[A Case of Primary Adenocarcinoma of the Duodenal Bulb with Laparoscopic Distal Gastrectomy]

A 66-year-old male presented with a torose lesion at the duodenal bulb, detected via endogastroduodenoscopy(EGD) during a medical check-up. It was histopathologically diagnosed as a low-grade adenoma. He was referred to the Department of Gastroenterology for follow-up observation. An endoscopic mucosal resection(EMR)was performed due to the increasing tumor size. The pathological findings of the resected specimen showed a tubular adenoma. The patient was then followed up as an outpatient. Two months later, a follow-up EGD revealed a mass lesion, suspected to be a remnant tumor. A laparoscopic distal gastrectomy, #3, #4sb, #5, #6 dissection, and Billroth Ⅱ+Braun anastomosis reconstruction were performed. Pathological examination showed a tubular adenocarcinoma in adenoma, tub1, with depth M, and no lymph node metastasis. Non-papillary duodenal carcinoma is a rare disease that has no established guidelines for radical surgery and the extent of lymph node dissection. Pancreaticoduodenectomy is often performed in advanced cases. However, due to the increasing number of patients and the risk of complications, limited resection should be considered as an alternative management option.

[Laparoscopic Surgical Treatment of Differentiated Intramucosal Gastric Cancer with Lymph Node Metastasis-A Case Report]

A 78‒year‒old man was admitted to our hospital with the chief complaint of 5 kg weight loss in 6 months. An esophagogastroduodenoscopy revealed a 0‒Ⅱa lesion in the posterior wall of the antrum, and biopsy findings showed a well‒differentiated adenocarcinoma. Endoscopic ultrasonography did not show an obvious invasion of the submucosal layer. Contrast‒ enhanced abdominal computed tomography(CT)revealed an enlargement of the #11p lymph node to approximately 30 mm, and positron emission tomography(PET)‒CT showed an accumulation in the same lymph node. Since no other apparent distant metastases were observed, laparoscopic distal gastrectomy and D2 dissection were performed. The postoperative pathological diagnosis was L, 7×8 mm, 0‒Ⅱa, tub1, pT1a, ly0, v0, pPM0(73 mm), pDM0(35 mm), N2, and pStage ⅡA. We report this case because the successful laparoscopic resection of a differentiated gastric mucosal cancer with lymph node metastasis has been considered to be extremely rare.

[A Case of Long-Term Survival after Multidisciplinary Treatment for Neuroendocrine Carcinoma of the Anal Canal]

A 75-year-old man presented to a local clinic with anal pain, and a palpable anal tumor on was found on digital examination of the rectum. A biopsy led to the diagnosis of neuroendocrine carcinoma. Besides the anal tumor, an right-inguinal lymph node was revealed on computed tomography(CT). Positron emission tomography-CT showed abnormal uptake in the 2 regions. He was diagnosed with lymph node metastases from anal canal carcinoma, and an abdominoperineal resection was performed. The resected specimen included the anal canal tumor with a size of 27×18 mm in diameter. On immunohistochemistry, the anal canal tumor was strongly positive for synaptophysin and positive for chromogranin A, with a Ki- 67 positivity index of 70%. After the surgery, he was administered chemotherapy with 4 courses of cisplatin and CPT-11. One year after the surgery, CT revealed lymph node recurrence. Therefore, cisplatin and CPT-11 therapy was repeated. After 11 courses of the cisplatin and CPT-11 treatment, tumor regrowth was still detected. The treatment protocol was changed to an amrubicin monotherapy regimen. However, the patient's general condition worsened after the therapies, and he died 38 months after the surgery.

[A Case of Long-Term Survival after Chemotherapy for Gastric Cancer with Peritoneal Dissemination]

The patient was a 58-year-old man who had undergone wide gastrectomy for gastric ulcer at 22 years of age. Endoscopic examination revealed an advanced type 3 gastric cancer in the anastomotic region. We performed total gastrectomy and D1 lymph node dissection because of the bleeding from the tumor, although peritoneal dissemination was found during the surgery. A post-operative pathological diagnosis of gastric cancer pT4b(SI, abdominal wall)N0M1(PER), pStage Ⅳ, was made. After the surgery, he was administered chemotherapy with S-1 and cisplatin. After 9 courses of the treatment, the treatment protocol was changed to an S-1 therapy regimen because of general fatigue. Four years and 8 months after the surgery, the tumor marker had increased, and CT scans revealed a dissemination nodule at the left back side of the bladder. Therefore, PTX plus Rmab therapy was administered as a second-line chemotherapy. Treatment with PTX plus Rmab resulted in tumor reduction, with an improvement of the QOL of the patient; partial response was maintained for 12 months. After 16 courses of the PTX plus Rmab treatment, tumor regrowth was detected. The treatment protocol was changed again to a nivolumab regimen. After 4 courses, the tumor marker was normalized, and CT scans revealed that the peritoneal dissemination had shrunk. Although the prognosis of gastric cancer with dissemination is very poor, it is possible to prolong survival with chemotherapy.

[A Case of Hypophysitis Due to Immune Check Point Inhibitor Treatment]

The patient was a man in his 70s with bone metastasis from renal cell carcinoma who had received immune checkpoint inhibitors(ICI)therapy. After 2 courses of chemotherapy, he was admitted to our hospital with diverticulitis. His diverticulitis could be treated with antibiotics, but he presented with severe hyponatremia and consciousness disorder during hospitalization. Brain MRI showed pituitary swelling, and his serum TSH, ACTH, cortisol levels decreased. We therefore diagnosed him with hypopituitarism due to ICIs. Hydrocortisone improved his hyponatremia and consciousness disorder. Endocrine stimulation tests revealed no reaction of ACTH, and low-level reactions of TSH, LH and FSH, ICIs cause many types of immune- related adverse events(irAEs). The indications for ICI therapy are expanding; thus, we can expect to experience more cases of serious irAEs in association with ICI treatment. Further studies should be performed to improve our understanding of irAEs.

[A Case of HER2-Positive Gastric Cancer with Multiple Liver Metastases Treated with Curative Conversion Therapy after Chemotherapy]

A 66-year-old man underwent chemotherapy with S-1 plus cisplatin plus trastuzumab to treat advanced gastric cancer that was diagnosed as cStage Ⅳ adenocarcinoma(T3N1M1[P0, CYX, H1]). After 8 courses, liver metastases were absent on contrast-enhanced MRI. The patient underwent a laparoscopic distal gastrectomy with D2 lymphadenectomy. The gross appearance of the surgically resected specimen showed a shrunk gastric tumor measuring 1 mm. The postoperative course was uneventful, and the patient has been well, receiving maintenance chemotherapy of S-1 plus trastuzumab without evidence of recurrence for 15 months following the operation. Conversion surgery following chemotherapy might be an effective treatment for patients with advanced gastric cancer; however, further studies are needed to establish this treatment strategy.

[Analysis of Renal Toxicity of S-1 plus CDDP Regimen with Short Hydration for Outpatients with Gastric Cancer]

BACKGROUND

Although the S-1 plus CDDP(SP)regimen is the standard treatment for advanced gastric cancer, hydration and admission have been recommended after cisplatin has been administered. In this study, short hydration(SH)method was used and SP was administered in outpatient settings. We evaluated renal toxicity of cisplatin in the SH-SP regimen at our hospital.

METHODS

Eleven of 16 patients(5 underwent only 1 course and so were excluded)received the SH-SP regimen between January 2012 and January 2018 to present and were included. Serum creatinine(Cr)and estimated glomerular filtration rate(eGFR)were used to assess renalfunction.

RESULTS

Median course was 5. Rate of 5-course accomplishment was 72.7%. Grade 1 Cr elevation was observed in only 3 patients and there was no severe renal disorder.

