[A Case of Mesenteric Hematoma Caused by Abdominal Metastasis of Small Cell Lung Carcinoma]

Chemoradiation was performed at Osaka Police Hospital's department of respiratory medicine on a 70-year-old male with small cell lung carcinoma(cT4N3M0, cStage ⅢC). Subsequent to secondary chemotherapy for multiple bone metastases that had been observed, he received care to control the disease. He arrived at the hospital complaining of epigastric pain. He got CT-scan and was referred to our department because of a suspected hematoma around the right gastroepiploic artery. He was treated conservatively because circulatory dynamics were steady and there was no indication that anemia had progressed. However, when a test laparotomy was performed the day after the start of treatment because he presented with decreased blood pressure and progressive anemia, a massive hematoma was found around the right gastroepiploic artery. The hematoma was removed, and hemostasis was performed. Based on the pathological findings of the excised specimen, he was diagnosed with abdominal metastasis of small cell lung carcinoma. This is a report on our experience and a literature review on a case of mesenteric hematoma caused by abdominal metastasis of small cell lung carcinoma.

[A Case of Retroperitoneal Dedifferentiation Type Liposarcoma in Which Total Pancreatectomy and Radiation Therapy Was Performed at the Remnant Pancreas after Pancreaticoduodenectomy]

A 75-year-old man presented with a fever. Computed tomography revealed a 10 cm solid tumor under the duodenum. A pre-operative diagnosis of liposarcoma was established using biopsy. Pancreaticoduodenectomy was performed, and the pathological examination led to the diagnosis of dedifferentiation type liposarcoma. Two years later, the liposarcoma recurred at the remnant pancreas. A total remnant pancreatectomy was performed. The pathological examination revealed dedifferentiated type liposarcoma and positive surgical margins. Therefore, radiotherapy of 59.4 Gy in 33 fractions was performed at the recurrence area. The patient has been recurrence-free from 1 year 6 months since the second operation.

A case of hepatic pseudolymphoma in a patient with primary biliary cirrhosis

Hepatic pseudolymphoma is a very rare benign reactive lymphoid hyperplasia associated with autoimmunity and chronic inflammatory liver diseases such as primary biliary cirrhosis and may mimic hepatocellular carcinoma. This diagnosis should be suspected in female with a suspicious single tumor. Close monitoring is needed in view of its premalignant nature.

Abstract 401: Clinical impact of viable circulating tumor cells (v-CTC) detection and PD-L1 expression on v-CTC in the patients with resectable pancreatic cancer

[Introduction] The capture and analysis of CTCs as “liquid biopsy” provides the possibility to avoid invasive biopsies, obvious implications in cancer diagnosis and staging. We tested novel methods for viable CTCs (v-CTC) isolation in the patients (pts) with pancreatic cancer (PC), and investigated the clinical potential of v-CTCs in prognosis. We analyzed the PD-L1(L1) expression in both PC tumors and v-CTCs.

[Pts and Methods] 7.5 ml of venous blood was collected prospectively from 39 PC pts, either surgery first (S group) or pre-treatment, consisted of Gem:800mg/m2; and S-1:80mg/m2 given concurrently with IMRT to 60Gy (NACRT:N group). To detect v-CTCs, we employed a telomerase-specific replication-selective adenovirous expressing GFP. For S group, samples were obtained before/after resection. For N group, samples were obtained before/after NACRT and after resection. To distinguish between leucocyte and cells with either epithelial or mesenchymal origin, cells were stained by anti-CD45, anti-Cytokeratin and anti-Vimentin Abs. GFP-positive and CD45-negative cells were counted as v-CTC. To assess L1 expression in PC tissues (IHC) and v-CTCs, L1 IHC kit (22C3, for tissues) and anti-human L1 mAb(MIH1,for CTCs) were employed.

