[A case of successful surgical resection after repeated transcatheter arterial chemoembolization for far advanced multiple hepatocellular carcinomas in both lobes associated with Vp₂ portal vein tumor thrombus]

Treatments for hepatocellular carcinoma (HCC) include surgical resection, transcatheter arteral chemoembolization (TACE), percutaneous local therapy and systemic chemotherapy. However, it is difficult to perform a curative treatment for patients with far advanced multiple hepatocellular carcinomas. Here we report a case of successful surgical resection after repeated TACE for far advanced multiple hepatocellular carcinomas in both lobes associated with Vp₂ portal vein tumor thrombus. A 54-year-old male who had multiple HCC lesions in lateral, median and right lobes with portal vein tumor thrombus was admitted to our hospital. Three attempts of TACE resulted in a successful control of the tumors in the right lobe. Left hepatic lobectomy was therefore performed, and a relapse-free survival was obtained for over 5 years after surgery.

[A case of complete response to interferon-α and S-1 combination therapy for multiple pulmonary recurrences of hepatocellular carcinoma after hepatic resection]

A 77-year-old man was diagnosed as hepatocellular carcinoma, and was referred to our hospital. After he was treated by transcatheter chemoembolization, he underwent a left hepatic lobectomy of the liver and cholecystectomy. Serum AFP and PIVKA-II remarkably elevated 7 months after surgery, and CT scan revealed multiple metastatic nodules in bilateral lungs. The nodules were diagnosed as lung metastasis of HCC. Because the lesions grew larger, S-1/IFN was administered. Diagnostic imaging and tumor markers showed a marked improvement after 4 courses of S-1/IFN therapy, and he is still alive with good condition without recurrence and progression of tumors.

[A case report of port-site metastasis of pancreatic cancer after laparoscope assistted distal pancreatectomy]

Laparosopic port-site metastasis is rare, but a well recognized outcome following surgery in gastroenterological surgery for gastric cancer, colon cancer and gallbladder cancer with its etiology was not clearly understood. We report a port-site metastasis of pancreatic cancer diagnosed by position emission tomography( PET). A 49-year-old man was diagnosed as splenic tumor with pancreatic tail invasion due to malignant lymphoma, and received a laparoscope assisted distal pancreatectomy. Unsuspected pancreatic cancer was discovered with histological result of moderate differentiated invasive ductal adenocarcinoma of the pancreas infiltrating spleen. Systemic chemotherapy with 1,000 mg/m² of gemcitabine (GEM) was performed for six months. Unfortunately, our patients relapsed one year after the surgery with multiple lesions in the peritoneum, abdominal wall, as well as a laparoscopic port-site metastasis. He was started on 100 mg/body of S-1 daily, subsequently, combined chemotherapy with GEM( 80 mg/m²) and S-1( 80 mg/body) was also performed. Furthermore, he underwent palliative radiation therapy( 40 Gy) to care the pain. Fortunately, a long-term survival of 3 years was elicited by these systemic treatments and radiography. Laparoscopic port-site metastases are associated with presence of advanced cancer. Therefore, we should carefully precede a laparoscopic resection against pancreatic cancer.

[A case of successful treatment by interferon-α and 5-fluorouracil combination therapy (FAIT) and transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus]

We report a case of successful treatment by interferon-α (IFN) and 5-fluorouracil (5-FU) combination therapy and transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). A 70-year-old woman, who was diagnosed as unresectable HCC with PVTT in the main trunk of portal vein and multiple intrahepatic metastases, was admitted to our hospital for further treatment for HCC. First, she was treated by 3 courses of IFN and 5-FU combination therapy. Three courses after the combination therapy, PVTT was shrunken and portal flow to the liver was reperfused. Therefore, she was treated by TACE for intrahepatic tumors. She received a repeat treatment of the combination therapy and TACE. Four years after the initial treatment, she is still alive with good condition with intrahepatic tumors. This case suggested that some patient of HCC with PVTT could get a long-term survival if an initial treatment was succeeded and could apply further treatment such as TACE.

miR-146a suppresses the sensitivity to interferon-α in hepatocellular carcinoma cells

BACKGROUND

Interferon-based (IFN-based) therapy is effective in the treatment of advanced hepatocellular carcinoma (HCC). However, the issue of resistance to this therapy remains to be solved. The aim of this study was to identify microRNAs (miRNAs) that govern the sensitivity to IFN-α in HCC cells.

METHODS

miRNA microarray analysis using IFN-α-resistant clones of PLC/PRF/5 (PLC-Rs) and their parental cells (PLC-P) was conducted. Changes in the anti-cancer effects of IFN-α were studied after gain-of-function and loss-of-function of the candidate miRNA.

RESULTS

miR-146a expression was significantly higher in PLC-Rs than in PLC-P. miR-146a decreased the sensitivity to IFN-α through the suppression of apoptosis. Further experiments showed that miR-146a-related resistance to IFN-α was mediated through SMAD4.

CONCLUSIONS

The results indicated that miR-146a regulated the sensitivity of HCC cells to the cytotoxic effects of IFN-α through SMAD4, suggesting that this miRNA could be suitable for prediction of the clinical response and potential therapeutic target in HCC patients on IFN-based therapy.

Advantage of autologous blood transfusion in surgery for hepatocellular carcinoma

AIM: To evaluate the significance of autologous blood transfusion (AT) in reducing homologous blood transfusion (HT) in surgery for hepatocellular carcinoma (HCC).

METHODS: The proportion of patients who received HT was compared between two groups determined by the time of AT introduction; period A (1991-1994, n = 93) and period B (1995-2000, n = 201). Multivariate logistic regression analysis was performed in order to identify independent significant predictors of the need for HT. We also investigated the impact of AT and HT on long-term postoperative outcome after curative surgery for HCC.

RESULTS: The proportion of patients with HT was significantly lower in period B than period A (18.9% vs 60.2%, P < 0.0001). Multivariate logistic regression analysis identified AT administration as a significant independent predictor of the need for HT (P < 0.0001). Disease-free survival in patients with AT was comparable to that without any transfusion. Multivariate analysis identified HT administration as an independent significant factor for poorer disease-free survival (P = 0.0380).

CONCLUSION: AT administration significantly decreased the need for HT. Considering the postoperative survival disadvantage of HT, AT administration could improve the long-term outcome of HCC patients.

Donor hepatectomy for living donor liver transplantation: learning steps and surgical outcome

BACKGROUND AND AIM

Complications associated with live liver donor surgery should be minimized. There is little information on the impact of team experience and learning on the surgical outcome. The aim of this study was to clarify the impact of team experience in a single center on the outcome of live donor hepatectomy.

METHODS

Graft livers consisted of 56 right lobes, 40 left lobes with/without caudate, 36 left lateral section (LLS), and 11 right posterior section (RPS). Surgeries were divided according to the time of execution: era I (n=50), era II (n=50) and era III (n=43).

