Histopathologic tumor spread in very low rectal cancer treated with abdominoperineal resection

PURPOSE

We have pathologically evaluated the tumor spread in low rectal cancer treated with abdominoperineal resection to clarify the potential indication of intersphincteric resection and other anus-preserving operations with external sphincter muscle resection.

METHODS

A total of 197 patients received abdominoperineal resection between 1982 and 2001. We determined histopathologically any invasion or metastasis into the anal canal structures.

RESULTS

When the lowest edge of a tumor was located above the dentate line, the invasion was rarely beyond the internal sphincter muscle, in particular, where the distance between the tumor and the dentate line was longer than 2 cm. When the lowest edge was located at or below the dentate line (Pb-cancer), invasion tended to extend into the external sphincter muscle and into the intermuscular groove. A logistic regression analysis showed that the Pb-cancer, any distant metastasis, and the tumor histology of mucinous carcinoma were each an independent significant risk factor to invasion beyond the internal sphincter muscle, whereas the Pb-cancer, the poorly differentiated adenocarcinoma, and the mucinous carcinoma were each an independent significant risk factor to invasion into the intermuscular groove.

CONCLUSION

The anus-preserving operation with sphincter muscle resection was theoretically possible for low rectal cancer in patients who underwent abdominoperineal resection. However, the procedure cannot be indicated for a tumor where the lowest edge is below the dentate line and where a preoperative biopsy shows a poorly differentiated adenocarcinoma or mucinous carcinoma, even if the intermuscular groove is macroscopically unaffected by the tumor.

Intellectual property strategies for university spinoffs in the development of new drugs

We will explain a new business model for university spinoffs involving the development of two types of products. The first are highly innovative, such as new drugs, while the second are typically less difficult to develop, such as functional foods. It is our belief that development of the second type of product can help solve the financial problems and stabilize management of Academic Start-ups. The key to development of several different types of products is accumulation of knowledge consisting not only of technical knowhow, e.g. tips for use in injection, but also ideas obtained by researchers with the potential for future applications. Examination of the features of venture enterprises which have arisen from universities suggests that inventors, who are also professors, should participate in such start-ups.

Molecular mechanisms of sequence-dependent antitumor effects of SN-38 and 5-fluorouracil combination therapy against colon cancer cells

BACKGROUND

The aim of this study was to clarify the molecular mechanisms of the sequence-dependent antitumor activity of SN-38 and 5-fluorouracil (5-FU) against colon cancer cells.

MATERIALS AND METHODS

KM12SM and HCT116 colon cancer cells were exposed to 5-FU and/or SN-38 in various conditions. The nature of interactions was determined by median-effect analysis. Cell cycle, apoptosis, and expression of thymidylate synthase (TS) were analyzed.

RESULTS

A strong synergism was observed after initial sequential exposure of SN-38, and the activity was enhanced by a 24 h-interval to the drug-exposure. Antagonism was observed after low-dosage initial sequential exposure of 5-FU. Low-dosage 5-FU caused G(2) arrest and high-dosage 5-FU caused G(1) arrest. TS protein level significantly decreased after exposure to SN-38.

CONCLUSION

The sequence dependency between SN-38 and 5-FU against colon cancer cells may be related to the dual action on cell cycle regulation by 5-FU and to the down-regulation of TS level by SN-38.

DWIBS (diffusion weighted whole body imaging with background signal suppression) scan for colorectal cancer and its evaluation: Comparison with CT or PET scans

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Background: The most important clinical point for the colorectal cancer patients after surgery is to find out local recurrence and distant metastasis to liver or lungs in early state. Recently, DWIBS (diffusion weighted whole body imaging with background body signal suppression) scan, one of the diffusion weighted MRI imaging methods, was developed, and it has been become used for diagnosis of lung cancer and bladder cancer instead of PET scan. In this report, we examined whether it was more useful method for the diagnosis of recurrence or distant metastasis of the colorectal cancer after surgery than PET/CT scan or not. Methods: All the 12 primary colorectal carcinomas were resected at the surgical division, Kumamoto Central Hospital, Fukuoka Saisekai Ohmuta Hospital and Kurume University Medical Center from 2000 to 2008. (Table 1) After surgery, 14 recurrent regions (seven liver metastasis, two lung metastasis and five local recurrence) were diagnosed by CT and MRI scans. Then all the cases were performed by DWIBS scan. And also the seven out of 12 cases (three liver metastasis, two lung metastasis and four local recurrence) were performed by PET scan. Conditions set before DWIBS scan were six hours of fasting with no restriction on drinking water and normal oral administration of regularly used drugs. No bowel preparation was carried out in any of the patients. Informed consent was obtained from each patient before DWIBS scan. Results: All the 14 metastatic and recurrent regions (seven liver metastasis, two lung metastasis and five local recurrence ) of 12 recurrent patients were performed by DWIBS, MRI and CT scans. Within the seven out of 12 recurrent patients (three liver metastasis, two lung metastasis and five local recurrence), performed by PET scan, all the liver and lung metastatic regions were detected, on the other hand, three out of four local recurrent regions were diagnosed but the other one was not diagnosed by PET scan. Conclusions: DWIBS is not only useful diagnostic method for local recurrence of colorectal cancer after surgery, but also less invasive method than PET scan.