CONCLUSION

The SHSP regimen could be administered in outpatient settings and was considered safe as it did not cause renal toxicity.

[A Case of Breast Cancer Liver Metastases with Jaundice Responding to Chemotherapy]

A 50-year-old woman was referred to our hospital due to breast cancer with multiple liver metastasis diagnosed by CT scan. Laboratory findings showed liver dysfunction(T-Bil 7.6mg/dL)with marked elevation of tumor markers(CEA 727.9 ng/mL). Breast tumor biopsy showed an invasive ductal carcinoma(scirrhous type), ER(+), PgR(-), and HER2(3+). Combination therapy with docetaxel, carboplatin and, trastuzumab was administered after the end of 1 course of weekly paclitaxel plus bevacizumab regimen. The patient maintained a good condition without liver dysfunction 8 months after the first visit. Follow-up CT scan showed partial response of breast and hepatic tumors. Our case suggests that careful chemotherapy can improve the prognosis of breast cancer with liver metastasis even if a patient is in an icteric condition.

[Three Cases of Unresectable Colorectal Cancer Curatively Resected after Effective Chemotherapy]

Case 1: A60-year-old man underwent resection of a brain tumor, which was pathologically diagnosed as adenocarcinoma. As he was diagnosed with unresectable rectal cancer due to pulmonary metastasis, we performed abdominoperineal resection after chemotherapy. Since pulmonary metastasis and local recurrence were detected 1 year after the surgery, he was administered chemotherapy. He died 37 months after the surgery. Case 2: A6 4-year-old man was diagnosed with unresectable rectal cancer due to pulmonary and hepatic metastases, resulting in an examination for melena. We performed laparoscopic low anterior resection and hepatic partial resection after chemotherapy. No relapse has occurred 1 year after the surgery. Case 3: A39 -year-old man was examined for abdominal pain and distension and was diagnosed with unresectable rectal cancer due to invasion of the left ureter and multiple hepatic metastases. We performed anterior resection, hepatic partial resection, and RFAafter chemotherapy. He has remained in relapse-free survival for 15 months after the surgery. These results suggest that curative resection after chemotherapy improves the prognosis of unresectable colorectal cancer.

[A Case of Apocrine Carcinoma in the Breast That Was Difficult to Distinguish from Axillary Apocrine Adenocarcinoma]

An 86-year-old woman visited our hospital with a tumor on her right axilla. Ultrasonography(US)showed a 4 cm tumor between mammary gland and axilla with swelling of some lymph nodes. No distant metastatic lesions were found. The pathological findings revealed breast apocrine carcinoma; therefore, we performed total mastectomy and axillary lymph node dissection. The postoperative pathological findings revealed breast apocrine carcinoma with pT4N2M0, Stage Ⅲb(ER positive, PgR negative, HER2 positive, Ki-67 6%). We present a case of breast apocrine carcinoma confused with axially apocrine adenocarcinoma during the diagnosis and report the relevant literature.

[A Case of Breast Cancer with Infarcted Necrosis That Was Diagnosed Based on Axillary Lymph Node Metastasis]

A 61-year-old woman with a breast tumor detected by mammography examination was admitted to our hospital. Ultrasonography showed a 15.5×7.2mm sized irregular mass at the left BD area. Vacuum-assisted biopsy did not reveal any malignant cells. After 3 months, ultrasonography reexamination showed that the irregular mass had increased to 24.2×16.5mm in size, and it had spread to multiple axillary lymph nodes. The patient was diagnosed with breast cancer by core needle biopsy of the axillary lymph node. Total mastectomy with axillary lymph node dissection was performed. The pathological diagnosis was solid-tubular carcinoma with infarcted necrosis. The number of metastatic axillary lymph nodes was confirmed to be 23 in total. This case was considered very rare and important because there have been very few reports of breast cancer with infarcted necrosis.

Intraductal papillary mucinous neoplasm originating from a heterotopic pancreas within the jejunum: a case report

We report a case of intraductal papillary mucinous neoplasm arising within the heterotopic pancreatic tissue which was found incidentally in the jejunum during surgery for bowel obstruction. A 54-year-old female patient was admitted to our hospital due to sudden abdominal pain. In preoperative findings, we diagnosed bowel obstruction and performed surgery. Intra-operative findings showed adhesive intestinal obstruction, we performed synechiotomy for adhesion release. During surgery, when searching the small intestine, we coincidentally found a tumor in the jejunum and partial resected the jejunum. Pathological examination revealed a 1.2 cm × 1.0 cm × 1.0 cm white yellow nodule with cystic spaces. Histological examination demonstrated heterotopic pancreatic tissue consisting of well-formed lobules of pancreatic acini and cystically dilated ducts containing intraductal papillary neoplasm. Moreover, in immunohistochemical staining, MUC5AC was diffusely expressed, but not MUC1, MUC2 and MUC6.

Intracystic papillary carcinoma of the male breast: a case report

Background

Intracystic papillary carcinoma (IPC) is defined as cancer that develops from the wall of a cyst in the breast. As breast cancer in men accounts for only 1% of all breast cancers, male IPC is an extremely rare form of the disease. The present case report examines IPC in a man, along with an in-depth literature discussion.

Case presentation

A 64-year-old Japanese man noticed a mass in the right breast and sought medical attention. An elastic and soft neoplastic 3-cm lesion was palpated in the right papilla. As a 1-cm solid tumor with a gradual rise from the cyst wall was confirmed within the cyst, vacuum-assisted biopsy (VAB) was performed on that site. Pathological examination of the biopsy revealed heterotypic cells with an enlarged oval nucleus forming dense papillary structures mainly of vascular connective tissue component. Contrast-enhanced computed tomography (CT) confirmed thickening of the wall that protruded outside the cyst. The preoperative diagnosis was right breast cancer (male IPC) TisN0M0 stage 0 luminal B-like. Total mastectomy and sentinel lymph node biopsy were performed. In the excised specimen, a 4.0-cm unilocular cyst was found, along with a 1-cm solid tumor with a gradual rise from the cyst wall. Pathological diagnosis of the resected specimen shared similar characteristics with the solid tumor in the cyst: notably, an oval nucleus with histologically clear nucleolus and fine granular chromatin, cylindrically shaped heterotypic cells, and the presence of basophilic cells in the papillary growth with a thin stem of fibrovasculature as the axis. Some invasion of tumor cells into the interstitium was confirmed. As such, the final diagnosis was right breast cancer (male IPC) T2N0M0 stage IIA luminal B-like. The expression of hormone receptor (ER and PgR) was high, and endocrine therapy was initiated postoperatively (20 mg/day tamoxifen). At the present time (3 months postoperation), there has not been any evidence of metastasis.

Conclusions

We reported a rare case of an IPC in the male breast, along with a literature review.

[Usefulness of Vacuum-Assisted Biopsy(VAB)at Initial Biopsy]

In recent years, breast micro-lesions such as ductal carcinoma in situ(DCIS)were detected with progress of the image diagnosis. We investigated the usefulness of vacuum-assisted biopsy(VAB)for initial biopsy of breast tumors. We analyzed 32 cases of VAB performed for breast tumors. The pathological diagnosis of the biopsy specimens was malignant lesions in 10 cases, border-line lesions in 1 and benign lesions in 21 cases. 11 cases underwent surgery and the final histopathological diagnosis was the same in 10 of them. One case histopathology varied from DCIS to invasive ductal carcinoma(IDC). It was suggested that VAB at initial biopsy was a useful biopsy method.

