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Yamamoto S, Kanzaki H, Sakaguchi C, Mouri H, Tsuzuki T, Nasu J, Kobayashi S, Toyokawa T, Obayashi Y, Inoue M, Kato R, Matsubara M, Kita M, Okada H. Current prognostic factors of advanced gastric cancer patients treated with chemotherapy: real world data from a Japanese 12 institutions. Jpn J Clin Oncol 2023; 53:928-935. [PMID: 37519053 DOI: 10.1093/jjco/hyad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Understanding the prognostic factors of advanced gastric cancer before starting chemotherapy is important to determine personalized treatment strategies. However, the details of chemotherapy and the prognosis of advanced gastric cancer patients have changed with the time and environment. The aim of this study was to understand the current reality of chemotherapy and to estimate the prognostic factors of advanced gastric cancer patients before starting chemotherapy at multiple centers. This includes specialized cancer hospitals and community hospitals, with the latest data under the Japanese insurance system. METHODS We evaluated the clinical parameters and treatment details of 1025 patients who received systemic chemotherapy for unresectable advanced gastric cancer from 2012 to 2018 at 12 institutions in Japan. Prognostic factors were analyzed using the Cox proportional hazards regression model. RESULTS As of April 2021, 953 (93%) patients had died, while 72 (7%) patients survived. The median overall survival and progression-free survival of first-line chemotherapy was 11.8 months (95% confidence interval, 10.8-12.3 months) and 6.3 months (95% confidence interval, 5.9-6.9 months), respectively. Multivariate analysis revealed eight prognostic factors: age < 40 years, performance status ≥2, no gastrectomy, diffuse histological type, albumin <3.6, alkaline phosphatase ≥300, creatinine ≥1.0 and neutrophil-to-lymphocyte ratio > 3.0. Patients using trastuzumab showed better survival than patients without (16.1 months vs. 11.1 months; P = 0.0005). CONCLUSIONS We identified eight prognostic factors for patients with advanced gastric cancer undergoing Japanese standard chemotherapy. Our results will help clinicians develop treatment strategies for every patient.
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Affiliation(s)
- Shumpei Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Okayama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Okayama, Japan
| | - Chihiro Sakaguchi
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takao Tsuzuki
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Okayama, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Sayo Kobayashi
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan
| | - Yuka Obayashi
- Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Ryo Kato
- Department of Gastroenterology, Iwakuni Clinical Center, National Hospital Organization, Iwakuni, Japan
| | - Minoru Matsubara
- Department of Gastroenterology, Sumitomo Besshi Hospital, Niihama, Japan
| | - Masahide Kita
- Department of Endoscopy, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Department of Internal Medicine, Japanese Red Cross Himeji Hospital, Okayama, Japan
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Shiode J, Fujii M, Nasu J, Itoh M, Ishiyama S, Fujiwara A, Yoshioka M. Correlation between hospital-onset and community-onset Clostridioides difficile infection incidence: Ward-level analysis following hospital relocation. Am J Infect Control 2022; 50:1240-1245. [PMID: 35167897 DOI: 10.1016/j.ajic.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The development of hospital-onset Clostridioides difficile infection (HO-CDI) is affected by patient and environmental risk factors. We investigated changes in the incidence of HO-CDI after relocation to a newly built hospital with 50% private rooms and evaluated the associated factors. METHODS A retrospective study was conducted to assess trends in CDI incidences before and after the relocation using segmented regression analysis model. The association between CDI incidence and environmental factors at the ward-level was assessed using a linear regression analyses model. RESULTS The HO-CDI incidence decreased from 6.14 to 1.17 per 10,000 patient-days in the old and new hospital, respectively. Similarly, the community-onset CDI (CO-CDI) incidence decreased from 1.71 to 0.46 per 1000 admissions. HO-CDI incidence was positively correlated with CO-CDI incidence and inversely correlated with the private room ratio (adjusted R2 = 0.83). Almost half of the CO-CDI patients had been hospitalized within 28 days preceding the onset. DISCUSSION Environmental improvements after relocation may have reduced the reservoir of C. difficile, resulting in a decrease in the number of asymptomatic carriers and CO-CDI patients. CONCLUSION Relocation to a new hospital significantly reduced HO-CDI incidence, concomitantly decreasing the incidence of CO-CDI, potentially due to environmental improvements.
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Affiliation(s)
- Junji Shiode
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan.
| | - Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Mamoru Itoh
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Shuhei Ishiyama
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Akiko Fujiwara
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
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Inukai M, Ohara A, Nasu J, Kawai H, Watanabe K, Watanabe H, Inaba A. [Screening for Dehydration in Outpatient Cancer Chemotherapy-Use of Serum Osmolality and Hidden Dehydration Check Sheet]. Gan To Kagaku Ryoho 2022; 49:775-778. [PMID: 35851349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Weight loss during cancer chemotherapy affects the continuation of treatment; therefore, it is important to maintain and improve nutritional status. Additionally, appropriate fluid and electrolyte replacement is essential for maintaining life. This study included 100 patients who underwent outpatient chemotherapy in April 2021. The degree of dehydration was assessed based on serum osmolality, and the possibility of screening was examined by a hidden dehydration check sheet. Hidden dehydration was noted in 38 patients and dehydration in 6 patients. The incidence of pancreatic cancer was significantly lower than that of lung cancer. In the hidden dehydration check sheet, 51 patients were found to present with high possibility of hidden dehydration and required consultation to a medical professional. The serum osmolality of the results was not significantly different. During outpatient cancer chemotherapy, a certain percentage of patients present with hidden dehydration. To detect dehydration at an early stage, serum osmolality should be actively measured and continuous diet counseling, including confirmation of food and fluid intake, is required.
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Affiliation(s)
- Michio Inukai
- Dept. of Internal Medicine, Okayama Saiseikai General Hospital
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Yamasaki Y, Uedo N, Akamatsu T, Kagawa T, Higashi R, Dohi O, Furukawa M, Takahashi Y, Inoue T, Tanaka S, Takenaka R, Iguchi M, Kawamura T, Tsuzuki T, Yamasaki T, Yamashina T, Nasu J, Mannami T, Yamauchi A, Matsueda K, Aizawa S, Mitsuhashi T, Okada H. Nonrecurrence Rate of Underwater EMR for ≤20-mm Nonampullary Duodenal Adenomas: A Multicenter Prospective Study (D-UEMR Study). Clin Gastroenterol Hepatol 2022; 20:1010-1018.e3. [PMID: 34217879 DOI: 10.1016/j.cgh.2021.06.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Endoscopic resection of nonampullary duodenal adenoma is often challenging, and its technique has not yet been standardized. To overcome the practical difficulty of conventional endoscopic mucosal resection, underwater endoscopic mucosal resection (UEMR) was recently developed; therefore, we investigated the effectiveness and safety of UEMR for nonampullary duodenal adenoma. METHODS A multicenter, prospective cohort study was conducted at 21 institutions in Japan. We enrolled patients with no more than 2 nonampullary duodenal adenomas ≤20 mm in size, who were planned to undergo UEMR. After UEMR, follow-up endoscopies were scheduled at 2 and 12 months after the procedure, and biopsy specimens were taken from the post-UEMR scars. The primary endpoint was the proportion of patients with histologically proven nonrecurrence at follow-up endoscopy and biopsy. RESULTS A total of 155 patients with 166 lesions underwent UEMR. One patient with a non-neoplastic lesion in the resected specimen and 10 patients with 10 lesions who were lost to follow-up were excluded. Finally, 144 patients with 155 lesions who received all follow-up endoscopies were analyzed for the primary endpoint. The proportion of patients with proven nonrecurrence was 97.2% (n = 140 of 144; 95% confidence interval, 92.8%-99.1%) which exceeded the predefined threshold value (92%). Two cases of delayed bleeding (1.2%) occurred and they were successfully managed by clips. All recurrences were successfully treated by additional endoscopic treatment. CONCLUSIONS This multicenter, prospective cohort study demonstrated effectiveness and safety of UEMR for nonampullary duodenal adenomas ≤20 mm in size. (University Hospital Medical Network Clinical Trials Registry, Number: UMIN000030414).
