[Analysis of KRAS status in cancer tissue with submucosal or deeper invasion in patients with familial adenomatous polyposis]

The KRAS status in cancer tissue with submucosal or deeper invasion was investigated in patients with familial adenomatous polyposis (FAP). Fifteen cancerous lesions in 10 FAP patients were subjected to analysis for KRAS status. The clinical features of FAP were the dense type in 2 patients and the sparse type in 8 patients. Of the 15 cancerous lesions, 6 (40%) were identified as having wild-type KRAS and the remaining 9 (60%), as having mutated KRAS. Of the 9 mutated lesions, the G13D mutation was recognized in 4 patients and was the most frequent pattern. With regard to the KRAS status in patients with multiple cancerous lesions, 1 patient had 3 cancerous lesions of which 2 were of the mutated type and 1 was of the wild type and another patient had 4 cancerous lesions of which 3 were of the mutated type and 1 was of the wild type. These results suggest that the frequency of wild-type KRAS in cancer associated with FAP was approximately 40%, although it was lower than that in sporadic cancer. Moreover, we need to analyze the KRAS status in all cancerous lesions in clinical practice when chemotherapy with anti-epidermal growth factor receptor (EGFR) antibody is required for the treatment of FAP patients with unresectable advanced multiple cancers.

C-reactive protein is a negative independent factor in patients with stage IV colorectal cancer undergoing oxaliplatin-based chemotherapy

BACKGROUND/AIM

To determine the clinical significance of C-reactive protein (CRP) concentration in patients with stage IV colorectal cancer (CRC) undergoing oxaliplatin-based chemotherapy.

PATIENTS AND METHODS

We retrospectively reviewed the medical charts of 112 patients with stage IV CRC who had received modified FOLFOX6 (5-fluorouracil, oxaliplatin, leucovorin) between January 2006, and December 2010 and used Cox's proportional hazard model to determine for independent prognostic factors of survival. We generated receiver operating characteristics (ROC) curves to determine the optimal cut-off for the discrimination of the duration of survival by CRP concentration.

RESULTS

According to the multivariate analysis, increased CRP concentration (p=0.04) and non-curative surgery (p<0.01) were independent unfavorable factors for survival, and the optimal cut-off CRP concentration according to dichotomized duration of survival (3-24 months) ranged from 0.8 to 1.2 mg/dl.

CONCLUSION

Pre-chemotherapy CRP concentrations may be useful for predicting survival of patients with stage IV CRC.

[Outcomes of patients with small bowel carcinoma treated with appropriate chemotherapy selected on the basis of genetic analysis findings]

Small bowel carcinoma is a rare tumor, for which a standardized chemotherapy regimen has not yet been established. Further, this tumor may belong to the group of Lynch syndrome-associated tumors, which are resistant to 5-fluorouracil (5-FU) -based chemotherapy. We investigated mismatch repair protein expression and K-ras gene mutation status in 8 patients with aggressive small bowel carcinoma and determined the chemotherapy regimen used in these patients. Immunohistochemical staining indicated normal mismatch repair protein expression in all surgical specimens. Of 8 patients, 4( 50%) had K-ras codon 12 mutations. Because small bowel carcinoma is not significantly associated with Lynch syndrome, 5-FU-based chemotherapy would be appropriate for the treatment of these patients. The prevalence of K-ras codon 12 mutations was relatively similar to that in patients with sporadic colorectal carcinoma, and the usefulness of anti- epidermal growth factor receptor (EGFR) antibody for the treatment of small bowel carcinoma should be evaluated in the future.

[Theoretical background of our original single-incision laparoscopic-assisted surgery technique for colon cancer via a periumbilical approach]

We assessed the theoretical background of our original single-incision laparoscopic-assisted surgery( SILS) technique involving a periumbilical approach. The subjects included 10 cases who underwent periumbilical SILS colectomy and had their surgical wounds photographed before and after skin incision between September 2009 and October 2010. Using an image analyzer, we estimated the theoretical oval area after a 3/4-circumferential periumbilical skin incision, the actual oval area after placement of the wound retractor, and the length of the skin incision. The mean oval area after the placement of the wound retractor was 2.9 times (range: 1.6-5.0 times) larger than that of the theoretical area. The square of the length of the skin incision positively correlated with the actual oval area created by placing the wound retractor( p=0.04, r=0.67). There were 5 patients, whose actual oval area was ≤700 mm2, and thus required additional radial skin incision( s)( 1 in 3 cases, 2 in 1 case and 3 in 1 case). When performing our original SILS via the periumbilical approach, the area of the actual surgical window can be predicted by measuring the distance from the center of the umbilicus to its edge.

[Efficacy of oxaliplatin-based chemotherapy in Stage IV colorectal cancer patients with peritoneal carcinomatosis]

PURPOSE

This retrospective study evaluated the outcome of oxaliplatin-based chemotherapy for peritoneal metastasis from colorectal cancer.

PATIENTS AND METHODS

The study included 49 patients with peritoneal metastasis from colorectal cancer who underwent oxaliplatin-based chemotherapy between January 2006 and November 2012 and 25 patients who underwent systematic chemotherapy before oxaliplatin-based chemotherapy. Patient background characteristics, overall survival(l OS), and prognostic outcomes were examined.

RESULTS

OS was significantly longer in patients treated with oxaliplatin -based chemotherapy than in those treated with prior chemotherapy( median, 20.5 months vs 11.7 months, p= 0.04). Multivariate analysis showed that treatment with oxaliplatin-based chemotherapy, age less than 70 years(p=0.03), and primary tumor resection( p=0.02) were significant independent factors affecting OS.

CONCLUSION

Oxaliplatin-based chemotherapy improved the prognosis of patients with peritoneal metastasis from colorectal cancer. In the treatment of such patients, initiation of chemotherapy after primary tumor resection appears to be important, especially in patients aged <70 years.

[Strategy for surgery in familial adenomatous polyposis patients with invasive colorectal cancer]

PURPOSE

Total proctocolectomy with ileal pouch-anal anastomosis (IPAA) has been established as the standard operative procedure for classic familial adenomatous polyposis( FAP). However, it is unclear which type of surgery should be undertaken for FAP patients with invasive colorectal cancer in clinical practice. This study evaluated the outcome of different surgeries performed in FAP patients with invasive colorectal cancer.