Kimura's disease affecting the axillary lymph nodes: a case report

Background

Kimura’s disease (KD; eosinophilic granuloma of soft tissue) is an inflammatory granulomatous disorder of unknown cause with eosinophilic infiltration that occurs mainly in soft tissue. KD occurs mainly in the head and neck, but development in the axillary region is very rare.

Case presentation

A 74-year-old Japanese woman was evaluated for a mass that she noted in the left axillary region. On physical examination, there was a palpable, thumb-sized, hard, elastic, freely movable mass in the left axilla. Blood tests showed elevated soluble interleukin-2 receptor (sIL-2R), normal serum immunoglobulin (Ig) G4, and elevated serum IgE. Ultrasonography of the left axilla showed multiple lymph nodes (LNs) with irregular margins in which central hyperechogenicity was lost. A systemic search by computed tomography (CT) showed no systemic lymphadenopathy or other mass-like lesions suspicious for a primary tumour other than in the left axillary LNs. Biopsy of an excised LN was performed under local anaesthesia for a definitive diagnosis. Histopathology showed various-sized lymphoid follicles, large nodular lesions with an enlarged mantle zone, multiple various-sized germinal centres in single nodules, and eosinophilic infiltration between the nodes. Immunohistochemical (IHC) staining of the germinal centres was positive for cluster of differentiation (CD) 10, positive for B-cell lymphoma (bcl)-6, and negative for bcl-2. These findings led to a diagnosis of KD. Ultrasound after 3 months of follow-up showed disappearance of the axillary lymphadenopathy.

Conclusions

A very rare case of KD in the axillary LNs was described. KD has the potential to occur in any region.

[A case of advanced gastric cancer responding to S-1/CDDP neoadjuvant chemotherapy, leading to a pathological complete response]

A 66-year-old man with cStage III B (cT4aN2H0P0M0) advanced gastric cancer in the cardia with esophageal invasion was treated with S-1/CDDP as neoadjuvant chemotherapy. After 3 courses of chemotherapy, a significant reduction in tumor burden was observed. Total gastrectomy and splenectomy with lymph node dissection (D2) were performed. Pathological specimens showed no cancer cells in the stomach and lymph nodes, indicating a pathological complete response.

Comparison of recombinant human thrombomodulin and gabexate mesylate for treatment of disseminated intravascular coagulation (DIC) with sepsis following emergent gastrointestinal surgery: a retrospective study

PURPOSE

Recombinant thrombomodulin (rTM) has been available in Japan since 2008, but there is concern about its association with postoperative hemorrhage. The efficacy and safety of rTM were examined in patients with disseminated intravascular coagulation (DIC) caused by a septic condition after gastrointestinal surgery.

METHODS

Forty-two patients were emergently admitted to the intensive care unit after emergent gastrointestinal surgery in Kyushu University Hospital from May 2008 to April 2013. Of these patients, 22 had DIC (defined as an acute DIC score ≥ 4). All but three patients received treatment with gabexate mesylate (GM) (n = 9) or rTM (n = 10). The causes of sepsis were peritonitis with colorectal perforation, anastomotic leakage, and intestinal necrosis. Acute DIC score, sepsis-related organ failure assessment score, platelet count, and a variety of biochemical parameters were compared between rTM and GM recipients after treatment administration.

RESULTS

There were no significant differences between the groups for any parameter except C-reactive protein levels. The CRP level tended to be lower in the rTM group than in the GM group. Acute DIC score in the rTM group resolved significantly earlier than that in the GM group. No patient stopped the administration of rTM because of postoperative bleeding.

CONCLUSION

rTM may be an effective therapeutic drug for the treatment of septic patients with DIC following emergent gastrointestinal surgery.

[A case of rectal cancer with brain metastasis successfully treated with combined modality therapy - a case report]

The authors report their experience in a patient with brain metastasis from rectal cancer who has survived without recurrence after multidisciplinary treatment. A 60-year-old man presented to the Department of Neurosurgery with the primary complaint of spasm of the left side of the face. Examination revealed a tumor 2 cm in diameter in the right frontal lobe. The tumor was suspected to be metastatic, and brain metastasis from rectal cancer was diagnosed. The brain tumor was removed by a neurosurgeon, and the patient was transferred to the Department of Surgery. Removal of the primary lesion in the rectum was attempted, but only colostomy could be performed due to extensive anterior invasion. Postoperatively, 5 courses of capecitabine and oxaliplatin (XELOX) + bevacizumab were administered. The rectal tumor shrank in size, while another mass, suspected to be a lung metastasis, remained unchanged. Therefore, a second surgery on the rectum was scheduled, and abdominoperineal resection of the rectum and lateral lymphadenectomy were performed. Postoperatively, 4 courses of XE LOX therapy were administered. The patient is currently alive without recurrence at 1 year after surgery. Treatment (including timing) for brain metastasis from rectal cancer has not been established and prognosis is poor. However, multidisciplinary treatment may provide the possibility of cure.

[A case of desmoid tumor and advanced sigmoid colon cancer with liver metastasis in familial adenomatous polyposis (FAP)]

We report on a 30-year-old man with familial adenomatous polyposis (FAP ) who developed advanced sigmoid colon cancer with desmoid tumors. The patient initially presented with melena. FAP advanced sigmoid colon cancer was diagnosed following a laparoscopy-assisted proctocolectomy in 2007. A computed tomography (CT) scan, conducted 7 months later, revealed a tumor around the branch of the common iliac artery. We diagnosed sigmoid colon cancer recurrence and attempted treatment by surgical removal. However, there were many smooth tumors within the patient's abdomen, which were diagnosed as desmoid tumors using rapid intraoperative pathological diagnosis. Although the patient was administered a COX-2 inhibitor and tamoxifen after surgery, the tumor grew. Dacarbazine (DTIC) and doxorubicin (DOX) were subsequently administered to the patient, and after 4 courses, the tumor was reduced by 60% and stable disease (SD) was achieved. In 2009, a CT scan indicated sigmoid colon cancer recurrence in the liver. The patient underwent a left hepatic lobectomy by laparoscopy-assisted surgery. To date, 4 years and 6 months after surgery, we have been unable to find new disease or desmoid tumor growth.

[Significance of preoperative neutrophil-to-lymphocyte ratio as a predictor of prognosis in patients with stage IV colorectal cancer]

This study aimed to investigate the clinical significance of preoperative neutrophil-to-lymphocyte ratio(NLR)as a predictor of prognosis in patients with Stage IV colorectal cancer. A total of 130 patients who underwent operation for Stage IV colorectal cancer were enrolled in the study. Of the patients, 69 had an NLR of ≥ 3.0 and were defined as the high-NLR group. Patients who received preoperative therapy and underwent emergency operation for perforation were excluded from the analysis. The 2-year survival rate was 58.1% in the high-NLR group and 43.5% in the low-NLR group. The median survival time was 38.0 months in the high-NLR group and 22.3 months in the low-NLR group. The patient prognosis in the high-NLR group was significantly worse than that in the low-NLR group. A univariate analysis indicated that high NLR, peritoneal dissemination, curability C, histological type( non-differentiated), and number of organs involved in metastasis (more than 1 organ) were the risk factors of poor survival. All of these factors, except peritoneal dissemination, were independent risk factors for poor survival on multivariate analysis. A high preoperative NLR may be considered as a convenient biomarker to identify patients with a poor prognosis after operation for stage IV colorectal cancer.

[A case of familial adenomatous polyposis presenting with thyroid cancer]

We report a case of familial adenomatous polyposis( FAP) presenting with thyroid cancer. A 24-year-old woman, on histological examination, was diagnosed as having the cribriform-morular variant of papillary thyroid carcinoma, which is known to be associated with FAP. Therefore, she underwent colonoscopy, and FAP was diagnosed. In addition, abdominal computed tomography( CT) scans revealed a tumor, approximately 12 cm in diameter, in the right lower abdomen. After total thyroidectomy, total proctocolectomy and excision of the tumor arising from the mesentery of the small intestines were performed. The histological diagnosis was FAP with a desmoid tumor arising from the mesentery.