[Results]S group: 24 pts aged 53~85 years (male/female=12/12) were enrolled. 24 pts underwent curative resection. No v-CTCs were detected in 6 pts at both before and after resection, and 5 of 6 pts survived without recurrence. V-CTCs were identified in 18 of 24 pts, and 13 of 18 pts developed liver metastasis. Marked decrease of CTC counts were seen after resection in 10 of 18 pts, but 9 pts developed recurrence. N group: 15 PC pts aged 44~77 years (male/female=4/11) were enrolled. 15 pts underwent curative resection. No v-CTCs were detected in 5 pts, and 5 pts survived without recurrence. V-CTCs was identified in 10 of 15 pts, and only 3 out of 10 pts developed disease recurrence. Marked increase in CTC counts was observed after NACRT in 5 of 6 CTC-positive pts before NACRT, and 3 of 5 pts developed liver metastasis and died. NACRT may induce tumor cell dissemination into the blood circulation for CTC-positive pts. PD-L1 expression: L1 expression were assessed for 21 pts (S group:18, N group: 3). No patients with IHC-L1 high expression (≥50%) were observed (<1% [negative]:9, 10%:6, 20%:4, 40%:2). For S group, IHC-L1 low +/CTC-L1 + were detected in 12/18 pts (66%). IHC-L1-/CTC-L1+ were detected in 3/18 pts (17%). IHC-L1 - /no detectable CTCs were detected in 3/18 pts (17%). For N group, IHC-L1 - were detected in 3 pts, but CTCs-L1 + were detected in 2 pts (1 pt had no CTCs). The majority of detectable v-CTCs were positive for L1-expression (89% [92/103 CTCs]), despite L1-negative or -low expression in PC tissues.

[Conclusions] Viable CTC detection appears as a promising prognostic marker. Immunotherapy with anti-PD-1/PD-L1 Abs may effectively target v-CTCs.

Note: This abstract was not presented at the meeting.

Citation Format: Masahiro Tanemura, Kenta Furukawa, Manabu Mikamori, Takurou Saito, Masahisa Otsuka, Yozo Suzuki, Kentaro Kishi, Hironao Yasuoka, Masahiko Tsujimoto, Yasuo Urata, Hiroki Akamatsu. Clinical impact of viable circulating tumor cells (v-CTC) detection and PD-L1 expression on v-CTC in the patients with resectable pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 401.

[A Case of Myeloid Sarcoma That Primarily Developed in the Spleen]

We report a case of myeloid sarcoma(MS)that primarily developed in the spleen. The patient was a 60s man with a chief complainant of low-grade fever following a dental implant. Although he underwent intensive antibiotic treatment, including levofloxacin, meropenem, and vancomycin, no significant decline in fever was observed. Abdominal contrast-enhanced CT revealed an LDA occupying the majority of his spleen, which was diagnosed as a splenic abscess. Although a CT-guided biopsy and drainage for the spleen were considered, a puncture of the spleen was not performed due to the substantial concern of bleeding. Subsequently, a splenectomy was performed and HE staining revealed mitosis of tumor cells and massive necrosis. Immunohistochemical analysis revealed that the tumor cells were positive for myeloperoxidase, CD43, CD45, and CD68. Finally, the splenic LDA was diagnosed as MS instead of a splenic abscess. He was treated with systemic chemotherapy. MS primarily develops in the spleen is quite rare: we found only 2 case reports of this disease. The prognosis of MS is poor due to the complications of AML. Accordingly, MS should be considered as a differential diagnosis for accurate diagnosis and treatment of splenic LDA.

The postoperative peak number of leukocytes after hepatectomy is a significant prognostic factor for cholangiocarcinoma