PATIENTS AND METHODS

The study included 21 classic FAP patients with or without invasive colorectal cancer, who underwent proctocolectomy at our institute between 2000 and 2013. Patient background, type of operation, and prognosis were retrospectively examined.

RESULTS

In the non-invasive cancer group, total proctocolectomy with IPAA was performed in 7 patients, and colectomy with ileorectal anastomosis (IRA) was performed in 5 patients. Conversely, in the invasive cancer group, IPAA, proctocolectomy with end ileostomy (TPC), and IRA were performed in 2, 2, and 5 patients, respectively. Overall survival did not differ significantly between the 2 groups( 5 year survival, 88.9% vs 75.0%, p=0.48).

CONCLUSION

These results suggest that IPAA, IRA, or TPC might contribute to survival time prolongation in patients with invasive colorectal cancer, as is the case for those without invasive colorectal cancer.

Isomers in 128Pd and 126Pd: evidence for a robust shell closure at the neutron magic number 82 in exotic palladium isotopes

The level structures of the very neutron-rich nuclei 128Pd and 126Pd have been investigated for the first time. In the r-process waiting-point nucleus 128Pd, a new isomer with a half-life of 5.8(8) μs is proposed to have a spin and parity of 8(+) and is associated with a maximally aligned configuration arising from the g(9/2) proton subshell with seniority υ=2. For 126Pd, two new isomers have been identified with half-lives of 0.33(4) and 0.44(3) μs. The yrast 2(+) energy is much higher in 128Pd than in 126Pd, while the level sequence below the 8(+) isomer in 128Pd is similar to that in the N=82 isotone 130Cd. The electric quadrupole transition that depopulates the 8(+) isomer in 128Pd is more hindered than the corresponding transition in 130Cd, as expected in the seniority scheme for a semimagic, spherical nucleus. These experimental findings indicate that the shell closure at the neutron number N=82 is fairly robust in the neutron-rich Pd isotopes.

Clinicopathologic characteristics and clinical outcomes of esophageal basaloid squamous carcinoma: experience at a single institution

This retrospective study investigated the clinicopathologic characteristics and clinical outcomes of esophageal basaloid squamous carcinoma (BSC). Among 190 patients with esophageal carcinoma treated surgically between 1998 and 2011, we identified 9 (4.7%) with BSC. All of the patients were male, with a median age of 65 years. The frequencies of venous invasion, lymphatic invasion, and lymph node metastasis were 56%, 89%, and 67%, respectively. A total of 2 patients were pathologic stage 1, 5 were stage 2, and 2 were stage 3. Tumor recurrence was observed in 56% of the patients. The 5-year survival rate for patients with esophageal BSC was 40%, which was compatible with the figure of 53.8% for control patients (n = 18) with typical squamous cell carcinoma matched for sex, age, tumor location, and pathologic stage (P = 0.45). Although esophageal BSC shows aggressive lymph-vascular invasion and has a high likelihood of recurrence, its prognosis seems identical to that of typical squamous cell carcinoma.

Oxaliplatin-based chemotherapy in patients aged 75 years or older with metastatic colorectal cancer

AIM

To evaluate the tolerability and efficacy of oxaliplatin-based chemotherapy (OBC) in patients ≥ 75 years old with metastatic colorectal cancer (CRC).

PATIENTS AND METHODS

We reviewed the medical records of 126 patients with unresectable stage IV CRC in terms of OBC administered as first-line chemotherapy whenever feasible.

RESULTS

Use of first-line OBC was significantly less frequent in patients ≥ 75 years old (n=18) than in patients <75 years old (n=108) (46% vs. 81% p<0.01). When analysis was restricted to patients receiving OBC, the two age groups did not differ significantly in terms of response rate (44% vs. 36%, p=0.54), progression-free survival (18.7 months vs. 13.0 months, p=0.44), overall survival (25.4 months vs. 17.5 months, p=0.53), and frequency of grade 3-4 toxicity (72% vs. 58%, p=0.26).

CONCLUSION

In selected patients aged 75 years or greater, the clinical outcomes of OBC seem equivalent to those of younger patients.

Influence of preoperative docetaxel, cisplatin, and 5-fluorouracil on the incidence of complications after esophagectomy for resectable advanced esophageal cancer

A limited number of patients with resectable advanced esophageal cancer can be cured by surgery alone. Although a regimen that consists of docetaxel, cisplatin, and 5-fluorouracil (DCF) is a potential preoperative chemotherapy (PCT) option for squamous cell carcinoma of the esophagus, the influence of DCF on subsequent esophagectomies remains unclear. A total of 80 patients who received preoperative DCF chemotherapy, and 174 patients who did not receive any preoperative treatment were retrospectively analyzed. There were no treatment-related deaths. No delays in surgery due to adverse events related to DCF were reported. Although patients who received PCT had significantly more advanced cancers and worse preoperative conditions, the incidence rates of complications did not increase. Although the frequency of severe complications was significantly higher in patients who received PCT, this treatment was not an independent factor for the occurrence of severe complications. PCT with DCF did not negatively affect subsequent esophagectomies with regard to the frequency of complications.

Polymorphisms of GSTP1, ERCC2 and TS-3'UTR are associated with the clinical outcome of mFOLFOX6 in colorectal cancer patients