RESULTS

No postoperative mortality was recorded. Blood loss steadily decreased and operation time decreased after era II (P<0.0001). The overall frequency of postoperative morbidities by the Clavien system was significantly less for LLS graft [P=0.009, right lobe (42.9%) vs. LLS (13.9%)]. Multivariate risk factor analysis showed that donors in recent years were at low risk of morbidity and bile leakage (P=0.025 and 0.010, respectively). There was less impact for team experience on the outcome in LLS graft than other types of grafts.

CONCLUSION

Our analysis demonstrated several learning steps in live liver donor surgery and confirmed their positive impact on surgical outcome.

Successful pregnancy after simultaneous pancreas-kidney transplantation from a brain-dead donor: the first case report in Japan

Simultaneous pancreas-kidney transplantation is a revolutionary medical procedure to cure diabetes mellitus and its complications in one step. For women with type 1 diabetes mellitus and end-stage renal disease, this procedure not only treats their disease but may also allow them to have children. Worldwide, 77 pregnancies from 43 pancreas-kidney recipients have been reported. Here, we present the first case report of successful pregnancy after simultaneous pancreas-kidney transplantation from a brain-dead donor in Japan. She conceived spontaneously 32 months after transplantation. Her pregnancy course was favorable except for mild rejection of the grafted pancreas and development of gestational diabetes. She delivered a 2882-g healthy infant in October 2010. Pregnancy after simultaneous pancreas-kidney transplantation is discussed.

Long-term outcome of combined interferon-α and 5-fluorouracil treatment for advanced hepatocellular carcinoma with major portal vein thrombosis

BACKGROUND/AIM

We previously reported the beneficial effects of a combination therapy of interferon (IFN)-α/5-fluorouracil (FU) for advanced hepatocellular carcinoma (HCC) with tumor thrombi in the major portal branches. This report describes the results of longer follow-up and includes more than twice the number of patients relative to the previous report; it also evaluates the clinical predictor on the response to the combination therapy and long-term survival.

METHODS

The study subjects were 102 patients with advanced HCC and tumor thrombi in the major branches of the portal vein (Vp3 or 4). They were treated with at least 2 courses of IFN-α/5-FU.

RESULTS

No major treatment-related complications were noted. In the 102 patients, 40 (39.2%) showed objective response [11 (10.8%) showed complete response, 29 (28.4%) partial response], 8 (7.9%) showed no response and 54 (52.9%) showed progressive disease.

CONCLUSION

IFN-α/5-FU combination therapy is a promising modality for advanced HCC with tumor thrombi in the major portal branches.

Abstract 759: Vaccination with pancreatic cancer cells expressing α-gal epitopes effectively induced immune responses against not only differentiated cancer cells but also cancer stem cells

Cancer stem cells (CSCs) are generally dormant or slowly cycling tumor cells that have the ability to reconstitute tumors. It is necessary to develop an effective therapy for CSCs to eradicate cancer cells. But, they are thought to be involved in highly tumor resistance to chemo/radiation therapy and tumor relapse and progression. Recently, pancreatic cancer cells expressing the cell surface markers CD44, CD24, and epithelial-specific antigen (ESA) were identified as pancreatic CSCs. Human natural Ab, anti-Gal is an IgG known to be present in large amounts in normal subjects and patients with malignancies, comprising ∼1% of serum circulating IgG. Anti-Gal specifically interacts with α-gal epitopes (Galα1, 3Galβ1, 4GlcNAc-R), synthesized by α1, 3 galactosyltransferase (α1,3GT) on cell surface glycolipids and glycoproteins. We hypothesized that biosynthesis of α-gal epitopes on the carbohydrate of CSC markers, including CD44, CD24, expressed on pancreatic CSCs could effectively induce Ab production against these CSCs. To address this strategy, a human pancreatic cancer cell line, PANC1, which expresses MUC1 was employed and transfected with α1,3GT gene (α-gal PANC1). High anti-Gal α1,3GT KO mice, which displayed anti-Gal titers similar to those found in humans were generated by immunization of pig tissue. These mice were vaccinated with either 1 × 106 irradiated parental PANC1 (control group) or α-gal PANC1 (α-gal group). We investigated that α-gal PANC1 vaccination elicited both the production of anti-MUC1 Abs [number of anit-MUC1 spots at 1 × 106 splenocytes by ELISPOT: α-gal vs. control: 553.6 ± 66.7 vs. 319.5 ± 18.9 (p&lt;0.0001)] and the expansion of systemic T-cell response to MUC1 [number of IFNγ spots at 1 × 106 splenocytes by ELISPOT: α-gal vs. control: 1237.5±283.1 vs. 211± 33.4 (p&lt;0.0001)]. We confirmed that the subpopulation of pancreatic CSCs, which expressed CD44, CD24, and ESA in parental PANC1 cells. Flow cytometric quantification showed that 70.4 % of PANC1 cells were CD44+CD24+ and 82.4 % were CD44+ESA+. We isolated PANC1 cells with CD44+CD24+ phenotype by magnetic beads and assessed Ab production against both pancreatic CSCs (binding cells with beads) and differentiated cancer cells (nonbinding cells with beads). A strong Ab production against both CSCs and differentiated cancer cells was effectively elicited by α-gal PANC1 vaccination as judged by the mean fluorescence intensity (MFI) [MFI of pancreatic CSCs: α-gal vs. control: 181.9 vs. 10.3, MFI of differentiated cancer cells: α-gal vs. control: 261.2 vs. 11.5]. We conclude that the buildup of α-gal epitopes on carbohydrates of CSC markers to be internalized by APC, is a novel strategy for treatment of cancer cells, including differentiated/pancreatic CSCs and may cure pancreatic cancer by destruction of micro-metastasis and minimal residual disease.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 759. doi:10.1158/1538-7445.AM2011-759

Abstract 4356: Combination use of anti-CD133 antibody and SSA lectin can effectively enrich cells with high tumorigenicity

A growing body of evidence has suggested that tumors are frequently composed of heterogeneous cell types, and that tumor initiation and growth are driven by a small subset of cells, termed cancer stem cells (CSCs) or tumor-initiating cells. CSCs can self-renew and also give rise to more differentiated progeny that comprise the bulk of a tumor. Glycans exhibit characteristic changes in their structures during development and thus have been used as markers for stem/progenitor cells. However, the glycan structures unique to CSCs have remained unknown. In this study, we examined glycan structures in CD133+CD13+ CSCs, which were recently found to have a high CSC ability, by means of lectin microarray. Seven sialylated glycan-recognizing lectins, MAL-I, SNA, SSA, TJA-I, ACG, ABA, and MAH, showed higher affinity to CD133+CD13+ CSCs than CD133+ cells with a lower CSC ability. In addition, we demonstrated that CD133+SSA+ cells isolated from Huh7 cells had a significantly higher ability to form tumors in NOD/SCID mice and spheres under serum-free conditions than CD133+SSA- cells. These results suggest that hepatic CSCs highly express sialylated glycans and that SSA lectin can be used as a tool for isolating CSCs. This study is the first report to demonstrate the characteristic glycan structures in CSCs and to indicate a new methodology involving lectins for isolating CSCs.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4356. doi:10.1158/1538-7445.AM2011-4356

Abstract 774: Preliminary experiment of α-gal epitopes immune-based therapy against pancreatic cancer using tumor cell lysates

