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Bang Y, Chung H, Xu J, Lordick F, Sawaki A, Al-Sakaff N, Lipatov O, See C, Rueschoff J, Van Cutsem E. Pathological features of advanced gastric cancer (GC): Relationship to human epidermal growth factor receptor 2 (HER2) positivity in the global screening programme of the ToGA trial. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4556] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4556 Background: HER2 positivity is thought to be a negative prognostic factor in GC, correlating with poor survival rates. Reported HER2-positivity rates in GC have varied widely (6–35%). The ToGA trial is evaluating the addition of trastuzumab (Herceptin) to chemotherapy in HER2-positive advanced GC. It is the first randomised Phase III trial to provide prospective information on HER2-positivity rates in GC. Enrollment is complete, with 3,883 patients screened in 24 countries. The pathological features of GC and the relationship with HER2 positivity will be examined. Methods: Advanced GC tumour samples were centrally screened by immunohistochemistry (IHC; HercepTest) and fluorescence in situ hybridisation (FISH; PharmDx) in parallel. A HER2-scoring system modified from the protocol in breast cancer (BC) was used: a score of IHC 3+ and/or FISH positive was defined as HER2 positive. Results: Final data showed an overall HER2-positivity rate of 22.1% evaluated from 3807 patients. The HER2-positivity rate was similar between Europe (23.6%) and Asia (23.5%). HER2-positivity rates were higher in gastro-oesophageal junction (GEJ) than stomach cancer (33.2% vs 20.9%; p<0.001) and in intestinal than diffuse/mixed cancer (32.2% vs 6.1%/20.4%; p<0.001). This is reflected in above-average HER2-positivity rates in countries with the highest GEJ:stomach cancer ratios (France 0.56 [HER2 positivity 26.9%]; Germany 0.53 [23.7%]; UK 0.33 [25.8%]) and intestinal:diffuse cancer ratios (UK 3.4 [HER2 positivity 25.8%]; Australia 2.6 [32.8%]; Japan 2.8 [27.8%]). The modified HER2-scoring system showed concordance between IHC and FISH results of 87.5%. In BC most IHC 0/1 samples are FISH negative but, in ToGA, the frequency of IHC 0/1 samples testing FISH positive was almost as high as IHC 2/FISH-positive samples (23% vs 26%). Conclusions: The overall HER2-positivity rate in advanced GC in ToGA is 22.1%. Variations in tumour location and type mostly explain the difference in HER2-positivity rates between countries. Efficacy data will enable further evaluation of the clinical significance of HER2 IHC and FISH scoring patterns. [Table: see text]
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Affiliation(s)
- Y. Bang
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - H. Chung
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - J. Xu
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - F. Lordick
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - A. Sawaki
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - N. Al-Sakaff
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - O. Lipatov
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - C. See
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - J. Rueschoff
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
| | - E. Van Cutsem
- Seoul National University Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea; Affiliated Hospital (307 Hospital) Cancer Centre, Beijing, China; National Centre for Tumour Diseases, Heidelberg, Germany; Aichi Cancer Center, Nagoya, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Roche Products Ltd, Welwyn Garden City, United Kingdom; TARGOS Molecular Pathology GmbH, Kassel, Germany; University Hospital Gasthuisberg, Leuven, Belgium; Bashkirian Republican
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Matsumoto K, Sawaki A, Kobayashi Y, Mizuno N, Hara K, Takagi T, Sawai Y, Shimizu Y, Yatabe Y, Yamao K. Diagnostic yield of nonfunctional pancreatic neuroendocrine tumor using endoscopic ultrasound-guided fine needle aspiration biopsy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15680 Background: Radiological examinations including computed tomography (CT) and endoscopic ultrasound sonography (EUS) are important for the diagnosis of pancreatic neuroendocrine tumors (PNETs). Pathological diagnosis is not needed with functional PNETs because the diagnosis is made by biochemical testing. Therefore, pathological diagnosis is essential for the non-functional PNETs (nf-PNETs). In this study, we examined the diagnostic yield of radiological examinations and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for nf-PNETs. Methods: From January 1997 to December 2007, consecutive 38 cases were pathologically diagnosed from as nf-PNETs at Aichi Cancer Center Hospital. Of these 33 patients was diagnosed with surgical specimen, 5 patients with EUS-FNA specimen. Of 33 patients, 16 patients underwent EUS-FNA preoperatively, and were examined further: their EUS-FNA specimens were submitted for additional immunohistochemical examination for CD 56, chromogranin A, synaptophysin, somatostatin receptor 2A (SSTR2A) and Ki-67 using cell block method. Staging of PNETs was performed according to WHO classification. Results: 16 patients (10 men and 6 women) who ranged in age from 23 to 81 years. The mean of tumor size was 2.2 cm and ranged from 0.7 to 4.4 cm. Diagnosis by CT and EUS was 12 (75.0%) PNETs, two pancreatic cancer, one solid papillary tumors and one malignant lymphoma. Accurate diagnosis by cytology and immunohistochemistry was 75.0% and 93.8%, respectively. The Ki-67 in specimens of malignancy tended to be higher than those of benign or uncertain behavior. If we assumed that a tumor with Ki-67 of more than 2% was malignancy, the diagnostic accuracy was 75.0%. Positive reaction to SSTR2A was up to 14 out of 16 nf-PNETs. Conclusions: The EUS-FNA is a useful tool for diagnosing nf-PNETs with immunohistochemical staining compared to cytology and radiological examinations. Ki-67 may be also effective to predict the degree of malignancy. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - K. Hara
- Aichi Cancer Center, Nagoya, Japan
| | | | - Y. Sawai
- Aichi Cancer Center, Nagoya, Japan
| | | | | | - K. Yamao
- Aichi Cancer Center, Nagoya, Japan
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103
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Takahashi T, Nishida T, Sakurai S, Kanda T, Sawaki A, Wada R, Hasegawa T, Hirota S. Validation of genotyping of gastrointestinal stromal tumor in Japan. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e21502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21502 Background: Most gastrointestinal stromal tumors (GIST) have activating mutations in the KIT or PDGFRA gene. Genotyping of GIST is important in Dx and Tx of GIST. Methods of genotyping using genomic DNA extracted from paraffin-embedded specimens are diverse and not standardized. We did validation study of genotyping using special reference to sequencing data obtained from cDNA from fresh GIST samples. Methods: Three DNA extraction methods (QIAamp, DEXPAT, or original) and four PCR methods (Ex Taq, AmpliTaq condition-1, AmpliTaq condition-2, or QIAGEN Tag) were compared using 20 paraffin-embedded specimens with special reference to sequencing data obtained from cDNA from corresponding 20 fresh GIST samples. After DNA extraction, KIT exon 9, 11, 13 and 17, and PDGFRA exon 12 and 18 were amplified by each PCR method using specific primers and directly sequenced. Results: In evaluation of PCR method, the protocol with Ex Taq showed 100% amplication of DNA and sequence agreement, the protocol with QIAGEN Tag 99%, and the protocol with AmpliTaq condition-2 86% agreement, and the protocol with AmpliTaq condition-1 showed much less amplication and higher disagreement. For the DNA extraction, the protocol with QIAamp showed best DNA extraction and its DNA sequence data were consistent with reference sequence in 98%, DNA sequence obtained using DEXPAT showed 33% consistency, and 89% of DNA sequence data obtained from an original method was agreed with reference data. Some modifications improved DNA amplication but inconsistent sequence data also increased probably due to miss-PCR. Conclusions: Each DNA extraction method had different quantity of DNA and four PCR methods showed different quality. Using this validation study, a standard genotyping method in Japan was established. No significant financial relationships to disclose.