[A case of emphysematous cholecystitis during the course of chemotherapy for gastric cancer]

A 77-year-old woman with Stage IV gastric cancer was admitted to our hospital because of high fever, poor appetite, and abdominal pain during combined chemotherapy with S-1 and cisplatin( CDDP). Abdominal computed tomography (CT) revealed the presence of gas in the submucosal layer on the basis of which emphysematous cholecystitis (EC) was diagnosed. We performed cholecystectomy and were able to proceed with the chemotherapy 1 month after surgery. Destruction of the gallbladder mucosa by ischemia has been reported to be a possible cause of emphysematous cholecystitis. Moreover, underlying systemic diseases such as arterial sclerosis and diabetes mellitus could be risk factors for EC. Our case suggested that chemotherapeutic agents might trigger ischemic changes in the gallbladder and thus result in EC.

Meta-analysis of laparoscopic and open surgery for gastric gastrointestinal stromal tumor

AIM

A meta-analysis was conducted to evaluate and compare the short- and long-term outcomes of laparoscopic and conventional open surgery for gastric gastrointestinal stromal tumors (GISTs).

MATERIALS AND METHODS

We searched MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant articles published between 2000 and July 2013 by using the search terms "laparoscopic", "laparoscopy-assisted", "surgery", "gastrointestinal tumor", "GIST" and "gastric".

RESULTS

We identified 12 articles reporting results that compared laparoscopic surgery with open surgery for gastric GISTs. Our meta-analysis included 644 patients with GISTs; 312 had undergone laparoscopic surgery, and 332 had undergone open surgery. In the short-term period, 14 outcome variables were examined. In the long-term period, six oncological variables were analyzed. Laparoscopic surgery for gastric GIST was associated with a reduction in intraoperative blood loss, shorter period to flatus, earlier resumption of oral intake, and shorter duration of hospital stay over the short-term, and with a significantly lower rate of overall recurrence, metastatic recurrence and local recurrence in the long-term compared to open surgery.

CONCLUSION

Laparoscopic surgery may be an acceptable surgical treatment option compared to open surgery for gastric GIST.

[Promising effects of pregabalin in the treatment of oxaliplatin-induced sensory neuropathy in patients with colorectal carcinoma]

Thirteen patients with metastatic colorectal cancer who suffered from oxaliplatin-induced sensory neuropathy were evaluated to determine the neuropathy Grade before and after the administration of pregabalin. All patients received oxaliplatin as adjuvant or first-line chemotherapy. The mFOLFOX6 and CapeOX groups included 3 and 10 cases, respectively, and the average treatment regimens were 8 and 5 doses, respectively. Before receiving pregabalin, sensory neuropathy was classified as Grade 3 in 2 patients, as Grade 2 in 8 patients, and as Grade 1 in 3 patient. The average amount of pregabalin administered to patients was 237 (range: 150-450) mg. After administering pregabalin, we observed improvements in 8 neuropathy cases (61. 5%)within approximately 2 weeks. All side effects were mild. In this study, pregabalin was shown to positively impact sensory neuropathy resulting from oxaliplatin treatment and to enable the long-term use of oxaliplatin-based chemotherapy.

Low expression of claudin-1 and presence of poorly-differentiated tumor clusters correlate with poor prognosis in colorectal cancer

BACKGROUND

Claudins are integral membrane proteins that constitute tight junctions. The aim of this study was to determine the clinical significance of claudin-1 in terms of the cell-cell adhesion, considering the poorly-differentiated tumor component.

PATIENTS AND METHODS

A total of 344 cases of stage II and III colorectal cancer were enrolled. We evaluated the expression of claudin-1 by immunohistochemistry and the extent of the poorly differentiated component.

RESULTS

Low expression of claudin-1 was associated with lymphatic involvement, histological differentiation, extent of poorly-differentiated component, reduced disease-free and overall survival. Multivariate analysis indicated that lymph node metastasis, venous involvement and low claudin-1 expression were independent predictors of recurrence, and that lymph node metastasis, venous involvement and low claudin-1 expression were associated with poor survival.

CONCLUSION

Our study not only showed the significance of low expression of claudin-1 as a predictor of poor prognosis of colorectal cancer but also supported the concept of grading of the poorly-differentiated component.

A high preoperative neutrophil-to-lymphocyte ratio is associated with poor survival in patients with colorectal cancer

BACKGROUND

Previous studies have reported that an elevated preoperative neutrophil-to-lymphocyte ratio (NLR) is associated with a poor prognosis in patients with various types of cancers. The aim of this study was to determine the prognostic significance of preoperative NLR in patients with colorectal cancer and to determine an appropriate cut-off value of the NLR.

PATIENTS AND METHODS

We enrolled 674 patients who underwent surgery for stage I-IV colorectal cancer. The mean NLR was 2.74±2.20. To determine the appropriate cut-off value of the NLR, we used a receiver operating characteristic curve. A total of 262 patients with an NLR of 2.5 or more were classified as high-NLR individuals in this study. The prognostic significance of a high NLR was evaluated using a multivariate analysis.

RESULTS

The cancer-specific survival was significantly (p<0.001) worse in the patients with a high NLR. The multivariate analysis indicated that the tumor diameter, the presence of lymph node or distant metastasis, and a high NLR were independent risk factors for poor survival.

CONCLUSION

Preoperative NLR measurement is a convenient biomarker and predictor of a poor prognosis after surgery for colorectal cancer.

Abstract 4054: Significance of CXCR4/SDF-1 axis expression in gastric cancer under hypoxic enviroment

Background: Various types of solid tumors, including gastric cancer, have a heterogeneously hypoxic environment which has been currently considered to be associated with aggressive tumor phenotypes cancer. Stromal cell-derived factor (SDF)-1 and C-X-C chemokine receptor type 4 (CXCR-4) form an important chemokine/receptor pair, and are supposed to be up-regulated by hypoxia inducible factor-1 (HIF-1). Although the chemokine signaling is associated with malignant potential of various carcinomas, few studies have addressed the expression and function of CXCR4 and SDF-1 under hypoxia in gastric cancer. The aim of our study was to clarify the significance of CXCR4 and SDF-1 under hypoxia in gastric carcinoma by evaluating the expression of a hypoxic marker, a carbonic anhydrase 9 (CA-9).

Experimental Design: A total of 297 patients who had undergone a resection of the primary tumor and were confirmed histologically to have sporadic gastric cancer were enrolled in this study. Expressions of CXCR4, SDF-1, and CA-9, were assessed by immunohistochemistry. We examined the association between the expression levels of CXCR4, SDF-1, and CA-9 and clinicopathologic variables of patients with gastric cancers. Furthermore, using three diffuse-type gastric cancer cell lines, OCUM-2M, OCUM-2MD3, and OCUM-12, expression level of CXCR4 and SDF-1 in hypoxia (1% O2) were examined by RT-PCR.

Results: CA-9 expression was found in 48% (143/297) of gastric cancers, CXCR4 was 47% (141/297), and SDF-1 was 41% (122/297). The CA9 expression was significantly correlated with CXCR4 expression and SDF-1. The CA9 expression level was significantly high in cases diffuse-type carcinoma (p=0.028). The prognosis for CA-9-positive patients was significantly poorer than that of CA-9-negative patients (p&lt;0.001,log-rank). The CXCR4 expression level was significantly correlated with lymph node metastasis (p&lt;0.001), and with higher stages (p&lt;0.001). The SDF-1 expression level was significantly higher with lymph node metastasis(p&lt;0.001), and with higher stages (p&lt;0.001). The prognosis for CXCR4-positive patients was significantly poorer than that of CXCR4-negative patients (p&lt;0.001, log-rank). The prognosis for SDF-1-positive patients was significantly poorer than that of SDF-1-negative patients (p=0.008, log-rank). The expression level of CXCR4 mRNA was significantly increased by hypoxia, in comparison with that in normoxia in all of gastric cancer cells.