Potential targets for the immunotherapy of pancreatic cancer are antigens such as MUC1 and mutant ras. But, vaccinating against a single antigen has disadvantages, because it is unknown which of the identified antigens have the potential to induce an effective anti-tumor immune response. Immunity against a single antigen may be ineffective in tumors with heterogeneous cell population and carries the risk of inducing tumor-associated antigen (TAA) escape variants. The use of tumor cell lysate circumvents these disadvantages. Unfortunately, TAAs fail to stimulate immune response against cancer cells, because immunity toward TAAs in cancer patients is weak and the presentation of TAAs to the immune system seems to be poor. Human natural Ab, Anti-Gal, which is an IgG known to be present in large amounts in normal subjects and cancer patients, comprising ∼1% of serum circulating IgG. Anti-Gal specifically binds to α-gal epitopes (Galα1, 3Galβ1, 4GlcNAc-R), synthesized by α1, 3 galactosyltransferase (α1,3GT) on cell surface glycolipids and glycoproteins. This study addresses the effectiveness of elicitation of both Ab production and T cell responses against pancreatic cancer by the tumor lysate vaccination, expressing α-gal epitopes. A human pancreatic cancer cell line, PANC1, which expresses MUC1 was employed and transfected with α1,3GT gene (α-gal PANC1). Cell lysates were created by injection of either 2 × 106 parental PANC1 or α-gal PANC1 into NOD/SCID mice, respectively. The mice were sacrificed and tumors were enucleated for preparing cell lysates. α1,3GT KO mice were immunized with pig tissue to generate anti-Gal in their sera like human. These mice were vaccinated intraperitoneally by either 10 mg of parental (control group) or α-gal PANC1 cell lysate (α-gal group). Cell lysate of parental PANC1 lacked of α-gal epitopes and it of α-gal PANC1 expressed ∼40 × 106 of these epitopes per 1mg of lysate. MUC1 expression in both cell lysates was observed at similar level. Production of anti-PANC1 Ab in α-gal group was 16∼64-fold higher than that of control group. Anti-MUC1 Ab production in α-gal group was also increased in comparison with that in control group (16-fold higher). Expansion of anti-MUC1 B cells in α-gal group was significantly higher [number of spots at 1 × 106 splenocytes: α-gal vs. control; 305.3 ± 44.0 vs. 136.7 ± 93.2 (p&lt;0.007)]. Expansion of specific T-cell response to MUC1 peptide in α-gal group was significantly higher [number of IFN-γ spots at 1 × 106 splenocytes: α-gal vs. control; 626.7 ± 118.6 vs. 181.7 ± 27.5 (p&lt;0.0031)]. We conclude that vaccination with cell lysate expressing α-gal epitopes may result in elicitation of immune response toward tumor antigens, including MUC1 and thus to mount an immune response that may lead to cure pancreatic cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 774. doi:10.1158/1538-7445.AM2011-774

Combination use of anti-CD133 antibody and SSA lectin can effectively enrich cells with high tumorigenicity

Glycans exhibit characteristic changes in their structures during development and thus have been used as markers for stem/progenitor cells. However, the glycan structures unique to cancer stem cells (CSC) remain unknown. In the present study, we examined glycan structures in CD133+ CD13+ CSC, which were recently found to have a high CSC ability, by means of a lectin microarray. Seven sialylated glycan-recognizing lectins, MAL-I, SNA, SSA, TJA-I, ACG, ABA and MAH, showed higher affinity to CD133+ CD13+ CSC than CD133+ cells with a lower CSC ability. In addition, we demonstrated that CD133+ SSA+ cells isolated from Huh7 cells had a significantly higher ability to form tumors in non-obese diabetic/severe combined immunodeficiency disease (NOD/SCID) mice and spheres under serum-free conditions than CD133+ SSA- cells. These results suggest that hepatic CSC highly express sialylated glycans and that SSA lectin can be used as a tool for isolating CSC. This study is the first report to demonstrate the characteristic glycan structures in CSC and to indicate a new methodology involving lectins for isolating CSC.

IGFBP7 downregulation is associated with tumor progression and clinical outcome in hepatocellular carcinoma

Insulin-like growth factor-binding protein 7 (IGFBP7) functions in several cellular processes including proliferation, senescence and apoptosis. This study analyzed IGFBP7 function in hepatocellular carcinoma (HCC) cells by gene manipulation and investigated the prognostic significance of IGFBP7 expression in clinical HCC samples. In this study, we investigated changes in malignant potential such as cell growth and invasiveness in an HCC cell line, PLC/PRF/5, after transfection with shRNA against IGFBP7. The extent of apoptosis and cell cycle progression were examined after the transfection. The correlation between immunohistochemically determined IGFBP7 expression and long-term postoperative prognosis after curative resection was also investigated in clinical HCC specimens obtained from 104 patients. PLC/PRF/5 cells transfected with shRNA against IGFBP7 showed significantly more rapid growth and stronger invasiveness than control cells. Annexin V assays showed that the IGFBP7-depleted cells were significantly more resistant to apoptosis than the control cells, and showed decreased expression of cleaved caspase-3 and PARP. Cell cycle progression was more rapid in the IGFBP7-suppressed cells. In clinical HCC specimens, IGFBP7 expression was judged as positive in 67 patients (64.4%) and negative in the remaining 37 patients (35.6%). The IGFBP7 downregulation correlated significantly with poor postoperative prognosis, and IGFBP7 status was identified as an independent significant prognostic factor. Our results indicated that IGFBP7 expression correlated significantly with the malignant potential in HCC cells, suggesting that the expression could be a useful prognostic marker for HCC.

Significance of alanine aminopeptidase N (APN) in bile in the diagnosis of acute cellular rejection after liver transplantation

BACKGROUND

Allograft dysfunction after liver transplantation requires histopathologic examination for confirmation of the diagnosis, however, the procedure is invasive and its interpretation is not always accurate. The aim of this study was to find novel protein markers in bile for the diagnosis of acute cellular rejection (ACR) after liver transplantation.

MATERIALS AND METHODS

Quantitative proteomic analysis using the (18)O labeling method was used to search for bile proteins of interest. Nine recipients were selected who had liver dysfunction, diagnosed by liver biopsy, either with ACR (ACR group, n = 5) or without (LD group, n = 4). Donor bile samples were obtained from nine independent live liver donors. Enzyme activity in bile samples was assayed and liver biopsy specimens were immunostained for candidate protein of ACR.

RESULTS

The analysis identified 78 proteins, among which alanine aminopeptidase N (APN/CD13) was considered a candidate marker of ACR. Comparative analysis of the ACR and LD groups showed high APN enzyme activity in three (60%) of five cases of the ACR group, while it was as low as donor level in all patients of the LD group. APN enzyme activity in bile samples of liver dysfunction liver transplantation (LDLT) recipients of the ACR group collected within 3 d before biopsy-confirmed ACR (n = 10) was significantly higher (584 ± 434 U/g protein) than in those of recipients free of ACR (n = 96, 301 ± 271 U/g protein) (P = 0.004). APN overexpression along bile canaliculi was observed during ACR in all five cases of the ACR group.