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Affiliation(s)
- T. Takahashi
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - T. Nishida
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - S. Sakurai
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - T. Kanda
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - A. Sawaki
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - R. Wada
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - T. Hasegawa
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
| | - S. Hirota
- Osaka University School of Medicine, Osaka, Japan; Gunma University Graduate School of Medicine, Maebashi, Japan; Niigata University Graduate School of Medical and, Niigata, Japan; Aichi Cancer Center, Nagoya, Japan; Hirosaki University School of Medicine, Hirosaki, Japan; Sapporo Medical University School of Medicine, Sapporo, Japan; Hyogo College of Medicine, Nishinomiya, Japan
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104
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Muro K, Shitara K, Ura T, Takahari D, Yokota T, Sawaki A, Kawai H, Munakata M, Sakata Y. Chemotherapy for patients with advanced gastric cancer with performance status 2. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e15627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15627 Background: S-1 plus cisplatin is considered to be the standard chemotherapy for Japanese patients with advanced gastric cancer (AGC) according to the results of three phase III trials (JCOG9912/SPIRITS/TOP-002). However, since few patients with poor performance status (PS2) were included in these phase III trials (27 of 1317; 2%), the standard treatment of patients with PS2 has not been established yet. In also, the characteristics and prognosis of AGC patients with PS2 has not been reported in detail. Methods: We retrospectively analyzed 545 patients with AGC treated by chemotherapy during the period from January 2003 to June 2008. Patients characteristic and treatment results were compared between PS0–1 and PS2. Results: At the beginning of 1st-line chemotherapy, PS0–1/2/3–4 was 454/69/22 cases respectively. Patients with peritoneal/pleural dissemination was more common in PS2 than PS0–1 (75% vs. 43%, p<0.001). Patients with multiple metastatic places was more common in PS2 (62% vs. 43%; p=0.007). Fewer patients in PS2 were registered in clinical trial (1.4% vs. 25%, p<0.001). First-line chemotherapy using oral drug (S- 1/capecitabine) was significantly fewer in PS2 (43% vs. 75%, P<0.001). Median time to treatment failure was significantly shorter in PS2 (2.3 months vs. 4.2 months, p<0.001). Patients who could receive second-line chemotherapy were significantly fewer in PS2 (50% vs. 75%, p<0.001). With the median follow up time of 42 months, median survival time of patients with PS0–1 was 14.8 months (95% CI;13.1–16.5) and that of patients with PS2 was 6.1 months (4.3 to 7.4 months; hazard ratio for death 3.0: 95% CI2.3–4.0; p<0.001). Mortality rate within 30 days was higher in PS2 (3% vs. 0.2%; p<0.001). Conclusions: AGC patients with PS2 had not only had poor prognosis compared with PS0–1 but also had fewer chance of registration in the clinical trial, shorter time to treatment failure, and higher mortality rate within 30 days. Considering these different characteristics and treatment results of PS0–1 and PS2, clinical trial especially targeting AGC patients with PS2 is necessary to evaluate optimal chemotherapeutic regimens for PS2 patients. No significant financial relationships to disclose.
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Affiliation(s)
- K. Muro
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - K. Shitara
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - T. Ura
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - D. Takahari
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - T. Yokota
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - A. Sawaki
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - H. Kawai
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - M. Munakata
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
| | - Y. Sakata
- Aichi Cancer Center, Nagoya, Japan; Misawa City Hospital, Misawa, Japan
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105
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Hoki N, Mizuno N, Sawaki A, Tajika M, Takayama R, Shimizu Y, Bhatia V, Yamao K. Diagnosis of autoimmune pancreatitis using endoscopic ultrasonography. J Gastroenterol 2009; 44:154-9. [PMID: 19214678 DOI: 10.1007/s00535-008-2294-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2007] [Accepted: 09/04/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND Revised clinical criteria for autoimmune pancreatitis (AIP) have been proposed by the Research Committee of Intractable Disease of the Pancreas and the Japan Pancreas Society. These criteria require distinguishing AIP from neoplastic lesions. However, this can be difficult, and patients often undergo surgery on the basis of suspected pancreatic cancer (PC). METHODS AIP was diagnosed in 25 patients at the Aichi Cancer Center Hospital (ACCH) according to the revised AIP criteria. In each patient, endoscopic ultrasonography (EUS) was used to describe the conventional pancreatic parenchymal and ductal features of chronic pancreatitis (Sahai criteria), and other abnormal features, namely, diffuse hypoechoic areas (DHAs), diffuse enlargement (DE), focal hypoechoic areas (FHAs), focal enlargement, bile duct wall thickening (BWT), lymphadenopathy, and peripancreatic hypoechoic margins (PHMs). We compared these features between 25 patients with AIP and 30 patients with pancreatic cancer resected at ACCH. RESULTS Few conventional EUS features of chronic pancreatitis (CP) were seen in patients with AIP (mean, 2.0 features). Frequencies of DHA, DE, BWT, and PHM were significantly higher in AIP than in PC. DHAs, DE, and FHAs resolved after steroid treatment. CONCLUSIONS Novel EUS features of AIP are useful in distinguishing AIP from PC and for following the effects of steroid therapy.
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Affiliation(s)
- Noriyuki Hoki
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
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106
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Abstract
Endoscopic ultrasonography (EUS) is the combination of endoscopy and intraluminal ultrasonography. This allows use of a high frequency transducer, which, due to the short distance to the target lesion, enables ultrasonographic images of high resolution to be obtained. Endoscopic ultrasonography is now a widely accepted modality for the diagnosis of pancreatobiliary diseases. It can be used to determine the depth of invasion of gastrointestinal malignancies, and often for visualizing lesions more precisely than other imaging modalities. The most important early limitation of EUS was the lack of specificity in the differentiation between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (EUS-FNA) of lesions in the pancreas head has been made possible using a curved linear array echoendoscope. Since then, many researchers have expanded the indication of EUS-FNA to various kinds of lesions and also for a variety of therapeutic purposes. In this review, we particularly focus on the present and future roles of interventional EUS, including EUS-FNA and therapeutic EUS.
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Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
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107
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Yoshinaga S, Yamao K, Vhatia V, Mizuno N, Sawaki A, Tajika M, Ishii N, Abbas WA, Shimizu Y. Endoscopic ultrasound-guided choledochoduodenostomy for treatment of ampullary cancer. Clin J Gastroenterol 2009; 2:55-58. [PMID: 26191811 DOI: 10.1007/s12328-008-0041-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Accepted: 09/25/2008] [Indexed: 11/28/2022]
Abstract
We describe the case of a patient for whom choledochoduodenostomy was performed under endoscopic ultrasound (EUS) guidance as an alternative to percutaneous transhepatic biliary drainage (PTBD) for the treatment of obstructive jaundice. An 82-year-old man with ampullary cancer was considered operable, but he refused surgery. Endoscopic biliary drainage (EBD) with an 8.5-French plastic stent was performed 2 months later because of the development of obstructive jaundice. The EBD stent was occluded 5 months after the stent insertion, and EUS choledochoduodenostomy (EUS-CDS) was performed. Pneumoperitoneum occurred 1 day after the procedure, which resolved with conservative treatment. Six months later, multiple lymph node metastases occurred, and the patient was effectively treated by chemotherapy (S-1). The patient is still alive with a good quality of life more than 2 years after EUS-CDS. We conclude that EUS-CDS is an effective alternative to PTBD or EBD for patients with malignant biliary obstruction, especially due to ampullary cancer.
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Affiliation(s)
- Shigetaka Yoshinaga
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. .,Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
| | - Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Vikram Vhatia
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masahiro Tajika
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norimitu Ishii
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Wael A Abbas
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuhiro Shimizu
- Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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108
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Suzuki T, Matsuo K, Sawaki A, Mizuno N, Hiraki A, Kawase T, Watanabe M, Nakamura T, Yamao K, Tajima K, Tanaka H. Alcohol Drinking and One-Carbon Metabolism-Related Gene Polymorphisms on Pancreatic Cancer Risk. Cancer Epidemiol Biomarkers Prev 2008; 17:2742-7. [DOI: 10.1158/1055-9965.epi-08-0470] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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109
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Shitara K, Muro K, Ura T, Takahari D, Yokota T, Sawaki A, Kawai H, Ito S, Yamamura Y. Chemotherapy for gastric cancer that recurs after adjuvant chemotherapy with S-1. Jpn J Clin Oncol 2008; 38:786-9. [PMID: 18820010 DOI: 10.1093/jjco/hyn096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We retrospectively analyzed the efficacy of chemotherapy in patients whose gastric cancer recurred after adjuvant chemotherapy with S-1. A total of 51 patients were evaluated. Twenty-one patients received S-1-containing chemotherapy as first-line treatment after recurrence [cohort A: S-1 plus cisplatin (n = 10), S-1 monotherapy (n = 7), S-1 plus irinotecan (n = 3) and S-1 plus docetaxel (n = 1)]. The other 30 patients received a non-S-1-containing regimen [cohort B: paclitaxel or docetaxel (n = 22), irinotecan plus cisplatin (n = 6) and other drugs (n = 2)]. No objective responses occurred in cohort A, while five patients achieved a partial response in cohort B (response rate, 0 versus 16%; P = 0.04). Median progression-free survival was significantly longer in cohort B than in cohort A (4.3 versus 2.3 months, P = 0.02). S-1-containing chemotherapy does not appear to be effective in patients whose gastric cancer recurs after adjuvant S-1 chemotherapy. Other chemotherapeutic agents should be evaluated in this setting.