Conclusion: CXCR4/SDF-1 expression of gastric cancer cells might be regulated with by hypoxic condition. CXCR4/SDF-1 axis might play an important role for the progression of diffuse-type gastric carcinoma with hypoxic environment.

Citation Format: Haruhito Kinoshita, Masakazu Yashiro, Tamami Morisaki, Tatsunari Fukuoka, Tsuyoshi Hasegawa, Toshiki Hirakawa, Naoki Aomatsu, Katsunobu Sakurai, Kenjiro Kimura, Hisashi Nagahara, Takahiro Toyokawa, Ryosuke Amano, Eiji Noda, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Hiroshi Otani, Kiyoshi Maeda, Masaichi Ohira, Kosei Hirakawa. Significance of CXCR4/SDF-1 axis expression in gastric cancer under hypoxic enviroment. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4054. doi:10.1158/1538-7445.AM2013-4054

Abstract 3995: Antitumor effect of prostaglandin D2 by peroxisome proliferator-activated receptor gamma (PPARγ)-dependent pathway in gastric carcinoma

Introduction: Prostaglandin D2 (PGD2) has been demonstrated to have not only physiological responses but also anti-tumor effects against some types of cancer cells such as a lung cancer. PGD2 act through two major receptors, DP1 and DP2 of chemoattractant receptor-like molecule on the Th2 cell. Recently, some papers reported that PGD2 may act through PPARγ, suggesting that the effects of PGD2 are involved in either PGD2 dependent or independent pathway. PGD2 metabolite, 15-deoxy-Δ12 14-PGJ2, activates peroxisome proliferator-activated receptor γ (PPARγ) which induces growth inhibition of various cells. PPARγ is expressed in various types of cancers including gastric cancer. Since the role of PGD2 on gastric cancer cells is still unknown, this study is aimed to investigate the effect of PGD2 signalings on the proliferation of gastric cancer cells.

Materials and Methods: Three human gastric cancer cell lines, OCUM-2M, OCUM-12, and MKN-74, were used. Effect of PGD2 or PPARγ antagonist on the proliferation of cancer cells was examined by MTT assay.

The expression level of PGD2 receptor, DP1 and DP2, and PPARγ of gastric cancer cells was examined by RT-PCR. The effect of PGD2 on cell cycle was examined with PI staining by flowcytometry.

Results: PGD2 significantly decreased the proliferation of OCUM-2M and MKN-74 cells at a dose-dependent manner, but not that of OCUM-12. PGD2 receptors, DP1 and DP2, were not expressed in 3 gastric cancer cell lines while PPARγ was expressed in OCUM-2M and MKN-74. BADGE, a PPARγ antagonist, significantly suppressed the growth-inhibitory effects of PGD2 on OCUM-2M and MKN-74 cells. PGD2 increased G0/G1 phase of cancer and decereased G2/M phase.

Conclusion: PGD2 decreased the proliferation of gastric cancer cells through PPARγ dependent pathway. PGD2 might be a promising therapeutic agent for gastric cancer with PPARγ expression.

Citation Format: Tatsunari Fukuoka, Masakazu Yashiro, Hiroshi Takeda, Takayuki Maruyama, Haruhito Kinoshita, Tamammi Morisaki, Tsuyoshi Hasegawa, Toshiki Hirakawa, Naoki Aomatsu, Katsunobu Sakurai, Kenjiro Kimura, Hisashi Nagahara, Takahiro Toyokawa, Ryosuke Amano, Eiji Noda, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Hiroshi Otani, Kiyoshi Maeda, Masaichi Ohira, Kosei Hirakawa. Antitumor effect of prostaglandin D2 by peroxisome proliferator-activated receptor gamma (PPARγ)-dependent pathway in gastric carcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3995. doi:10.1158/1538-7445.AM2013-3995

SPan-1 is a useful prognostic marker for patients with stage IV gastric cancer who underwent palliative gastrectomy: a retrospective multivariate study

BACKGROUND

We retrospectively investigated prognostic factors to be used in selecting the patients with stage IV gastric cancer (GC) who have an unfavorable prognosis after palliative gastrectomy.

METHODS

A total of 146 GC patients at stage IV who had undergone palliative gastrectomy were enrolled. Various clinicopathological parameters were evaluated for prognosis.

RESULTS

Surgical morbidity and hospital mortality occurred in 35 (23.9 %) and 4 (2.7 %) patients, respectively. The overall 5-year survival rate and the median survival time were 11.2 % and 13.2 months, respectively. Of the 146 patients, 64 had uncomfortable symptoms associated with GC and 76 had no such symptoms. Of the 64 patients with uncomfortable symptoms, 60 (93.7 %) experienced relief of these symptoms after palliative surgery. Multivariate analysis for patients without uncomfortable symptoms associated with GC revealed that the number of incurable factors and serum SPan-1 level were independent prognostic factors.

CONCLUSIONS

Patients with stage IV GC who had multiple incurable factors and a high level of serum SPan-1 might not be candidates for palliative gastrectomy for the purpose of prognostic benefit.

Successful resection of esophageal cancer with right aortic arch by video-assisted thoracoscopic surgery: a case report

The right aortic arch (RAA) forms a vascular ring, encircling both the esophagus and trachea. We herein report a case of thoracic esophageal cancer with RAA successfully resected using video-assisted thoracoscopic surgery (VATS). A 64-year-old man who presented with a complaint of abdominal pain, was admitted to our hospital. Further examinations revealed gall stones and multiple superficial esophageal carcinomas. Three-dimensional computed tomographic images showed RAA and aortic diverticulum. The trachea and esophagus were completely encircled by the RAA, the aortic diverticulum and the pulmonary artery. We successfully and safely performed VATS esophagectomy for esophageal cancer accompanied with RAA. To the best of our knowledge, this report is the first case for which VATS esophagectomy for esophageal cancer, accompanied with RAA, was carried out. Marking of the left recurrent laryngeal nerve with colored tape at the cervical part of the surgery made it easy to identify it during the thoracoscopic part of the surgery.

Expression of E-cadherin and KRAS mutation may serve as biomarkers of cetuximab-based therapy in metastatic colorectal cancer

Cetuximab (Cmab), a chimeric monoclonal antibody for targeting the epidermal growth factor receptor, has become one of the standard treatments for metastatic colorectal cancer (mCRC). However, only a small proportion of patients respond to Cmab, and it has been reported that KRAS mutation is a negative biomarker of response to Cmab therapy. The aim of this study was to detect additional biomarkers of response to Cmab therapy in patients with mCRC. We evaluated the effects of Cmab therapy in 36 patients with mCRC according to the Response Evaluation Criteria in Solid Tumors, and classified patients who achieved complete response, partial response or stable disease as responders, and patients who achieved progressive disease as non-responders. We retrospectively examined the difference between the two groups using KRAS analysis and immunohistochemistry to determine the expression of E-cadherin, p53 and Ki67. Nineteen patients were responders, while 17 patients were non-responders. KRAS status and expression of E-cadherin were significantly correlated with the effect of Cmab therapy. Moreover, the expression of E-cadherin was significantly correlated with the effect of Cmab therapy in KRAS wild-type patients. In KRAS mutant-type patients, the expression of E-cadherin did not significantly correlate with the effect of Cmab therapy, but all responders with KRAS mutant-type tumors expressed E-cadherin. Our results indicate that the expression of E-cadherin detected by immunohistochemistry may be a positive predictor of Cmab-based therapy in mCRC, and that a combination of E-cadherin immunohistochemistry and KRAS analysis may be a more sensitive biomarker than KRAS analysis alone.