CONCLUSION

APN in bile seems to be a useful and noninvasive biomarker of ACR after liver transplantation.

Ep-CAM is a significant prognostic factor in pancreatic cancer patients by suppressing cell activity

The identification of molecular markers useful for predicting prognosis in pancreatic cancer patients is crucial for advances in disease management. The epithelial cell adhesion molecule (Ep-CAM) is known to express in most epithelial malignancies and was reported as a tumor marker or a candidate of molecular targeting therapy. However, the clinical significance of Ep-CAM expression in pancreatic cancer is not well-known. We determined the difference of malignant potential between parental and Ep-CAM-transfected pancreatic cancer cell lines by using proliferation, invasion and migration assay. Furthermore, we determined the relationship between tumoral Ep-CAM expression of resected specimens and clinical prognosis in 95 pancreatic cancer patients receiving radical surgery at two different cancer centers. One of the three Ep-CAM-transfected cell lines showed significantly low proliferation rate compared with the parental cell, while there was no difference in the other two cell lines. In invasion and migration assays, Ep-CAM-transfected cells showed significantly lower malignant potential than parental in all of the three cell lines. In 95 pancreatic cancer patients, 47 patients showed high-Ep-CAM expression, while 48 patients showed low, and there was no difference of clinicopathological features between Ep-CAM high and low-expression group. High-Ep-CAM expression group showed significantly good prognosis in overall survival (3-year survival; 56.2 versus 19.2%, P=0.0018) as well as in disease-free survival (3-year survival; 40.3 versus 14.4%, P=0.038) compared with low-expression group. In addition, the impact of Ep-CAM was observed strongly in LN-negative group when the influence of Ep-CAM was examined with dividing patients into LN-positive and negative group. In multivariate analysis, Ep-CAM expression was one of the independent prognostic factors as well as histology and lymph node metastasis. Ep-CAM expression was found to be related to the suppression of pancreatic cancer cell activity and the good prognosis in pancreatic cancer patients receiving the curative resection.

Mural nodule in branch duct-type intraductal papillary mucinous neoplasms of the pancreas is a marker of malignant transformation and indication for surgery

BACKGROUND

The management of branch duct-type intraductal papillary mucinous neoplasms (IPMNs) remains controversial. This study aimed to elucidate the preoperative clinical factors that identify high-risk malignant transformation in branch duct-type IPMN.

METHODS

We retrospectively evaluated 38 patients diagnosed with branch duct-type IPMN who underwent pancreatectomy, identifying different preoperative factors between adenoma (intraductal papillary mucinous adenoma [IPMA]) and carcinoma (intraductal papillary mucinous carcinoma [IPMC]).

RESULTS

Twelve patients were diagnosed with IPMC. The mean tumor size was 31.9 ± 11.8 mm for IPMA and 35.7 ± 17.1 mm for IPMC (P = .467). No significant differences were found between IPMA and IPMC patients with regard to age, sex, symptoms, and tumor number. The mean diameter of the main pancreatic duct was significantly larger in IPMCs (8.3 ± 5.9 mm) compared with IPMAs (4.7 ± 2.3 mm; P = .011). The mural nodule was a good predictor of malignancy (P = .0002) and was identified as the only independent and significant marker of IPMC in multivariate analysis.

CONCLUSIONS

The presence of mural nodules is a potentially suitable marker for differentiating IPMC from IPMA, and is important for making decisions about surgical interventions.

Synergistic antitumor effect of interferon-ß with gemcitabine in interferon-α-non-responsive pancreatic cancer cells

Interferon (IFN)-ß is reported to have more potent antitumor effects than IFN-α. The aim of this study was to compare the synergistic antitumor activity of both IFNs when combined with gemcitabine on cultured pancreatic cancer cells expressing various levels of IFN receptor. The growth-inhibitory effects of IFN-α and IFN-ß in combination with gemcitabine on three human pancreatic cancer cell lines (BxPC-3, MIAPaCa-2, Panc-1) were evaluated by MTT assay and isobolographic analysis. We also correlated their growth-inhibitory effects with the expression status of type I IFN receptor type 2 (IFNAR2). Western blot analysis indicated strong expression of IFNAR2 in BxPC-3 and MIAPaCa-2, but weak expression in Panc-1. The growth-inhibitory effect of gemcitabine was enhanced synergistically by IFN-α in BxPC-3 and MIAPaCa-2, but not in Panc-1. IFN-ß exhibited more potent synergistic growth-inhibitory effects with gemcitabine in BxPC-3 and MIAPaCa-2 compared to IFN-α, and also synergistic enhancement in Panc-1. In conclusion, our results indicated that the growth-inhibitory effect of IFN-ß with gemcitabine was synergistic not only in pancreatic cancer cells with strong expression of IFNAR2, but also in those with weak expression of IFNAR2.

Clinical significance of alpha-fetoprotein mRNA in peripheral blood in liver resection for hepatocellular carcinoma

PURPOSE

Detection of AFP mRNA in peripheral blood is considered a useful predictor of HCC recurrence after resection. However, its interpretation and clinical significance remains to be determined. This study was designed to evaluate the clinical significance of detecting AFP mRNA positive cells in peripheral blood.

METHODS

A total of 153 patients without macroscopic vascular invasion, who underwent liver resection, were prospectively enrolled in this study. The pattern of HCC recurrence was confirmed by image studies and divided into four types: (1) no recurrence (control group, n = 68); (2) intrahepatic single recurrence (SR group, n = 28); (3) intrahepatic multiple recurrences (MR group, n = 38); and (4) extrahepatic HCC recurrence (EX group, n = 19).

RESULTS

HCC recurrence was identified in 85 (55.6%) patients during a follow-up of 8.6 ± 6.7 (range, 0.7-36) months. Multivariate analysis identified preoperative AFP mRNA (HR = 2.54; P = 0.006) as an independent risk factor for HCC recurrence. Preoperative AFP mRNA expression was a significant predictor of HCC recurrence in the MR/EX group (P = 0.029) but not in the SR group (P = 0.467).

CONCLUSIONS

Detection of AFP mRNA expression in peripheral blood before surgery for HCC is a useful predictor of multiple or extrahepatic HCC recurrences.

A thick pancreas is a risk factor for pancreatic fistula after a distal pancreatectomy: selection of the closure technique according to the thickness

BACKGROUND/AIMS

Hand-sewn closures or stapler closures of the pancreatic remnant after a distal pancreatectomy have commonly been employed; however, the choice of technique in each patient depending on their clinical characteristics has not been discussed.

METHODS

Forty-eight patients who underwent a distal pancreatectomy at Osaka University Hospital between January 2007 and October 2009 were enrolled. A hand-sewn closure was planned during the 1st period (before June 2008, 26 consecutive patients), whereas a stapler closure was planned for the 2nd period (after June 2008, 22 consecutive patients). The incidence of pancreatic fistula and the patients' characteristics were retrospectively investigated.