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Affiliation(s)
- Kohei Shitara
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
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110
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Sawaki A, Kanemitsu Y, Mizuno N, Takahashi K, Nakamura T, Ioka T, Tanaka S, Nakaizumi A, Salem AA, Ueda R, Yamao K. Practical prognostic index for patients with metastatic pancreatic cancer treated with gemcitabine. J Gastroenterol Hepatol 2008; 23:1292-7. [PMID: 18700899 DOI: 10.1111/j.1440-1746.2006.04734.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM The aim of this study was to identify factors that predict treatment outcome in patients with metastatic pancreatic cancer treated with gemcitabine, and then to use these factors to develop a practical prognostic index. METHODS A retrospective study was performed on 66 consecutive patients with histologically confirmed pancreatic adenocarcinoma who were treated with gemcitabine. Factors that predicted treatment outcome were identified by univariate and multivariate analyses using the Cox proportional hazards model. RESULTS Multivariate analysis identified Eastern Cooperative Oncology Group performance status, primary tumor location, and C-reactive protein as important independent predictive factors. Prognostic score was calculated using the following formula: score = (1 if performance status is 0 or 1; 2 if performance status is 2; and 5 if performance status is 3) + (1 if primary site is body or tail, 3 if primary site is head) + (1 if C-reactive protein is <1 mg/dL, 3 if C-reactive protein is 1-3 mg/dL, 6 if C-reactive protein is >3 mg/dL). Patients were accordingly divided into three groups: good (prognostic index = 3 or 4), fair (prognostic index = 5-7), and poor (prognostic index = 8). Median survival was 265, 155, and 65 days for each group, respectively (P < 0.0001). The internally validated c-index (receiver operating characteristics area under the curve) of this model was 0.711. Applied to another data set, the externally validated c-index was 0.692. Prognosis was favorable in the good prognosis group, patients in the fair prognosis group were likely to benefit from gemcitabine, and those in the poor prognosis group were unlikely to benefit. CONCLUSION This index improved predictive ability in patients with metastatic pancreatic cancer treated with gemcitabine, which may be helpful in counseling patients and making first treatment decisions.
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Affiliation(s)
- Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan.
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111
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Matsumoto K, Yamao K, Okubo K, Hara K, Sawaki A, Mizuno N, Tajika M, Kawai H, Ashida R. Endoscopic ultrasound-guided ethanol injection in the pancreas in a porcine model: a preliminary study. J Gastroenterol Hepatol 2008; 23:e1-6. [PMID: 18702683 DOI: 10.1111/j.1440-1746.2007.04918.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Despite aggressive multimodal treatments, survival rates for patients with pancreatic cancer remain disappointing. Local progression is problematic, and minimally invasive procedures allowing locoregional control are needed. In this study, we attempted endoscopic ultrasound (EUS)-guided injection of ethanol into the pancreas. METHODS Under EUS guidance, pure ethanol (2 mL) was injected into normal tissue of the pancreatic body in two anesthetized domestic pigs. Serum concentrations of amylase, aspartame aminotransferase, alanine aminotransferase, alkaline phosphatase, and lactate dehydrogenase were measured before treatment and at 2 h, 48 h and 2 weeks after injection. Body weight and clinical signs were also observed. After the animals were euthanized, the pancreases were analyzed histologically. RESULTS EUS imaging allows real-time surveillance of the injection procedure. Mild diarrhea was noted in one animal, but no other adverse effects were observed. No marked changes in laboratory tests were noted. Histologically, parenchymal necrosis extending over a wide area was seen without severe inflammation. CONCLUSION EUS-guided ethanol injection in the pancreas seems to be technically simple. More detailed assessments of the safety and dose-effect relationship issues associated with this procedure are required.
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Affiliation(s)
- Kakuya Matsumoto
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
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112
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Sawaki A, Mizuno N, Hoki N, Takagi T, Nakamura T, Tajika M, Kawaki H, Takayama R, Takeda Y, Yamao K. Diagnosis of gastric submucosal tumors using endoscopic ultrasound guided fine needle aspiration. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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113
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Bang Y, Chung H, Sawaki A, Xu J, Shen L, Lipatov O, Park SR, Gangadharan VP, Advani SH, Kang YK. HER2-positivity rates in advanced gastric cancer (GC): Results from a large international phase III trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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114
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Yamao K, Bhatia V, Mizuno N, Sawaki A, Ishikawa H, Tajika M, Hoki N, Shimizu Y, Ashida R, Fukami N. EUS-guided choledochoduodenostomy for palliative biliary drainage in patients with malignant biliary obstruction: results of long-term follow-up. Endoscopy 2008; 40:340-2. [PMID: 18389451 DOI: 10.1055/s-2007-995485] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Five patients with obstructive jaundice caused by malignant periampullary biliary stenosis underwent EUS-guided choledochoduodenostomy (EUS-CDS) from the first portion of the duodenum using a convex echoendoscope and a needle knife. All the steps of the procedure including passage dilatation and the plastic stent placement were performed through the accessory channel of the echoendoscope over the guide wire. Stent insertion was technically successful in all five patients. The procedure was also clinically effective in relieving jaundice in all cases. One patient developed pneumoperitoneum, which resolved with conservative management. Stent exchange was successful in seven of eight attempts in patients with stent occlusion. One failure was due to tumor invasion to the choledochoduodenal fistula. Stent patency was maintained in the remaining patients throughout their survival period. The average stent patency was 211.8 days. EUS-CDS from the first portion of the duodenum appears to be feasible and safe in cases of obstructive jaundice caused by distal bile duct obstruction.
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Affiliation(s)
- K Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Japan.
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115
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Inoue H, Mizuno N, Sawaki A, Takahashi K, Aoki M, Bhatia V, Matuura K, Tabata T, Yamao K. Life-threatening delayed-onset bleeding after endoscopic ultrasound-guided 19-gauge Trucut needle biopsy of a gastric stromal tumor. Endoscopy 2008; 38 Suppl 2:E38. [PMID: 17366401 DOI: 10.1055/s-2006-944672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- H Inoue
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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116
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Yamao K, Mizuno N, Sawaki A, Shimizu Y, Chang KJ. Risk factors for pancreatic cancer and early diagnosis of pancreatic cancer. Nihon Shokakibyo Gakkai Zasshi 2008; 105:8-16. [PMID: 18176038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital
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117
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Sawaki A, Mizuno N, Hoki N, Ishikawa H, Takagi T, Yamao K. [Effect of S-1 in a patient with post-operative recurrence of carcinoma of the ampulla of Vater]. Gan To Kagaku Ryoho 2007; 34:2301-2303. [PMID: 18079635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report a case of recurrent carcinoma of the ampulla of Vater with multiple lung and abdominal lymph node metastases that well responded to S-1, an oral fluoropyrimidine. A 56-years-old woman underwent a pylorus-preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater in October 2003. Multiple lung metastases were detected by chest X-ray as a post operative screening a year after surgery. Computed tomography showed multiple abdominal lymph node metastases. The patient was treated with S-1 (80 mg/day, day 1-28, followed by 2 weeks rest) from November 2003. Anti-tumor efficacy was confirmed to be partial response by Response Evaluation Criteria in Solid Tumors (RECIST). Leukocytopenia, anemia, and mucositis were observed. Every toxicity was mild to moderate, and no other severe toxicities were noted. S-1 might be an effective and safe agent for carcinoma of the ampulla of Vater.
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Affiliation(s)
- Akira Sawaki
- Dept. of Gastroenterology, Aichi Cancer Center Hospital
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León-Chong J, Lordick F, Kang YK, Park SR, Bang YJ, Sawaki A, Van Cutsem E, Stoss O, Jordan BW, Feyereislova A. HER2 positivity in advanced gastric cancer is comparable to breast cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15057 Background: Accurate HER2 testing is required to identify patients eligible for treatment with trastuzumab (Herceptin®). HER2 positivity is reported as 6–35% in gastric cancer (GC). This range is due to small sample sets and differing methods of evaluation or scoring. A specific HER2-testing process was established for the Phase III ToGA trial, which is evaluating trastuzumab added to chemotherapy in HER2-positive advanced GC. Methods: A validation study was completed to standardise IHC (HercepTest™) and FISH (PharmDx™) protocols, and to establish a scoring system specific for GC (M Hofmann et al. ASCO Gastrointestinal Cancers Symposium 2006. Abstract no. 24). Tumour samples for ToGA were then centrally tested by both IHC and FISH to identify patients eligible for enrolment. Results: To date, 1024 tumour samples have been assessed (243 HER2 positive and 781 HER2 negative) giving an overall HER2-positivity rate of 23.7%. Both IHC and FISH results are available for 960 patients, with 87% concordance. Differences were largely due to FISH-positive cases that were IHC 0/1+. HER2 positivity differed significantly by histological subtype: 36% in intestinal, 7% in diffuse and 23% in mixed. HER2 positivity also varied according to the site of the tumour: 36% (8/22) for gastro-oesophageal junction tumours and 21% (60/291) for gastric tumours. Sample numbers were very small so these results must be treated with caution. The HER2- positivity rate was similar in specimens obtained by biopsy (168/689; 24%) and surgery (71/322; 22%). Conclusions: Using validated methodology and based on the large sample set from the ongoing ToGA trial, the HER2-positivity rate observed in advanced GC is as high as in breast cancer: ∼24%. The first efficacy data from ToGA are expected in 2009. No significant financial relationships to disclose.