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Tomo Kagawa
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Reiji Higashi
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masanori Furukawa
- Division of Endoscopy, Nara Medical University Hospital, Nara, Japan
| | - Yu Takahashi
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Takuya Inoue
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Shouichi Tanaka
- Department of Gastroenterology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Takao Tsuzuki
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Tomoaki Yamasaki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Yamashina
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tomohiko Mannami
- Department of Gastroenterology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shigeyuki Aizawa
- Department of Gastroenterology, Nara Prefecture Seiwa Medical Center, Nara, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
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Hamada K, Kanzaki H, Miyahara K, Nakagawa M, Mouri H, Mizuno M, Takahashi S, Hori S, Nasu J, Tsuzuki T, Miyaike J, Takenaka R, Yamauchi K, Kobayashi S, Toyokawa T, Inoue M, Nishimura M, Matsubara M, Tomoda J, Yamasaki Y, Tanaka T, Shirakawa Y, Kawahara Y, Fujiwara T, Okada H. Clinicopathological Characteristics of Superficial Barrett's Adenocarcinoma in a Japanese Population: A Retrospective, Multicenter Study. Intern Med 2022; 61:1115-1123. [PMID: 35431302 PMCID: PMC9107981 DOI: 10.2169/internalmedicine.6942-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Although Barrett's adenocarcinoma (BA) remains a minor disease in Japan, its incidence has been gradually increasing. We analyzed the characteristics of BA in Japanese populations. Methods We retrospectively reviewed medical records and analyzed the clinicopathological differences between short-segment Barrett's esophagus (SSBE) and long-segment Barrett's esophagus (LSBE), as well as metastasis. Local recurrence and metachronous lesions were analyzed only in patients who underwent endoscopic resection (ER). Patients Consecutive patients who had pathological T1 BAs resected by ER or surgery from January 2003 to December 2017. Results A total of 168 patients were analyzed, including 139 with SSBE and 29 with LSBE. In total, 67% of the SSBE lesions and 32% of the LSBE lesions were located between 0 and 3 o'clock (p=0.0014). No patients who achieved pathological margin-free resection (pR0) and 17% of patients who did not achieve pR0 experienced local recurrence (p=0.0131). None of the patients without lymphovascular involvement, a poorly differentiated component, lesion size of >30 mm, and submucosal invasion of >500 μm experienced metastasis. The 5-year cumulative incidence rate of metachronous BA after ER was 0% in patients with SSBE and 40% in patients with LSBE (p=0.0005). Conclusion Superficial BA was likely to be detected at the right anterior wall of SSBE in the Japanese population. The risk for metachronous BA after ER was high in Japanese patients with LSBE, as in Western patients.
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Affiliation(s)
- Kenta Hamada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hospital, Japan
| | | | - Hirokazu Mouri
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Japan
| | - Motowo Mizuno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Japan
| | - Sakuma Takahashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Takao Tsuzuki
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Japan
| | - Jiro Miyaike
- Department of Internal Medicine, Saiseikai Imabari Hospital, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Japan
| | - Kenji Yamauchi
- Department of Gastroenterology, Mitoyo General Hospital, Japan
| | - Sayo Kobayashi
- Department of Internal Medicine, Fukuyama City Hospital, Japan
| | - Tatsuya Toyokawa
- Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Japan
| | | | - Minoru Matsubara
- Department of Internal Medicine, Sumitomo Besshi Hospital, Japan
| | - Jun Tomoda
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Japan
| | - Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuhiro Shirakawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Yokoi T, Ma S, Kasahara Y, Kasahara S, Shibauchi T, Kurita N, Tanaka H, Nasu J, Motome Y, Hickey C, Trebst S, Matsuda Y. Half-integer quantized anomalous thermal Hall effect in the Kitaev material candidate α-RuCl 3. Science 2021; 373:568-572. [PMID: 34326240 DOI: 10.1126/science.aay5551] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 04/19/2020] [Accepted: 06/29/2021] [Indexed: 02/01/2023]
Abstract
Half-integer thermal quantum Hall conductance has recently been reported for the two-dimensional honeycomb material α-RuCl3 We found that the half-integer thermal Hall plateau appears even for a magnetic field with no out-of-plane components. The measured field-angular variation of the quantized thermal Hall conductance has the same sign structure as the topological Chern number of the pure Kitaev spin liquid. This observation suggests that the non-Abelian topological order associated with fractionalization of the local magnetic moments persists even in the presence of non-Kitaev interactions in α-RuCl3.
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Affiliation(s)
- T Yokoi
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
| | - S Ma
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
| | - Y Kasahara
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan.
| | - S Kasahara
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
| | - T Shibauchi
- Department of Advanced Materials Science, University of Tokyo, Chiba 277-8561, Japan
| | - N Kurita
- Department of Physics, Tokyo Institute of Technology, Meguro, Tokyo 152-8551, Japan
| | - H Tanaka
- Department of Physics, Tokyo Institute of Technology, Meguro, Tokyo 152-8551, Japan
| | - J Nasu
- Department of Physics, Yokohama National University, Hodogaya, Yokohama 240-8501, Japan
| | - Y Motome
- Department of Applied Physics, University of Tokyo, Bunkyo, Tokyo 113-8656, Japan
| | - C Hickey
- Institute for Theoretical Physics, University of Cologne, 50937 Cologne, Germany
| | - S Trebst
- Institute for Theoretical Physics, University of Cologne, 50937 Cologne, Germany
| | - Y Matsuda
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan.
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Shinozaki K, Yamada T, Nasu J, Matsumoto T, Yuasa Y, Shiraishi T, Nagano H, Moriyama I, Fujiwara T, Miguchi M, Yoshida R, Nozaka K, Tanioka H, Nagasaka T, Kurisu Y, Kobayashi M, Tsuchihashi K, Inukai M, Kikuchi T, Nishina T. A phase II study of FOLFOXIRI plus bevacizumab as initial chemotherapy for patients with untreated metastatic colorectal cancer: TRICC1414 (BeTRI). Int J Clin Oncol 2020; 26:399-408. [PMID: 33097971 PMCID: PMC7819906 DOI: 10.1007/s10147-020-01811-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE FOLFOXIRI plus bevacizumab is regarded as a first-line therapeutic option for selected patients with metastatic colorectal cancer (mCRC). Our aim was to assess the efficacy and safety of induction treatment with FOLFOXIRI plus bevacizumab in patients with untreated mCRC harboring UGT1A1 wild (*1/*1), or single-hetero (*1/*6 or *1/*28) genotypes. METHODS Twelve cycles of FOLFOXIRI plus bevacizumab were administered to patients with untreated mCRC. The primary endpoint was the overall response rate (ORR) assessed by central independent reviewers. Secondary endpoints included time to treatment failure (TTF), progression-free survival (PFS), overall survival (OS), relative dose intensity (RDI), R0 resection rate, and safety. The exploratory objectives were early tumor shrinkage (ETS) and depth of response (DoR). RESULTS Of the 47 patients enrolled, 46 and 44 patients were eligible for the safety and efficacy analysis, respectively. The primary endpoint was met. The ORR was 63.6% (95% CI 47.8-77.6). At a median follow-up of 25.4 months, median TTF, PFS, and OS was 8.1, 15.5, and 34.4 months, respectively. The median RDI of 5-fluorouracil, irinotecan, oxaliplatin, and bevacizumab was 72, 69, 62, and 71%, respectively. R0 resection rate was 22.7%. Grade 3 or higher adverse events (≥ 10%) included neutropenia (65.2%), febrile neutropenia (26.1%), leukopenia (23.9%), anorexia (10.9%), nausea (10.9%), and diarrhoea (10.9%). No treatment-related deaths were observed. ETS and DoR were 70.5 and 45.4%, respectively. CONCLUSIONS FOLFOXIRI plus bevacizumab induction treatment of Japanese patients was shown to be beneficial and manageable, although caution is required since the treatment causes febrile neutropenia.
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Affiliation(s)
- Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Hiroshima, 734-8530, Japan.
| | - Takeshi Yamada
- Division of Gastroenterology, University of Tsukuba, Tsukuba, 305-8577, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, 700-8501, Japan
| | - Toshihiko Matsumoto
- Department of Internal Medicine, Himeji Red Cross Hospital, Himeji, 670-8540, Japan
| | - Yasuhiro Yuasa
- Department of Surgery, Tokushima Red Cross Hospital, Tokushima, 773-8502, Japan
| | - Takeshi Shiraishi
- Department of Medical Oncology, Matsuyama Red Cross Hospital, Matsuyama, 790-8520, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological Surgery, Yamaguchi University Graduate School of Medicine, Ube, 755-8505, Japan
| | - Ichiro Moriyama
- Innovative Cancer Center, Shimane University Hospital, Izumo, 693-0021, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8530, Japan
| | - Masashi Miguchi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, 731-0293, Japan
| | - Ryosuke Yoshida
- Department of Surgery, Okayama Rosai Hospital, Okayama, 702-8055, Japan
| | - Kimiyasu Nozaka
- Department of Surgery, Sanin Rosai Hospital, Yonago, 683-8605, Japan
| | - Hiroaki Tanioka
- Department of Clinical Oncology, Kawasaki Medical School Hospital, Kurashiki, 701-0192, Japan
| | - Takeshi Nagasaka
- Department of Clinical Oncology, Kawasaki Medical School Hospital, Kurashiki, 701-0192, Japan
| | - Yasuro Kurisu
- Department of Surgery, Hamada Medical Center, Hamada, 697-8511, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, 783‑8505, Japan
| | - Kenji Tsuchihashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, 812-8582, Japan
| | - Michio Inukai
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, 700-8501, Japan
| | - Takashi Kikuchi
- Foundation for Biomedical Research and Innovation at Kobe for Medical Innovation, Kobe, 650-0047, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, 791-0280, Japan
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Fujii M, Ozato T, Mizukawa S, Nasu J, Kawai H, Fujioka SI, Yoshioka M, Shiode J, Yamamoto K. A rare case of immunotherapy-induced cholangitis and gastritis. Clin J Gastroenterol 2020; 13:1083-1090. [PMID: 32886336 DOI: 10.1007/s12328-020-01218-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
Immune checkpoint inhibitor-related liver injury usually appears as a hepatitis pattern, with a cholangitis pattern being a rare immune-related adverse event. We report a Japanese man in his fifties with immune checkpoint inhibitor-induced cholangitis and gastritis. The patient had been treated for approximately 7 months with carboplatin, pemetrexed sodium hydrate, and bevacizumab for an undifferentiated cancer of unknown primary, with metastases to the right pleura and nasolacrimal duct. The patient was then treated with immune checkpoint inhibitors, including 2 months of atezolizumab followed by 1 month of ramucirumab and docetaxel. Laboratory examinations showed elevated levels of biliary tract enzymes. He complained of generalized fatigue. Computed tomography revealed thickening of the gallbladder and external hepatic bile duct walls and the periportal collar sign. Endoscopic retrograde cholangiopancreatography was negative for bile duct obstruction but showed diffuse asymmetric irregular findings from the hilar region to the distal bile duct. Upper endoscopy showed diffuse irregular erosions and redness. Histopathological examination of specimens of bile duct and gastric mucosa revealed CD8-predominant inflammatory cell infiltrates. We diagnosed the findings as immunotherapy-induced cholangitis and gastritis. Because there are no published reports on immunotherapyinduced cholangitis combined with gastritis, we here report our patient as a rare case.