RESULTS

Seven patients (27%) developed a fistula in the hand-sewn group, while 5 (23%) developed a fistula in the stapler group (p = n.s.). Using logistic regression analysis for all patients, younger age and the thickness of the pancreatic remnant were identified as independent risk factors for pancreatic fistula. In the stapler group, 50% of patients with a thick pancreas developed a pancreatic fistula, while no patients with a thin pancreas developed one.

CONCLUSION

Thick pancreas is one of the risk factors for pancreatic fistula after a distal pancreatectomy; however, a stapler closure seems to be suitable at least for thin pancreas.

Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma

AIM: To investigate whether fresh frozen plasma (FFP) transfusion affects outcomes following hepatic resection for hepatocellular carcinoma (HCC) in terms of liver function, postoperative complications and cancer prognosis.

METHODS: We retrospectively compared the incidence of postoperative complications between 204 patients who underwent hepatectomy for HCC with routine FFP transfusion in an early period (1983-1993, Group A) and 293 with necessity for FFP transfusion during a later period (1998-2006, Group B), and also between two subgroups of Group B [22 patients with FFP transfusion (Group B1) and 275 patients without FFP transfusion (Group B2)]. Additionally, only in limited patients in Group B1 and Group B2 with intraoperative blood loss ≥ 2000 mL (Group B1_{≥ 2000 mL} and Group B2_{≥ 2000 mL}), postoperative complications, liver function tests, and cancer prognosis were compared.

RESULTS: No mortality was registered in Group B, compared to 8 patients (3.9%) of Group A. The incidence of morbidity in Group B2 [23.2% (64/275)] was not significantly different from Group B1 [40.9% (9/22)] and Group A [27.0% (55/204)]. The incidence of complications and postoperative liver function tests were comparable between Group B1_{≥ 2000 mL}vs Group B2_{≥ 2000 mL}. Postoperative prognosis did not correlate with administration of FFP, but with tumor-related factors.

CONCLUSION: The outcome of hepatectomy for HCC is not influenced by FFP transfusion. We suggest FFP transfusion be abandoned in patients who undergo hepatectomy for HCC.

Utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography in differential diagnosis of benign and malignant intraductal papillary-mucinous neoplasm of the pancreas

Intraductal papillary-mucinous neoplasm (IPMN) of the pancreas presents in various histopathological stages from benign to malignant lesions. The differentiation between benign and malignant IPMN is important in order to determine the treatment of the patients. However, pre-operative differentiation remains difficult. The aim of this study was to assess the utility of 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in pre-operative differentiation of benign and malignant IPMN of the pancreas. In the present study we prospectively investigated 29 patients who underwent CT, FDG-PET, and surgery for IPMNs, followed by histopathological examination. The maximum standardized uptake value (SUVmax) was determined on FDG-PET, and differentiation of benign from malignant IPMN was tested using various SUVmax cut-off levels and various parameters derived from the CT. SUVmax was found to be significantly higher in malignant IPMNs (4.7+/-3.0) than that in benign IPMNs (1.8+/-0.3, P=0.0011). SUVmax values correlated with the histopathological types of IPMN (adenoma/borderline lesion/carcinoma in situ/invasive carcinoma) (Spearman rank correlation 0.865, P<0.0001). The specificity, sensitivity and accuracy values were best for SUVmax of 2.5 (100, 93, and 96%, respectively). The combination of mural nodule, detected on CT, and SUVmax of 2.5 offered the best diagnosis of malignant IPMN. These results suggest that FDG-PET is useful for differentiation of malignant IPMN of the pancreas, and that it should be performed in combination with other conventional imaging modalities.

[A long-term survival case of hepatocellular carcinoma with bone metastasis and inferior vena cava tumor thrombus successfully treated with multidisciplinary therapy]

A 54-year-old man was diagnosed as hepatitis B in 1987 and observed. In January 2007, he was detected a 7 cm mass in the posterior segment of the liver with inferior vena cava tumor thrombus (Vv3), a 4.5 cm mass and multiple small nodules in the liver by computed tomography. Moreover, his right pubic bone has solitary small osteolytic change in x-ray and abnormal up take on bone scintigram. We diagnosed it having a highly advanced hepatocellular carcinoma (HCC) with bone metastasis. We started to treat with multidisciplinary therapy. We performed Transarterial chemoembolization (TACE) twice for intrahepatic lesions and radiotherapy for bone metastasis. Interferon-α and S-1 combination therapy were performed for three months. A new lesion in the liver was appeared advanced slowly 16 months after the last TACE, and caused to increase PIVKA-II. He received TACE for this lesion. Three years after the diagnosis, and he is alive in good condition without a new extrahepatic metastasis. This case suggests that some patients with highly progressive HCC involving inferior vena cava tumor thrombus (Vv3) and bone metastasis can gain a long-term survival by multidisciplinary therapy including TACE and Interferon-α and S-1.

[A long-term survival case of hepatocellular carcinoma with portal vein and inferior vena cava tumor thrombi]

We report a case of advanced hepatocellular carcinoma (HCC) successfully treated by hepatic arterial infusion of 5-fluorouracil (5-FU) combined with systemic administration of interferon (IFN)-α and trans-arterial infusion (TAI) therapy of cisplatin (CDDP). A case was a 60-year-old man who had right upper abdominal pain and back pain. The abdominal CT revealed an early enhanced lesion in the posterior segment of the liver with portal vein and inferior vena caval tumor thrombi and multiple intrahepatic metastases. Tumor markers were elevated, AFP 2,480 ng/mL, PIVKA-II 31,900 mAU/mL. The patient underwent 4 courses of IFN-α/5-FU combination therapy and 8 times of TAI therapy of CDDP. After these therapies, tumors in the liver disappeared and tumor markers returned to the normal range. The patient is alive more than 58 months after the initial treatment. This case suggests that some patients with advanced HCC with tumor thrombus can get a long-term survival when intrahepatic lesions are controlled by various therapies including IFN-α/5-FU combination therapy.

[A case report--intrahepatic arterial infusion with CDDP and S-1 administration can elicit long-term survival for the patient with recurrenced intrahepatic cholangiocarcinoma after resection]

To cure intrahepatic cholangiocarcinoma (ICC), only a surgical resection is the potential treatment at present. However, recurrence tumors in residual liver and/or distant organs even after curative surgery are commonly experienced in clinical course. Unfortunately the potential treatment for this recurrent disease is not established at present. Accordingly, the prognosis of this recurrent ICC is extremely poor. Here, we report the prolonged survival case with recurrent ICC after hepatic resection followed by combined therapy of intrahepatic arterial infusion with CDDP and S-1 administration. The patient was a 71-year-old female. She had been treated for hepatitis B for last 5 years. After that, liver tumor of 30 mm in diameter was detected in S1/8 by abdominal CT examination. Subsequently, caudate lobectomy and partial resection of Segment 8 were performed under the diagnosis of Hepatocellular carcinoma in Osaka university hospital. The pathological stage was T2N0M0, Stage II with moderately differentiated intrahepatic cholangiocarcinoma. As the recurrence tumor was found in Segment 4 of residual liver, we started a treatment with intrahepatic arterial infusion with CDDP and S-1 administration, immediately. These combined therapy displayed beneficial effects and a recurrent liver tumor was well controlled. At present, this patient is still survived for over 5 years after the operation.