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Affiliation(s)
- J. León-Chong
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - F. Lordick
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Y. K. Kang
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - S. R. Park
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - Y. J. Bang
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - A. Sawaki
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - E. Van Cutsem
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - O. Stoss
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - B. W. Jordan
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
| | - A. Feyereislova
- National Institute for Neoplastic Diseases, Surquillo, Peru; Munich University of Technology, Munich, Germany; Asan Medical Center, Seoul, Republic of Korea; National Cancer Center, Goyang, Republic of Korea; Seoul National University Hospital, Seoul, Republic of Korea; Aichi Cancer Center, Nagoya, Japan; University Hospital Gasthuisberg, Leuven, Belgium; TARGOS Molecular Pathology GmbH, Kassel, Germany; F. Hoffmann-La Roche, Basel, Switzerland
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Sawaki A, Takayama R, Mizuno N, Tajika M, Hoki N, Sayed ZE, Matsuo K, Nakagawa H, Nakamura Y, Yamao K. Serum REG4 protein in pancreatic cancer as a tumor marker: A prospective study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15063 Background: Pancreatic cancer (PC) shows the worst mortality rate in common malignancies, with 5-year survival rate of 4%. The only way to cure the disease is surgical resection of early stage PC. Establishment of a screening strategy to detect early stage PC is eagerly expected. REG4, a member of the regenerating islet-derived (REG) family, are secreted proteins that play a role in tissue regeneration and inflammation in digestive organs. We reported overexpression of REG4 in PC cells and serum, and preliminary data of the serum REG4 level of pancreatic disease patients including PC patients. We conducted a prospective study to evaluate the role of serum REG4 in PC. Methods: The series included 57 patients diagnosed pathologically as PC between November 2004 and December 2005. Serum REG4 was quantified by standard sandwich ELISA (Enzyme Linked Immunosorbent Assay) using original kit (MBL116: provided by Medical and Biological Laboratories Co., LTD, Japan) before treatment. The upper limit of the test was set at 3.52ng/ml and was based on studies of serum from 48 healthy control subjects. Results: With a specificity of 100%, the diagnostic sensitivity and accuracy were 63.2% and 80.0%, respectively. The ROC (receiver operating characteristic) analysis showed that area under the curve was 0.91. REG4 levels were a significant differences between PC and control (p<0.001), between each T stage and control (T1,T2, T3 or T4 v control), and between each TMN stage and control (stage 1, stage 2, stage 3 or stage 4 v control), but were not a statistical significance with T stage (T1 v T2 v T3 v T4), M stage (M0 v M1) or TNM stage (stage 1 v stage 2 v stage 3 v stage 4) in PC patients. The diagnostic sensitivity of carcinoembryonic antigen (CEA>5.0ng/ml) and carbohydrate antigen19–9 (CA19–9>50U/ml) was 56.5% and 68.4%, respectively. No significant correlation was demonstrated between REG4 and CA19–9 (coefficient of correlation [rs]=0.45). Conclusions: This study shows the potential of serum REG4 as a screening test for PC, especially for early PC. REG4 is considered to be a more useful marker in combination with CA19- 9. No significant financial relationships to disclose.
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Affiliation(s)
- A. Sawaki
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - R. Takayama
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - N. Mizuno
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - M. Tajika
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - N. Hoki
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Z. E. Sayed
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - K. Matsuo
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - H. Nakagawa
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Y. Nakamura
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - K. Yamao
- Aichi Cancer Center, Nagoya, Japan; Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Boku N, Yamamoto S, Shirao K, Doi T, Sawaki A, Koizumi W, Saito H, Yamaguchi K, Kimura A, Ohtsu A. Randomized phase III study of 5-fluorouracil (5-FU) alone versus combination of irinotecan and cisplatin (CP) versus S-1 alone in advanced gastric cancer (JCOG9912). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.lba4513] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA4513 Backgrounds: We conducted a 3-arm phase III study to investigate superiority of CP and non-inferiority of S-1 to 5-FU for advanced gastric cancer in the primary endpoint of overall survival (OS) and secondary endpoints of response rate (RR), time to treatment failure (TTF), non-hospitalized survival (NHS) and toxicities. Methods: Treatments with 5-FU (800mg/m2/d, ci, d1–5, q4w), CP (irinotecan, 70mg/m2, div, d1&15 and cisplatin, 80mg/m2, div, d1, q4w) and S-1 (40mg/m2, b.i.d., d1- 28, q6w) were continued until disease progression or unacceptable toxicities. Tumors were evaluated every two months. With 230 patients (pts) per arm, this study had 80% power to demonstrate 10% superiority of CP and non-inferiority with 5% margin (hazard ratio, HR=1.16) of S-1 and 0.05 study-wise 1-sided alpha. Results: 704 pts having unresectable or recurrent gastric adenocarcinoma with/without target lesions (TL) were randomized between Nov 2000 and Jan 2006. Final analysis was performed in Feb 2007 when 601 pts (85%) were dead. The results of OS are shown in Table . Median TTF/NHS were 2.3M/7.2M for 5-FU, 3.7M/9.5M for CP, and 4.0M/9.2M for S-1. Incidences (%) of grade 4 neutropenia, grade ≥3 febrile neutropenia, infection with neutropenia, anorexia, diarrhea within 6M, and treatment related death (5- FU/CP/S-1) were 0/37/0, 0/9/0, 0/8/0, 13/33/12, 0/9/8, and 0/1.3/0.4. In the subset having TL, RRs of 5-FU/CP/S-1 (n=175/181/175) were 9%/38%/28%, and their median survival times (MST) were 9.0M/12.1M/10.5M and HRs to 5-FU were 0.78 (95%CI, 0.63–0.98) for CP and 0.85 (0.68–1.06) for S-1. In the subset not having TL, the MSTs of 5-FU/CP/S-1 (n=59/55/59) were 13.5M/14.4M/18.1M and HRs were 1.02 (0.68–1.55) for CP and 0.82 (0.55–1.24) for S-1. Conclusions: S-1 showed a significant non-inferiority to 5-FU. Although CP did not show statistically significant superiority to 5-FU in all pts, it may have a benefit for some subgroups such as pts with measurable metastatic diseases. [Table: see text] [Table: see text]
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Affiliation(s)
- N. Boku
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - S. Yamamoto
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - K. Shirao
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - T. Doi
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - A. Sawaki
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - W. Koizumi
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - H. Saito
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - K. Yamaguchi
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - A. Kimura
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
| | - A. Ohtsu
- Shizuoka Cancer Center Hospital, Shizuoka, Japan; JCOG data center, Tokyo, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Chiba, Japan; Aichi Cancer Center, Aichi, Japan; Kitasato University East Hospital, Kanagawa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; Saitama Cancer Center Hospital, Saitama, Japan
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Yoshino T, Koizumi W, Yamaguchi K, Miyata Y, Kato T, Toh Y, Sawaki A, Hyodo I, Nishina T, Boku N. Phase I/II study of oral fluoropyrimidine S-1 plus oral Leucovorin as first-line treatment for metastatic colorectal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4093 Background: The results of phase I portion of the treatment with the oral S-1 (a new oral fluoropyrimidine) plus oral leucovorin (LV) in patients (pts) with untreated metastatic colorectal cancer (mCRC) was reported at ESMO 2006. Dose limiting toxicities (DLTs) were grade 3 stomatitis/pharyngitis, nausea, diarrhea, ileus and exanthema. The recommended doses (RDs) for this phase II portion were determined to be S-1 40 mg/m2 and LV 25 mg/body orally given twice daily on days 1 to 14 of a 28-day cycle. The PK profiles of S-1 plus LV were similar to those of S-1 monotherapy and UFT plus LV, respectively. The main purpose of this phase II portion is to evaluate the efficacy and safety of S-1 plus LV at RD level in pts with untreated mCRC. Methods: Pts were eligible as follows; unresectable mCRC with no prior chemotherapy or receiving adjuvant chemotherapy completed at least 6 months before, histologically proven adenocarcinoma, PS(ECOG) 0–2, age 20 to 75, measurable lesions, adequate organ function and written informed consent. The pts received 40 mg/m2 of S-1 plus 25 mg/body of LV twice daily as RD in this phase II portion. The primary endpoint was the objective response rates (RRs), and secondary endpoints were time to progression (TTP) and toxicities. Results: Between Sep 2004 and Jun 2006, 56 pts of 65 enrolled pts received the treatment at RD level. The objective RRs were 55% (36 of 65) for all pts and 55% (31 of 56) for pts at RD. Disease control rates (DCRs) were 86% (56 of 65) for all pts and 86% (48 of 56) for pts at RD. Median TTP was 5.5 months for pts at RD, with a median follow-up of 5.5 months. The median survival time is under observation. During the 6 months from starting the treatment, the most common grade 3/4 toxicities at RD were as follows: diarrhea, 23%; stomatitis, 20%; anorexia, 18%; and neutropenia 13%. Conclusions: A combination of S-1 plus oral LV is an effective, well tolerated, and convenient regimen in pts with untreated mCRC, without the addition of either oxaliplatin or irinotecan. The updated results of the objective RRs, DCRs, TTP reviewed extramurally, and detailed safety profile will be presented at the meeting. This trial was supported by Taiho pharmaceutical co., Ltd., Tokyo, Japan. No significant financial relationships to disclose.