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Affiliation(s)
- Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan.
| | - Toshiki Ozato
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Sho Mizukawa
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Haruyuki Kawai
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Shin-Ichi Fujioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Junji Shiode
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
| | - Kazuhide Yamamoto
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-City, 700- 8511, Japan
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9
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Hara H, Takeno A, Yasui H, Imamura H, Akamatsu H, Fujitani K, Nakane M, Kondoh C, Yukisawa S, Nasu J, Miyata Y, Makiyama A, Ishida H, Yoshida N, Matsumura E, Ishigami M, Sugihara M, Ochiai A, Doi T. DS-Screen: Prospective analysis of the expression status of FGFR2 and HER2 in colorectal and gastric cancer population. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
431 Background: FGFR2 and HER2 proteins are well-known molecular targets for cancer therapy, and there are emerging attractive protein-targeted agents such as second generation antibody-drug conjugates. However, there are still limited information about the expression status of FGFR2 and HER2 in gastrointestinal cancer and their relationship to patient background with cancer. In this study, expression status of FGFR2 and HER2 in advanced/metastatic gastric cancer (GC) and colorectal cancer (CRC) were prospectively analyzed in clinical setting. Moreover, eligible patients for the clinical trials of DS-1123 or DS-8201, which are FGFR2- or HER2-targeting anti-cancer agent respectively, were screened. Methods: Patients with advanced/metastatic GC, gastroesophageal junctional cancer (GEJ), and CRC were enrolled. Expression status of FGFR2 and HER2 were prospectively analyzed by IHC and/or FISH. Results: A total of 565 patients (GC; 160, GEJ; 16, CRC; 389) have been enrolled in this study from November 2016 to June 2018. FGFR2 expression (IHC 1+~3+) was observed in 24%, 44%, and 3% of GC, GEJ, and CRC respectively. HER2 expression (IHC 2+, 3+) was observed in 24%, 44%, and 17% of GC, GEJ, and CRC respectively. Expression levels of FGFR2 and HER2 seemed to be not correlated with each other in all 3 types of cancer. Distributions of expression level of FGFR2 or HER2 were slightly different among the histological types in GC. In CRC, distribution of HER2 expression level was also slightly different among the histological types and HER2 expression level was higher in KRAS/NRAS wild type compared to KRAS/NRAS mutant. There was no association between HER2 expression level and primary tumor sites in patients with CRC. Slight concordance of HER2 expression was observed between IHC and FISH in CRC. A total of 7 patients have been enrolled in clinical trials of DS-1123 or DS-8201 through this study based on the analysis findings. Conclusions: This study showed insights into the expression status of FGFR2 and HER2 in GC and CRC as a large-scale prospective analysis. Seven patients who had no standard therapy could access exploratory new drug based on targetable agents through this study. Clinical trial information: 163380.
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Affiliation(s)
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | | | | | - Minoru Nakane
- Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Chihiro Kondoh
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Seigo Yukisawa
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | | | | | - Akitaka Makiyama
- Department of Hematology/Oncology, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
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10
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Yamada T, Nishina T, Nasu J, Matsumoto T, Yuasa Y, Shiraishi T, Nagano H, Moriyama I, Fujiwara T, Miguchi M, Yoshida R, Nosaka K, Tanioka H, Nagasaka T, Kurisu Y, Kobayashi M, Tsuchihashi K, Inukai M, Kikuchi T, Shinozaki K. A phase II study of FOLFOXIRI plus bevacizumab (Bmab) as initial chemotherapy for patients (pts) with untreated metastatic colorectal cancer (mCRC): TRICC1414 (Be TRI). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
134 Background: FOLFOXIRI-Bmab has been recognized as one of the standard first-line treatments for mCRC. We conducted a single arm, multicenter, phase II study to assess the efficacy and safety of FOLFOXIRI-Bmab in pts with untreated mCRC harboring UGT1A1(*6 and *28) wild or single hetero genotype. Methods: Pts received FOLFOXIRI-Bmab (irinotecan 165 mg/m2, oxaliplatin 85 mg/m2, l-leucovorin 200mg/m2, fluorouracil 3200 mg/m2 and Bmab 5mg/kg repeated biweekly) up to a maximum of 12 cycles, followed by the sequential therapy which consisted of the remaining drugs if any of the individual drugs were discontinued at the investigator’s discretion. Protocol therapy was continued until progressive disease, an unacceptable adverse event, tumor resection or consent withdrawal. The primary endpoint was ORR evaluated by central reviewers. Secondary endpoints include TTF, PFS, OS, R0 resection rate, relative dose intensity (RDI) and safety. The exploratory objectives were early tumor shrinkage (ETS), depth of response (DoR). Results: 47 pts were enrolled from 16 centers between April 2015 and May 2017, of whom 1 was excluded for not meeting the inclusion criteria. The full analysis set consisted of 44 pts because 2 had no target lesions that were considered measurable lesion by central reviewers. 46 pts had the following characteristics: median age 58 (29-68), 57% male, 76% PS0, 22% right-sided tumors and 52% UGT1A1 wild. RAS status was 37% wild, 52% mutant, 11% unknown. Primary endpoint was met. The ORR was 63.6% (95% CI, 47.8-77.6). ETS and DoR was 70.5%, 43.9%, respectively. R0 resection rate was 23%. Median PFS was 15.5mo (95% CI, 11.5-23.4). Median TTF was 8.1mo (95% CI, 5.3-10.1). Median OS was 34.4mo (95% CI, 26.4-not reached). The mean RDI of fluorouracil, irinotecan and oxaliplatin were 71%, 67%, and 64%, respectively. Grade 3 or higher adverse events (≥10%) were neutropenia (65.2%), febrile neutropenia (FN) (26.1%), anorexia (10.9%), nausea (10.9%), and diarrhea (10.9%). No treatment-related deaths were observed. Conclusions: Our results of FOLFOXIRI-Bmab in Japanese pts showed to be beneficial and manageable although caution to FN is required. Clinical trial information: NCT02497157.
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Affiliation(s)
- Takeshi Yamada
- Division of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomohiro Nishina
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | | | | | - Takeshi Shiraishi
- Department of Medical Oncology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological Sugery,Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masashi Miguchi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Ryosuke Yoshida
- Department of Surgery, Okayama Rosai Hospital, Okayama, Japan
| | | | - Hiroaki Tanioka
- Department of Clinical Oncology, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Takeshi Nagasaka
- Department of Clinical Oncology, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Yasuro Kurisu
- Department of Surgery, Hamada Medical Center, Hamada, Japan
| | | | - Kenji Tsuchihashi
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | | | - Takashi Kikuchi
- Foundation for Biomedical Research and Innovation at Kobe for Medical Innovation, Kobe, Japan
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11
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Matsueda K, Kanzaki H, Matsueda K, Nasu J, Yoshioka M, Nakagawa M, Inoue M, Inaba T, Imagawa A, Takatani M, Takenaka R, Suzuki S, Tomoda J, Yagi T, Fujiwara T, Tanaka T, Okada H. The clinicopathological differences of sporadic non-ampullary duodenal epithelial neoplasm depending on tumor location. J Gastroenterol Hepatol 2019; 34:1540-1544. [PMID: 30812050 DOI: 10.1111/jgh.14640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Although sporadic non-ampullary duodenal adenoma is speculated to be precancerous lesion, the relationship between adenoma and carcinoma remains unclear due to their rarity. Previous studies on sporadic non-ampullary duodenal epithelial neoplasm (SNADEN) have mainly targeted superficial tumors, like adenoma and early carcinoma. The clinicopathological features, including those of advanced carcinoma, remain poorly investigated. We assessed the clinicopathological features of SNADEN, including advanced carcinoma, focusing on tumor location. METHODS We retrospectively collected the data of 410 patients who had been clinically and pathologically diagnosed with SNADEN at 11 institutions in Japan between June 2002 and March 2014. RESULTS The SNADEN was mucosal neoplasia and invasive carcinoma in 321 (78.3%) and 89 (21.7%) patients, respectively. The proportion of invasive carcinomas in SNADEN was significantly higher on the oral side of the papilla of Vater (oral-Vater) than on the anal side (anal-Vater) (27.9% vs 14.4%, P < 0.001). Undifferentiated-type carcinoma was significantly more frequent with oral-Vater than anal-Vater (38.7% vs 14.8%, P = 0.026). The recurrence rate of surgically R0 resected locally advanced carcinomas was significantly higher with oral-Vater than anal-Vater (46.4% vs 8.3%, P = 0.021). Furthermore, the relapse-free survival with oral-Vater was significantly shorter than with anal-Vater (hazard ratio: 2.35; 95% confidence interval: 1.09-5.50; P = 0.028). CONCLUSIONS The clinicopathological features of SNADEN on oral-Vater were different from those on anal-Vater. SNADEN on oral-Vater was more likely to be invasive carcinomas and might behave more aggressively due to biologically higher malignancy than that on anal-Vater.