[A case of early gastric cancer with cervical lymph nodes recurrence 5 years after a curative resection]

A 61-year-old man exhibiting epigastric malaise on hunger was diagnosed with early gastric cancer by upper gastrointestinal endoscopy. Since no obvious metastasis was recognized by abdominal computed tomography(CT), he underwent distal gastrectomy with D1+ lymphadenectomy. Histopathological examination revealed a pStage IA lesion[pT1a (m), pN0]. He received no adjuvant chemotherapy, and he remained alive and in good health without recurrence for more than 5 years. At 5 years and 7 months after gastrectomy, he noticed cervical lymph node swelling and underwent further examination. He was diagnosed with recurrent gastric cancer in cervical lymph nodes, and treatment with S-1 (120 mg/ day) was initiated. He remained alive and free of progression for approximately 1 year on S-1 therapy, but he suddenly died from disseminated intravascular coagulation without an obvious cause. We report a rare case of late recurrence after curative resection in a patient treated for early gastric cancer.

[Locally recurrent case of gastric cancer with serosal invasion after four months of endoscopic submucosal dissection]

A 52-year-old woman underwent endoscopic submucosal dissection (ESD) for early gastric cancer at the lesser curvature. Microscopic examination revealed tub1, pSM1, ly0, v0, pHM0, and pVM0, which were considered to be relative resection. Four months later, upper gastrointestinal endoscopy showed local recurrence with suspected SM massive tumor infiltration. We performed a laparoscopic distal gastrectomy with lymph node dissection. Postoperative pathology showed tub2, pT4a (SE), pN2, ly0, v0, and fStage IIIb. This indicated that a few remnant cancer cells were stimulated by the local inflammation associated with ESD. ESD is less invasive than open surgery, but strict observation following curative resection is essential to rule out inflammation-mediated recurrence.

[A case of far-advanced gastric cancer successfully treated with S-1/paclitaxel/krestin immunochemotherapy, followed by curative resection]

A 57-year-old woman suffering from lower abdominal malaise was diagnosed with cStage IV advanced gastric cancer because of simultaneous liver metastasis and peritoneal dissemination. Because she was regarded as inoperable, she was administered combined immunochemotherapy comprising S-1/paclitaxel(PTX) and Krestin(PSK). One course of therapy lasted for 3 weeks as follows: 80 mg/m2 of S-1 on days 1-14 orally, 50 mg/m2 of PTX on days 1 and 8 intravenously, and 3g/day of PSK on days 1-21 orally. After 20 courses of this treatment, the metastatic liver tumor and peritoneal dissemination had disappeared on the abdominal computed tomography scan. At that time, curative resection was considered possible and she underwent total gastrectomy (Roux-en Y) with D2 lymphadenectomy. Histopathological examination revealed pStage IB [pT2 (mp), pN0] and the histological effects of the main tumor were diagnosed as grade 2. She is alive and free from recurrent disease for more than 6 years, and remains in a good condition. This combination of immunochemotherapy using S-1/PTX/PSK can be safe and effective, and is an initial treatment option for unresectable advanced gastric cancer.

[A case report of a stage IV gastric cancer patient with rapid progression of liver metastases induced by postoperative anastomotic leakage]

The patient was a 39-year-old man with type 3 gastric cancer with synchronous multiple liver and lung metastases, who was diagnosed as cStage IV(cT4aN1M1H1). He received induction chemotherapy with S-1 and CDDP. After chemotherapy, the liver and lung metastases had disappeared completely. He underwent total gastrectomy and splenectomy, with D2 nodal dissection. Anastomotic leakage occurred on postoperative day 6, and substantial inflammatory conditions continued for 2 weeks. He died 6 weeks after surgery with multiple liver metastases. This case suggests that elevated inflammatory conditions may cause tumor progression.

A comparative study of single-incision versus conventional multiport laparoscopic ileocecal resection for Crohn's disease with strictures

INTRODUCTION

Single-incision laparoscopic surgery (SILS) offers excellent cosmetic results compared with conventional multiport laparoscopic surgery. Recently, this technique has been applied to colorectal disease. However, there have been few reports about its application to Crohn's disease (CD) in the literature. The aim of this study is to describe our early experience with SILS for 11 patients with CD and make comparisons with the conventional multiport laparoscopic surgery.

METHODS

We reviewed all patients with CD who underwent laparoscopic surgery for the presence of ileocolic strictures at our institution between January 2006 and March 2011. Data from consecutive patients undergoing SILS were analyzed and compared with those from conventional multiport laparoscopic surgeries.

RESULTS

During the study period, 11 patients underwent SILS. All surgeries were completed with SILS. Operative time, blood loss and conversions were not significantly different between the two groups. Postoperative complications and length of hospital stay also had no significant difference.

CONCLUSION

In conclusion, SILS for CD may be safe and feasible in selected patients, and have better cosmetic results than conventional multiport laparoscopic surgery. Further studies are needed to evaluate the outcome of SILS compared to that of conventional laparoscopic surgery.

Successful resection of esophageal carcinoma associated with double aortic arch: a case report

Double aortic arch (DAA) is an extremely rare vascular malformation which causes tracheal and esophageal compression, resulting in respiratory symptoms such as stridor and wheezing, or feeding problems such as dysphagia, usually during the first few months of life. In contrast, this disorder is rarely diagnosed in adults. We herein present an elderly case with thoracic esophageal carcinoma with DAA. To the best of our knowledge, this is only the second report of a successfully resected case of esophageal cancer associated with DAA in the English literature. Moreover, this is the first reported case of symptomatic DAA with esophageal carcinoma. Spiral computed tomography and three-dimensional reconstruction was very useful for preoperative assessment of the abnormal vessels.

Predictive value of expression of ERCC 1 and GST-p for 5-fluorouracil/oxaliplatin chemotherapy in advanced colorectal cancer

BACKGROUND/AIMS

The aim of this study was to determine whether expression of the excision repair cross complementing protein (ERCC1), glutathione S-transferase pi (GST-p) and thymidylate synthase (TS) predict response in patients with advanced colorectal cancer treated with 5-fluorouracil/oxaliplatin chemotherapy.

METHODOLOGY

The study population consisted of 39 patients with advanced colorectal cancer (median age, 65 years). Patients were treated with the modified FOLFOX 6 regimen. The expression of ERCC-1, GST-p and TS of primary tumors were examined by immunohistochemistry.

RESULTS

The response rate of modified FOLFOX 6 chemotherapy was 51.3%. The positive rates of ERCC-1, GST-p and TS were 43.6%, 33.3% and 66.7%, respectively. The patients without ERCC-1 (p=0.0248) or GST-p? (p=0.0019) expression were more likely to respond to chemotherapy. TS expression did not correlate with chemotherapeutic response.

CONCLUSIONS

Immunohistochemical studies for ERCC-1 and GST-p may be useful in prediction of the response to 5-fluorouracil/oxaliplatin chemotherapy in advanced colorectal cancer patients.