Cholangiocarcinoma (CCA) is a lethal disease. A new predictive factor to identify patients suitable for adjuvant chemotherapy is needed. The relationship between the long-term prognosis and the perioperative immune responses in patients with CCA remains unclear. We therefore investigated the clinical impact of perioperative immune responses on the long-term prognosis in patients receiving hepatectomy for CCA. We investigated 81 patients who underwent hepatectomy between February 2000 and October 2012: 57 intra-hepatic CCA (iCCA) patients and 24 extra-hepatic CCA (eCCA) patients. We checked the postoperative level of C-reactive protein and the numbers of leukocytes. A multivariate analysis of the clinicopathological factors identified 2 significant risk factors for the overall survival: The postoperative maximum number of leukocytes (PNL) among patient factors (P=0.0406) and the TNM-stage among tumor factors (P=0.0059). On evaluating the distribution of each kind of leukocyte with a multivariate analysis, both the postoperative maximum number of neutrophils (PNN) and the postoperative maximum number of eosinophils (PNE) were detected as significant factors among leukocytes (PNN/PNE, P=0.0367/0.0083). In conclusion, the PNL after hepatectomy was significantly associated with the long-term prognosis in patients with CCA. Changes in the numbers of leukocytes after hepatectomy may be a marker on treatment for CCA.

Exosomal miR-155 Derived from Hepatocellular Carcinoma Cells Under Hypoxia Promotes Angiogenesis in Endothelial Cells

PURPOSE

In this study, we aim to clarify whether exosomes secreted from hepatocellular carcinoma (HCC) cells under hypoxia affect angiogenesis in endothelial cells.

METHODS

Exosomes derived from human liver cancer cell lines were cultured under hypoxic or normoxic conditions for 24 h, isolated using ExoQuick-TC^®, and co-cultured with HUVECs to evaluate angiogenic activity. We also evaluated the expression of miR-155 in the exosomes from 40 patients with HCC.

RESULTS

Exosomes under hypoxia remarkably enhanced tube formation of HUVECs. Both cellular and exosomal miR-155 were significantly up-regulated under hypoxic conditions. Knockdown of miR-155 in HCC cells attenuated the promotion of tube formation by exosomes under hypoxia in HUVECs, and high expression of exosomal miR-155 in preoperative plasma was significantly correlated with early recurrence.

CONCLUSION

These results suggest that exosomes derived from HCC cells under hypoxia induce tube formation of HUVECs and that exosomal miR-155 may affect angiogenic activity in HCC.

[A Case of Cecal Cancer in a Patient with Situs Inversus Treated with Single-Port Laparoscopic Surgery]

A 67-year-old woman who had been treated for cardiac sarcoidosis was diagnosed with cecal cancer by detailed examination. Although an anatomical abnormality was present, we determined that a curative operation with single-port laparoscopic surgery(SILS)was feasible. We safely performed ileocecal resection with D3 lymph node dissection(operative time of 91 min with almost no intraoperative blood loss), and the patient developed no operation-related complications during the postoperative course. Although cecal cancer with situs inversus is very rare, SILS is thought to be safe and feasible when performed by surgeons, who are familiar with the SILS technique and the spatial-cognitive features of situs inversus.

[A Comparative Study on Feasibility of SOX Therapy and SP Therapy with Short Hydration for Gastric Cancer in the Outpatient Setting]

We conducted a retrospective comparative study on feasibility of S-1/oxaliplatin(SOX)therapy and S-1/cisplatin therapy with short hydration(SP-SH)for gastric cancer in the outpatient setting. The subjects were patients with gastric cancer aged younger than 75 years who underwent SOX or SP-SH therapy at our hospital. There were 22 patients in the SOX group and 30 patients in the SP-SH group. Both the groups received the first course during hospitalization and then received the subsequent courses in the outpatient section. Evaluation items for each therapy included the treatment rate in the outpatient setting, number of re-hospitalization cases, relative dose intensity(RDI), and adverse events. The treatment rate in the outpatient setting was 100%(22/22)in the SOX group and 96%in the SP-SH group(26/27). Re-hospitalization cases included 1 case of loss of appetite in the SOX group and 1 cases of loss of appetite and 2 cases of febrile neutropenia(FN)in the SP-SH group. The median values of the RDI were 86% with S-1 and 85% with oxaliplatin in the SOX group and 92% with S-1 and 80% with cisplatin in the SP-SH group. The SP-SH group had a higher proportion of neutropenia cases of Grade 3 or higher(SP-SH 33% v. s SOX 5%, p=0.012). The SOX group showed a higher proportion of loss of appetite cases for all the Grades(SOX 86% v. s SP-SH 50%, p=0.007)and peripheral neuropathy cases(SOX 64% v. s SP-SH 23%, p=0.003). It was considered that SOX and SP-SH therapies can be treated in the outpatient section, although the occurrence of loss of appetite and FN must be considered.