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Affiliation(s)
- Katsunori Matsueda
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, Kanonji, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Seiyu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama, Japan
| | - Jun Tomoda
- Department of Internal Medicine, Akaiwa Medical Association Hospital, Okayama, Japan
| | - Takahito Yagi
- Department of Hepato-Biliary-Pancreatic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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12
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Tanioka H, Nagasaka T, Uno F, Inoue M, Okita H, Katata Y, Kanzaki H, Kuramochi H, Satake H, Shindo Y, Doi A, Nasu J, Yamashita H, Yamaguchi Y. Relationship between peripheral neuropathy and effectiveness in second-line chemotherapy for unresectable advanced gastric cancer: a prospective, observational, multicenter study protocol. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Fujii M, Fujimoto K, Yabe S, Nasu J, Miyaike J, Yoshioka M, Shiode J, Yamamoto K, Matsuda S. Impact of Body Mass Index of Japanese Gallbladder Cancer Patients on their Postoperative Outcomes. Acta Med Okayama 2019; 73:51-59. [PMID: 30820054 DOI: 10.18926/amo/56458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We investigated the relationship between body mass index (BMI) and postoperative outcomes in 450 gallbladder cancer patients in Japan. We collected patient information, including sex, age, underlying disease, BMI, stage, surgery method, postoperative time to discharge, and postoperative Medicare fees, from the Japanese administrative database associated with the Diagnosis Procedure Combination system. We classified patient BMIs as underweight (BMI<18.5 kg/m2), normal (BMI≥18.5 kg/m2 and <25 kg/m2) or overweight/obese (BMI≥25 kg/m2), then investigated the relationship between these categories and two postoperative outcomes: time to discharge and postoperative Medicare fees. The median postoperative time to discharge was 12 days in all patients, and 12 days in each of the three weight groups (p=0.62, n.s.). The median postoperative Medicare fees from surgery until discharge were (USD): all patients, $5,002; underweight, $5,875; normal weight, $4,797; and overweight/obese, $5,179 (p=0.146, n.s.). A multivariate analysis with adjustment for competing risk factors revealed that BMI was not associated with increased risk of longer postoperative time to discharge (normal weight: HR 1.17, p=0.29; overweight/obese: HR 1.17, p=0.37) or higher postoperative Medicare fees (OR 0.99, p=0.86, n.s.). Thus, high BMI was not found to be a factor for poor postoperative outcomes in Japanese patients with gallbladder cancer.
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Affiliation(s)
- Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511,
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14
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Okura T, Fujii M, Shiode J, Ito Y, Kojima T, Nasu J, Niguma T, Yoshioka M, Mimura T, Yamamoto K. Impact of Body Mass Index on Survival of Pancreatic Cancer Patients in Japan. Acta Med Okayama 2018; 72:129-135. [PMID: 29674761 DOI: 10.18926/amo/55853] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The impact of body mass index (BMI) on postoperative survival in Japanese patients with pancreatic cancer is unclear. We examined the relationship between preoperative BMI and the prognosis of Japanese patients who underwent surgery for pancreatic cancer to determine whether BMI affects these patients' prognosis. Of the patients who underwent pancreatectomy between January 2004 and August 2015 at our institution, 246 were pathologically diagnosed with pancreatic tubular adenocarcinoma; the cancer was located in the pancreatic head (n=161) and in the body and tail (n=85). We classified the patients by BMI: underweight (n=22), normal weight (n=190), and overweight/obese (n=34) groups. We retrospectively analyzed medical records for patient characteristics, lesion location, disease stage, postoperative complications, chemotherapy, and prognosis. Lesion location, disease stage, postoperative complications, and chemotherapy were not significantly different among the BMI groups. The median survival times were as follows (days): all patients, 686; underweight, 485; normal weight, 694; and overweight/obese, 839. In a multivariate analysis, after adjusting for competing risk factors, low BMI was associated with an increased risk of death (normal weight: HR 0.58, p=0.038; overweight/obese: HR 0.54, p=0.059). High BMI was not found to be a postoperative factor for poor prognosis in Japanese pancreatic cancer patients.
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Affiliation(s)
- Tomohiro Okura
- Department of Residency Program, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan
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15
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Kasahara Y, Ohnishi T, Mizukami Y, Tanaka O, Ma S, Sugii K, Kurita N, Tanaka H, Nasu J, Motome Y, Shibauchi T, Matsuda Y. Majorana quantization and half-integer thermal quantum Hall effect in a Kitaev spin liquid. Nature 2018; 559:227-231. [DOI: 10.1038/s41586-018-0274-0] [Citation(s) in RCA: 448] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/24/2018] [Indexed: 11/09/2022]
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16
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Saito H, Shiode J, Ohya S, Yao A, Saito S, Fujii M, Itoh M, Ishiyama S, Fujiwara A, Nasu J, Yoshioka M, Yamamoto K. Whipple's Disease with Long-term Endoscopic Follow-up. Intern Med 2018; 57:1707-1713. [PMID: 29434152 PMCID: PMC6047986 DOI: 10.2169/internalmedicine.9631-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 72-year-old man presented with anorexia and 15-kg weight loss over 3 years. Endoscopy revealed yellow, shaggy mucosa alternating with erythematous, eroded mucosa in the duodenum. Biopsy specimens showed massive infiltration of periodic acid-Schiff-positive macrophages in the lamina propria, consistent with Whipple's disease. The patient was treated with intravenous ceftriaxone for four weeks, followed by oral trimethoprim-sulfamethoxazole. His condition improved, and he gradually gained weight. Although the endoscopic findings improved with continuous trimethoprim-sulfamethoxazole administration, macrophage infiltration of the duodenal mucosa persisted. However, the patient has been symptom-free for eight years.
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Affiliation(s)
- Hiroaki Saito
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
- Saito Clinic, Japan
| | - Junji Shiode
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Shogen Ohya
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
- Kawaguchi-Medical Clinic, Japan
| | - Atsushi Yao
- Department of Internal Medicine (Nephrology), Kanto Rosai Hospital, Japan
| | - Shunsuke Saito
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Masakuni Fujii
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Mamoru Itoh
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Shuhei Ishiyama
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Akiko Fujiwara
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
| | - Kazuhide Yamamoto
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Japan
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17
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Kasahara Y, Sugii K, Ohnishi T, Shimozawa M, Yamashita M, Kurita N, Tanaka H, Nasu J, Motome Y, Shibauchi T, Matsuda Y. Unusual Thermal Hall Effect in a Kitaev Spin Liquid Candidate α-RuCl_{3}. Phys Rev Lett 2018; 120:217205. [PMID: 29883185 DOI: 10.1103/physrevlett.120.217205] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/17/2018] [Indexed: 06/08/2023]
Abstract
The Kitaev quantum spin liquid displays the fractionalization of quantum spins into Majorana fermions. The emergent Majorana edge current is predicted to manifest itself in the form of a finite thermal Hall effect, a feature commonly discussed in topological superconductors. Here we report on thermal Hall conductivity κ_{xy} measurements in α-RuCl_{3}, a candidate Kitaev magnet with the two-dimensional honeycomb lattice. In a spin-liquid (Kitaev paramagnetic) state below the temperature characterized by the Kitaev interaction J_{K}/k_{B}∼80 K, positive κ_{xy} develops gradually upon cooling, demonstrating the presence of highly unusual itinerant excitations. Although the zero-temperature property is masked by the magnetic ordering at T_{N}=7 K, the sign, magnitude, and T dependence of κ_{xy}/T at intermediate temperatures follows the predicted trend of the itinerant Majorana excitations.