Abstract 3396: Predictive value of metastatic lymph node ratio in diagnosis of recurrence after surgical resection of gastric cancer

Peritoneal meatastasis is the most important pattern in postoperative recurrence of gastric cancer. The purpose of this study was to investigate the predictive factors of peritoneal recurrence in gastric cancer patients who underwent surgical resection. We retrospectively analyzed clinical data of 137 consecutive patients diagnosed with peritoneal recurrence after curative gastrectomy at Department of Osaka City University Hospital. We evaluated association of clinicopathological features with relapse free survival rate. Parameters analyzed in this study included age, sex, tumor diameter, histological type, tumor infiltration, number of lymph node metastasis, TNM stage, lymphatic invasion, venous invasion, and metastatic lymph node ratio (MLR). Median survival time of entire patients was 12 months and mean MLR was 34%. For statistical analysis, we divided patients into two groups based on relapse free survival time. 78 patients who had peritoneal recurrence within one year after gastrectomy were defined as early recurrence group. The remaining 59 patients were stratified to late recurrence group. In comparison of both groups, univariate analysis showed statistically significant predictive factors associated with recurrence, for example, peritoneal lavage cytology, lymphatic invasion, tumor diameter, number of lymph node metastasis, and MLR. In multivariate analysis, MLR was identified as an independent predictive factor. Also the patients with 20% or higher MLR had poorer prognosis in overall survival. We demonstrated that lymph node metastasis was associated with peritoneal recurrence. Our findings suggested that MLR should be considered for postoperative adjuvant therapy to impede progression of peritoneal metastasis for gastric cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3396. doi:1538-7445.AM2012-3396

Abstract 514: Relationship between loss of heterozygosity of HLA-A gene and HLA class I expression in gastric cancer

[Introduction]Human leukocyte antigen (HLA), located on 6p21.3, encodes for genes involved in antigen processing and presentation. Loss of heterozygosity (LOH) at 6p21.3 may cause downregulation of HLA class I, and may provide tumor cells with an immune-escape tumor phenotype. The aim of this study is to examine HLA class I expression in gastric cancer tissues and cell lines, to clarify the clinical impact of HLA-A dawnregulation on progression of gastric cancer. [Materials and methods]We examined HLA class I expression in clinical samples from 206 patients by immunohistochemical staining. By flow cytometric analysis, we analyzed the expression of HLA class I antigen in gastric cancer cell lines. Furthermore, we performed HLA-A typing in gastric cancer cell lines by PCR-SBT method. [Results]We observed that HLA class I expression was downregulated in metastatic lymph node compared with in primary lesion. HLA class I expression in primary lesion was associated with ly factors and histological types. Furthermore, patients with negative expression of HLA class I showed significantly poorer prognosis. In vitro, we observed the downregulation of HLA class I antigen in OCUM-2MLN cells which have a high potential for lymph node metastasis. By PCR-SBT method, we detected loss of heterozigosity of HLA-A gene in OCUM-2MLN. [Conclusion]We observed that HLA class I expression was associated with poor prognosis of gastric cancer and LOH of HLA-A was recognized in cancer cell line which has potential to develop lymph node metastasis. Our findings suggested that LOH of HLA-A gene would result in provide cancer cells with capacity to metastasize into lymph nodes.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 514. doi:1538-7445.AM2012-514

Abstract 3380: Comparison proteome analysis of scirrhous gastric carcinoma stem cell-like SP and hypoxia-resistant cell lines

Intro Cancer stem cells (CSCs) are considered to be responsible for cancer metastasis, and hypoxia is supposed to be an important regulator of CSCs differentiation. Furthermore, tumor hypoxia was reported to be associated with more aggressive tumor phenotypes such as high metastatic ability and resistance to various anti-cancer therapies which may lead to a poorer prognosis. This raises the question of whether there might be proteins representing similar alterations which are responsible for the correlation between hypoxic and CSCs phenotypes. We have established a diffuse-type of gastric carcinoma cell line (OCUM-12), and a hypoxia-resistant cancer cell line (OCUM-12/Hypo) cloned from parent OCUM-12 cells by continuous exposure to 1% oxygen. The side population (SP), as evaluated by a flow cytometric analysis using Hoechst 33342, has been known as CSC-rich population. To investigate and compare the proteomes of the hypoxic (OCUM-12/Hypo), stem cell (OCUM-12SP) and parent OCUM-12 diffuse-type gastric carcinoma cell lines, protein lysates from those cell lines were analyzed using QSTAR Elite LC MS/MS. Method Triplicate pooled samples (10 ug protein each) from stomach cancer cell lines were prepared and labeled with iTRAQ reagents. MS/MS data were searched against the Swiss Protein database (HUMAN) using ProteinPilot™ 2.0 software (AB Sciex). The Ingenuity Pathway analysis program was utilized, to assign biological significance, and to identify networks of interacting differentially expressed proteins, functional groups and pathways. Result In both OCUM-12SP and OCUM-12/Hypo cells, significant overexpression of Wnt signaling pathway was obvious. Furthermore, elevation of MTHFD1, a protein controlling histidine and purine nucleotide metabolism, cytokeratins 18 (CK18), and 19 (CK19) regulating cell cycle, apoptosis and angiogenesis, transcriptional regulator ANP32A, and cellular chaperones heat shock proteins A9 and STIP was observed as compared to the parent OCUM-12 cell line. Furthermore, anterior gradient homolog 2 (AGR2)was down-regulated in both cell lines. Conclusion Wnt signal, MTHFD1, CK18, CK19, ANP32A, HSPA9 and STIP, AGR2 might be responsible for the stem-like phenotype, hypoxia resistance and higher invasiveness of gastric cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3380. doi:1538-7445.AM2012-3380

Abstract 708: Clinical significance of insulin-like growth factor 1 receptor (IGF1R) expression in pancreatic cancer

Introduction: Insulin like growth factor 1 receptor (IGF1R) reported to be overexpressed in some types of human carcinomas, including lung cancer, and breast cancer. However no report of the significance of IGF1R expression was available in pancreatic cancer. Most patients with pancreatic cancer die within 2 years at diagnosis even after curative resection. The objective of this study was to evaluate the significance of IGF1R expression in human pancreatic cancer. Material and Methods: A total 122 patients with pancreatic cancer was studied. Paraffin embedded species of pancreatic cancers were stained with antibodies against IGF1R. IGF1R expression was evaluated by intensity of staining. Semi-quantitative scores of zero (no staining), 1+ (weak staining), 2+ (moderate staining), or 3+ (strong staining) were assigned to each sample based on the intensity of staining. Scores of 2+ or 3+ were defined as IGF1R-positive staining. The association between IGF1R expression and clinicopathologic variables was examined. Results: IGF1R expression was positive in 50 (40.1%) of 122 cases. Kaplan-Meier analysis demonstrated the prognosis of IGF1R-positive patients was significantly (p=0.0076) poorer than that of IGF1R-negative, and median survival time of patients with IGF1R-positive was 37.3 months, while that of patients with IGF1R-negative samples was 60.8 months. There were no associations between IGF1R overexpression and clinicopathological factors, including tumor location, tumor size, tumor differentiation, and T/N categories according to the International Union against Cancer. Multivariate analysis showed IGF1R expression and lymph node metastasis were independent predictors of worse prognosis in pancreatic cancer. Conclusion: The expression of IGF1R might be a novel predictive prognostic marker for patients with pancreatic cancers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 708. doi:1538-7445.AM2012-708

Abstract 3440: Effect of neoadjuvant therapy for the number of lymph node micrometastasis in esophageal squamous cell carcinoma