[A case of curative resected hilar bile duct cancer with hepatic artery and portal vein reconstructions]

The indication for surgical resection due to hilar bile duct cancer (BDC) with vessel reconstructions is still controversial. We report herein a successfully resected case due to hilar BDC with hepatic artery (HA) and portal vein (PV) reconstructions using autograft from a resected liver. A 57-year-old woman was diagnosed as hilar BDC, and computed tomography showed a tumor invaded left and common hepatic duct, right and left HA, and left main branch of PV. Because the extrahepatic area of right HA was free from the tumor, we performed left hepatectomy and caudate lobectomy with HA and PV reconstructions. We used auto left hepatic vein graft from the resected liver for PV reconstruction, because there was no appropriate size vein graft, e.g. inferior mesenteric vein. The patient is alive without any evidence of recurrence for 8 months after the surgery.

A single-incision laparoscopic hepatectomy for hepatocellular carcinoma: initial experience in a Japanese patient

Minimally invasive approaches for small liver tumors are desirable. We describe a single-incision laparoscopic hepatectomy (SILH) using total laparoscopic surgery (TLS) technique. SILH was performed to remove a solitary 2-cm hepatocellular carcinoma located at segment 3. The technique included a one-inch skin incision with three ports (one 12 mm and two of 5 mm each). The liver was sealed and dissected by three different devices: Harmonic scalpel, TissueLink sealing dissector, and Endoclip. Operation time was 70 minutes and blood loss was trivial. The patient required no analgesia postoperatively and walked unaided the next day. Various aspects of the procedure were not different from TLS. SILH is a safe procedure with several advantages. The procedure is promising as minimally invasive liver surgery.

Tyrosine kinase inhibitor PTK/ZK enhances the antitumor effects of interferon-α/5-fluorouracil therapy for hepatocellular carcinoma cells

PURPOSE

There is no standardized treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombus. We previously reported the efficacy of interferon-alpha and 5-fluorouracil combination (IFN/5-FU) therapy for these patients and the potential mechanism via the regulation of vascular endothelial growth factor (VEGF). In this study, we showed the VEGF-related effects of IFN/5-FU therapy using VEGF-receptor (VEGFR) selective inhibitor, PTK787/ZK222584 (PTK/ZK), in HCC cells.

METHODS

Using two VEGF secreting and VEGFR expressing human HCC cell lines, PLC/PRF/5 and HuH7, we performed growth inhibitory assays in vitro and in vivo, apoptosis assay, cell cycle analysis, and Western blot analysis for the mechanism, with or without PTK/ZK in IFN/5-FU therapy.

RESULTS

The combination of PTK/ZK and IFN/5-FU significantly inhibited cell growth in vitro and tended to reduce tumor growth in vivo in a HuH7 xenograft model in nude mice-in both cases without affecting VEGF secretion. PTK/ZK enhanced the IFN/5-FU induced apoptosis, based on increased proteins levels of Bax and reduced Bcl-xL and Bcl-2. Cell cycle analysis showed different results between the HCC cell lines following the combination therapy, possibly due to differences in p21 protein.

CONCLUSIONS

VEGF signaling inhibition would support an antitumor effect of IFN/5-FU therapy against HCC cell lines via induction of apoptosis and cell cycle delay.

Isolated metastasis to the gallbladder from hepatocellular carcinoma

AIM

Metastasis to gallbladder (GB) from hepatocellular carcinoma (HCC) is rare, and it is difficult to determine indications for surgery. We report eight cases of synchronous isolated GB metastasis, and analyze their features retrospectively.

METHODS

Among 439 HCC patients who underwent hepatectomy from 1998 to 2008 at our institution, 393 (89.5%) underwent concurrent cholecystectomy.

RESULTS

Among them, eight (1.8%) had GB metastasis without other distant metastases. None of these cases showed evidence of direct invasion. All cases had advanced portal vein thrombus (PVTT) and their main tumor located near the GB bed. Five cases had apparent tumor mass in the GB wall, and the other three cases had only tumor thrombus in the GB veins. Six cases were treated postoperatively with local infusion therapy with interferon, and three of them showed long-term survival.

CONCLUSION

Our eight cases of GB metastasis from HCC were closely related to PVTT. Surgical resection and multimodal treatment would be necessary for long-term survival in cases with isolated GB metastasis.

Increased immunogenicity of tumor-associated antigen, mucin 1, engineered to express alpha-gal epitopes: a novel approach to immunotherapy in pancreatic cancer

Mucin 1 (MUC1), a bound mucin glycoprotein, is overexpressed and aberrantly glycosylated in >80% of human ductal pancreatic carcinoma. Evidence suggests that MUC1 can be used as a tumor marker and is a potential target for immunotherapy of pancreatic cancer. However, vaccination with MUC1 peptides fails to stimulate the immune response against cancer cells because immunity toward tumor-associated antigens (TAA), including MUC1, in cancer patients is relatively weak, and the presentation of these TAAs to the immune system is poor due to their low immunogenicity. We investigated whether vaccination with immunogenetically enhanced MUC1 (by expressing alpha-gal epitopes; Galalpha1-3Galbeta1-4GlcNAc-R) can elicit effective antibody production for MUC1 itself as well as certain TAAs derived from pancreatic cancer cells and induced tumor-specific T-cell responses. We also used alpha1,3galactosyltransferase (alpha1,3GT) knockout mice that were preimmunized with pig kidney and transplanted with B16F10 melanoma cells transfected with MUC1 expression vector. Vaccination of these mice with alpha-gal MUC1 resulted in marked inhibition of tumor growth and significant improvement of overall survival time compared with mice vaccinated with MUC1 alone (P = 0.003). Furthermore, vaccination with pancreatic cancer cells expressing alpha-gal epitopes induced immune responses against not only differentiated cancer cells but also cancer stem cells. The results suggested that vaccination using cells engineered to express alpha-gal epitopes is a novel strategy for treatment of pancreatic cancer.

Effects of pre-operative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: Implication of circulating cancer cells by detection of α-fetoprotein mRNA

Transcatheter arterial chemoembolization (TACE) is useful for the treatment of multiple hepatocellular carcinomas (HCCs). Pre-operative TACE is used to reduce recurrence caused by peri- and post-operative spread of cancer cells; however, the efficacy is controversial. In this study, we evaluated the efficacy of pre-operative TACE for HCC and the implication of circulating cancer cells, retrospectively. We analyzed 495 patients with HCC who had undergone hepatectomy between 1980 and 2006, including 252 patients (50.9%) who received pre-operative TACE. The median follow-up period was 49.9 months. We compared the survival of TACE and non-TACE groups and also performed subgroup analysis. α-fetoprotein (AFP) mRNA was quantified to represent circulating cancer cells. Pre-operative TACE prolonged disease-free survival after hepatectomy in patients with HCCs greater than 5 cm (5-year disease-free survival of the pre-operative TACE and no-TACE groups was 37.3 vs. 14.8%, p<0.05). Patients with tumors showing 70% or greater necrosis had a significantly more favorable survival, and those with complete necrosis were all AFP mRNA-negative. The survival of the AFP mRNA-positive patients was worse than that of the AFP mRNA-negative patients. Pre-operative TACE may be beneficial for patients with tumors larger than 5 cm, and AFP mRNA quantification may be useful for the prediction of survival after surgery in TACE-treated patients.