[Nephrotoxicity of a Short Hydration Method for the Cisplatin Regimen in Patients with Gastric Cancer]

BACKGROUND

S-1 plus cisplatin(CDDP)has been a key regimen for advanced gastric cancer treatment. However, CDDP confers dose-limiting nephrotoxicity, requires a hospital stay for conventional massive hydration, and reduces patients' quality of life. We evaluated the nephrotoxicity of CDDP combination chemotherapy in an outpatient setting with short hydration for gastric cancer and investigated the feasibility of the short hydration method.

METHODS

Twenty-nine gastric cancer patients aged under 75 years with creatinine clearance rate >40mL/min and who received S-1 plus CDDP(60mg/m2)were recruited. Intravenous hydration was administered at 1,900 mL with magnesium and a diuretic. Any renal dysfunction over 5 courses of chemotherapy was analyzed.

RESULTS

The majority(24/29)of patients could receive outpatient chemotherapy. The highest serum creatinine Grade in each course was Grade 1, and none of the patients developed creatinine toxicity of Grade 2 or higher over 5 courses of chemotherapy. An elevation in eGFR grade was found in 51.7%(15/29)patients; in 13 of those patients, the escalation was of at least 1 Grade.

CONCLUSION

The short hydration method is feasible for gastric cancer patients receiving chemotherapy including CDDP in an outpatient setting.

[A Case of Resection of a Huge Intrahepatic Cholangiocarcinoma of Extrahepatic Growth Type]

A 44-year-old woman was admitted to our hospital because of an abdominal mass. Blood examination showed no elevation of hepatic enzyme levels but did show a slight increase in the levels of tumor marker CA19-9. An abdominal contrastenhanced CT scan showed a large pedunculated tumor(15 cm)growing from the S5 to the extrahepatic area, with a pattern of earlyenhancement and wash out. Fortunately, organ invasion and tumor dissemination were not observed. Upon FDG-PET examination, marked uptake of FDG was observed in the tumor. S5 hepatic subsectionectomywas performed. The final pathological finding of this tumor was moderatelydifferentiated cholangiocarcinoma. Intrahepatic cholangiocarcinoma with exophytic growth is quite rare, and is reported to have a poor prognosis. Therefore, strict follow-up, including follow-up CT and examination for tumor markers(CA19-9 and CEA), is required.

[A Case of Endometrioid Adenocarcinoma in the Sac of a Femoral Hernia]

A 74-year-old woman presented to our institution with right inguinal swelling. The swelling had appeared 1 year previously and exhibited a tendency to increase in size. Physical examination revealed a thumb tip-sized swelling in the right inguinal region. Computed tomography revealed a right femoral hernia and fluid accumulation, resulting in the diagnosis of a right femoral hernia. Using the anterior approach, we completely removed the cystic nodule and repaired the femoral hernia. The hernia sac contained elastic nodules, and pathological examination led to the diagnosis of endometrioid adenocarcinoma. Although postoperative positron emission tomography-computed tomography and magnetic resonance imaging revealed no tumor residue, systemic chemotherapy was selected after consultation with the obstetrics and gynecology department. In summary, we herein report a case of an endometrioid adenocarcinoma that occurred in the sac of a femoral hernia.