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Affiliation(s)
- T. Yoshino
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - W. Koizumi
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - K. Yamaguchi
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Y. Miyata
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - T. Kato
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Y. Toh
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - A. Sawaki
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - I. Hyodo
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - T. Nishina
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
| | - N. Boku
- Shizuoka Cancer Center, Shizuoka, Japan; Kitasato University East Hospital, Kanagawa, Japan; Saitama Cancer Center, Saitama, Japan; Saku Central Hospital, Nagano, Japan; Minoh City Hospital, Osaka, Japan; National Kyushu Cancer Center, Fukuoka, Japan; Aichi Cancer Center, Nagoya, Japan; University of Tsukuba, Tsukuba, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan
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Isaka T, Nakamura T, Tajika M, Kawai H, Imaoka H, Okamoto Y, Aoki M, Inoue H, Takahashi K, Mizuno N, Sawaki A, Yamao K, Seto M, Yokoi T, Yatabe Y, Nakamura S. API2-MALT1chimeric transcript-positive gastroduodenal MALT lymphoma with subsequent development of adenocarcinoma as a collision tumour over a clinical course of 7 years. Histopathology 2007; 51:119-23. [PMID: 17542995 DOI: 10.1111/j.1365-2559.2007.02718.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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123
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Tajika M, Nakamura T, Kawai H, Sawaki A, Mizuno N, Takahashi K, Yokoi T, Yatabe Y, Hirai T, Yamao K, Kato T. A case of colonic morule with colitis cystica profunda. Gastrointest Endosc 2007; 65:162-3; discussion 163. [PMID: 17185099 DOI: 10.1016/j.gie.2006.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 06/08/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Masahiro Tajika
- Department of Endoscopy, Gastroenterology, and Gastroenterological Surgery, Division of Pathology and Molecular Diagnosis, Aichi Cancer Center Hospital, Nagoya City, Japan
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124
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Ueno H, Sato T, Yamamoto S, Tanaka K, Ohkawa S, Takagi H, Yokosuka O, Furuse J, Saito H, Sawaki A, Kasugai H, Osaki Y, Fujiyama S, Sato K, Wakabayashi K, Okusaka T. Randomized, double-blind, placebo-controlled trial of bovine lactoferrin in patients with chronic hepatitis C. Cancer Sci 2006; 97:1105-10. [PMID: 16984383 DOI: 10.1111/j.1349-7006.2006.00274.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several studies have suggested that lactoferrin administration may decrease the serum level of hepatitis C virus (HCV) RNA in patients with chronic hepatitis C. The aim of the present study was to confirm the efficacy of orally administered bovine lactoferrin (bLF) in patients with chronic hepatitis C. The patients with chronic hepatitis C randomly received either oral bLF at a dose of 1.8 g daily for 12 weeks, or an oral placebo. The primary endpoint was the virologic response, defined as a 50% or greater decrease in serum HCV RNA level at 12 weeks compared with the baseline. The secondary endpoint was the biochemical response, which was defined as a 50% or greater decrease in the serum alanine aminotransferase (ALT) level at 12 weeks compared with the baseline. One hundred and ninety-eight of 199 patients were evaluable for efficacy and safety. bLF treatment was well tolerated and no serious toxicities were observed. A virologic response was achieved in 14 of 97 patients (14.4%) in the bLF group, and 19 of 101 (18.8%) in the placebo group. There was no significant difference in virologic response rates between the two groups (-4.4%, 95% confidence interval -14.8, 6.1). In addition, bLF intake did not have any favorable effect on the serum ALT level. The virologic responses were not different between two groups in any subgroup analysis. In conclusion, orally administered bLF does not demonstrate any significant efficacy in patients with chronic hepatitis C.
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Affiliation(s)
- Hideki Ueno
- Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
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125
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Mochizuki Y, Kodera Y, Fujiwara M, Ito S, Yamamura Y, Sawaki A, Yamao K, Kato T. Laparoscopic wedge resection for gastrointestinal stromal tumors of the stomach: initial experience. Surg Today 2006; 36:341-7. [PMID: 16554991 DOI: 10.1007/s00595-005-3164-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 09/13/2005] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgery for gastrointestinal stromal tumors (GIST) of the stomach is now frequently performed using a laparoscopic approach. We investigated the feasibility and effectiveness of laparoscopy in the management of GIST of the stomach. METHODS We reviewed the records of 12 consecutive patients who underwent laparoscopic surgery for GIST between April 2000 and April 2004, and compared their short-term outcomes with those of patients who underwent open surgery. All laparoscopic wedge resections were done using stapling devices and 3-4 trocars, often with the aid of intraoperative gastroscopy. We examined all patients preoperatively using various diagnostic modalities, including endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). A laparoscopic approach was not indicated if the tumor was located near the cardia or pylorus or if it was >=5 cm in diameter. RESULTS A specific diagnosis of GIST was obtained preoperatively by EUS-FNA in 10 of the 12 patients. The median diameter of the lesion was 2.7 cm (range, 1.5-4.8 cm). Although intraoperative complications were encountered in two patients, conversion to open surgery was not required, and we were able to perform complete tumor excision with negative surgical margins in all patients. The median operative time was 100 min (range, 65-180 min), similar to that for open surgery. First flatus was passed earlier, and the interval to resuming oral intake was shorter than after open surgery. No major postoperative complications such as leakage developed, and the median postoperative hospital stay was 7 days (range, 5-12 days). All diagnoses made by EUS-FNA were confirmed by immunohisto-pathological evaluation of resected specimens. CONCLUSION Laparoscopic wedge resection is a feasible treatment option for GISTs of the stomach if the lesion is <5 cm in diameter.
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Affiliation(s)
- Yoshinari Mochizuki
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
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126
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Yamao K, Sawaki A, Takahashi K, Imaoka H, Ashida R, Mizuno N. EUS-guided choledochoduodenostomy for palliative biliary drainage in case of papillary obstruction: report of 2 cases. Gastrointest Endosc 2006; 64:663-7. [PMID: 16996372 DOI: 10.1016/j.gie.2006.07.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 07/05/2006] [Indexed: 12/18/2022]
Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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127
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Mizuno N, Sawaki A, Yamao K. [Resolution of liver metastases in response to S-1 monotherapy in advanced pancreatic cancer--a case report]. Gan To Kagaku Ryoho 2006; 33:1511-4. [PMID: 17033249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We report a case in a late phase II clinical study investigating the efficacy and safety of the oral fluoropyrimidine anticancer drug S-1. The drug proved effective in a patient with inoperable advanced pancreatic cancer in whom radiation therapy was not indicated. The antitumor effect after 4 courses was rated excellent, with a target site (liver) evaluation of CR and overall evaluation of PR. In particular, two liver metastases, measuring 18.7 x 15.4 mm and 16.2 x 14.6 mm, respectively, both resolved, and S-1 was found to exert a potent antitumor effect against metastases. Assessment of adverse events revealed no grade 3 or 4 adverse reactions, and other adverse events were all mild. Based on the above results, S-1 appeared to be effective against advanced pancreatic cancer and showed excellent tolerability.