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Affiliation(s)
- Y Kasahara
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
| | - K Sugii
- Institute for Solid State Physics, University of Tokyo, Kashiwa 277-8581, Japan
| | - T Ohnishi
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
| | - M Shimozawa
- Institute for Solid State Physics, University of Tokyo, Kashiwa 277-8581, Japan
| | - M Yamashita
- Institute for Solid State Physics, University of Tokyo, Kashiwa 277-8581, Japan
| | - N Kurita
- Department of Physics, Tokyo Institute of Technology, Meguro, Tokyo 152-8551, Japan
| | - H Tanaka
- Department of Physics, Tokyo Institute of Technology, Meguro, Tokyo 152-8551, Japan
| | - J Nasu
- Department of Physics, Tokyo Institute of Technology, Meguro, Tokyo 152-8551, Japan
| | - Y Motome
- Department of Applied Physics, University of Tokyo, Bunkyo, Tokyo 113-8656, Japan
| | - T Shibauchi
- Department of Advanced Materials Science, University of Tokyo, Chiba 277-8561, Japan
| | - Y Matsuda
- Department of Physics, Kyoto University, Kyoto 606-8502, Japan
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18
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Ojima H, Mishima H, Sawaki A, Nagasaka T, Shimokawa M, Inukai M, Shinozaki K, Tanioka H, Nasu J, Nishina T, Hazama S, Okajima M, Tsuji A, Tsuji Y, Munemoto Y, Yamaguchi S, Yamaguchi Y. A randomized phase III clinical trial of sequential capecitabine or 5-FU plus bevacizumab (Cape/5-FU+Bmab) followed by Cape/5-FU plus oxaliplatin plus Bmab (CapeOX/mFOLFOX6+Bmab) versus combination CapeOX/mFOLFOX6+Bmab in advanced colorectal cancer: The C-cubed (C 3) study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.tps872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS872 Background: Less intensive regimens, focusing on survival and disease control, may be better first-line treatments in unresectable metastatic colorectal cancer (mCRC). Several randomized trials suggested that sequential cytotoxic agents in mCRC may improve overall survival compared with combination chemotherapy. This study investigated whether sequential treatment with Bmab-based first-line therapy with oxaliplatin has superior efficacy to combination treatment for unresectable mCRC. Methods: This study is a two-arm, multicenter, open-label, randomized phase III trial in Japan, comparing the efficacy and safety of sequential Cape/5-FU+Bmab with escalation to CapeOX/mFOLFOX6+Bmab versus combination CapeOX/mFOLFOX6+Bmab as the first-line treatment of mCRC. The primary endpoint is Time to failure of strategy (TFS). In the sequential arm (Arm A: oxaliplatin ‘wait-and-go’), treatment escalation from Cape/5-FU+Bmab to CapeOX/mFOLFOX6+Bmab is recommended for progressive disease. In the combination arm (Arm B: oxaliplatin ‘stop-and-go’), de-escalation from CapeOX/mFOLFOX6+Bmab to Cape/5-FU+Bmab is possible after 12 weeks of treatment. Re-escalation to CapeOX/mFOLFOX6+Bmab after progressive disease is considered only for patients who received de-escalation of oxaliplatin, not caused by oxaliplatin-associated toxicity, after 12 weeks of treatment. A target sample size of 304 evaluable patients is considered sufficient to detect a hazard ratio of 0.69 for the TFS of the sequential ‘wait-and-go’ approach compared with the combination ‘stop-and go’ approach with 80% power and a 2-sided significance level of 5%. From December 2014 to September 2016, 311 patients were enrolled across 81 centers in Japan. The follow-up period is until March 2018, and results are expected in 2019, and results are expected in 2019. Clinical trial information: 000015405.
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Affiliation(s)
| | | | | | - Takeshi Nagasaka
- Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | | | | | | | | | | | - Shoichi Hazama
- Yamaguchi University Graduate School of Medicine, Ube, Japan
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19
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Sakae H, Kanzaki H, Nasu J, Akimoto Y, Matsueda K, Yoshioka M, Nakagawa M, Hori S, Inoue M, Inaba T, Imagawa A, Takatani M, Takenaka R, Suzuki S, Fujiwara T, Okada H. The characteristics and outcomes of small bowel adenocarcinoma: a multicentre retrospective observational study. Br J Cancer 2017; 117:1607-1613. [PMID: 28982111 PMCID: PMC5729438 DOI: 10.1038/bjc.2017.338] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/23/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Small bowel adenocarcinoma (SBA) is a rare malignancy that accounts for 1–2% of gastrointestinal tumours. We investigated the clinical characteristics, outcomes, and prognostic factors of primary SBA. Methods: We retrospectively analysed the characteristics and clinical courses of 205 SBA patients from 11 institutions in Japan between June 2002 and August 2013. Results: The primary tumour was in the duodenum and jejunum/ileum in 149 (72.7%) and 56 (27.3%) patients, respectively. Sixty-four patients (43.0%) with duodenal adenocarcinoma were asymptomatic and most cases were detected by oesophagogastroduodenoscopy (EGD), which was not specifically performed for the detection or surveillance of duodenal tumours. In contrast, 47 patients (83.9%) with jejunoileal carcinoma were symptomatic. The 3-year survival rate for stage 0/I, II, III, and IV cancers was 93.4%, 73.1%, 50.9%, and 15.1%, respectively. Multivariate analysis revealed performance status 3–4, high carcinoembryonic antigen, high lactate dehydrogenase (LDH), low albumin, symptomatic at diagnosis, and stage III/IV disease were independent factors for overall survival (OS). Ten patients (18.5%) with stage IV disease were treated with a combination of resection of primary tumour, local treatment of metastasis, and chemotherapy; this group had a median OS of 36.9 months. Conclusions: Although most SBA patients were diagnosed with symptomatic, advanced stage disease, some patients with duodenal carcinoma were detected in early stage by EGD. High LDH and symptomatic at diagnosis were identified as novel independent prognostic factors for OS. The prognosis of advanced SBA was poor, but combined modality therapy with local treatment of metastasis might prolong patient survival.
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Affiliation(s)
- Hiroyuki Sakae
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Hiromitsu Kanzaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Junichiro Nasu
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan.,Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ku, Okayama 700-8511, Japan
| | - Yutaka Akimoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Kazuhiro Matsueda
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Masao Yoshioka
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ku, Okayama 700-8511, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima 730-8518, Japan
| | - Shinichiro Hori
- Department of Endoscopy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Masafumi Inoue
- Department of Gastroenterology, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Kita-Ku, Okayama 700-8607, Japan
| | - Tomoki Inaba
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, 5-4-6 Ban-cho, Takamatsu, Kagawa 760-8557, Japan
| | - Atsushi Imagawa
- Department of Gastroenterology, Mitoyo General Hospital, 708 Himehama, Kanonji, Kagawa 769-1695, Japan
| | - Masahiro Takatani
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo 670-8540, Japan
| | - Ryuta Takenaka
- Department of Internal Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0848, Japan
| | - Seiyu Suzuki
- Department of Internal Medicine, Sumitomo Besshi Hospital, 3-1 Ouji-cho, Niihama, Ehime 792-8543, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 700-8558, Japan
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Nagasaka T, Mishima H, Sawaki A, Shimokawa M, Inukai M, Shinozaki K, Tanioka H, Nasu J, Nishina T, Hazama S, Okajima M, Yamaguchi Y. Protocol of a randomised phase III clinical trial of sequential capecitabine or 5-fluorouracil plus bevacizumab (Cape/5-FU-Bmab) to capecitabine or 5-fluorouracil plus oxaliplatin plus bevacizumab (CapeOX/mFOLFOX6-Bmab) versus combination CapeOX/mFOLFOX6-Bmab in advanced colorectal cancer: the C-cubed (C3) study. BMJ Open 2016; 6:e011454. [PMID: 27256093 PMCID: PMC4893850 DOI: 10.1136/bmjopen-2016-011454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Results from several randomised trials suggest that the sequential use of cytotoxic agents in patients with metastatic colorectal cancer (mCRC) has the potential to improve overall survival compared with combination chemotherapy. This study is designed to investigate whether sequential treatment with bevacizumab-based first-line treatment with oxaliplatin is superior to combination treatment of mCRC. METHODS AND ANALYSIS The C-cubed (C(3)) study is a two-arm, multicentre, open-label, randomised phase III trial in Japan comparing the efficacy and safety of sequential capecitabine or 5-fluorouracil plus bevacizumab (Cape/5-FU-Bmab) with escalation to capecitabine or 5-fluorouracil plus oxaliplatin plus bevacizumab (CapeOX/mFOLFOX6-Bmab) versus combination CapeOX/mFOLFOX6-Bmab as the first-line treatment of mCRC. In the sequential arm (Arm A: oxaliplatin 'wait-and-go'), treatment escalation from Cape/5-FU-Bmab to CapeOX/mFOLFOX6-Bmab is recommended in the case of progressive disease. In the combination arm (Arm B: oxaliplatin 'stop-and-go'), de-escalation from CapeOX/mFOLFOX6-Bmab to Cape/5-FU-Bmab is possible after 12 weeks of treatment. Re-escalation to CapeOX/mFOLFOX6-Bmab after progressive disease is considered only for patients who received de-escalation of oxaliplatin after 12 weeks of treatment not caused by oxaliplatin-associated toxicity. A target sample size of 304 evaluable patients is considered sufficient to validate an expected HR for time to failure of strategy of the sequential approach 'wait-and-go' compared to the combination approach 'stop-and go' with 80% power and 2-sided 5% α in case of a true HR<0.69. ETHICS AND DISSEMINATION This study is conducted according to the standards of Good Clinical Practice and in compliance with the Declaration of Helsinki 2013 and local regulations, and has been submitted and approved by the Ethical Committee of the Non-Profit Organization MINS Institutional Review Board. The protocol and the trial results, even inconclusive, will be presented at international oncology congresses and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER UMIN000015405, Pre-results.