[A Case Report of Sigmoid Colon Cancer with a Synchronous Large Liver Metastasis Curatively Resected Following Multidisciplinary Therapy]

A 50's woman referred to our hospital with high serum CEA level was found to have RAS-wild sigmoid colon cancer with a 15 cm size unresectable synchronous liver metastasis(LM)in the right lobe during the endoscopic, radiological, and immunohistological examinations. CapeOX was introduced, but the LM lesion enlarged to 18 cm after 2 courses. Therefore, the regimen was switched to FOLFIRI plus panitumumab. Six courses ofchemotherapy resulted in the reduction ofthe LM lesion to 11 cm, and the Response Evaluation Criteria in Solid Tumors revealed PR with no severe adverse effects, and curative surgical resection was planned. The patient underwent laparoscopic sigmoidectomy resection, followed by percutaneous transhepatic portal embolization(PTPE)ofthe right branch ofthe portal vein to secure the volume ofthe future remnant liver. Right lobectomy and partial resection ofsegment 4 ofthe liver and cholecystectomy was then performed. Currently, 28 months postoperatively, the patient continues to do well with no signs ofrecurrence. This case demonstrates that the sequential combination ofsystemic therapy with FOLFIRI plus panitumumab and PTPE enabled the curative surgical management ofthe sigmoid colon cancer with a large synchronous LM.

Possible involvement of Enterococcus infection in the pathogenesis of chronic pancreatitis and cancer

(Aim) Bacterial infection underlies the pathogenesis of many human diseases, including acute and chronic inflammation. Here, we investigated a possible role for bacterial infection in the progression of chronic pancreatitis. (Materials and Methods) Pancreatic juice was obtained from patients with pancreatic cancer (n = 20) or duodenal cancer/bile duct cancer (n = 16) and subjected to PCR using universal primers for the bacterial 16S ribosomal RNA gene. Bacterial species were identified by PCR using bile samples from four pancreatic cancer patients. PCR products were subcloned into T-vectors, and the sequences were then analyzed. Immunohistochemical and serologic analyses for Enterococcus faecalis infection were performed on a large cohort of healthy volunteers and patients with chronic pancreatitis or pancreatic cancer and on mice with caerulein-induced chronic pancreatitis. The effect of E. faecalis antigens on cytokine secretion by pancreatic cancer cells was also investigated. (Results) We found that 29 of 36 pancreatic juice samples were positive for bacterial DNA. Enterococcus and Enterobacter species were detected primarily in bile, which is thought to be a pathway for bacterial infection of the pancreas. Enterococcus faecalis was also detected in pancreatic tissue from chronic pancreatitis and pancreatic cancer patients; antibodies to E. faecalis capsular polysaccharide were elevated in serum from chronic pancreatitis patients. Enterococcus-specific antibodies and pancreatic tissue-associated E. faecalis were detected in mice with caerulein-induced chronic pancreatitis. Addition of Enterococcus lipoteichoic acid and heat-killed bacteria induced expression of pro-fibrotic cytokines by pancreatic cancer cells in vitro. (Conclusion) Infection with E. faecalis may be involved in chronic pancreatitis progression, ultimately leading to development of pancreatic cancer.

Primary Intrahepatic Squamous Cell Carcinoma with Histological Collision of Adenocarcinoma and Squamous Cell Carcinoma: A Case Report

Patient: Male, 82

Final Diagnosis: Intrahepatic squamous cell carcinoma

Symptoms: None

Medication: —

Clinical Procedure: —

Specialty: Oncology

Hypoxia-Induced PLOD2 is a Key Regulator in Epithelial-Mesenchymal Transition and Chemoresistance in Biliary Tract Cancer

BACKGROUND

The prognosis of biliary tract cancer (BTC) is unfavorable due to its chemoresistance. Hypoxia triggers epithelial-to-mesenchymal transition (EMT), which is closely related to drug resistance. In this study, we focused on the functional roles of procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2), a hypoxia-induced gene, in BTC, and assessed the clinical significance of PLOD2.

METHODS

The expression of PLOD2 under hypoxia was assessed in BTC cell lines. Gemcitabine-resistant (GR) BTC cell lines were transfected with small interfering RNA (siRNA) against PLOD2, and EMT markers and chemoresistance were evaluated. PLOD2 expression was also characterized using immunohistochemistry in BTC clinical specimens following resection. Patient survival was analyzed and the role of PLOD2 expression was examined.