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128
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Tajika M, Nakamura T, Kawai H, Sawaki A, Mizuno N, Takahashi K, Yokoi T, Yatabe Y, Yamao K. Short-term development of esophageal pyogenic granuloma observed on endoscopy. Gastrointest Endosc 2006; 64:269-70. [PMID: 16860082 DOI: 10.1016/j.gie.2006.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Accepted: 01/29/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya City, Japan
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129
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Suzuki T, Matsuo K, Sawaki A, Ito H, Hirose K, Wakai K, Sato S, Nakamura T, Yamao K, Ueda R, Tajima K. Systematic review and meta-analysis: importance of CagA status for successful eradication of Helicobacter pylori infection. Aliment Pharmacol Ther 2006; 24:273-80. [PMID: 16842453 DOI: 10.1111/j.1365-2036.2006.02994.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Some, but not all studies have provided evidence that the CagA status of Helicobacter pylori strains is a predictive factor for the outcome of eradication therapy. AIM To clarify the association between CagA status and eradication outcome. METHODS We included studies reporting the numbers of successful and failed cases in H. pylori-eradication therapy according to the CagA status. Fourteen studies (1529 patients) were included of 325 articles identified in the search. The pooled risk ratio for H. pylori-eradication failure in CagA-negative relative to CagA-positive strains and the pooled risk difference in eradication success between the two groups were used as summary statistics. Meta-regression was used for examining the source of heterogeneity. RESULTS The summary risk ratio for eradication failure in CagA-negative relative to CagA-positive was 2.0 (95% CI: 1.6-2.4, P < 0.001), corresponding with the summary risk difference for eradication success between the groups of 11% (95% CI: 3-19%, P = 0.011). Meta-regression analysis demonstrated that usage of polymerase chain reaction examination for CagA status and a high proportion of non-ulcer dyspepsia patients were factors for heterogeneity among studies. CONCLUSIONS Our meta-analysis confirmed the importance of the presence of CagA as a predictor for successful eradication of H. pylori.
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Affiliation(s)
- T Suzuki
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
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130
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Sato Y, Inaba Y, Yamaura H, Shimamoto H, Nishiofuku H, Oyama T, Kanemitsu Y, Sawaki A, Arai Y, Muro K. [Retrospective analysis of tegafur/uracil (UFT) plus oral leucovorin (LV) regimen in patients with advanced colorectal cancer]. Gan To Kagaku Ryoho 2006; 33:887-90. [PMID: 16835473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The clinical efficacy and safety of tegafur/uracil (UFT) plus oral Leucovorin (LV) regimen for advanced or metastatic colorectal cancer were studied retrospectively. From September 2003 to March 2005, 82 patients were treated with UFT (300 mg/m(2)/day)/LV (75 mg/day) at our institute. The objective overall response rate was 14. 8% (95% confidence interval, 5.3 to 24.3%) in 54 evaluable patients. The response rate was 33.3% for previously untreated patients and 5.5% for previously treated patients, respectively. Grade 3 or more severe adverse reactions such as diarrhea or liver function abnormalities were only 7.3%. In 28 previously untreated patients,the median survival was 25.8 months with 1-and 2-year survival rates of 88.0% and 60.5%, respectively. This retrospective study demonstrated the reproducible activity and safety of UFT/LV for advanced or metastatic colorectal cancer in clinical practice.
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Affiliation(s)
- Yozo Sato
- Dept. of Diagnostic and Interventional Radiology, Aichi Cancer Center, National Cancer Center Hospital
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131
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Sawaki A, Mizuno N, Takahashi K, Nakamura T, Tajika M, Kawai H, Inoue H, Masatoshi A, Ahmed Z, Yamao K. Recurrence after imatinib treatment for gastrointestinal stromal tumor: Japanese experience in a single institute. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.19504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19504 Background: Although imatinib is the most effective agent for metastatic gastrointestinal stromal tumors (GISTs), resistance to imatinib develops in most patients. While the effectiveness of an oral multitageted tyrosine kinase inhibitor for intolerant GIST is already reported, many of imatinib resistant patients are not available. We report clinical results of first imatinib and post imatinib treatment in a patient with metastatic or unresectable GIST. Methods: A retrospective review was undertaken in patients with metastatic or unresectable GIST treated with imatinib at Aichi Cancer Center Hospital between June 2001 and December 2005. Treatment schedule was four or six 100-mg capsules of imatinib orally once daily. Patients were evaluated for treatment, recurrence, and survival. Results: Forty-five patients (26 males and 43 metastatic patients) were treated with imatinib at first. The median age was 58 years (range 25–79). Primary tumor sites were as follow; stomach was 13, duodenum 9, small intestine except for duodenum 18, and colorectum 5. Metastatic sites were liver (21 patients), peritoneum (11 patients), both of them (10 patients), and the other (1 patient). The response rate (by RECIST) and PFS was 71.1% (32/45) and 24 months, respectively. Imatinib was well tolerated; only two patients stopped treatment due to nausea and vomiting. Twenty-six patients with disease progression were treated by the combination of many methods, and the following methods underwent as the second therapy; 9 patients underwent surgical resection, 7 patients underwent transarterial chemoembolization (TACE) for liver metastases, 9 patients enrolled in a clinical trial, and 9 patients continued imatininb because of clinical benefit and no other therapeutic options. PFS of surgery and TACE were 6 and 7 months, respectively. Out of 16 patients treated with surgery or TACE, 2 patients were well controlled by TACE more than 1 year. One patient, however, was suffering from intractable liver abscess after TACE. Conclusions: The efficacy and safety of imatinib for GIST is almost the same as in U.S. reports. TACE may be an effective treatment for liver metastases if new agents are not available. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | | | - H. Kawai
- Aichi Cancer Center, Nagoya, Japan
| | - H. Inoue
- Aichi Cancer Center, Nagoya, Japan
| | | | - Z. Ahmed
- Aichi Cancer Center, Nagoya, Japan
| | - K. Yamao
- Aichi Cancer Center, Nagoya, Japan
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132
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Imaoka H, Yamao K, Salem AAS, Mizuno N, Takahashi K, Sawaki A, Isaka T, Okamoto Y, Yanagisawa A, Shimizu Y. Pseudomyxoma peritonei caused by acute pancreatitis in intraductal papillary mucinous carcinoma of the pancreas. Pancreas 2006; 32:223-4. [PMID: 16552347 DOI: 10.1097/01.mpa.0000194611.62723.51] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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133
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Suzuki T, Matsuo K, Ito H, Sawaki A, Hirose K, Wakai K, Sato S, Nakamura T, Yamao K, Ueda R, Tajima K. Smoking increases the treatment failure for Helicobacter pylori eradication. Am J Med 2006; 119:217-24. [PMID: 16490464 DOI: 10.1016/j.amjmed.2005.10.003] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Revised: 09/30/2005] [Accepted: 10/03/2005] [Indexed: 12/14/2022]
Abstract
PURPOSE Treatment failure for Helicobacter pylori (H. pylori) eradication is encountered in approximately 10-20% of patients, and many studies have pointed to a link with smoking. To investigate the effects of smoking on eradication outcome, we performed a meta-analysis. METHODS A PubMed search was performed to retrieve articles published up to August 2005. Pooled odds ratio (OR) and differences rate for H. pylori eradication failure in smokers compared with nonsmokers were used as summary statistics. Meta-regression was used for examining the source of heterogeneity. RESULTS Twenty-two published studies (5538 patients), which provided information on eradication failure according to smoking status, were included in the analysis. The summary OR for eradication failure among smokers relative to nonsmokers was 1.95 (95% confidence interval [CI]: 1.55-2.45; P <.01). It corresponds with the differences in eradication rates between smokers and nonsmokers (8.4% [95% CI: 3.3-13.5%, P <.01]). Meta-regression analysis demonstrated that a high proportion of nonulcer dyspepsia patients in studies revealed a higher failure rate among smokers, compared with a low proportion of nonulcer dyspepsia. CONCLUSIONS Our meta-analysis demonstrated that smoking increases the treatment failure rate for H. pylori eradication.