No significant financial relationships to disclose.

Elevated preoperative serum carcinoembrionic antigen level may be an effective indicator for needing adjuvant chemotherapy after potentially curative resection of stage II colon cancer

BACKGROUND

To determine the prognostic factors and to rationalize adjuvant therapy, the clinicopathologic data of patients with a stage II colon cancer were analyzed retrospectively.

PATIENTS AND METHODS

A total of 392 patients underwent potentially curative resection at the Kurume University Hospital between 1982 and 2005. Postoperative adjuvant chemotherapy using oral fluoropyrimidines was administered in 163 patients, and the other 229 patients underwent surgery alone. Univariate and multivariate analyses for prognostic factors were carried out.

RESULTS

Invasive type in gross features, elevated preoperative CEA level, and surgery alone were each an independently significant factor for shorter relapse-free survival, and tumor size <50 mm, invasive type in gross features, elevated preoperative CEA level, and surgery alone were each an independently significant factor for shorter overall survival. The relapse-free survival rate and overall survival rate in the patients who received postoperative adjuvant chemotherapy were significantly higher than those in the patients treated with surgery alone even after stratifying to the preoperative CEA level.

CONCLUSION

Patients with an elevated preoperative CEA may be candidates for adjuvant chemotherapy after curative resection in stage II colon cancer. These findings warrant clinical trials to test out the efficacy of adjuvant chemotherapy in stage II colon cancer with an elevated preoperative CEA.

Nicotine suppresses bone sialoprotein gene expression

BACKGROUND AND OBJECTIVE

Tobacco smoking is a risk factor for periodontitis and osteoporosis. Nicotine is a major component of tobacco, and has been reported to inhibit proliferation and differentiation of osteoblasts. Bone sialoprotein (BSP) is a mineralized tissue-specific protein expressed by differentiated osteoblasts that appears to function in the initial mineralization of bone. The purpose of this study was to determine the effects of nicotine on bone metabolism.

MATERIAL AND METHODS

We used rat osteobast-like UMR106 and ROS 17/2.8 cells and rat stromal bone marrow RBMC-D8 cells. To determine the molecular basis of the transcriptional regulation of the BSP gene by nicotine, we conducted Northern hybridization, transient transfection analyses with chimeric constructs of the BSP gene promoter linked to a luciferase reporter gene and gel mobility shift assays.

RESULTS

Nicotine (250 microg/mL) decreased the BSP mRNA levels at 12 and 24 h in UMR106 and ROS 17/2.8 cells. From transient transfection assays using various sized BSP promoter-luciferase constructs, nicotine decreased the luciferase activities of the construct, including the promoter sequence nucleotides -116 to +60, in UMR106 and RBMC-D8 cells. Nicotine decreased the nuclear protein binding to the cAMP response element (CRE), fibroblast growth factor 2 response element (FRE) and homeodomain protein-binding site (HOX) at 12 and 24 h.

CONCLUSION

This study indicates that nicotine suppresses BSP transcription mediated through CRE, FRE and HOX elements in the proximal promoter of the rat BSP gene.