RESULTS

The expression of PLOD2 was induced by hypoxia in vitro and was upregulated in BTC-GR cell lines, which had low expression of epithelial markers and high expression of mesenchymal markers. Downregulation of PLOD2 by siRNA resulted in improved chemoresistance, recovery of epithelial markers, and reduction of mesenchymal markers. In the resected BTC samples, PLOD2 expression was significantly correlated with lymph node metastasis (p = 0.037) and stage (p = 0.001). Recurrence-free survival (p = 0.011) and overall survival (p < 0.001) rates were significantly lower in patients with high expression of PLOD2. PLOD2 expression was an independent prognostic factor for overall survival (p = 0.019).

CONCLUSIONS

The expression of PLOD2 influenced chemoresistance through EMT, and high expression of PLOD2 was a significant unfavorable prognostic factor in BTC patients. PLOD2 might be a potential therapeutic target for overcoming chemoresistance.

Role of histone deacetylase 1 in distant metastasis of pancreatic ductal cancer

Current therapies for pancreatic ductal cancer (PDAC) do not sufficiently control distant metastasis. Thus, new therapeutic targets are urgently needed. Numerous studies have suggested that the epithelial-mesenchymal transition (EMT) is pivotal for metastasis of carcinomas. The fact that the EMT is reversible suggests the possibility that it is induced by an epigenetic mechanism. In this study, we aimed to investigate the role of histone deacetylase 1 (HDAC1), which is an epigenetic mechanism on distant metastasis of PDAC. We investigated the HDAC1 expression in 103 resected PDAC specimens obtained from patients who were treated with/without preoperative therapy using immunohistochemistry. To validate the findings in the clinical samples, we evaluated the HDAC1 activity, the EMT-associated genes and the migration/invasion ability in vitro, and performed an HDAC1 inhibitor assay. The high expression of HDAC1 in clinical samples was significantly associated with poor progression-free survival, especially distant metastasis-free survival. In vitro, HDAC1 inhibitors decreased the invasion ability and reversed the EMT change; the only factor to show a concomitant decrease was the expression of SNAIL. We confirmed that the HDAC1 expression was associated with the SNAIL expression in clinical samples. Moreover, the resistant cells and parental cells did not show any significant differences in the expression of HDAC1; this was consistent with the finding that preoperative therapy did not alter the HDAC1 expression in clinical samples. The targeting of HDAC1, which could suppress metastasis by inhibiting the EMT, is a promising treatment option for PDAC.

Abstract 4175: Endoscopic stent insertion for obstructive colorectal cancer may induce tumor cell dissemination into the peripheral circulation, resulting in viable circulating tumor cell detection

The placement of a self-expanding metallic stent (SEMS) in obstructive colorectal cancer (OCRC) is acknowledged to be a safe and effective procedure for the relief of obstruction. However, there is concern that shear forces acting on the tumor during stent expansion may release cancer cells into the circulation, resulting in distant metastasis. The aim of the present study was to determine whether colonic stent insertion increases viable circulating tumor cells (v-CTCs) in the peripheral blood. For detecting v-CTCs of colorectal cancer (CRC), we employed a novel method, TelomeScan F35 detection system. The system was constructed with a GFP-expressing attenuated adenovirus, in which the telomerase promoter regulates viral replication to detect only viable cancer cells. 7.5 ml of peripheral blood samples were obtained before/after stent insertion and after operation. GFP-positive and CD45-negative cells were counted as v- CTCs. This study was a single institution trial, approved by the Kure Medical Center IRB (No. 25-40). Between October 2013 and June 2015, 8 patients, aged 62-85 years (5 males and 3 females) were enrolled. Median follow-up was 28.1 months (range 15.5-34.6 months). All patients underwent successful SEMS insertion. Five patients had an Eastern Cooperative Oncology Group performance status of 0, and the remaining 3 patients had performance status of 1 or 2 (PS1 1, PS2 2). OCRCs were located in the sigmoid colon in 5 patients, descending colon in 2 patients, and transverse colon in 1 patient. Four patients were diagnosed as TNM stage II, and 4 patients were diagnosed as stage III. Stent insertion was performed as a bride to surgery in 7 patients and for palliation in one patient. Surgical resection (R0) was performed in 7 patients. No patients required a permanent stoma and have any complications. Four patients had no v-CTCs before SEMS placement, two of four measurable patients had an increased number of v-CTCs after SEMS placement (1-3 v-CTCs), and one of two patients with increased v-CTCs developed distant lymphatic metastasis 24 months after surgery despite curative resection and receiving systemic chemotherapy with UFT+LV. Four patients had v-CTCs (1-19 cells) before SEMS placement, and two of these four patients had an increase in the number of v-CTCs (20-21 cells) after SEMS placement, while one of the four patients died early with distant metastasis. In conclusion, the present study demonstrated that endoscopic stent insertion may result in tumor cell dissemination into the peripheral circulation and may induce early distant metastasis. Although stenting has some advantages as a BTS in OCRC, the oncological risk and long-term prognosis of this approach have not been clarified. The conclusions of this study may open a window of opportunity for raising an alarm about SEMS placement in OCRC.