The aim of the current study was to examine whether polymorphisms in drug metabolism genes have any clinical impact on patients treated with 5-fluorouracil (FU)/oxaliplatin for metastatic colorectal cancer (MCRC). In total, 63 patients with MCRC were recruited and treated with a modified FOLFOX6 (mFOLFOX6) treatment as a first-line chemotherapy. Polymorphisms in five drug metabolism genes and two DNA-repair genes were assessed in these patients using polymerase chain reaction (PCR), a PCR restriction fragment length polymorphism (PCR-RFLP) technique or invader techniques. These included a 28-bp tandem repeat in the 5'-untranslated region (UTR) and 6-bp deletions in the 3'-UTR of thymidylate synthase (TS), methylenetetrahydrofolate reductase (MTHFR; Ala677Val), glutathione S-transferase π (GSTP1; IIe105Val), GST θ1 (GSTT1; deletion) and GST μ1 (GSTM1; deletion) and the two DNA-repair genes, excision repair cross-complementing-1 (ERCC1; Asp118Asn) and ERCC2 (Lys751Gln). The correlation between these polymorphisms and the clinical outcome, including drug response, progression-free survival (PFS), overall survival (OS) and the incidence of peripheral neuropathy, were evaluated. Patients with the GSTP1-105 A/A genotype had poor responses to mFOLFOX6 treatment compared with those with the GSTP1-105 A/G and G/G genotypes (P=0.01). The median PFS of patients with the ERCC2-751 A/A genotype tended to be longer than that of patients with the ERCC2-751 A/C genotype (P=0.05). Patients with the TS-3'-UTR -6/-6 genotype had a significantly longer OS compared with patients with other genotypes (P=0.003). A statistically significant association between the incidence of peripheral neuropathy higher than grade 2 and the GSTP1-105 (P=0.03) and GSTM1 genotypes (P=0.02) was identified by multivariate logistic regression analyses. Results demonstrated that polymorphisms in GSTP1-105, ERCC2-751 and the 3'-UTR of TS may be a statistically significant predictors of clinical outcome. GSTP1-105 and GSTM1 genotypes may be useful markers of severe peripheral neuropathy in MCRC patients treated with 5-FU/oxaliplatin as first-line chemotherapy.

Methylation levels of LINE-1 in primary lesion and matched metastatic lesions of colorectal cancer

Background:

LINE-1 methylation level is a surrogate marker of global DNA methylation. LINE-1 methylation in primary colorectal cancers (CRCs) is highly variable and strongly associated with a poor prognosis. However, no study has examined LINE-1 methylation levels of metastatic CRCs in relation to prognosis or assessed the heterogeneity of LINE-1 methylation level within the primary CRCs.

Methods:

Pyrosequencing was used to quantify LINE-1 methylation level in 42 liver metastases, 26 matched primary tumours, and 6 matched lymph node (LN) metastases. KRAS, BRAF, and PIK3CA mutation status and microsatellite instability (MSI) status were also examined.

Results:

The distribution of LINE-1 methylation level in liver metastases was as follows: mean, 67.3; range, 37.1–90.1. Primary tumours showed LINE-1 methylation levels similar to those of matched liver and LN metastases. The difference in LINE-1 methylation level between superficial areas and invasive front areas was within 7.0 in all six cases evaluated. Prognostic impact of LINE-1 hypomethylation in liver metastases on overall survival was not observed. The concordance rate was 94% for KRAS, 100% for BRAF, 88% for PIK3CA, and 97% for MSI.

Conclusion:

Alteration of LINE-1 methylation level may occur in early CRC tumorigenesis, and the LINE-1 methylation level is relatively stable during CRC progression.

Influenza-associated bacterial pathogens in patients with 2009 influenza A (H1N1) infection: impact of community-associated methicillin-resistant Staphylococcus aureus in Queensland, Australia

BACKGROUND

Secondary bacterial pneumonia due to community onset methicillin-resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza-associated death. There is a risk that case reports of fatal outcomes with post-influenza MRSA pneumonia may unduly influence antibiotic prescribing.

AIMS

The aim of this study was to demonstrate the incidence of community-onset MRSA pneumonia in 2009 H1N1 influenza patients.

METHODS

The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included.

RESULTS

In 2009, 4491 laboratory-confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions.

CONCLUSIONS

Influenza-associated community-onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community-onset MRSA skin and soft tissue infections being very common. Although post-influenza MRSA pneumonia is of great concern, its influence on empiric-prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.

Safety of polypropylene mesh for incarcerated groin and obturator hernias: a retrospective study of 110 patients

PURPOSE

The purpose of this study was to evaluate the mesh repair for an incarcerated groin hernia.

METHODS

A total of 110 patients who underwent emergency surgery for incarcerated hernias were retrospectively analyzed using a multivariate analysis.

RESULTS

The postoperative complications were associated with bowel resection, odds ratio (OR) 2.984, and 95 % confidence interval (CI) 1.273 to 6.994. The risk factors for bowel resection were femoral hernia, (OR 5.621, 95 % CI 2.243 to 14.082), and late hospitalization (24 h<), (OR 2.935, 95 % CI 1.163-7.406). The hernias were repaired with mesh in ten of the 39 (25.6 %) patients with bowel resection and sixty-four of the 71 (90.1 %) patients without bowel resection. The complication rate of the patients with bowel resection was 53.8 % and was 26.8 % in those without. The ratios of wound infection were 23.1 and 0.0 %, respectively. Wound infections were detected in two (20 %) of the ten patients who underwent bowel resection with mesh repair; however, there were no patients in whom the mesh was withdrawn due to infection.

CONCLUSIONS

No wound infections in patients without bowel resection were detected, and mesh repair could be safely performed. Mesh repair for the patients with bowel resection is not contraindicated, as long as the clean-contamination of the wound was maintained during surgery.

Should isolated peritoneal carcinomatosis from colorectal cancer be sub-classified into stage IVB in era of modern chemotherapy?

BACKGROUND

According to the 7th edition of the TNM staging system, stage IV metastatic colorectal cancer (CRC) at the time of initial diagnosis is sub-classified into stage IVA or IVB disease. Peritoneal carcinomatosis (PC), considered to have a dismal prognosis, is exclusively sub-classified into stage IVB, even though other metastases to a sole organ are sub-classified into stage IVA, which is considered to be associated with better survival. This retrospective study was undertaken to investigate the overall survival in metastatic CRC patients, focusing on PC patients.

METHODS

We reviewed data on patients with metastatic CRC at initial diagnosis surgically treated between January 2006 and June 2011. A survival analysis was performed paying special attention to PC and sub-classifying patients with PC into three categories according to metastatic sites.