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Affiliation(s)
- Takeshi Nagasaka
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | | | - Akira Sawaki
- Department of Clinical Oncology, Kawasaki Medical School, Okayama, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Lab, Clinical Research Institute, National Hospital Organization Kyusyu Cancer Center, Fukuoka, Japan
| | - Michio Inukai
- Department of Integrated Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hiroaki Tanioka
- Department of Medical Oncology, Okayama Rosai Hospital, Okayama, Japan
| | - Junichiro Nasu
- Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Tomohiro Nishina
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama City, Japan
| | - Shoichi Hazama
- Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hospital, Hiroshima City, Japan
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Iwamuro M, Okada H, Takata K, Kawai Y, Kawano S, Nasu J, Kawahara Y, Tanaka T, Yoshino T, Yamamoto K. Magnified endoscopic features of duodenal follicular lymphoma and other whitish lesions. Acta Med Okayama 2015; 69:37-44. [PMID: 25703169 DOI: 10.18926/amo/53120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The sensitivity and specificity of magnified endoscopic features for differentiating follicular lymphoma from other diseases with duodenal whitish lesions have never been investigated. Here we compared the magnified endoscopic features of duodenal follicular lymphoma with those of other whitish lesions. We retrospectively reviewed the cases of patients with follicular lymphoma (n=9), lymphangiectasia (n=7), adenoma (n=10), duodenitis (n=4), erosion (n=1), lymphangioma (n=1), and hyperplastic polyp (n=1). The magnified features of the nine follicular lymphomas included enlarged villi (n=8), dilated microvessels (n=5), and opaque white spots of various sizes (n=9). The lymphangiectasias showed enlarged villi, dilated microvessels, and white spots, but the sizes of the white spots were relatively homogeneous and their margin was clear. Observation of the adenoma and duodenitis revealed only whitish villi. Although the lymphangioma was indistinguishable from the follicular lymphomas by magnified features, it was easily diagnosed based on the macroscopic morphology. In conclusion, magnified endoscopic features, in combination with macroscopic features, are useful for differentiating follicular lymphomas from other duodenal diseases presenting whitish lesions.
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Affiliation(s)
- Masaya Iwamuro
- Department of Molecular Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558,
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Horiguchi S, Kato H, Akimoto Y, Uchida D, Tomoda T, Matsumoto K, Yamamoto N, Tsutsumi K, Nasu J, Yamamoto K. FOLFIRINOX with modified regimen therapy for advanced pancreatic cancer in Okayama university hospital. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv472.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nasu J, Fujii M, Saitou S, Itou M, Ishiyama S, Fujiwara A, Yoshioka M, Shiode J. Retrospective analysis of FOLFIRINOX for unresectable pancreatic cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv472.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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24
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Muro S, Nasu J, Harada R, Matsubara M, Nakarai A, Kanzaki H, Tsutsumi K, Kato H, Tanaka T, Fujiwara H, Uno M, Okada H, Yamamoto K. Prompt resolution of hypoglycemia by hepatic transarterial embolization for malignant insulinoma with multiple liver metastases. Acta Med Okayama 2015; 68:303-6. [PMID: 25338488 DOI: 10.18926/amo/52900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 45-year-old female who presented with loss of consciousness and a cold sweat was found to have a pancreatic tumor and multiple liver metastases. Laboratory studies showed marked hypoglycemia and inappropriately elevated serum insulin, C-peptide, and serum tumor markers. Fine needle aspiration revealed Grade 3 small-cell type primary pancreatic neuroendocrine carcinoma. Consequently, the diagnosis of malignant insulinoma was made. Transarterial embolization (TAE) for hepatic metastases resulted in the reduction of tumor volume and prompt resolution of hypoglycemic attacks, whereas diazoxide and systemic chemotherapy had been ineffective for controlling blood glucose levels, and octreotide was unavailable due to the allergic effect. This case report highlights the potential usefulness of TAE for malignant insulinomas in the management of hypoglycemia.
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Affiliation(s)
- Shinichiro Muro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Yamasaki Y, Nasu J, Miura K, Kono Y, Kanzaki H, Hori K, Tanaka T, Kita M, Tsuzuki T, Matsubara M, Kawano S, Kawahara Y, Tabata M, Okada H, Yamamoto K. Intramucosal gastric mixed adenoneuroendocrine carcinoma completely resected with endoscopic submucosal dissection. Intern Med 2015; 54:917-20. [PMID: 25876572 DOI: 10.2169/internalmedicine.54.3469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Composite tumors in the stomach composed of adenocarcinoma and neuroendocrine carcinoma are rare. We herein report a case of intramucosal gastric mixed adenoneuroendocrine carcinoma (MANEC) that was treated with endoscopic submucosal dissection (ESD). A 77-year-old man who had previously received ESD for early gastric adenocarcinoma underwent esophagogastroduodenoscopy for screening, which showed a depressed lesion on the lesser curvature of the antrum. The tumor was removed en bloc via ESD and pathologically diagnosed as MANEC. The tumor was located within the mucosal layer, and no lymphovascular invasion was evident. Seven months after the ESD procedure, the patient is currently feeling well without recurrence or metastasis.
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Inada R, Nagasaka T, Mori Y, Nasu J, Matsubara M, Fujiwara Y, Mishima H, Fujiwara T. Differential Treatment Strategies for Advanced Colorectal Cancer by Mutation Spectrum in the RAS-RAF Pathway and MSI. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt459.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kawahara Y, Hori K, Takenaka R, Nasu J, Kawano S, Kita M, Tsuzuki T, Matsubara M, Kobayashi S, Okada H, Yamamoto K. Endoscopic submucosal dissection of esophageal cancer using the Mucosectom2 device: a feasibility study. Endoscopy 2013; 45:869-75. [PMID: 23884795 DOI: 10.1055/s-0033-1344229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) is being increasingly used for superficial esophageal cancers. However, esophageal ESD is technically difficult, time consuming, and less safe compared with endoscopic mucosal resection (EMR). To perform ESD safely and more efficiently, various types of knives have been developed. This study compared the efficacy of our newly developed device, Mucosectom2, with that of conventional devices for esophageal ESD. PATIENTS AND METHODS Between May 2007 and February 2011, ESD was performed for 172 esophageal lesions. Of these, 120 lesions were treated by conventional devices only, whereas 52 lesions were treated by conventional devices and the Mucosectom2. Procedure time, en bloc and R0 resection rates, and adverse events were retrospectively compared between the conventional and Mucosectom2 groups. RESULTS The median procedure time was 48.0 minutes in the conventional group and 21.5 minutes in the Mucosectom2 group; the procedure time was significantly shorter in the Mucosectom2 group than in the conventional group (P < 0.0001). The en bloc and R0 resection rates were lower in the conventional group than those in the Mucosectom2 group, although these differences were not significant. The rate of exposure of the muscle layer in the Mucosectom2 group was significantly lower than in the conventional group (P = 0.04). The rates of perforation and postoperative bleeding were not significantly different between the two groups. CONCLUSIONS This feasibility study suggests that, compared with conventional ESD devices, the Mucosectom2 may decrease the time required for esophageal ESD. Although our groups appeared comparable, they were studied at different times. Endoscopic expertise and endoscope quality may have differed during these periods, thereby affecting the results of our study. A prospective trial is therefore required to confirm our results.
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Affiliation(s)
- Yoshiro Kawahara
- Department of Endoscopy, Okayama University Hospital, Okayama, Japan
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Shirao K, Boku N, Yamada Y, Yamaguchi K, Doi T, Goto M, Nasu J, Denda T, Hamamoto Y, Takashima A, Fukuda H, Ohtsu A. Randomized Phase III study of 5-fluorouracil continuous infusion vs. sequential methotrexate and 5-fluorouracil therapy in far advanced gastric cancer with peritoneal metastasis (JCOG0106). Jpn J Clin Oncol 2013; 43:972-80. [PMID: 24014884 DOI: 10.1093/jjco/hyt114] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Owing to the risks of serious and sustained toxicity, anticancer drugs such as cisplatin and irinotecan cannot be readily administered to patients with gastric cancer and severe peritoneal metastasis. Therefore, a standard chemotherapy regimen has yet to be established for these types of patients. This randomized study investigated the utility of sequential methotrexate and 5-fluorouracil therapy vs. 5-fluorouracil continuous infusion for gastric cancer with peritoneal metastasis. METHODS Eligible patients had radiologically confirmed peritoneal metastasis with intestinal stenosis, peritoneal tumor or ascites. Treatment with 5-fluorouracil continuous infusion (800 mg/m(2)/day, ci, d1-5, q4w) or methotrexate and 5-fluorouracil therapy (methotrexate, 100 mg/m(2), bolus infusion, followed 3 h later by 5-fluorouracil, 600 mg/m(2), bolus infusion, with leucovorin rescue, q1w) was continued until disease progression or unacceptable toxicity. The projected sample size was 236, providing 80% power to detect a 40% increase in median overall survival in methotrexate and 5-fluorouracil therapy with a one-sided α of 0.05. RESULTS All 237 randomized patients were included in the primary analysis. The methotrexate and 5-fluorouracil therapy arm was not superior to the 5-fluorouracil continuous infusion arm (median survival time, 9.4 months in the 5-fluorouracil continuous infusion arm, 10.6 months in the methotrexate and 5-fluorouracil therapy arm; hazard ratio, 0.94; 95% confidence interval, 0.72-1.22; one-sided P = 0.31). Frequencies of Grade 3 or higher neutropenia, Grade 3 or higher anorexia and treatment-related deaths were 0.9, 27.4 and 1.7%, respectively, in the 5-fluorouracil continuous infusion arm, and 31.9, 33.6 and 0.9%, respectively, in the methotrexate and 5-fluorouracil therapy arm. CONCLUSIONS Methotrexate and 5-fluorouracil therapy is not suitable for use as standard therapy for advanced gastric cancer with peritoneal metastasis.