Physiological study of anal sphincteric resection in an experimental porcine model

This study was conducted to compare and evaluate the extent of anal sphincteric resection and the degree of anal dysfunction in sphincter saving operations for lower rectal cancer using experimental porcine models. Each 10 Clawn miniature pigs underwent transanal intersphincteric resection (ISR), ISR with partial (one-quarter) external sphincteric resection (ESR-25%), and ISR with partial (one-half) external sphincteric resection (ESR-50%). An anorectal physiological study was performed before, one month, and three months after surgery in these three groups. The anal maximum resting pressure (AMRP) decreased from 45.1 cmH(2)O in the control group to 14.8, 14.3 and 11.1 cmH(2)O one month after surgery, and to 15.2, 8.8 and 5.2 cmH(2)O three months after surgery, in the ISR, ESR-25% and ESR-50% groups, respectively. The anal maximum squeezing pressure (AMSP) decreased from 81.7 cmH(2)O in the control group to 42.1, 40.1 and 41.1 cmH(2)O one month after surgery in the ISR, ESR-25% and ESR-50% groups, respectively. Three months after surgery, the MSP increased to 78.1 and 68.1 cmH(2)O in the ISR and ESR-25% groups, respectively, but the ESR-50% group showed a significantly lower MSP of 39.2 cmH(2)O compared with other two groups. The ratio of the potential difference on electromyographic (EMG) was 0.19 in the ESR-50% group, and this value was significantly lower than 0.8 in the ISR and ESR-25% groups, one month after surgery. Three months after surgery, the potential ratio of EMG was increased almost to the preoperative level both in the ISR and ESR-25% groups, but the ratio of the potential difference in the ESR-50% group with redness, sore and soiling around anus was 0.19 and significantly lower compared with other groups. The results of this study indicate that porcine models with additional resection of less than one quarter of the external anal sphincter have little anal dysfunction. A human clinical trial is needed to determine the ESR for very low rectal cancer.

Efficacy of the combined use of bevacizumab and irinotecan as a postoperative adjuvant chemotherapy in colon carcinoma

We evaluated the efficacy of anti-human VEGF antibody (bevacizumab) with or without irinotecan (CPT-11) against lung metastases in which neovascularization was already induced, as a postoperative adjuvant therapy using orthotopically implanted colon cancer in rat. The high VEGF productive KM12SM human colon cancer cells were injected into the cecal wall. At 5 weeks after the injection, the cecum was removed including the tumor. Then, 5 mg/kg of bevacizumab and 40 mg/kg of CPT-11 were administered, alone or in combination, intravenously once a week for 3 weeks, from day 15 after the cecal removal. The results show that the incidences of macroscopic and/or microscopic lung metastases in the bevacizumab-alone group (B) and in the combination group (C) were significantly lower (B, p=0.001 and C, p=0.037) than that in the control group at day 35 after the cecal removal. The number of lung metastases in B was 0.8+/-0.8 (p=0.024) and in C 2.4+/-1.8 (p=0.060), each value lower than the 12.4+/-4.2 of the control group. The growth of a subcutaneously implanted tumor was significantly inhibited in the combination group compared to either the CPT-alone (p=0.003) or the bevacizumab-alone groups (p=0.027). Apoptosis was significantly (p<0.001) induced in the combination group. In conclusion, a beneficial effect of bevacizumab against postoperative lung metastases may be expected even after the establishment of neovascularization in metastatic foci in nude rat. The results from the present subcutaneously implanted tumor model suggested that a higher efficacy may be expected when bevacizumab is combined with the cytotoxic agent CPT-11, compared to bevacizumab alone, against tumors with a variety of VEGF production levels in clinical situations.

Bone sialoprotein and its transcriptional regulatory mechanism

BACKGROUND AND OBJECTIVE

Bone sialoprotein is a mineralized tissue-specific noncollagenous protein that is glycosylated, phosphorylated and sulfated. The temporo-spatial deposition of bone sialoprotein into the extracellular matrix of bone, and the ability of bone sialoprotein to nucleate hydroxyapatite crystal formation, indicates a potential role for bone sialoprotein in the initial mineralization of bone, dentin and cementum. Bone sialoprotein is also expressed in breast, lung, thyroid and prostate cancers.

MATERIAL AND METHODS

We used osteoblast-like cells (rat osteosarcoma cell lines ROS17/2.8 and UMR106, rat stromal bone marrow RBMC-D8 cells and human osteosarcoma Saos2 cells), and breast and prostate cancer cells to investigate the transcriptional regulation of bone sialoprotein. To determine the molecular basis of the transcriptional regulation of the bone sialoprotein gene, we conducted northern hybridization, transient transfection analyses with chimeric constructs of the bone sialoprotein gene promoter linked to a luciferase reporter gene and gel mobility shift assays.