Abstract 4747: MUC1, remodeled to express α-gal epitopes immune-based therapy, can elicit both significant prolonged survival and effective antibody production against multiple tumor-associated antigens

MUC1, a membrane bound mucin glycoprotein, is overexpressed and aberrantly glycosylated in more than 80% of human pancreatic carcinoma, has generated considerable interest as a potential target for immunotherapy. MUC1 immune-based therapies have not been successful, because immunity toward tumor-associated antigens (TAAs) in cancer patients is weak and the presentation of TAAs to the immune system is poor. Human natural antibody, Anti-Gal is an IgG known to be present in large amounts in normal subjects and patients with malignancies, comprising ∼1% of serum circulating IgG. Anti-Gal specifically interacts with α-gal epitopes (Galα1, 3Galβ1, 4GlcNAc-R), synthesized by α1, 3 galactosyltransferase (α1,3GT) on cell surface glycolipids and glycoproteins. MUC1 remodeled to express α-gal epitopes (α-gal MUC1), because MUC1 has five potential sites of N-glycans, can bind anti-Gal in situ at the vaccination site. Such interaction would enhance the recognition by APCs, resulting in more effective vaccination. We previously investigated the effectiveness of elicitation of both antibody production and T cell responses against MUC1 antigen by α-gal MUC1 vaccination. Present study addresses the usefulness of α-gal MUC1 vaccination for prolongation of survival and antibodies production, including anti-MUC1 and Abs toward other TAAs. A human pancreatic cancer cell line, PANC1, which expresses MUC1 was employed and transfected with α1,3GT gene (α-gal PANC1). High anti-Gal α1,3GT KO mice, which displayed anti-Gal titers similar to those found in humans were generated by immunization of pig tissue. These mice were vaccinated with either 1 × 106 irradiated parental PANC1 (control group) or α-gal PANC1 (α-gal group). To demonstrate in vivo tumor destruction by α-gal PANC1 vaccination, vaccinated mice were injected s.c. with 0.5 × 106 B16 melanoma cells, which were transfected with MUC1 gene. The mean survival of either control or α-gal group were found to be 21.1±10.5 days or 41.1±10.4 days, respectively, and the survival of α-gal group was significantly prolonged (control vs. α-gal group; p=0.003). To understand the induced antibody response for other TAAs, immunostained PANC1 proteins were investigated in Western blots with mice serum before/after vaccination. Although the serum from control group fail to display the significant bands, which was reflected by both anti-MUC1 Ab and anti-unknown TAAs Abs, the serum from α-gal group contained multiple antibodies that bound to not only MUC1 but also different unknown TAAs. We conclude that vaccination with tumor lysate remodeled to express α-gal epitopes can effectively upregulated immunogenicity of multiple TAAs, including MUC1 but also other unknown TAAs and may provide a chance to develop the potential immunotherapy for pancreatic cancer patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4747.

Impact of postoperative irradiation after non-curative resection of hilar biliary cancer

BACKGROUND

The aim of this retrospective study was to determine the effect of surgical margin on the outcome of postoperative radiotherapy (RT) in patients with resected hilar biliary cancer.

METHODS

The study subjects were 87 patients with hilar biliary cancer resected surgically before 2008. Based on the Japanese Society of Biliary Surgery (JSBS) criteria for diagnosis of biliary cancer, the surgical margin status was categorized as margin 1 (histopathologically margin negative, but cancer cells identified within 5 mm from the margin), margin 2 (histopathologically margin positive), and margin 0 (other margin status).

RESULTS

The surgical margin was 1 or 2 in 44 patients and 21 of these patients underwent RT. The 3-year overall survival and progression-free survival rates of the RT and non-RT groups were 47% and 23% (P = 0.0392), and 49% and 19% (P = 0.0197), respectively. Univariate and multivariate analyses identified RT as the only factor that influenced survival. Subgroup analysis showed that the effect of RT was dependent on pathologically negative lymph node metastasis and positive margin (margin 2).

CONCLUSION

Postoperative RT is beneficial for patients with margins 1 and 2, especially those who are lymph node metastasis negative and have histopathologically positive margin.

Salvage cystic duct anastomosis using a magnetic compression technique for incomplete bile duct reconstruction in living donor liver transplantation

In living donor liver transplantation (LDLT), bile duct reconstruction is often technically demanding due to the frequently anomalous anatomy of the bile duct, as well as the high incidence of biliary complications. A bile duct branch may also be accidentally left without anastomosis at the time of LDLT and found to be obstructed after surgery. Surgical revision for such cases is sometimes not feasible because of the invasiveness of the procedure. We report a case in which a bile duct branch was intentionally left without anastomosis and was later successfully anastomosed to the cystic duct stump using a magnetic compression anastomosis (MCA) technique. A combination of the MCA technique and cystic duct anastomosis is life-saving in certain situations and should be considered as the treatment of choice.

[A case of complete response to S-1 therapy for multiple pulmonary recurrences of hepatocellular carcinoma after hepatic resection]

A 68-year-old man lost in unconscious and was diagnosed as ruptured hepatocellular carcinoma (HCC) in a local emergency hospital. He was treated by transcatheter arterial embolization, and further investigation revealed simultaneous cancer in rectum. He was referred to our institute, and admitted in June 2005. He underwent lateral segment and S8 partial resection of the liver, cholecystectomy, anterior resection of rectum, and D3 lymphadenectomy in August 2005. Multiple HCC recurrences in the remnant liver appeared in December 2005. He was subsequently treated with transcatheter chemoembolization four times. In May 2006, CT scan revealed multiple metastatic nodules in bilateral lungs with remarkably elevated serum AFP and PIVKA-II. The nodules were diagnosed as lung metastasis of the HCC. Because the lesions grew larger, S-1 was started in February 2007. Diagnostic imaging and tumor markers showed a marked improvement 2 months after S-1 administration, and no recurrence has been found since then. This case illustrates that S-1 may be an effective treatment for HCC with extrahepatic metastasis.

Ultraviolet Laser Action in Ferromagnetic Zn1-xFexO Nanoneedles

Fe-doped ZnO nanoneedles (NDs) were fabricated by an Ar+ ion sputtering technique operated at room temperature. The as-grown samples show both ferromagnetic and lasing properties. The saturated magnetization moment was measured from 0.307 to 0.659 emu cm-3 at the field of 10 kOe with various Fe concentrations. Intense ultraviolet random lasing emission was observed from Zn1 - xFexO NDs at room temperature. The X-ray photoelectron spectroscopy result reveals that the doped Fe atoms occupy the Zn sites and lead to a decrease in oxygen deficiency.