Citation Format: Shinya Yamashita, Masahiro Tanemura, Yosuke Shimizu, Toshio Kuwai, Yasuo Urata, Kiyomi Taniyama. Endoscopic stent insertion for obstructive colorectal cancer may induce tumor cell dissemination into the peripheral circulation, resulting in viable circulating tumor cell detection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4175.

Vitamin D Supplementation is a Promising Therapy for Pancreatic Ductal Adenocarcinoma in Conjunction with Current Chemoradiation Therapy

BACKGROUND

The cancer-associated fibroblasts (CAFs) in pancreatic ductal adenocarcinoma (PDAC) are well known to play a dominant role in distant metastasis. Nevertheless, the effect on CAFs with current chemoradiation therapies remains uncertain.

OBJECTIVE

This study aimed to reveal the role of CAFs under current chemoradiation therapy (CRT) and investigate the factors regulating CAFs.

METHODS

α-SMA-positive cells in 86 resected PDAC specimens with/without preoperative CRT were evaluated by immunohistochemistry. Various factors, including the plasma levels of vitamin D, were investigated for association with the number of CAFs or distant metastasis-free survival (DMFS). Human pancreatic satellite cells (hPSCs) extracted from clinical specimens were used to validate the factors.

RESULTS

All PDAC samples contained CAFs but the number varied widely. Multivariate analysis for DMFS indicated a larger number of CAFs was a significant risk factor. Univariate analysis for the number of CAFs identified two clinical factors: preoperative CRT and lower plasma levels of vitamin D. In subgroup analysis, the higher plasma level of vitamin D was a dominant factor for longer DMFS in PDAC patients after preoperative CRT. These results were validated by using extracted hPSCs. Irradiation activated stromal cells into CAFs facilitating malignant characteristics of PDAC and the change was inhibited by vitamin D supplementation in vitro.

CONCLUSION

In conjunction with established current therapies, vitamin D supplementation may be an effective treatment for PDAC patients by inactivating CAFs.

Minimally invasive liver resection for hepatocellular carcinoma of patients with liver damage B: A propensity score-based analysis

AIM

Minimally invasive liver resection (MILR) is considered a safe and feasible treatment for malignant liver tumors. However, few studies have investigated the surgical outcomes of MILR in patients with impaired liver function. Liver damage is used for consideration of hepatectomy. The aim of this study is to clarify the efficacy of MILR for patients with impaired liver function by using propensity score matching.

METHODS

Ninety-nine patients with liver damage B underwent hepatic resection were analyzed. The patients were divided into two groups, the MILR group (n = 24) and the open liver resection (OLR) group (n = 75). After matching of a propensity score, we compared clinicopathological features and surgical outcomes.