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Affiliation(s)
- Takeshi Suzuki
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
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134
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Ashida R, Yamao K, Okubo K, Sawaki A, Mizuno N, Nakamura T, Tajika M, Kawai H, Shimizu Y. Indocyanine green is an ideal dye for endoscopic ultrasound-guided fine-needle tattooing of pancreatic tumors. Endoscopy 2006; 38:190-2. [PMID: 16479428 DOI: 10.1055/s-2005-870404] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Endoscopic ultrasound-guided fine-needle tattooing (EUS-FNT) is an ideal technique for preoperative marking of lesions detected on preoperative examination. Although India ink has been used for endoscopic tattooing, there have been numerous reports of complications associated with its use. This is the first report of EUS-FNT using indocyanine green (ICG) and describes its use for preoperative marking of a tumor in a 78-year-old man with multiple pancreatic tumors. There were no complications associated with the EUS-FNT procedure and it is suggested that ICG is a more suitable dye for tattooing of pancreatic lesions than India ink, being far less frequently associated with side effects.
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Affiliation(s)
- R Ashida
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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135
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Inoue H, Yamao K, Mizuno N, Takahashi K, Sawaki A. [Cytologic diagnosis of pancreatic cancer]. Nihon Rinsho 2006; 64 Suppl 1:135-9. [PMID: 16457236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Hiroyuki Inoue
- Department of Gastroenterology, Aichi Cancer Center Hospital
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136
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Sawaki A, Mizuno N, Takahashi K, Nakamura T, Tajika M, Kawai H, Isaka T, Imaoka H, Okamoto Y, Aoki M, Inoue H, Salem AAS, Yatabe Y, Yamao K. LONG-TERM FOLLOW UP OF PATIENTS WITH SMALL GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH USING ENDOSCOPIC ULTRASONOGRAPHY-GUIDED FINE-NEEDLE ASPIRATION BIOPSY. Dig Endosc 2006. [DOI: 10.1111/j.1443-1661.2006.00573.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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137
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Aoki M, Sawaki A, Mizuno N, Takahisa K, Yamao K. [Magnetic resonance cholangiopancreatography (MRCP) for diagnosis of biliary tract neoplasms]. Nihon Rinsho 2006; 64 Suppl 1:404-10. [PMID: 16457293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Masatoshi Aoki
- Department of Gastroenterology, Aichi Cancer Center Central Hospital
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138
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Imaoka H, Yamao K, Salem AAS, Sawaki A, Takahashi K, Mizuno N, Kawai H, Tajika M, Isaka T, Okamoto Y, Shimizu Y, Yanagisawa A. Pancreatic endocrine neoplasm can mimic serous cystadenoma. ACTA ACUST UNITED AC 2005; 35:217-20. [PMID: 16110124 DOI: 10.1385/ijgc:35:3:217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 57-yr-old female patient was referred to our hospital with a cystic lesion of the head of the pancreas that had been noted on abdominal computed tomography (CT). Endoscopic ultrasonography (EUS) showed a 3.0 cm rounded mass in the head of the pancreas. EUS images showed that the tumor had a solid component consisting of multiple microcysts separated by septae and a cystic component consisting of a macrocystic lesion. Thus, the tumor was suspected of being a serous cystadenoma (SCA). However, the histopathological diagnosis based on endoscopic ultrasound- guided fine-needle-aspiration biopsy (EUS-FNAB) was that of a pancreatic endocrine neoplasm (PEN). Surgical resection was performed. Despite having very similar macroscopic findings to SCA, microscopic examination revealed that the patient's tumor was definitely a PEN. This case suggests that it is very difficult to distinguish PENs from SCAs based solely on imaging methods. EUS-FNAB is essential for determining the appropriate therapeutic strategy, as it provides the histopathological diagnosis.
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Affiliation(s)
- Hiroshi Imaoka
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya, Japan.
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139
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Yamao K, Sawaki A, Mizuno N, Shimizu Y, Yatabe Y, Koshikawa T. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB): past, present, and future. J Gastroenterol 2005; 40:1013-23. [PMID: 16322944 DOI: 10.1007/s00535-005-1717-6] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 09/29/2005] [Indexed: 02/04/2023]
Abstract
Endoscopic ultrasound (EUS) is a combination of endoscopy and intraluminal ultrasonography. EUS also enables ultrasonographic images of high resolution to be obtained. However, whether a lesion is malignant or benign cannot be diagnosed solely from the findings of EUS. Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) was developed to enhance the diagnostic capabilities of EUS by providing additional pathological findings. Though more than 10 years have passed since EUS-FNAB was first used for pancreatic disease, EUS FNAB has not been widely accepted in Japan. This may be due to the technical difficulties, relatively low sensitivity for the detection of malignancies, and Japanese gastroenterologists' and surgeons' inherent conservative way of thinking. We describe here a short history of EUS-FNAB, with details of technical tips, current indications and contraindications, diagnostic accuracy, and complications. The clinical utility of EUS-FNAB has been gradually understood and EUS-FNAB procedures have been increasing in number in Japan. So in the near future, EUS followed by EUS-FNAB will be routinely performed in the same manner as gastrointestinal endoscopy, followed by biopsy under direct vision. Also, therapeutic EUS procedures, such as EUS-guided celiac plexus neurolysis, pancreatic tumor ablation, drainage of pancreatic pseudocysts, and the development of an anastomosis may become feasible as less invasive and safer techniques than those used at present.
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Affiliation(s)
- Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Nagoya 464-8681, Japan
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Sawaki A, Mizuno N, Takahashi K, Nakamura T, Tajika M, Kawai H, Kanemitsu Y, Salem AAS, Yamao K. A prognositc index predicts outcome following gemcitabine for patients with metastatic pancreatic cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Sawaki
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | - N. Mizuno
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | | | | | - M. Tajika
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | - H. Kawai
- Aichi Cancer Ctr Hosp, Nagoya, Japan
| | | | | | - K. Yamao
- Aichi Cancer Ctr Hosp, Nagoya, Japan
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141
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Isaka T, Mizuno N, Takahashi K, Sawaki A, Nakamura T, Tajika M, Kawai H, Imaoka H, Okamoto Y, Inoue H, Aoki M, Shimizu Y, Yatabe Y, Yamao K. [A case of anaplastic ductal carcinoma (giant cell carcinoma of osteoclastoid type) with portal vein and main pancreatic ductal invasion]. Nihon Shokakibyo Gakkai Zasshi 2005; 102:736-40. [PMID: 15981633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Toshifumi Isaka
- Department of Gastroenterology, Aichi Cancer Center Hospital
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142
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Ohmori M, Baba R, Miyazaki A, Sato H, Katano S, Sawaki A, Tanabe S, Masatuki N, Yasukawa T, Hasegawa A, Imade S, Sano A. P19 A study for the effect of tongue cleaning. Oral Dis 2005. [DOI: 10.1111/j.1601-0825.2005.01105_42.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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143
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Takahashi K, Yamao K, Okubo K, Sawaki A, Mizuno N, Ashida R, Koshikawa T, Ueyama Y, Kasugai K, Hase S, Kakumu S. Differential diagnosis of pancreatic cancer and focal pancreatitis by using EUS-guided FNA. Gastrointest Endosc 2005; 61:76-9. [PMID: 15672060 DOI: 10.1016/s0016-5107(04)02224-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite advances in diagnostic imaging techniques, the differentiation between pancreatic cancer and focal pancreatitis remains difficult. This study evaluated the effectiveness of EUS-guided FNA in the differential diagnosis between pancreatic cancer and focal pancreatitis, with particular reference to detection of the K-ras point mutation. METHODS The study included 62 consecutive patients with pancreatic ductal cancer and 15 patients with focal pancreatitis demonstrated as a pancreatic mass lesion by EUS. RESULTS Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of cytopathologic diagnosis were 82%, 100%, 86%, 100%, and 58%, respectively. Sensitivity, specificity, overall accuracy, positive predictive value, and negative predictive value of histopathologic diagnosis were 44%, 100%, 55%, 100%, and 32%, respectively. The K-ras point mutation was found in 74% of pancreatic cancers and 0% of focal pancreatitis lesions. No complication of EUS-guided FNA was observed. CONCLUSIONS EUS-guided FNA is useful for the differential diagnosis of pancreatic mass lesions caused by pancreatic cancer and focal pancreatitis. Analysis for the K-ras point mutation in specimens obtained by EUS-guided FNA may enhance diagnostic accuracy in indeterminate cases.
