[A case of CA19-9 producing gastric cancer treated by low-dose administration of TS-1 for adjuvant chemotherapy]

A 72-year-old woman underwent total gastrectomy for CA19-9 producing gastric cancer. TS-1 was administered for recurrent gastric cancer because the duodenal stump was histologically positive and the serum CA19-9 level elevated after temporary regression. The dose was reduced from 80 mg/body/day to 50 mg/body/day because of grade 3 neutropenia. One course consisted of consecutive administration for 28 days followed by 14 days' rest. Upon the completion of the second course, the serum CA19-9 level became within normal limits, and no recurrence nor remarkable adverse reaction has been recognized for 6 courses. Adjuvant use of TS-1 for gastric cancer is ongoing as clinical trials, however, the incidence of adverse reaction does not seem to be negligible with administration of the recommended dose. Low-dose administration of TS-1 is thought to be one effective method of postoperative adjuvant chemotherapy for gastric cancer.

Serum pepsinogen in screening for gastric cancer

To establish a sensitive and efficient screening method for gastric cancer using serum pepsinogen, we investigated the characteristics of serum pepsinogen I and II levels and the I/II ratio and their cut-off points. We found that the pepsinogen I level and the I/II ratio were significantly lower in patients with gastric cancer than in control subjects, especially in patients with cancers of the differentiated type, the elevated type, and the depressed type without ulceration. However, sex, depth of invasion, and location of tumor did not correlate with the pepsinogen levels. A suitable cut-off point in screening for gastric cancer was a pepsinogen I level of less than 50 ng/ml and a I/II ratio of less than 3.0, as determined by receiver operator characteristics curves. The sensitivity, the specificity, and the accuracy of detection for all types of gastric cancer were approximately 55%, 75%, and 72%, respectively. If restricted to cancers of the elevated and the depressed type without ulceration, the sensitivity was approximately 85%, and the specificity and accuracy were approximately 76% and 77%, respectively. These results suggest that, in screening for gastric cancer when using pepsinogen levels and morphological examinations, the suitable cut-off point in regard to specificity is as stated above. However, regarding sensitivity, when the pepsinogen method is used alone, a pepsinogen I level of less than 70 ng/ml and a I/II ratio of less than 3.0 is acceptable.

[Assessment for development of superficial colorectal neoplasm--endoscopic and clinicopathologic analysis of 149 submucosal invasive carcinomas]

We performed the endoscopic and clinicopathologic analysis for the development of superficial colorectal carcinoma, using 149 submucosal (sm) invasive colorectal carcinomas. It was observed that superficial colorectal carcinomas had a tendency to rise by their sm massive invasion. In this study, we judged that the sm colorectal carcinomas originated from superficial colorectal carcinoma were 37 (25%) of 149 lesions, and their distribution in the colon and rectum was similar to that of advanced colorectal carcinomas, although the lesions originated from non-superficial (polypoid) colorectal carcinoma did not show so tendency. On the other hand, sm colorectal carcinomas originated from superficial colorectal carcinoma contained the evident adenomatous components in 7 (19%) of 37 lesions and had significantly higher incidence of lymph node metastasis than those originated from non-superficial (polypoid) carcinoma. These results suspected the facts as follows; 1) Superficial early colorectal carcinoma may be compatible as the origin to advanced colorectal carcinoma and has higher malignant potential than non-superficial early carcinoma. 2) Superficial colorectal carcinoma might also have the route of the development of "adenoma-carcinoma sequence", as well as "de novo" histogenesis.

[A clinical study of pepsinogen I and II producing gastric carcinomas]

Anti-human pepsinogen (PG) I and II monoclonal antibodies were used in an immunohistochemical study of 56 cases of gastric carcinoma (37 early stage and 19 advanced stage). We examined the relationship between positivity of the carcinoma for producing PG I and II and serum PG I and II levels. We found that in 2 cases (3.6%), the carcinoma produced PG I and in 11 cases (19.6%), it produced PG II. Early gastric carcinomas and differentiated-type carcinomas produced PG II more frequently than advanced and undifferentiated-type carcinomas. Also, type II c carcinomas and carcinomas located in the C area of the stomach produced PG II more frequently. But there was no significant difference between PG I and II-positive and negative cases in relation to both serum PG I and II levels. Moreover, the rate of positivity did not correlate with cases of abnormally high levels of serum PG I and II, (except in 1 case with abnormally high serum PG I in which PG II was produced.) These results suggest that there is no significant relationship between PG I or II-producing gastric carcinomas and serum PG levels. Furthermore, we examined PG II-producing and non-producing carcinomas in relation to the grade of inflammation, atrophy and intestinal metaplasia in gastric mucosa. However, there was no statistically significant difference among these factors. Only serum PG I and II levels were related to these parameters.

Gastric acid secretion, serum pepsinogen I, and serum gastrin in Japanese with gastric hyperplastic polyps or polypoid-type early gastric carcinoma

We determined the maximum secretion of gastric acid and the fasting serum levels of pepsinogen I and gastrin in Japanese patients with gastric hyperplastic polyps or polypoid-type early gastric carcinoma, comparing those findings with observations in control subjects. Both the maximum acid secretion and fasting levels of serum pepsinogen I were significantly lower in the patients with gastric hyperplastic polyps or polypoid-type early gastric carcinoma than in the controls. Fasting serum gastrin levels were significantly higher in the patients with gastric hyperplastic polyps than in the other two groups of subjects. These data demonstrated that the combination of hypochlorhydria, a low level of pepsinogen I, and hypergastrinemia (type-A gastritis) was common in the patients with gastric hyperplastic polyps, whereas hypochlorhydria and a low pepsinogen I without hypergastrinemia (type-B gastritis) were common in those with polypoid-type early gastric carcinoma.