RESULTS

After matching, 36 patients (18 patients from each group) were selected and the patients' characteristics and tumor characteristics were not significantly different between the two groups. Blood loss (P = 0.0163) and complication rate (P = 0.0162) were significantly decreased in the MILR group. Complications were observed in eight patients, comprising one patient in the MILR group and seven patients in the OLR group. The postoperative hospital stay was significantly shortened in the MILR group (P = 0.0118).

CONCLUSION

Minimally invasive liver resection might be effective for patients with impaired liver function. It reduces surgical complications and consequently shortens hospitalization time.

Surgical outcome of extended liver resections for colorectal liver metastasis compared with standard liver resections

Colorectal liver metastatic lesions sometimes invade adjacent organs. A hepatectomy is often extended to include the involved adjacent organ to achieve negative surgical margins. The purpose of the present retrospective study was to evaluate the surgical outcomes of extended liver resections and patients' prognoses. The medical records of 178 patients with colorectal liver metastasis who underwent liver resections in the Department of Gastroenterological Surgery at Osaka University Hospital (Suita, Japan), from 2000 to 2015 were reviewed. These patients were divided into two groups: the extended resection group (n=20) and the non-extended resection group (n=158). The disease-free and overall survival curves were estimated with the Kaplan-Meier method and analyzed with the log rank test. It was observed that the extended resection group had longer operation times and increased blood loss, however perioperative morbidity was similar. The organs resected most frequently were the diaphragm (n=10) and inferior vena cava (n=5). Overall survival rates in the extended resection group were lower compared with the non-extended resection group (5-year survival rates; 45.0 vs. 67.9%), however the difference was not significant. It was indicated that the aggressive hepatectomy combined with resection of adjacent organs was an acceptable treatment with low perioperative morbidity. The overall survival rate may not be inferior to that of simple hepatectomy.

Safety and Feasibility of Single-port Surgery for Colon Cancer in Octogenarians

BACKGROUND/AIM

The use of single-port surgery (SPS) in elderly patients with colon cancer remains controversial. The aim of this study was to evaluate the clinical outcomes of elderly patients who underwent SPS.

PATIENTS AND METHODS

Consecutive patients >80 years old of age who underwent SPS (n=86) or multi-port surgery (MPS) (n=40) for colon cancer from January 2008 to December 2014 were analyzed. Short-term and long-term outcomes were compared between groups.

RESULTS

The morbidity rate in the SPS was significantly lower than that in the MPS (p=0.027). Length of hospital stay in the SPS was significantly shorter than that in the MPS (p=0.016). Similar oncological outcomes were observed in the groups. The 3-year disease-free survival rate, the 5-year overall survival rate and the 5-year cancer-specific survival rate did not differ significantly between groups.

CONCLUSION

SPS is safe and can provide clinical outcomes comparable to those of MPS in octogenarians with colon cancer.

Safety and feasibility of single-port laparoscopic multivisceral resection for locally advanced left colon cancer

The aim of the present study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (S-MVR) for locally advanced left colon cancer. S-MVR is a challenging technique and to the best of our knowledge this is the first report of S-MVR for left colon cancer invading or adhering to neighboring organs. A retrospective review was conducted of patients who underwent laparoscopic multivisceral resection for locally advanced left colon cancer invading or adhering to neighboring organs from January 2008 to December 2014. Short-term and long-term outcomes were analyzed between groups of patients who underwent S-MVR and multi-port laparoscopic multivisceral resection (M-MVR) retrospectively. A total of 14 patients underwent S-MVR and 15 patients underwent M-MVR. There were no significant differences between groups in terms of operative factors and postoperative complications. The length of hospital stay was significantly shorter in the S-MVR group compared with the M-MVR group (P=0.048). Three-year overall survival was 61.9% in the S-MVR group (n=14). In patients with stage II (P=0.600) and III (P=0714) disease the three-year overall and disease-free survival was 81.8 and 58.3% in the S-MVR group and 80.0 and 70% in the M-MVR groups over a median follow-up of 34 months. In conclusion, S-MVR for locally advanced left colon cancer is safe and feasible in selected patients.