RESULTS

There were 69 stage IVA patients (IVA group) and 83 stage IVB. Among stage IVB patients, 20 had isolated PC (PC-I group), 28 had PC with one or more other sites of metastasis (PC-II group), and 35 had at least 2 metastatic without peritoneal involvement (NPC group). Of 152 stage IV patients, 132 (87 %) underwent resection of the primary tumor and 19 (12 %) underwent radical resection of metastatic disease with microscopic free margins (R0 resection) including 5/20 (25 %) patients in the PC1 group. A total of 139 patients received oxaliplatin-based chemotherapy in a palliative (n = 125), neoadjuvant (n = 3), or adjuvant setting after R0 resection (n = 11). Compared with 36.6 months in the PC-I group, median survival was 32.5 months (P = 0.48) in the IVA group, 14.7 months (P = 0.07) in the PC-II group, and 12.9 months (P < 0.01) in the NPC group.

CONCLUSIONS

The sub-classification of isolated PC into stage IVA instead of IVB might be more appropriate in the era of modern chemotherapy. Further investigation is warranted.

Distal pancreatectomy using a no-touch isolation technique

BACKGROUND AND AIMS

Distal pancreatectomy is the only effective treatment for cancers of the pancreatic body and tail. The recurrence rate after DP has remained high. In an effort to over-come this problem, we developed a no-touch surgical technique for DP. This is a pilot study to see if distal pancreatectomy can be technically done using a no-touch surgical technique with-out deteriorating the post-operative prognosis.

PATIENTS AND METHODS

From November 2000 through May 2011, 16 pancreatic ductal adeno-carcinoma patients have been operated on using a no-touch technique by a single operator. We described the surgical technique, and we reported our preliminary experience. During the procedure, the pancreatic body and tail is neither grasped nor squeezed by the surgeon. And all drainage vessels from the pancreatic body and tail are ligated and divided during the early phase of the operation. Furthermore, for improved dissection of the retroperitoneal tissue (rightward and posterior margins), we use a hanging and clamping maneuver and dissection behind Gerota's fascia.

RESULTS

In the current series, the posterior and rightward resection margins were free in all patients, although seven were positive for anterior serosal invasion. The post-operative prognosis was not deteriorated with this technique.

CONCLUSION

No-touch distal pancreatectomy technique may have some theoretical advantages, which merit future investigation in randomized controlled trials.

External biliary drainage and liver regeneration after major hepatectomy

BACKGROUND

Bile acid signalling and farnesoid X receptor activation are assumed to be essential for liver regeneration. This study was designed to investigate the association between serum bile acid levels and extent of liver regeneration after major hepatectomy.

METHODS

Patients who underwent left- or right-sided hemihepatectomy between 2006 and 2009 at the authors' institution were eligible for inclusion. Patients were divided into two groups: those undergoing hemihepatectomy with external bile drainage by cystic duct tube (group 1) and those having hemihepatectomy without drainage (group 2). Serum bile acid levels were measured before and after hepatectomy. Computed tomography was used to calculate liver volume before hepatectomy and remnant liver volume on day 7 after surgery.

RESULTS

A total of 46 patients were enrolled. Mean(s.d.) serum bile acid levels on day 3 after hemihepatectomy were significantly higher in group 2 than in group 1 (11·6(13·5) versus 2·7(2·1) µmol/l; P = 0·003). Regenerated liver volumes on day 7 after hepatectomy were significantly greater in group 2 138·1(135·9) ml versus 40·0(158·8) ml in group 1; P = 0·038). Liver regeneration volumes and rates on day 7 after hemihepatectomy were positively associated with serum bile acid levels on day 3 after hemihepatectomy (P = 0·006 and P < 0·001 respectively). The incidence of bile leakage was similar in the two groups.

CONCLUSION

Initial liver regeneration after major hepatectomy was less after biliary drainage and was associated with serum bile acid levels. External biliary drainage should be used judiciously after liver resection.

Upregulation of ERCC1 and DPD expressions after oxaliplatin-based first-line chemotherapy for metastatic colorectal cancer

BACKGROUND

The updated randomised phase 2/3 FIRIS study demonstrated the noninferiority of IRIS (irinotecan and S-1) to FOLFIRI (irinotecan, folinic acid, and 5-FU) for metastatic colorectal cancer. Meanwhile, in the subset analysis including patients who previously have undergone oxaliplatin-containing chemotherapy, the IRIS group showed longer survival than the FOLFIRI group. However, the molecular mechanism underlying this result is still unknown.

METHODS

The National Cancer Institute 60 (NCI60) cell line panel data were utilised to build the hypothesis. A total of 45 irinotecan-naive metastatic colorectal cancer patients who had undergone hepatic resection were included for the validation study. The mRNA expressions of excision repair cross-complementing group 1 (ERCC1), dihydropyrimidine dehydrogenase (DPD), and topoisomerase-1 (TOP1) were evaluated by quantitative RT-PCR. The expressions of ERCC1 and DPD were also evaluated by immunohistochemistry.

RESULTS

Sensitivity to oxaliplatin in 60 cell lines was significantly correlated with that of 5-FU. Resistant cells to oxaliplatin showed significantly higher ERCC1 and DPD expression than sensitive cells. In validation study, ERCC1 and DPD but not TOP1 expressions in cancer cells were significantly higher in FOLFOX (oxaliplatin, folinic acid, and 5-FU)-treated patients (N=24) than nontreated patients (N=21). The ERCC1 and DPD protein expressions were also significantly higher in FOLFOX-treated patients.

CONCLUSION

The ERCC1 and DPD expression levels at both mRNA and protein levels were significantly higher in patients with oxaliplatin as a first-line chemotherapy than those without oxaliplatin. The IRIS regimens with the DPD inhibitory fluoropyrimidine may show superior activity against DPD-high tumours (e.g., tumours treated with oxaliplatin) compared with FOLFIRI.

Well developed deformation in 42Si

Excited states in (38,40,42) Si nuclei have been studied via in-beam γ-ray spectroscopy with multinucleon removal reactions. Intense radioactive beams of ^{40}S and (44)S provided at the new facility of the RIKEN Radioactive Isotope Beam Factory enabled γ-γ coincidence measurements. A prominent γ line observed with an energy of 742(8) keV in (42) Si confirms the 2(+) state reported in an earlier study. Among the γ lines observed in coincidence with the 2^{+} → 0+ transition, the most probable candidate for the transition from the yrast 4(+) state was identified, leading to a 4(1)+) energy of 2173(14) keV. The energy ratio of 2.93(5) between the 2(1)+ and 4(1)(+) states indicates well-developed deformation in (42) Si at N = 28 and Z = 14. Also for 38,40)Si energy ratios with values of 2.09(5) and 2.56(5) were obtained. Together with the ratio for (42)Si, the results show a rapid deformation development of Si isotopes from N = 24 to N = 28.

