruzzese, CQ HealthBeat, 8/11). "Optimism, Distress, Health-Related Quality of Life, and Change in Cancer Antigen 125 Among Patients With Ovarian Cancer Undergoing Chemotherapy," Psychosomatic Medicine: Janet de Moor of the Ohio State University School of Public Health and colleagues examined the outlook of 90 women with epithelial ovarian cancer at the beginning and end of chemotherapy. De Moor, who conducted the study while at the Dana-Farber Cancer Institute, analyzed the participants' self-reported feelings of optimism and distress, as well as aspects of health-related quality of life among the women, and compared their findings with the women's cancer antigen 125 levels (de Moor et al., Psychosomatic Medicine, 8/1). Decreases in CA 125 levels are used to determine the probability of remission and survival in women with ovarian cancer, Reuters Health reports (Rauscher, Reuters Health, 8/15). According to the study, women who reported higher levels of optimism at the start of chemotherapy experienced greater decreases in anxiety, distress and CA 125 levels than those who reported lower levels of optimism (Psychosomatic Medicine, 8/1). "It is important for health care providers to identify patients who feel less optimistic about life and their cancer and treatment because this population may be vulnerable to distress, diminished quality of life and suboptimum clinical outcomes," de Moor said, adding, "Patients who are less optimistic may benefit from interventions to help them cope with their cancer diagnosis" (Reuters Health, 8/15). This article is republished with kind permission from our friends at the The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for Kaisernetwork, a free service of The Henry J. Kaiser Family Foundation. 2006 Advisory Board Company and Kaiser Family Foundation. All rights reserved.