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Affiliation(s)
- Kuniaki Shirao
- *Department of Medical Oncology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu City, Oita 879-5593, Japan.
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Okada H, Takemoto M, Kawahara Y, Nasu J, Takenaka R, Kawano S, Inoue M, Ichimura K, Tanaka T, Shinagawa K, Yoshino T, Yamamoto K. A prospective analysis of efficacy and long-term outcome of radiation therapy for gastric mucosa-associated lymphoid tissue lymphoma. Digestion 2013; 86:179-86. [PMID: 22907329 DOI: 10.1159/000339497] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/14/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Few studies exist on the efficacy and long-term outcome of radiation therapy (RT) for gastric mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS Twenty-two patients with stage I or stage II(1) disease were prospectively evaluated, including 14 patients without Helicobacter pylori(H. pylori) infection and 8 patients with persistent lymphoma after H. pylori eradication. RT dose was 30 Gy in daily fractions of 1.5 Gy. All patients underwent endoscopic and histological follow-up regularly. RESULTS The study included 22 patients with a mean age of 63 years. The t(11;18)(q21;q21) translocation occurred in 8 of the 22 cases. All patients showed complete remission without any serious toxicity. At a median follow-up evaluation 74 months (range 27-159) after completion of RT, the overall and relapse-free survival rates after 5 years were 91 and 84%, respectively. Although no patient showed local recurrence of lymphoma, distant recurrence was detected in 3 patients, all of whom were H. pylori negative; MALT lymphoma relapsed in two patients with the t(11;18)(q21;q21) translocation, and diffuse large-cell lymphoma developed in one patient without the translocation. CONCLUSION RT provides excellent local control of the gastric MALT lymphoma. However, continuous follow-up is mandatory as relapse may occur in other sites.
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Affiliation(s)
- Hiroyuki Okada
- Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
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Iwamuro M, Okada H, Takata K, Kawano S, Kawahara Y, Nasu J, Shinagawa K, Yoshino T, Yamamoto K. Primary follicular lymphoma of the duodenum relapsing 11 years after resection. Intern Med 2012; 51:1031-5. [PMID: 22576382 DOI: 10.2169/internalmedicine.51.7060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 52-year-old Japanese woman was diagnosed with primary follicular lymphoma of the duodenum that was curatively resected by pancreatoduodenectomy. She remained in complete remission until 11 years after the surgery, when multiple enlarged intra-abdominal lymph nodes were demonstrated by computed tomography scans and positron emission tomography scans. Two years later, jejunal lesions were detected by endoscopy, and biopsy samples confirmed a recurrence of follicular lymphoma. This case indicates that primary gastrointestinal follicular lymphoma has a potential of relapse after an extended period of time, and thus patients must be followed up for over 10 years after complete remission.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
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Kanzaki M, Wada J, Nakatsuka A, Teshigawara S, Murakami K, Inoue K, Terami T, Katayama A, Nasu J, Yamamoto K, Makino H. A case of type 2 diabetes and metastatic liver cancer exhibiting hypercholesterolemia with abnormal lipoproteins. Intern Med 2012; 51:619-23. [PMID: 22449671 DOI: 10.2169/internalmedicine.51.6486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the appearance of abnormal lipoproteins in liver diseases is well known, the precise analyses of abnormal lipoproteins remain elusive. Here, we report a 71-year-old woman with type 2 diabetes whose serum cholesterol levels were elevated to 560 mg/dL over a 4-month period. High-performance liquid chromatography demonstrated the presence of lipoprotein-X and lipoprotein-Y and sigmoid colon cancer and multiple liver metastases were found by colonoscopy and computed tomography. Remission of the primary colon cancer and liver lesions was achieved by chemotherapy with oxaliplatin and fluorouracil and her serum cholesterol went back to basal levels associated with the disappearance of abnormal lipoproteins.
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Affiliation(s)
- Motoko Kanzaki
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Tsuzuki T, Okada H, Kawahara Y, Nasu J, Takenaka R, Inoue M, Kawano S, Kita M, Hori K, Yamamoto K. Usefulness and problems of endoscopic ultrasonography in prediction of the depth of tumor invasion in early gastric cancer. Acta Med Okayama 2011. [PMID: 21519368 DOI: 10.1016/j.gie.2011.03.362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objectives of this study were to evaluate the accuracy of endoscopic ultrasonography (EUS) in local and regional staging of early gastric cancer, to analyze the factors influencing the accuracy of EUS, and to reveal the usefulness and problems of EUS in pre-treatment staging of gastric cancer. We examined 105 lesions in 104 patients with histologically confirmed gastric cancer and retrospectively evaluated them with EUS. The diagnostic accuracy, sensitivity, and specificity of EUS were determined by comparing the pre-treatment EUS with the postoperative histopathological findings. The overall diagnostic accuracy of EUS for the depth of cancer invasion was 86%. The overall sensitivity and specificity were 60% and 96%, respectively. The accuracy significantly declined in lesions located in the upper-third of the stomach (70%). Type 0-I lesions tended to be over-staged (12&), and the upper-third lesions tended to be under-staged (23%). The accuracy significantly declined in differentiated adenocarcinoma with massive submucosal invasion (56.5%). EUS is useful for evaluating the depth of gastric cancer invasion which determines the feasibility of endoscopic treatment. However, it is noteworthy that the diagnostic accuracy of the invasion depth diminished for lesions in the upper third of the stomach.
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Affiliation(s)
- Takao Tsuzuki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Tsuzuki T, Okada H, Kawahara Y, Nasu J, Takenaka R, Inoue M, Kawano S, Kita M, Hori K, Yamamoto K. Usefulness and problems of endoscopic ultrasonography in prediction of the depth of tumor invasion in early gastric cancer. Acta Med Okayama 2011; 65:105-12. [PMID: 21519368 DOI: 10.18926/amo/45269] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objectives of this study were to evaluate the accuracy of endoscopic ultrasonography (EUS) in local and regional staging of early gastric cancer, to analyze the factors influencing the accuracy of EUS, and to reveal the usefulness and problems of EUS in pre-treatment staging of gastric cancer. We examined 105 lesions in 104 patients with histologically confirmed gastric cancer and retrospectively evaluated them with EUS. The diagnostic accuracy, sensitivity, and specificity of EUS were determined by comparing the pre-treatment EUS with the postoperative histopathological findings. The overall diagnostic accuracy of EUS for the depth of cancer invasion was 86%. The overall sensitivity and specificity were 60% and 96%, respectively. The accuracy significantly declined in lesions located in the upper-third of the stomach (70%). Type 0-I lesions tended to be over-staged (12&), and the upper-third lesions tended to be under-staged (23%). The accuracy significantly declined in differentiated adenocarcinoma with massive submucosal invasion (56.5%). EUS is useful for evaluating the depth of gastric cancer invasion which determines the feasibility of endoscopic treatment. However, it is noteworthy that the diagnostic accuracy of the invasion depth diminished for lesions in the upper third of the stomach.
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Affiliation(s)
- Takao Tsuzuki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
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Tsuzuki T, Okada H, Kawahara Y, Takenaka R, Nasu J, Ishioka H, Fujiwara A, Yoshinaga F, Yamamoto K. Proton pump inhibitor step-down therapy for GERD: A multi-center study in Japan. World J Gastroenterol 2011; 17:1480-7. [PMID: 21472108 PMCID: PMC3070023 DOI: 10.3748/wjg.v17.i11.1480] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 12/11/2010] [Accepted: 12/18/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the predictors of success in step-down of proton pump inhibitor and to assess the quality of life (QOL).
METHODS: Patients who had heartburn twice a week or more were treated with 20 mg omeprazole (OPZ) once daily for 8 wk as an initial therapy (study 1). Patients whose heartburn decreased to once a week or less at the end of the initial therapy were enrolled in study 2 and treated with 10 mg OPZ as maintenance therapy for an additional 6 mo (study 2). QOL was investigated using the gastrointestinal symptom rating scale (GSRS) before initial therapy, after both 4 and 8 wk of initial therapy, and at 1, 2, 3, and 6 mo after starting maintenance therapy.
RESULTS: In study 1, 108 patients were analyzed. Their characteristics were as follows; median age: 63 (range: 20-88) years, sex: 46 women and 62 men. The success rate of the initial therapy was 76%. In the patients with successful initial therapy, abdominal pain, indigestion and reflux GSRS scores were improved. In study 2, 83 patients were analyzed. Seventy of 83 patients completed the study 2 protocol. In the per-protocol analysis, 80% of 70 patients were successful for step-down. On multivariate analysis of baseline demographic data and clinical information, no previous treatment for gastroesophageal reflux disease (GERD) [odds ratio (OR) 0.255, 95% CI: 0.06-0.98] and a lower indigestion score in GSRS at the beginning of step-down therapy (OR 0.214, 95% CI: 0.06-0.73) were found to be the predictors of successful step-down therapy. The improved GSRS scores by initial therapy were maintained through the step-down therapy.
CONCLUSION: OPZ was effective for most GERD patients. However, those who have had previous treatment for GERD and experience dyspepsia before step-down require particular monitoring for relapse.
