European Journal of Cancer: Highlights of Issue 38:10

Examining the mind and body

Psyche cannot be separated from soma

In this issue Dalton and colleagues have examined the interesting question of whether major life events, depression and personality factors are risk factors for cancer. They extracted studies from keyword searches of the Medline and PsychINFO databases between 1966 and August 2001 and selected data where the psychological variable was collected independently to look for possible associations between these factors and the risk of cancer. However, they found little evidence to support such associations. As discussed by the authors, the analysis was hampered by the fact that many of the studies had methodological weaknesses and the findings were likely to be influenced by chance, bias and confounding. They suggest that further studies should have better-articulated hypotheses, prospective designs and large study populations to ensure statistical power and should also be adjusted for confounding. They conclude that “high scientific quality can be achieved only by taking into account the fact that psychological factors are closely related to the biological, physiological and behavioural characteristics of individuals”.

In a review published in the next issue (38.11), these same authors examine whether psychosocial interventions can improve survival and psychological well-being.

Increased erbB-4 expression after doxorubicin-based chemotherapy is associated with a poorer survival of STS patients.

In this issue, Merimsky and colleagues have investigated the role of erbB-4, a growth factor receptor, as a tissue marker in STS. They examined expression levels of erbB-4, in samples taken from 29 patients with STS of the extremities, before and after doxorubicin-based chemotherapy and looked for correlations with the response to chemotherapy. Interestingly, they found those patients who had an increase in erbB-4 expression more commonly showed no response to chemotherapy whilst those with either no change or decreased levels more commonly showed a response (P=0.004). Median disease-free survival also differed, although non-significantly, being 14 months in those with increased expression compared with 30 months in those with the same or decreased expression. They suggest that increased expression post-chemotherapy may represent an increased capability of growth and increased tumour aggressiveness. However, the numbers were small in these analyses and would require further confirmation in larger studies.

VEGF-C expression in gastric carcinomas- a predictor of lymph node metastases?

In gastric cancers with invasion of the submucosa, the risk of lymph node metastases following endoscopic mucosal resection (EMR) ranges from 10-25%. Moreover, it is unclear which patients following successful EMR should have a lymph node dissection. There is therefore a need for predictive markers in these cases. Vascular endothelial growth factor (VEGF)-C is a member of the platelet-derived growth factor (PDGF) family that play a role in angiogenesis. In this issue, Amioka and colleagues have examined the expression of VEGF-C by immunohistochemical staining of tissues samples from 139 patients with submucosally invasive gastric carcinoma who have undergone surgical resection. 23% were positive for VEGF-C (at least 30% of the cells showing cytoplasmic staining). This staining was also more intense at the more invasive parts of the tumours in 24 of these cases. Normal gastric mucosa showed no staining. In a multivariate analysis, lymphatic invasion and VEGF-C were significant risk factors for lymph node metastases. The authors conclude that “VEGF-C may be responsible for lymphatic dissemination in human gastric carcinoma”, although further investigation will be required.

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