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Affiliation(s)
- Kuniyuki Takahashi
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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144
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Sawaki A, Yamao K. Imatinib mesylate acts in metastatic or unresectable gastrointestinal stromal tumor by targeting KIT receptors--a review. Cancer Chemother Pharmacol 2004; 54 Suppl 1:S44-9. [PMID: 15309514 DOI: 10.1007/s00280-004-0886-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract. This tumor is resistant to conventional chemotherapy and radiotherapy. Although surgery has been the only effective treatment for GIST to date, it is not enough to manage metastatic GIST. Imatinib mesylate, a KIT tyrosine kinase inhibitor, is an oral agent that has been found to have a dramatic antitumor effect on metastatic GIST with either wild-type or mutant KIT. Although imatinib mesylate has been used in GIST treatment for several years, its use marks a new era of molecular targeting therapy. While several issues remain, they should be clarified by the current clinical trials and associated laboratory studies.
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Affiliation(s)
- Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, 464-0021 Nagoya, Japan.
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145
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146
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Sawaki A, Yamao K, Nakamura T, Suzuki T, Okubo K, Hara K, Kawai H, Yamamura Y, Ito S, Mochiduki Y, Ohno R. A pilot study of imatinib mesylate (STI571) on gastrointestinal stromal tumors in Japanese patients. J Gastroenterol 2004; 39:329-33. [PMID: 15168243 DOI: 10.1007/s00535-003-1298-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2003] [Accepted: 08/15/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumor (GIST) is the most common type of nonepithelial tumor in the gastrointestinal tract. The gastrointestinal stromal tumor is defined immunohistologically as a c-Kit-positive tumor. For those GISTs that are malignant, the only effective treatment modality has been surgical. Early clinical reports have shown that imatinib mesylate (STI571) produces substantial anticancer activity in patients with metastatic or unresectable GIST. METHODS Nine Japanese patients who were found clinically and immunohistochemically to have inoperable GISTs were entered into this study. These patients were given 400 mg STI571 orally once daily. We then evaluated the tumor response and the safety of the drug. RESULTS Five of the nine patients achieved partial responses, two had stable disease, and two had progressive disease. The main side effects were skin rash, edema, periorbital edema, diarrhea, nausea, and vomiting. Mild anemia, leukocytopenia, and neutropenia were also noted. No patients required dose reduction or cessation because of adverse events. CONCLUSIONS This study demonstrates that STI571 might be an active agent against malignant GIST in Japanese patients with manageable toxicities. Gastrointestinal stromal tumor (GIST) is the most common type of nonepithelial tumor in the gastrointestinal tract. The gastrointestinal stromal tumor is defined immunohistologically as a c-Kit-positive tumor. For those GISTs that are malignant, the only effective treatment modality has been surgical. Early clinical reports have shown that imatinib mesylate (STI571) produces substantial anticancer activity in patients with metastatic or unresectable GIST.
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Affiliation(s)
- Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-0021, Japan
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147
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Okubo K, Yamao K, Nakamura T, Tajika M, Sawaki A, Hara K, Kawai H, Yamamura Y, Mochizuki Y, Koshikawa T, Inada KI. Endoscopic ultrasound-guided fine-needle aspiration biopsy for the diagnosis of gastrointestinal stromal tumors in the stomach. J Gastroenterol 2004; 39:747-53. [PMID: 15338368 DOI: 10.1007/s00535-004-1383-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Accepted: 02/20/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND For the diagnosis of gastric submucosal tumors (SMTs), endoscopic ultrasound (EUS) alone does not reveal the complete pathology, such as the degree of malignancy, and EUS-guided fine-needle aspiration biopsy (EUS-FNAB) has been reported to be more useful. Recently, most cases initially diagnosed as leiomyosarcomas have received further study with immunohistochemical staining and have been given the new diagnosis of gastrointestinal stromal tumors (GISTs). The degree of malignancy of GISTs differs widely in clinical aspects. In this study, we examined whether EUS-FNAB was useful in diagnosing GISTs and differentiating their degrees of malignancy. METHODS From January 1997 to March 2002, 21 cases of gastric GISTs were diagnosed from the immunohistochemical staining of specimens resected at Aichi Cancer Center Hospital. Of these 21 patients, 14 (5 with high-grade malignancy and 9 with low-grade malignancy) underwent EUS-FNAB preoperatively, and were examined further: their EUS-FNAB specimens were submitted for additional immunohistochemical testing. RESULTS The EUS-FNAB specimens from all patients were positive for c-kit and CD34 immunohistochemical testing, coinciding with the staining results of the resected specimens. The MIB-1 labeling indices in specimens of high-grade malignancy were significantly higher than those of low-grade malignancy. If we assumed that a tumor with an MIB-1 labeling index of more than 5% was a high-grade malignancy, the diagnostic accuracy was 85.7%. CONCLUSIONS The EUS-FNAB procedure is a useful tool for diagnosing GISTs of the stomach with immunohistochemical staining. When used with MIB-1 staining, the procedure may indicate GIST prognosis and influence decisions regarding therapeutic strategies.
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Affiliation(s)
- Kenji Okubo
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, 464-8681 Nagoya, Japan
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148
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Sawaki A, Katsurahara M, Okubo K, Mizuno N, Nakamura T, Tajika M, Kawai H, Toyama T, Yamao K. Can decreasing the serum level of CA19–9 predict the survival benefit of gemcitabine for advanced pancreatic cancer? J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Sawaki
- Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - K. Okubo
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - N. Mizuno
- Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - M. Tajika
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - H. Kawai
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - T. Toyama
- Aichi Cancer Center Hospital, Nagoya, Japan
| | - K. Yamao
- Aichi Cancer Center Hospital, Nagoya, Japan
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149
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Funakoshi A, Okusaka T, Ishii H, Sawaki A, Ohkawa S, Ishikawa O, Saitoh S. Phase II study of irinotecan (CPT-11) alone in patients (pts) with metastatic pancreatic cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A. Funakoshi
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
| | - T. Okusaka
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
| | - H. Ishii
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
| | - A. Sawaki
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
| | - S. Ohkawa
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
| | - O. Ishikawa
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
| | - S. Saitoh
- National Kyushu Cancer Center, Fukuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Aichi Cancer Center, Nagoya, Japan; Kanagawa Cancer Center, Yokohama, Japan; Osaka Medical Center for Cancer & Cardiovascular, Osaka, Japan; Aomori Prefectural Central Hospital, Aomori, Japan
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150
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Tajika M, Matsuura A, Nakamura T, Suzuki T, Sawaki A, Kato T, Hara K, Ookubo K, Yamao K, Kato M, Muto Y. Risk factors for vitamin D deficiency in patients with Crohn's disease. J Gastroenterol 2004; 39:527-33. [PMID: 15235869 DOI: 10.1007/s00535-003-1338-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Accepted: 12/19/2003] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although the pathogenesis of osteopenia in Crohn's disease is not established, vitamin D deficiency is thought to be an important risk factor. However, little is known about the prevalence of vitamin D deficiency in patients with Crohn's disease in Japan. This study aimed to clarify the prevalence of vitamin D deficiency in patients with Crohn's disease in Japan and to examine the possible causes of the deficiency. METHODS We investigated serum 25-hydroxyvitamin D (25-OHD) levels, various laboratory parameters, and patient histories in 33 outpatients (25 men, 8 women; median age, 37 years; range, 26-57 years) and 15 age- and sex-matched healthy controls (8 men, 7 women; median age, 37 years; range, 24-57 years) and assessed risk factors for vitamin D deficiency. RESULTS Although patients with Crohn's disease did not have significantly lower serum concentrations of 25-OHD than controls, 9 of 33 patients (27.3%) were considered vitamin D deficient (serum 25-OHD level </=10 ng/ml) compared with only 1 of 15 (6.7%) controls. Serum 25-OHD levels were significantly related to disease duration ( r = 0.46, P = 0.003), Crohn's Disease Activity Index (CDAI) score ( r = 0.44, P = 0.005), International Organization for the Study of Inflammatory Bowel Disease score ( r = 0.30, P < 0.05), and serum values of ferritin ( r = 0.34, P = 0.03), C-reactive protein ( r = 0.34, P = 0.03), total cholesterol ( r = 0.31, P = 0.04), and intact parathyroid hormone ( r = 0.23, P < 0.05). A logistic regression analysis was performed to investigate the ability of variables to predict low or normal 25-OHD values. Results showed that disease duration ( P = 0.03) and CDAI score ( P = 0.04) could predict the occurrence of vitamin D deficiency ( r(2) = 0.472, P = 0.0004). CONCLUSIONS Vitamin D deficiency exists in patients with Crohn's disease in Japan. 25-OHD levels should be assessed in patients who have had Crohn's disease for a long time (>15 years) and who have been in the active stage of the disease for long periods.
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Affiliation(s)
- Masahiro Tajika
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, 464-8681, Nagoya, Japan
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