RESULTS

Bone sialoprotein transcription is regulated by hormones, growth factors and cytokines through tyrosine kinase, mitogen-activated protein kinase and cAMP-dependent pathways. Microcalcifications are often associated with human mammary lesions, particularly with breast carcinomas. Expression of bone sialoprotein by cancer cells could play a major role in the mineral deposition and in preferred bone homing of breast cancer cells.

CONCLUSION

Bone sialoprotein protects cells from complement-mediated cellular lysis, activates matrix metalloproteinase 2 and has an angiogenic capacity. Therefore, regulation of the bone sialoprotein gene is potentially important in the differentiation of osteoblasts, bone matrix mineralization and tumor metastasis. This review highlights the function and transcriptional regulation of bone sialoprotein.

Intraoperative thermal ablation therapy for small colorectal metastases to the liver

BACKGROUND/AIMS

Thermal ablation (TA) therapies such as microwave coagulation therapy (MCT) and radiofrequency interstitial thermal ablation (RFA) for colorectal metastasis to the liver cannot always achieve a complete tumor cell death, and the multiple insertions of the TA probe may lead to intrahepatic dissemination and/or distant metastasis.

METHODOLOGY

The achieved local control rate, any recurrence in the residual liver, and any extrahepatic recurrence has been evaluated in 105 patients who underwent hepatectomy and/or intraoperative TA between 1994 and 2004.

RESULTS

A total of 102 unresectable liver metastatic lesions (mean size 21mm) were selectively treated with TA either as initial treatment (32 patients) and/or as re-treatment (18 patients) for recurrence in the residual liver, in combination with hepatectomy. Overall, TA achieved a high local tumor control rate of 95%. Multivariate analysis revealed that initial-TA therapy was not a significant predictive factor of hepatic recurrence or any recurrence.

CONCLUSION

TA therapies in combination with hepatectomy may offer increased resectability without increased risk of intrahepatic dissemination or extrahepatic recurrence for certain patients who would otherwise be deemed inoperable, when relatively small tumors are indicated for TA.

Metronomic chemotherapy using weekly low-dosage CPT-11 and UFT as postoperative adjuvant therapy in colorectal cancer at high risk to recurrence

This study was designed to evaluate the antitumor efficacy and feasibility of postoperative adjuvant metronomic chemotherapy using weekly low-dosage CPT-11 and UFT in colorectal cancer at high risk to recurrence. A total of 49 patients (24 stage IIIb and 25 distant metastasis) who underwent a R0 operation were enrolled in this prospective study. Forty mg/m2 of CPT-11 were administered on day 1, day 8, and on day 15 in 28-day cycles. A dosage of 335 mg/m2/day of UFT was given perorally on daily schedule. Cycles were repeated for 6 months, and were followed by UFT alone for further 6 months. One or more adverse effects were seen in 43 of the 49 patients. However, most of these effects were mild at grade 1 or 2: with only nausea in 3 patients, vomiting in 2, leucopenia in 2 and neutropenia in 2 at grade 3. The overall survival rates were favorable both in the stage IIIb group (5-year: 73%) and in the distant metastases group (5-year: 62%). Postoperative adjuvant metronomic chemotherapy using weekly low-dosage CPT-11 and UFT might be safe and feasible and prolong survival time in colorectal cancer at high risk to recurrence.

Oral fluoropyrimidines may not reduce the risk of postoperative recurrence in colorectal cancer associated with mesenteric lymph node metastasis

To clarify the efficacy and problems of postoperative adjuvant chemotherapy using oral fluoropyrimidines, the clinicopathological data of 307 colorectal cancer patients treated with or without postoperative chemotherapy were analyzed retrospectively. Patients in the chemotherapy group (n=188) who underwent curative resection were followed by administration of oral fluoropyrimidine. The other 119 patients underwent surgery alone. The disease-free survival rates were compared between the two groups. The disease-free survival rate in the chemotherapy group was significantly higher than that in the surgery alone. However, no significant difference in disease-free survival rate was found for those with tumors that were associated with mesenteric lymph node involvement and tumors with a high grade of lymphatic invasion or high grade of venous invasion. Postoperative adjuvant chemotherapy using oral fluoropyrimidines such as UFT (litegafur +4:uracil) and 5'-DFUR (doxifluridine) might not reduce the risk of recurrence in colorectal cancer with mesenteric lymph nodes involvement.