[Clinical significance of serum anti-p53 antibody measurement for colorectal cancer]

We investigated the usefulness of serum anti-p53 antibody (anti-p53) measurement for the diagnosis of colon cancer. carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and anti-p53 were measured by enzyme-linked immunosorbent assay in 375 colorectal cancer patients and 115 healthy volunteers(control group). When the cut-off level of the serum anti-p53 antibody was set to 1.3 U/mL, 114 (30.4%) of the colorectal cancer patients tested positive. Twelve positive cases(10.4%) were recognized in the control group. The median levels of anti-p53 were 0.69 U/mL(0.69- 10,610) and 0.69 U/mL (0.69-19.5) in the colorectal cancer patients and control group, respectively. The positive rates of CEA level (cut-off value 6.7 ng/mL) and CA19-9 level (cut-off value 37 U/mL) were 40.0% and 18.9%, respectively. Of these tumor markers, positive cases with only anti-p53 were observed in 60 patients (16%). The positive rate of all markers examined was 61.6%. No significant correlation was observed between the level of anti-p53 and other markers. The positive rates of anti-p53 in each stage of the colon cancer patients were as follows: stage 0 and I, 19.4%; stage II, 27.0%; stage III,36.1%; and stage IV,61.0%. The positive rate of anti-p53 was higher than that of CEA and CA19-9 in the early stages of colorectal cancer. Furthermore, a combination of these markers improved the diagnosis of colorectal cancer by approximately 60%. These results suggest that the measurement of anti-p53 is useful for diagnosis of colorectal cancer in clinical practice.

[Clinicopathological characteristics and treatment outcome of retroperitoneal liposarcoma]

Six patients with retroperitoneal liposarcoma were referred to our institution and retrospectively analyzed. Clinicopathological factors, initial treatment, postoperative recurrence, treatment, disease-free survival, and overall survival were investigated. Median age was 67 years and the male to female ratio was 0.5. Every patient underwent a surgical procedure as an initial treatment. Maximum tumor diameter was 190 mm (range, 100-250 mm). Three patients had local excisions, whereas the remaining 3 had extended surgery. Histological classification included well-differentiated type in 3, dedifferentiated type in 2, and mucinous type in 1. Three patients developed recurrence (local, n=3; hematogeneous, n=2). Local recurrence was excised but the disease relapsed in 2 patients. Median disease-free survival period was 21 months and 3-year survival rate was 62.5%. Since surgical resection remains the only promising treatment for liposarcoma, total removal of the tumor with negative surgical margins is mandatory. Wide resection, including the neighboring organs, should be performed without hesitation in selected cases.

[Evaluation of chemoradiotherapy for Stage II and III( non-T4) esophageal cancer]

AIM

We retrospectively evaluated the clinical efficacy of chemoradiotherapy for surgically resectable Stage II and III (non-T4) esophageal cancer.

MATERIALS AND METHODS

93 patients were diagnosed with esophageal cancer of clinical stage II and III(non-T4) from April 2005 to December 2010. Among them, 20 patients who were treated with 5-fluorouracil(5-FU) and cisplatin(CDDP) plus 60 Gy extra beam radiation were enrolled in this study.

RESULTS

13 patients(65%) had a complete response (CR), 3 patients had a partial response (PR), and the overall response rate was 80%. Significant statistical differences in lymph node metastasis ratio and clinical stage before chemoradiotherapy were revealed between CR patients and non-CR patients. No statistical differences were observed between surgically-treated cases and chemoradiotherapy cases in overall five-year survival rate and disease-free survival rate. The five-year survival rate of the CR patients (71.6%) was significantly better than that of the non-CR patients(22.2%)( p=0.04).

CONCLUSION

Chemoradiotherapy for Stage II and III esophageal cancer appeared to be by no means inferior to esophagectomy and must be a choice during treatment planning.

[Prediction of the efficacy of first-line oxaliplatin-based chemotherapy for unresectable liver metastases of colorectal cancer by Köhne's index]

PURPOSE

This retrospective study was undertaken to examine the usefulness of Köhne's index(KI) for predicting the efficacy of first-line oxaliplatin-based chemotherapy for unresectable liver metastases of colorectal cancer.

PATIENTS AND METHODS

The subjects were 84 patients with unresectable liver metastases of colorectal cancer in whom first-line oxaliplatin- based chemotherapy was administered. The outcome of treatment was analyzed in relation to the KI.

RESULTS

The patients were classified into 3 groups: high risk group (n=12), intermediate risk group (n=20), and low risk group (n=52). There were no significant differences between the groups with regard to response rate, disease control rate, disease-free survival, overall survival, and the rate of conversion to hepatic metastatectomy.

CONCLUSION

Our results suggest that KI might not be useful for predicting the efficacy of first-line oxaliplatin-based chemotherapy for unresectable liver metastases of colorectal cancer.

[The efficacy of postoperative adjuvant chemotherapy for esophageal cancer with lymph node metastasis]

The clinical significance of postoperative 5-fluorouracil+cisplatin(FP) therapy for esophageal cancer with lymph node metastasis was retrospectively investigated. Overall, 37 patients who underwent curative resection of esophageal squamous cell cancer with lymph node metastasis were investigated. Clinical background and prognosis were compared between patients treated with FP therapy(FP group, 13 patients) and patients treated without FP therapy(non-FP group, 24 patients). In the FP group, the completion rate and adverse events were also analyzed. No significant difference was found between the FP and non-FP group in terms of age, gender, tumor location, number of dissected lymph nodes, and number of lymph node metastases. However, the frequency of 3-field lymph node dissection in the FP group was higher than that in the non-FP group(p=0.04), and the risk for operation in the FP group tended to be lower than that in the non-FP group(p=0.06). There was no significant difference in disease-free survival between these groups(p=0.46). Overall survival time in the FP group tended to be longer than that in the non-FP group (p=0.06). In the FP group, 2 patients with Grade 3 adverse events were recognized, and the completion rate of FP therapy was 77%. Although we analyzed a small number of patients in this study, postoperative adjuvant chemotherapy using FP does not contribute to the prevention of recurrence in esophageal cancer patients with lymph node metastasis.