[A long-term survival case of pancreatic cancer with hepatic metastasis after pancreaticoduodenectomy successfully treated by s-1 and gemcitabine combination chemotherapy]

Gemcitabine monotherapy is accepted as a standard first-line treatment for locally advanced unresectable or metastatic pancreatic cancer. On another front, S-1 and gemcitabine combination chemotherapy is challenging but promising. We report a long-term survival case of pancreatic cancer with hepatic metastasis after surgical resection treated by S-1 and gemcitabine combination chemotherapy. A 59-year-old woman was diagnosed as locoregionally advanced pancreas head cancer without metastatic disease. Pancreatoduodenectomy with regional lymph node dissection was performed after preoperative chemoradiotherapy. Pathological examination revealed a poorly differentiated adenocarcinoma. A solitary hepatic metastasis was detected by CT imaging one year after the surgery. The patient received 35 courses of S-1 and gemcitabine combination therapy. The metastatic tumor was disappeared, and serum CEA decreased to a normal level. S-1 and gemcitabine combination therapy is not only effective but also well tolerated and safe. This combination therapy should be considered one of selective choices for advanced or metastatic pancreatic cancer.

[A case of successful multimodal treatment for combined hepatocellular and cholangiocarcinoma with portal venous tumor thrombus]

We report a case of successful multimodal treatment for combined hepatocellular and cholangiocarcinoma with portal venous tumor thrombus. A 66-year-old man was diagnosed with hepatocellular carcinoma with Vp3 by abdominal enhanced CT. He underwent a complete tumor resection and following interferon and 5-FU combined intra-arterial chemotherapy as an adjuvant setting. The histological findings were consistent with combined hepatocellular and cholangiocarcinoma. At 9 months after the surgery, lymph node metastases were detected. Then we started an oral fluoropyrimidine anticancer agent S-1, because the recurrence was suspected to be originated from the cholangiocarcinoma component. Thereafter, sustained partial remission was achieved. In case of combined hepatocellular and cholangiocarcinoma, we need to create a treatment strategy against characteristics of both components.

[A long-term survival case of hepatocellular carcinoma with lymph node metastasis on the posterior surface of the pancreas head and portal vein tumor thrombus successfully treated with hepatopancreatoduodenectomy and adjuvant interferon-alpha and 5-fluorouracil combination therapy]

A 72-year-old man, who had undergone partial hepatectomy for hepatocellular carcinoma (HCC), was admitted to our hospital for treatment of HCC recurrence. At laparotomy, intrahepatic metastasis on S6/1 with lymph node metastasis on the posterior surface of the pancreas head, suggesting direct invasion to pancreas, and portal vein tumor thrombus were identified. Hepatopancreatoduodenectomy and removal of the tumor thrombus was performed. Microscopic examination confirmed intrahepatic metastasis from HCC with portal vein tumor thrombus and lymph node metastasis. After the surgery, adjuvant interferon-alpha and 5-fluorouracil combination therapy was administered. Forty-one months after the surgery, solitary intrahepatic recurrence was identified, and radiofrequency ablation therapy was performed. Sixty-six months after the surgery, he remains in good condition without recurrence. This case suggests that some patients with HCC involving lymph node metastasis and portal vein tumor thrombus can gain a long-term survival by multifocal treatment including curative surgery, even if the surgical procedure is highly stressful, and adjuvant interferon-alpha and 5-fluorouracil combination therapy.

[A case of locally advanced pancreatic cancer with superior membrane artery invasion successfully resected after gemcitabine-based chemoradiotherapy]

A 69-year-old man with chief complaint of epigastralgia was diagnosed as locally advanced borderline unresectable pancreatic head cancer that involved superior membrane artery (SMA). Gemcitabine (GEM) -based chemoradiotherapy (CRT) was administered for consecutive 3 weeks in the following fashion: continuous twice-a-day accelerated radiotherapy (2 daily fractions of 1.5 Gy, 5 days a week, with a 6-hr minimal interval between fractions) with 3-time weekly intravenous infusions of GEM. Total radiation dose was 45 Gy and GEM was given on days 1, 8 and 15 at dose of 800 mg/m2. After the completion of CRT, the involvement of SMA remained. Next, additional systemic chemotherapy with GEM was performed for 3 weeks in the following fashion: weekly intravenous infusions of GEM at dose of 1,000 mg/m2. Finally, the main tumor and the invasion to SMA were reduced. Surgical resection with negative margins (R0 resection) was performed. Adjuvant chemotherapy with 6 courses of GEM was also performed. The patient has no recurrence, suggesting the efficacy of GEM-based CRT for locally advanced borderline unresectable pancreatic cancer.

[A case of long-term survival for advanced gallbladder cancer]

A 50-year-old woman with epigastric uncomfortable feeling was referred to our hospital. We have diagnosed her as an advanced gallbladder cancer with direct liver invasion and lymph node metastasis of hepatoduodenal ligament by the image analysis, including enhanced abdominal CT, MRI and FDG-PET. Subsequently, we performed operation with cholecystectomy, hepatic segmentectomy of S4a/5, bile duct resection and D2 lymph node dissection, resulted in the curative operation. We additionally performed adjuvant chemotherapy with 6 courses of 800 mg/m2 of gemcitabine (GEM) on days 1, 8 and 15 for every 35 days. No recurrent signs were observed for 33 months after curative operation.

Combination of interferon-alpha and 5-fluorouracil inhibits endothelial cell growth directly and by regulation of angiogenic factors released by tumor cells

Background

The combination therapy of interferon (IFN)-alpha and 5-fluorouracil (5-FU) improved the prognosis of the patients with hepatocellular carcinoma (HCC). To determine the molecular mechanisms of the anti-tumor and anti-angiogenic effects, we examined the direct anti-proliferative effects on human umbilical vein endothelial cells (HUVEC) and indirect effects by regulating secretion of angiogenic factors from HCC cells.

Methods

The direct effects on HUVEC were examined by TUNEL, Annexin-V assays and cell cycles analysis. For analysis of the indirect effects, the apoptosis induced by the conditioned medium from HCC cell treated by IFN-alpha/5-FU and expression of angiogenic factors was examined.

Results

IFN-alpha and 5-FU alone had anti-proliferative properties on HUVEC and their combination significantly inhibited the growth (compared with control, 5-FU or IFN alone). TUNEL and Annexin-V assays showed no apoptosis. Cell cycle analysis revealed that IFN-alpha and 5-FU delayed cell cycle progression in HUVEC with S-phase accumulation. The conditioned medium from HuH-7 cells after treatment with IFN/5-FU significantly inhibited HUVEC growth and induced apoptosis, and contained high levels of angiopoietin (Ang)-1 and low levels of vascular endothelial growth factor (VEGF) and Ang-2. Knockdown of Ang-1 in HuH-7 cells abrogated the anti-proliferative effects on HUVEC while knockdown of Ang-2 partially rescue the cells.

Conclusion

These results suggested that IFN-alpha and 5-FU had direct growth inhibitory effects on endothelial cells, as well as anti-angiogenic effects through regulation of angiogenic factors released from HCC cells. Modulation of VEGF and Angs secretion by IFN-alpha and 5-FU may contribute to their anti-angiogenic and anti-tumor effects on HCC.