Significance of thymidine phosphorylase in metronomic chemotherapy using CPT-11 and doxifluridine for advanced colorectal carcinoma

BACKGROUND

A phase II study was designed to evaluate the efficacy, safety and predictors for response of metronomic chemotherapy using weekly low-dosage CPT-11 and doxifluridine (5'-DFUR) in 45 patients with metastatic colorectal cancer.

PATIENTS AND METHODS

Forty mg/m2 of CPT-11 was administered for 3 consecutive weeks in a 4-week treatment cycle, with 5'-DFUR (800 mg/day) given orally.

RESULTS

One or more adverse effects were seen in 42 patients. However, most of these were mild at grade 1 or 2, including only leucopenia in 2, neutropenia in 1, diarrhea in 1 and nausea in 1 as grade 3. The objective response rate was 36% with a median overall survival of 452 days. The response rate in patients with a high expression of thymidine phosphorylase (dThdPase) in tumor cells (47%) was higher (p=0.092) than that (19%) in patients with a low expression.

CONCLUSION

The efficacy of metronomic chemotherapy using low-dosage weekly CPT-1 and 5'-DFUR is worthy of further clinical study, especially in patients with a high expression of dThdPase in primary tumor cells.

Clinical examination of the water-soluble vitamin levels in blood during peripheral parenteral nutrition

The water-soluble vitamin (included vitamin B1, B6, B12 and C) preparations are not always replenished when peripheral parenteral nutrition (PPN) is used in Japan. We evaluated the need for administration of vitamins preparation during PPN, and involved analysis of the blood levels of water-soluble vitamins in patients receiving perioperative PPN before and after gastrectomy. Patients were examined as two set of groups as follows; 18 patients who did not receive water-soluble vitamin preparations during PPN, the Unsupplemented Group, and 22 patients who received such preparations during PPN, the Supplemented Group. Consequently, in the Unsupplemented Group, the blood vitamin B1 level during the early postoperative period was significantly lower than the preoperative level, but in the Supplemented Group, it was significantly higher than the preoperative level. In the Supplemented Group, the blood vitamin B12 level during the early postoperative period was markedly higher than the preoperative level. And in both groups, the blood vitamin C level remained below the lower limit of the criterion range throughout the perioperative period. These results suggested that administration of water-soluble vitamins during PPN was needed to avoid potential vitamin deficiencies after surgery and to prevent a potential onset of severe metabolic complications from any deficiencies.

[A resected case of advanced gastric cancer after treatment with low-dosage TS-1]

We report a case of advanced gastric cancer that responded well to low-dosage TS-1. A 72-year-old woman was diagnosed as having unresectable advanced gastric cancer with ascites and hydronephrosis in the right kidney. She was treated with chemotherapy using a low-dosage of TS-1 (80 mg/body/day) administered perorally for 4 weeks followed by a drug-free 2 weeks, in six-week cycles. However, she developed weight loss, appetite loss, and stomatitis. We therefore reduced the dosage of TS-1 from 80 mg/body/day to 60 mg/body/day. The ascites and hydronephrosis gradually improved during the following 3 months, whereupon she could undergo total gastrectomy. The postoperative findings showed no ascites and no peritoneal dissemination. The postoperative pathological findings showed that the cancer cells were localized to within the mucosa, and there were no cancer cells in the greater and lesser omentum. Three weeks after the operation, TS-1 was resumed at 60 mg/body/day. However, 3 months later,ascites and metastasis to the abdominal skin developed, and she died 9 months after the operation.

372 SPERM ASTER FORMATION AND BLASTOCYST DEVELOPMENT OF IN VIVO-MATURED BOVINE OOCYTES FERTILIZED BY INTRACYTOPLASMIC SPERM INJECTION