[Colon cancer with portal vein tumor thrombosis-a case report and review of the literature]

Colon cancer with portal vein tumor thrombosis has a poor prognosis. However, little is known about the clinicopathological characteristics of these patients. In this study, we attempted to clarify the clinicopathological characteristics of such patients reported in the Japanese literature, including our own case. This case concerns a 48-year-old female patient diagnosed as having transverse colon cancer with severe portal vein tumor thrombosis. Despite curative resection, the patient was found to have multiple liver metastases six months later, and chemotherapy did not prove to be adequately effective; she died 18 months after surgery. A search of the relevant literature revealed 9 reports of similar patients. The patients consisted of 4 males and 6 synchronous cases, with a median age of 70 years. Portal vein tumor thrombosis was observed in 6 patients. While the portal vein was the most frequent site of thrombosis, other patients showed tumor thrombosis of the superior and inferior mesenteric veins. Despite curative resection, 3 patients eventually developed liver metastases after the operation. The median disease-free survival of the patients who had undergone curative resection was 300 days, and the overall median survival of the patients was 420 days. Thus, for the portal vein tumor thrombosis, we need to adopt adjuvant chemotherapy in consideration of a high risk for the liver metastases.

[The clinical significance of serum anti-p53 antibody as a monitoring marker in colorectal cancer]

We examined alterations in the level of serum anti-p53 antibody(S-p53 Ab) in colorectal cancer patients who underwent curative resection and analyzed the usefulness of S-p53 Ab as a monitoring marker for postoperative observation. The measurement of S-p53 Ab was performed preoperatively and postoperatively in 16 stage II/III colorectal cancer patients with a high level of S-p53 Ab. A time course analysis of both S-p53 Ab and CEA levels was performed in 6 of these patients who were carcinoembryonic antigen (CEA) positive. The median S-p53 Ab level was 29.9 U/mL and the half-life of the S-p53 Ab level was 40.3 days. In 4(25%) cases, the level of S-p53 Ab recovered to within normal limits by 79-142 days. When the half-lives of S-p53 Ab and CEA were analyzed in 6 patients who were both S-p53 Ab and CEA positive, the half-lives of S-p53 Ab and CEA were 32.3 and 13.2 days, respectively. In the case of recurrence with liver metastasis after resection of ascending colon cancer, the S-p53 Ab level did not respond quickly while the CEA level increased. Therefore, it is difficult to use the level of S-p53 Ab as a marker for monitoring treatment, and priority should be given to the examination of CEA and imaging modality.

[A case of vaginal metastasis of rectal cancer post -operation]

Vaginal metastasis is extremely rare, as is metastatic colorectal cancer. A 78-year-old woman was diagnosed with rectal cancer and uterine fibroid. Low anterior resection and simple hysterectomy was performed and the final diagnosis was fStage IIIa. Adjuvant chemotherapy was not performed. One year after the surgery, she was referred to our hospital with the chief complaint of hematuria. A tumor was observed in the posterior wall of the vagina. We performed vaginal mucosal resection and the pathological diagnosis was metastasis of rectal cancer. One year and 5 months after the surgery, we performed left inguinal node dissection and the pathological diagnosis was metastasis of rectal cancer. The patient has remained disease-free for 3 years and 5 months without adjuvant chemotherapy after resection of the vaginal metastasis.

[A patient with unresectable progressive advanced rectal cancer maintained in a state of remission by using combination therapy]

We report the case of a patient with unresectable progressive advanced rectal cancer, who has been able to maintain a good quality of life because of combination therapy, including chemoradiotherapy. A 52-year-old woman was diagnosed with progressive locally advanced rectal cancer and invasion of the adnexa of the uterus and the left ureter. No distant metastasis was detected. Colostomy was performed, followed by chemoradiotherapy combined with S-1; then, mFOLFOX6 +bevacizumab (BV) therapy was administered. Aggravation of bilateral hydronephrosis was detected upon completion of 2 courses of treatment, and therefore, percutaneous nephrostomy of the right kidney was performed. After the patient underwent 20 courses of treatment, imaging showed a reduction in the size of the lesion, and the CEA level returned to normal. Later, remission was sustained by sLV5FU2+BV therapy and oral administration of S-1. As a result, we were able to remove the nephrostomy tube from the right kidney in February 2011. Four years after initiation of the treatment, the patient has shown no indication of recurrence.

[Predictive value of Köhne's index on the efficacy of FOLFIRI regimen in the treatment of unresectable liver metastatsis of colorectal cancer]

The aim of this retrospective study was to analyze the predictive value of Köhne's index on the efficacy of FOLFIRI regimen in the treatment of unresectable liver metastasis of colorectal cancer. The subjects were 44 patients with unresectable liver metastasis from colorectal cancer treated with FOLFIRI regimen as second-line, for all of whom oxaliplatin-based regimen had previously failed. Bevacizumab was concomitantly used in 23 patients. Classification of the Köhne's index revealed high risk in 22 patients, intermediate risk in 7 patients, and low risk in 15 patients. The response rate was 13.6% in the patients with high risk(H group) and 27.3% in the patients with intermediate or low risk(non-H group)(p=0.45). The disease control rate was 50% in the H group and 68.2% in the non-H group (p=0.36). In the H group, the median progression -free survival time was 4.1 months and in the non-H group it was 7.1 months (p=0.33). Compared with the H group, the non-H group showed significantly better overall survival (10.8 months vs 23.9 months, p=0.03). None of the patients has received hepatectomy (conversion therapy). These results suggest that the predictive value of Köhne's index is limited in terms of the effect of shrinkage of liver metastases, including conversion therapy.