[Introduction] Esophageal squamous cell carcinoma (ESCC) often develops lymph node metastasis. Several study demonstrated that micrometastasis (MM) in lymph nodes was an independent prognostic factor for ESCC. Recently effect of neoadjuvant therapy including chemotherapy and chemoradiontherapy has been reported. The aim of this study was to investigate the affect of on MM in lymph nodes for ESCC. [Materials and methods] We retrospectively reviewed clinical data of consecutive162 patients with ESCC who underwent esophagectomy accompanied with systemic lymphadectomy in our institution from 2000 to 2010. Firstly, we analyzed the relapse free survival of 90 patients who underwent surgical resection without neoadjuvant therapy and assessed the impact of MM in lymph nodes on prognosis of ESCC by immunohistochemistry using anti-cytokeratin antibody. Next we examined MM in lymph nodes of 72 patients who underwent surgical resection with neoadjuvant therapy and evaluate the effect of neoadjuvant therapy on MM in lymph nodes. [Results] Of 5414 lymph nodes from 90 patients with cStage II/III (surgery group), we detected 311(5.1%) of overt metastasis detected by H&E staining and 124(2.3%) of MM in lymph nodes. The clinicopathological factors related to the postoperative relapse included pTNM Stage and number of lymph node metastasis with MM. Otherwise, in neoadjuvant Group, Of 3466 lymph nodes from 72 patients, we detected 154(4.4%) of overt metastasis and 19(0.4%) of MM. In neoadjuvant group, the rate of MM was decreased from 2.3% to 0.4% as compared to that of surgery group. Importantly, the rate of MM in upper mediastinal region was decreased by neoadjuvant therapy. [Conclusion] We demonstrated the significance of micrometastasis in lymph nodes for prognosis of esophageal cancer. Our findings suggested that neoadjuvant therapy may reduce the number of micrometastasis. Neoadjuvant therapy should be estimated as the standard therapy against esophageal squamous cell carcinoma.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3440. doi:1538-7445.AM2012-3440

Abstract 711: The expression of human equilibrative nucleoside transporter 1 (hENT1) is associated with overall survival in advanced biliary tract carcinoma (BTC) treated with gemcitabine

[Introduction] The outcome of patients with unresectable and postoperative recurrent biliary tract carcinoma (BTC) is mostly miserable and most patients are possible candidates for palliative chemotherapy. Gemcitabine is a pyrimidine nucleoside analogue that is commonly used chemotherapeutic agent for advanced BTC. Gemcitabine is transported into the cell mostly by human equilibrative nucleoside transporter 1(hENT1). The hENT1 expression has been demonstrated to play an important role in predicting clinical outcome after gemcitabine chemotherapy for several types of cancer. The aim of the present study was to investigate a predictive marker for good prognosis of gemcitabine chemotherapy for unresectable and postoperative recurrent BTC. [Materials and methods] The analysis was performed on samples from 25 patients with unresectable (6 patients) and postoperative recurrent (19 patients) BTC treated with gemcitabine at the host institute between January 1997 and January 2011. The hENT1 expression levels in tumors were evaluated by immunohistochemistry. The clinical and histopathological variables were analyzed to evaluate predictive values for survival. [Results] Of the 25 tumor specimens, 18 (72%) specimens had positive hNET1 immunostaing, while 7 (28%) specimens were classified as negative. No statistical significant differences were found between the expression of hENT1 and patient characteristics (gender, age, tumor stage, lymph node stage, lymph duct invasion, vascular invasion, perineural invasion). In the univariate analysis, hENT1 expression was significantly correlated with overall survival (OS). The median OS was 15.3 versus 4.2 months, respectively in patients with positive versus negative hENT1 staining (p=0.006). As a result of multivariate analysis, hENT1 expression was useful as a predictive marker for good prognosis with significant difference (p&lt;0.001). [Conclusions] Patients with positive hENT1 expression in BTC have a significantly longer survival after gemcitabine chemotherapy than patients with negative hENT1 expression. Our results suggest that hENT1 expression in advanced BTC patients treated with gemcitabine is a prognostic predictive indicator and is useful to decide gemcitabine chemotherapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 711. doi:1538-7445.AM2012-711

Parathyroid hormone-related protein expression, in combination with nodal status, predicts bone metastasis and prognosis of breast cancer patients

Parathyroid hormone-related protein (PTHrP) has been known to play an important role in the formation of meta-static lesions in the bone. However, there remains controversy over its practical role in predicting the occurrence of bone metastasis and the prognosis of breast cancer patients. In this study, we attempted to investigate the clinical value of PTHrP expression status in the primary lesions of breast cancer patients. We immunohistochemically investigated PTHrP expression in surgically resected specimens from 125 primary breast cancer patients whose clinicopathological background and long-term prognosis were available. Positive PTHrP staining was demonstrated in 79 (63.2%) tumors. PTHrP was expressed significantly more frequently in the tumors of premenopausal patients. Bone metastases were significantly more common in patients with T4 tumors, with a positive node, with distant metastasis and with PTHrP-positive tumors. Multivariate logistic analysis revealed positive PTHrP expression as an independent risk factor for predicting bone metastasis. PTHrP expression was significantly related to a shorter overall survival. Bone metastasis was found significantly more frequently (28.3%) in PTHrP- and node-positive cases than in double-negative cases, and the rate was more pronounced in postmenopausal cases (32.1%). Expression of PTHrP in primary lesions, in combination with positive nodal status, is indicative of an increased risk of bone metastasis in breast cancer patients.

The usefulness of double-balloon enteroscopy in gastrointestinal stromal tumors of the small bowel with obscure gastrointestinal bleeding

OBJECTIVE

Gastrointestinal stromal tumors (GISTs) are the most frequently occurring mesenchymal tumors of the GI tract. Double-balloon enteroscopy (DBE) and capsule endoscopy (CE) promise the detection and accurate diagnosis of small bowel diseases in patients with obscure GI bleeding (OGIB). The aim of the present study was to analyze the clinical characteristics of small bowel GISTs and the usefulness of DBE, CE and computed tomography (CT).

METHODS

Among 705 cases with OGIB examined between December 2003 and January 2011, 12 (1.7%) cases of small bowel GIST were identified. We analyzed endoscopic appearance, tumor-size and location, detection rate by DBE, CE and CT and clinical course in each of these cases.

RESULTS

Of the 12 patients with GIST, eight were men. The mean patient age was 53.6 years. The presenting symptoms in most patients included tarry stools and/or anemia. Six patients required blood transfusions. The detection rates of DBE, CE and CT were 92%, 60% and 67%, respectively. All cases, except for one incomplete study, were identified using DBE; however, one case was not diagnosed as a tumor because of the presence of extramural growth. A pathological diagnosis of GIST was obtained using biopsies during DBE in three (45%) of seven cases. Lower detection rates were found in cases with intramural and extramural growth, larger tumors (≥35 mm) detected by CE and intraluminal growth and smaller tumors (<35 mm) detected by CT.

CONCLUSION

DBE or a combination of CE and CT are thus considered to be useful for detecting small bowel GISTs.

[A case of long-term survival after undergoing S-1 based multidisciplinary therapy for liver metastasis of gastric cancer]

We encountered a case of gastric cancer accompanied with liver metastasis, which had a good response to chemotherapy of S-1. A 68-year-old female was admitted to our hospital due to further examination of gastric tumor detected by an outpatient physician. She was found to have a type-3 gastric cancer in upper gastrointestinal endoscopy and a metastatic tumor of the liver in abdominal CT. Although chemotherapy of S-1 was inducted for the lesions, both the primary and liver tumors were dramatically reduced. We subsequently performed total gastrectomy and partial hepatectomy. Abdominal CT scan at 11 months after the initial operation revealed metachronous liver metastasis. She received combination chemotherapy of S-1 and CDDP. After 5 courses of the combination chemotherapy, the liver tumor disappeared. She has survived for 8 years without a recurrence after the initial operation. There was negative findings of immunostaining with thymidylate synthetase (TS), which was target enzyme for 5-FU at a biopsy sample of the primary gastric tumor before chemotherapy of S-1. TS immunostaining may be a useful marker for S-1 combined therapy for gastric cancer associated with liver metastases.