In cattle, activation treatment after intracytoplasmic sperm injection (ICSI) is required to improve cleavage and blastocyst rates (Horiuchi et al. 2002 Theriogenology 57, 1013–1024). The reason why the exogenous activation treatment in bovine ICSI is needed to promote cleavage and blastocyst development is not clear. The objective of this study was to examine the effect of activation treatment on sperm aster formation, cleavage, and blastocyst development of in vivo- and in vitro-matured bovine oocytes following ICSI. In vivo-matured oocytes were collected using transvaginal devices under ultrasound guide at about 29 h after GnRH injection from Japanese Black cows superstimulated with a total 19 mg FSH (Antrin�; Denka Pharmaceutical Co., Kanagawa, Japan) divided into twice daily over 3 days, and treated with 750 �g cloprostenol (Estramate�; Sumitomo Chemical Co., Tokyo, Japan). In a total of 8 aspiration sessions, 131 oocytes were collected; of 116 oocytes with expanded cumulus cells, 84 (72%) had a first polar body and were used for ICSI. On the other hand, in vitro-matured bovine oocytes were prepared by culturing immature follicular oocytes derived from abattoir ovaries. Bull spermatozoa, immobilized by scoring their tails, were injected into in vivo- or in vitro-matured oocytes. At 4 h after ICSI, the oocytes were treated with or without 7% ethanol for 5 min for activation. The injected oocytes were fixed at 8 h after ICSI, and sperm aster formation was examined by using specific antibodies and immunofluorescence microscopy. Data were analyzed by the chi-square test in all experiments. The rate of sperm aster formation in in vivo-matured oocytes was similar regardless of activation treatment (71% vs. 65%), but the rate in in vitro-matured oocytes was significantly (P &lt; 0.05) higher in the group receiving activation treatment than in the non-activation group (57% vs. 19%). Cleavage (88% vs. 88%) and blastocyst rates (59% vs. 47%) of in vivo-matured oocytes after ICSI were also similar, regardless of activation treatment, but cleavage (72% and 20%) and blastocyst rates (19% and 7%) of in vitro-matured oocytes were significantly (P &lt; 0.05) higher in the group receiving activation treatment than in the non-activation group. Moreover, the blastocyst rate of in vivo-matured oocytes was significantly (P &lt; 0.05) higher than the rate in in vitro-matured oocytes. These results show that activation treatment after ICSI of in vivo-matured bovine oocytes is not necessary for cleavage and blastocyst development, and suggest that the necessity of activation treatment in bovine ICSI has relevance to in vitro maturation of bovine oocytes.

Functional outcome after sphincter excision for ultralow rectal cancer

This article shows a prospective study investigating bowel function after transanal rectal resection with internal and external sphincterectomy for low rectal cancer. Eight patients underwent standard low anterior resection with colonic J-pouch anal anastomosis (LARJ), and eight patients underwent transanal rectal resection with internal and external sphincter resection (IESR). Manometry, manovolumetry, transit time study, and a questionnaire were performed before and after the operation. Six and 12 months after the operation, maximum resting pressure and squeezing pressure were significantly lower in IESR group than in LARJ group, whereas there was no significant difference between the two groups in terms of constant sensation, maximum tolerable volume, or neorectal compliance. Although the functional score of the IESR group remained low at 6 months after the operation in comparison with the LARJ group, it improved at 12 months after the operation. Transanal rectal resection with internal and external sphincterectomy showed usefulness in preserving bowel function and avoiding permanent colostomy.

The expression of vascular endothelial growth factor determines the efficacy of post-operative adjuvant chemotherapy using oral fluoropyrimidines in stage II or III colorectal cancer

The aim of this study was to determine any correlation between the efficacy of post-operative adjuvant chemotherapy using oral fluoropyrimidines and the vascular endothelial growth factor (VEGF) expression in primary colorectal cancer tissues. The data were reviewed retrospectively on 342 patients with colorectal cancer at stage II or III, who underwent potentially curative resection between 1988 and 1998. Of these, 225 received post-operative administration of oral fluoropyrimidines such as UFT and 5'-DFUR, while the other 117 patients underwent surgery alone. Immunostaining for VEGF was performed using colorectal tumours. Overall, VEGF was positively expressed in primary tumour cells in 48% of patients. The disease-free survival rate and the overall survival rate in the chemotherapy group were higher than those in the surgery-alone group, although not significantly. However, the disease-free survival rate and the overall survival rate were similar between the two groups in patients with a tumour positive for VEGF. Multivariate analysis revealed that the VEGF expression was an independent factor for post-operative recurrence, and the VEGF expression and post-operative adjuvant chemotherapy were an independent factor for overall survival, in addition to the lymph node metastasis and the venous invasion. In conclusion, the efficacy of post-operative adjuvant chemotherapy using oral fluoropyrimidines may not be as great for patients with a tumour positive for VEGF having a greater risk of post-operative recurrence. The results support further investigation on efficacy of molecular targeting therapy for VEGF in combination with oral fluoropyrimidines as post-operative adjuvant therapy in colorectal cancer positive for VEGF.