[A long-term survivor of colorectal cancer associated with multiple liver metastases and peritoneal carcinomatosis treated through a multidisciplinary approach]

Even in the era of new anticancer drugs, an optimal treatment strategy for colorectal cancer associated with liver metastasis and peritoneal carcinomatosis has yet to be established. Here we report the case of a long-term survivor with very advanced colon cancer who underwent repeated resective surgery and chemotherapy. This 69-year-old man underwent a Hartmann's procedure and the resection of peritoneal metastases of cancer of the rectosigmoid, which had infiltrated the retroperitoneum giving rise to multiple liver metastases and peritoneal carcinomatosis. The resection margin was positive for cancer. After 14 courses of a modified FOLFOX6 (mFOLFOX6) regimen, a partial response with no development of new lesions was obtained. Multiple partial hepatectomies were subsequently performed. After the completion of an additional 6 courses of mFOLFOX6, a positron-emission tomography (PET)/computed tomography (CT) examination demonstrated a hot spot in segment 4. This hot deposit disappeared after a further 8 courses of mFOLFOX6. The patient then underwent a left lateral segmentectomy for a newly developed lesion in segment 3, which was detected 2 years and 7 months after the first operation. The patient has remained free from recurrence for 2 years since his last operation.

[Clinical outcome of Stage IV colorectal cancer on the basis of the seventh edition of the TNM classification]

Recent advances in chemotherapy for stage IV colorectal cancer have improved clinical outcome. According to the seventh edition of the TNM classification of colorectal cancer, stage IV is classified into stage IVA and stage IVB. In this study, we assessed the clinical validity of this classification as a prognostic factor. The subjects were 170 patients with stage IV colorectal cancer(stage IVA, n=78; stage IVB, n=92)treated between January 2006 and December 2011 at our institute. Of 92 patients with stage IVB, peritoneal carcinomatosis alone was recognized in 21 patients. The median survival periods for patients with stage IVA and IVB were 29.2 and 16.1 months, respectively( p=0.13). The median survival period for patients with peritoneal carcinomatosis alone was 37.6 months, and there was no difference between survival in patients with stage IVA and those with peritoneal carcinomatosis alone. Our present results suggest that it may be reasonable and useful to classify peritoneal carcinomatosis alone into stage IVA instead of stage IVB in clinical practice.

[A case of simultaneous resection of pancreatic tail and transverse hematogenous metastasis]

CASE

A 51-year-old male patient visited our hospital after a positive result for a stool test for occult blood. Subsequent lower gastrointestinal endoscopy showed a neoplastic lesion in the transverse colon, and abdominal computed tomography revealed a tumor in the tail of the pancreas. Since there was the possibility of multiple cancers with pancreatic cancer and transverse colon cancer, resection of pancreatic tail and transverse colectomy were performed. Histopathological findings: The pancreatic lesion was found to be a moderately differentiated tubular adenocarcinoma, and the lesion in the transverse colon was mainly located in the submucosal layer. In light of the principal lesion having the same histopathological characteristics as the pancreatic lesion, it was diagnosed as hematogenous metastasis of pancreatic cancer to transverse colon. Postoperative course: After 9 courses of 3-week administration of gemcitabine(GEM) and 1-week cessation, he developed hepatic metastasis. The treatment with GEM+S-1 was additionally repeated 7 times, but the patient was not responsive to the treatment, and died 1 year and 6 months after his first visit to our hospital.

CONCLUSION

Surgery is not generally indicated in patients with pancreatic cancer with hematogenous metastasis. In this case, a comparatively long-term survival period was achieved after simultaneous resections.

[Adjuvant chemotherapy comprising modified FOLFOX6 after curative resection of synchronous or metachronous metastasis from colorectal cancer]

PURPOSE

This retrospective study evaluated the outcome of adjuvant chemotherapy comprising modified FOLFOX6 (mFOLFOX6) after potentially curative metastasectomy from colorectal cancer.

PATIENTS AND METHODS

The subjects were 40 patients with colorectal cancer who underwent potentially curative metastatectomy without any prior chemotherapy between December 2003 and November 2011. Patient background, type of adjuvant chemotherapy, and prognosis were examined.

RESULTS

Adjuvant chemotherapy was given in 30 patients (mFOLFOX6, n=26; oral fluoropyrimidines, n=4). The median relapse-free survival tended to be longer in patients treated with mFOLFOX6 compared to those treated with fluoropyrimidines (28.5 months vs 14.8 months; p=0.11). The median overall survival did not differ significantly between the 2 groups (37.9 months vs 31.3 months, p=0.56). When the analysis was restricted to patients treated with mFOLFOX6, no significant differences were found in relapse-free survival (p=0.46), overall survival (p=0.29), and frequency of adverse events during chemotherapy(Grade 3, p=0.32) between patients with synchronous metastasis(n=11) and those with metachronous metastasis (n=15).

CONCLUSION

These results suggest that mFOLFOX6 might contribute to prolonging the time to relapse and that the timing of developing metastasis(synchronously or metachronously) may not have any effect on the outcome of adjuvant mFOLFOX6.

[Clinical differences between palliative gastrectomy and reduction surgery for gastrectomy in curatively unresectable gastric cancer]

Surgical treatments for curatively unresectable gastric cancer include reduction surgery and palliative surgery(palliative gastrectomy and bypass operation). Both palliative gastrectomy and reduction surgery reduce the tumor volume. In this study, the clinical significance of these treatment methods was investigated. The subjects were 58 patients with unresectable gastric cancer for which surgery was performed as the primary treatment. Of these patients, 38 patients underwent reduction surgery and 20 patients underwent palliative surgery. On univariate analysis, age and gender were not significant. Pre-operative performance status(PS) in patients treated with reduction surgery was favorable compared to that in patients receiving palliative surgery(PS 0: 65.8 vs 40.0%, p=0.06). The administration rate of post-operative chemotherapy in patients treated with reduction surgery was higher than that in patients with palliative surgery (92.1 vs 65.0%, p<0.01). The median survival time in patients treated with reduction surgery was 18.2 months, while that in patients with palliative surgery was 11.0 months (p<0.01). These results indicated that reduction surgery was clinically different compared to palliative surgery in terms of the administration rate of post-operative chemotherapy and prognosis.

[A case of multiple hepatic epithelioid hemangioendothelioma mimicking metastatic hepatic tumor]

We report a case of multiple hepatic epithelioid hemangioendothelioma( EHE) mimicking hepatic metastasis of colon cancer. A 71-year-old man was referred to our hospital for further evaluation of multiple hepatic tumors. Enhanced CT scan was not performed because of renal dysfunction. Total colonoscopy revealed a type 1 cancer at the rectosigmoid junction. We therefore diagnosed the hepatic tumors as metastases from rectal cancer. Anterior resection was performed and postoperative chemotherapy targeting the hepatic tumors was carried out. Unfortunately, the size of the hepatic tumors increased. We therefore performed lateral segmentectomy and partial hepatectomies (11 lesions). The macroscopic findings indicated basically localized tumor without diffuse infiltration. Microscopically, spindle and oval-shaped cells with abundant eosinophilic cytoplasm were observed; immunohistochemical staining was positive for factor VIII and CD34. These data were conclusive for EHE. EHE of the liver is a rare neoplasm of which little is currently known. We herein report a case of EHE in the liver, misdiagnosed as colorectal metastatic tumor.

Up-regulation of nm23/NDP kinase expression in regenerating hepatocytes

We analyzed the kinetics and subcellular localization of nm23-M1 and nm23-M2 in in vivo proliferating mouse liver cells after partial hepatectomy. Along with the regenerative growth rate measured by mitotic index, the expression of both nm23-M1 and nm23-M2 was altered with distinct kinetics. Among the subcellular fractions of regenerating hepatocytes, the increase in the quantity of nm23-M1 and nm23-M2 was the most dominant in the nuclear fractions. In in vitro proliferating human hepatocellular carcinoma cells (PLC/PRF/5) stimulated by hepatocyte growth factor, both nm23-H1 and nm23-H2 were dominantly accumulated around nuclear membranes.

Gastric-cancer associated with pregnancy - a case-report

We treated a 27-year-old pregnant woman with Borrmann type IV gastric cancer and immunohistochemically detected micrometastasis of cancer cells in the bone marrow. Total gastrectomy combined with splenectomy was followed by postoperative chemotherapy. Despite intensive treatment, she died with tumor progression 6 months later. When malignant cells are present in the bone marrow, the prognosis is poor. The literature on gastric cancer associated pregnancy is reviewed.

[Esophageal cancer surgery for patients with chronic respiratory diseases]

Esophageal cancer frequently occurs in the elderly and many of the patients have smoking history. Therefore, some of them have pulmonary comorbidity such as chronic respiratory diseases. As postoperative pulmonary complications after esophagectomy can be a cause of hospital death, careful evaluation is needed before the decision of the indication for surgery. In order to prevent postoperative pulmonary complications in patients with pulmonary comorbidities, modifications in the surgical procedures are needed. Even for cases who can tolerate standard esophagectomy, both the bronchial arteries and pulmonary branches of the vagal nerve should be preserved as far as possible. For patients who cannot tolerate the thoracotomy, transhiatal esophagectomy or non-surgical treatment should be selected. Postoperatively, airway cleansing using a bronchoscopy or mini-tracheostomy should be performed for cases with difficulty in sputum excretion. An enhanced recovery program by multidisciplinary team is effective to prevent postoperative pulmonary complications. Perioperative use of corticosteroid and sivelestat may reduce the incidence of pulmonary complications. As aspiration pneumonia is sometimes fatal in patients after esophagectomy, care to avoid aspiration is needed. Respiratory care is essential during the follow-up period as well as perioperative period in esophagectomized patients with pulmonary comorbidities.

Identification of the β+ isovector spin monopole resonance via the 208Pb and 90Zr(t,3He) reactions at 300 MeV/u

The double-differential cross sections for the (208)Pb and (90)Zr(t,(3)He) reactions at 300 MeV/u have been measured at the RI Beam Factory at RIKEN. This was the first physics experiment with the SHARAQ magnetic spectrometer. The combined analysis of the present (t,(3)He) data and previous (n,p) data provides the clearest identification for the β(+) isovector spin monopole resonance both in the (208)Tl and (90)Y nuclei, and puts the observations of this giant resonance on a firm foundation. The measured distributions of the (t,(3)He) monopole cross sections were well reproduced by the distorted-wave Born approximation calculation, where the target transition density was calculated with the self-consistent Hartree-Fock plus random-phase approximation using the T43 Skyrme interaction. A major part of the expected β(+) isovector spin monopole strength was found in the measured cross section spectra.

Hindered proton collectivity in 16(28)S12: possible magic number at Z=16

The reduced transition probability B(E2;0(gs)(+)→2(1)(+)) for (28)S was obtained experimentally using Coulomb excitation at 53 MeV/nucleon. The resultant B(E2) value 181(31) e(2)fm(4) is smaller than the expectation based on empirical B(E2) systematics. The double ratio |M(n)/M(p)|/(N/Z) of the 0(gs)(+)→2(1)(+) transition in (28)S was determined to be 1.9(2) by evaluating the M(n) value from the known B(E2) value of the mirror nucleus (28)Mg, showing the hindrance of proton collectivity relative to that of neutrons. These results indicate the emergence of the magic number Z=16 in the |T(z)|=2 nucleus (28)S.

Salvage lymphadenectomy for cervical lymph node recurrence after esophagectomy for squamous cell carcinoma of the thoracic esophagus

Prognosis of patients with recurrent esophageal cancer is usually unsatisfactory. We have successfully treated five patients with cervical node recurrence after esophagectomy with multimodal treatment including salvage lymphadenectomy. In order to clarify the efficacy of salvage surgery for cervical node recurrence, we have reviewed the clinical course and prognosis of these patients. From August 2004 to December 2007, 30 patients with 33 recurrent sites were treated in the Department of Surgery, Iizuka Hospital. Among these patients, there were five patients with recurrence limited within the cervical nodes. Salvage cervical lymphadenectomy was performed for all five patients. Curative resection was achieved in four patients and reduction surgery followed by planned chemoradiotherapy was performed in another patient. All stations including the suspicious node were dissected and a partial sternotomy was added for one patient whose recurrent tumor was located in the right recurrent nerve node. There was no mortality and one minor complication (subcutaneous hemorrhage) was observed. Median duration of hospital stay was 7 days. Adjuvant chemotherapy was performed for all patients. Median follow-up period was 54 months and all patients are alive without relapse of the disease. Salvage cervical lymphadenectomy is a safe and effective treatment for patients with cervical node recurrence after esophagectomy.