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Takiuchi H, Fukuda H, Boku N, Shimada Y, Nasu J, Hamamoto Y, Hironaka S, Yamaguchi K, Takashima A, Ohtsu A. Randomized phase II study of best-available 5-fluorouracil (5-FU) versus weekly paclitaxel in gastric cancer (GC) with peritoneal metastasis (PM) refractory to 5-FU-containing regimens (JCOG0407). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Boku N, Yamamoto S, Fukuda H, Shirao K, Doi T, Sawaki A, Koizumi W, Saito H, Yamaguchi K, Takiuchi H, Nasu J, Ohtsu A. Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol 2009; 10:1063-9. [PMID: 19818685 DOI: 10.1016/s1470-2045(09)70259-1] [Citation(s) in RCA: 459] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The best chemotherapy regimen for metastatic gastric cancer is uncertain, but promising findings have been reported with irinotecan plus cisplatin and S-1 (tegafur, 5-chloro-2,4-dihydropyrimidine, and potassium oxonate). We aimed to investigate the superiority of irinotecan plus cisplatin and non-inferiority of S-1 compared with fluorouracil, with respect to overall survival, in patients with metastatic gastric cancer. METHODS We undertook a phase 3 open label randomised trial in 34 institutions in Japan. We enrolled patients aged 20-75 years or younger, who had histologically proven gastric adenocarcinoma, and randomly assigned them by minimisation to receive either: a continuous infusion of fluorouracil (800 mg/m(2) per day, on days 1-5) every 4 weeks (n=234); intravenous irinotecan (70 mg/m(2), on days 1 and 15) and cisplatin (80 mg/m(2), on day 1) every 4 weeks (n=236); or oral S-1 (40 mg/m(2), twice a day, on days 1-28) every 6 weeks (n=234). The primary endpoint was overall survival. Analyses were done by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00142350, and with UMIN-CTR, number C000000062. FINDINGS All randomised patients were included in the primary analysis. Median overall survival was 10.8 months (IQR 5.7-17.8) for individuals assigned fluorouracil, 12.3 months (8.1-19.5) for those allocated irinotecan plus cisplatin (hazard ratio 0.85 [95% CI 0.70-1.04]; p=0.0552), and 11.4 months (6.4-21.3) for those assigned S-1 (0.83 [0.68-1.01]; p=0.0005 for non-inferiority). Three treatment-related deaths occurred in the irinotecan plus cisplatin group and one was recorded in the S-1 group. INTERPRETATION S-1 is non-inferior to fluorouracil and, in view of the convenience of an oral administration, could replace intravenous fluorouracil for treatment of unresectable or recurrent gastric cancer, at least in Asia. Irinotecan plus cisplatin is not superior to fluorouracil in this setting.
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Yamada Y, Yamamoto S, Ohtsu A, Suzuki Y, Nasu J, Yamaguchi K, Denda T, Tsuji A, Hara Y, Boku N. Impact of dihydropyrimidine dehydrogenase status of biopsy specimens on efficacy of irinotecan plus cisplatin, S-1, or 5-FU as first-line treatment of advanced gastric cancer patients in JCOG9912. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4535] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4535 Background: JCOG9912 (randomized phase III trial) showed a significant non-inferiority of S-1 to 5-FU (P<0.001); however, either S-1 or irinotecan plus cisplatin (IP) failed to show superiority to 5-FU (P=0.034 and 0.055, respectively) in overall survival. Excision repair cross-complementing group 1 (ERCC1), thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) are reportedly related to outcome of advanced gastric cancer (AGC) patients (pts) treated with IP or 5-FU. Efficacy analyses are performed to evaluate the status of ERCC1, TS, DPD and 5 biomarkers related to anticancer drug sensitivity in first-line pts treated with IP, S-1, or 5-FU monotherapy under controlled conditions. Methods: Blocks from endoscopic biopsy specimens of primary lesions before chemotherapy were available from 365 of 704 pts in JCOG9912. Using laser-captured microdissection and real-time RT-PCR, we analyzed mRNA expression of ERCC1, TS, DPD in paraffin-embedded specimens. Expression levels of each gene were categorized into low and high values at each median. Results: The subjects with available tissue for analysis were representative of all randomized pts; 232 samples were assessable for TS, 168 for DPD, and 235 for ERCC1. There were no statistical differences in patient numbers between 3 arms. Pts with high TS showed worse progression-free survival (PFS) compared with those with low TS (hazard ratio (HR):1.26 [95%CI: 0.97–1.63]) in all pts; there was no difference in PFS between DPD and ERCC1 expression level. IP showed better PFS than S-1 in low DPD (HR: 0.57 [95%CI: 0.32–1.01]) but not in high DPD (HR: 1.24 [95%CI: 0.76–2.04]); there was no clear difference in PFS between pts treated with IP and S-1 regardless of TS and ERCC1 expression status. S-1 showed almost consistently better PFS than 5-FU regardless of mRNA expression status. Conclusions: This large analysis showed the prognostic value of TS status in AGC pts and the predictive value of DPD status for IP and S-1 as first-line treatment. Studies of DPD as a predictive marker for IP activity in AGC are warranted in future personalized phase III. [Table: see text]
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Affiliation(s)
- Y. Yamada
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - S. Yamamoto
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - A. Ohtsu
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - Y. Suzuki
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - J. Nasu
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - K. Yamaguchi
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - T. Denda
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - A. Tsuji
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - Y. Hara
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
| | - N. Boku
- National Cancer Center Hospital, Tokyo, Japan; National Cancer Center Hospital East, Kashiwa, Japan; Yamagata Prefectural Central Hospital, Yamagata, Japan; NHO Shikoku Cancer Center, Matsuyama, Japan; Saitama Cancer Center Hospital, Kitaadachi-gun, Japan; Chiba Cancer Center, Chiba, Japan; Kochi Health Sciences Center, Kochi, Japan; Yokohama Municipal Citizen's Hospital, Yokohama, Japan; Shizuoka Cancer Center Hospital, Sunto-gun, Japan
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Shirao K, Boku N, Yamada Y, Yamaguchi K, Doi T, Takiuchi H, Nasu J, Nakamura K, Fukuda H, Ohtsu A. Randomized phase III study of 5-fluorouracil continuous infusion (5FUci) versus methotrexate and 5-FU sequential therapy (MF) in gastric cancer with peritoneal metastasis (JCOG0106). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4545 Background: Gastric cancer (GC) with peritoneal metastasis (PM) often complicates ascites or intestinal stenosis and the prognosis is still poor. Anti-cancer drugs generally can not be administered for such patients (pts) due to the risk of serious and prolonged adverse events. However, 5FU-based chemotherapy is reportedly relatively safe for PM. We conducted a phase III study to investigate the superiority of MF over 5FUci for GC with PM with a primary endpoint of overall survival (OS) and secondary endpoints of toxicities, ingestion-possible survival (IPS) in pts with initially possible ingestion and proportion of ingestive improvement (%II) in pts requiring nutrition support. Methods: Eligibility criteria included pts with histologically proven gastric adenocarcinoma; inoperable or recurrent GC; PM with radiologically confirmed intestinal stenosis or ascites; 20–75 years old; PS 0–2; no prior treatment except surgery or adjuvant chemotherapy. Treatment with 5FUci (800mg/m2/d, civ, d1–5, q4w) or MF (methotrexate, 100mg/m2, iv, followed 3 h later by 5FU, 600mg/m2, iv, with leucovorin rescue, q1w) were continued until disease progression or unacceptable toxicities. Projected sample size was 236 in total, which had 80% power to detect 40% increase of median OS in MF with 1-sided alpha 0.05. Results: A total of 237 pts were randomized between Oct 2002 and Apr 2007. Final analysis was performed in Dec 2008 when 224 pts (95%) were dead. Results of OS are shown in Table . Median IPS was 8.1M for 5FUci(n=102) and 9.0M for MF(n=103) (p=0.60). %II was 41%(7/17) for 5FUci and 57%(8/14) for MF (p=0.48). Frequencies (%) of grade 4 neutropenia, grade >3 febrile neutropenia, infection with neutropenia, anemia, anorexia, diarrhea, abdominal pain within 6M, and treatment related death (5-FUci/MF) were 0/9, 0/3, 0/5, 10/16, 27/34, 1/10, 5/10 and 2/1, respectively. Conclusions: MF could not become new standard therapy for GC with PM. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- K. Shirao
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - N. Boku
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - Y. Yamada
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - K. Yamaguchi
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - T. Doi
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - H. Takiuchi
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - J. Nasu
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - K. Nakamura
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - H. Fukuda
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
| | - A. Ohtsu
- Oita University Faculty of Medicine, Yufu, Japan; Shizuoka Cancer Center, Shizuoka, Japan; National Cancer Center Hospital, Tokyo, Japan; Saitama Cancer Center, Saitama, Japan; National Cancer Center Hospital East, Chiba, Japan; Osaka Medical College, Osaka, Japan; National Hospital Organization Shikoku Cancer Center, Ehime, Japan; JCOG Data Center, Tokyo, Japan
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Tanimizu M, Kawamura S, Narumoto K, Fujii T, Takaoka S, Nasu J, Kikuuchi Y, Miyawaki S, Funada C, Matsuhisa T. [Local communication system between hospitals, clinics and nursing homes and their team approaches are essential in a consistent medical care for cancer patients]. Gan To Kagaku Ryoho 2007; 34 Suppl 2:170-174. [PMID: 20443252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Designated cancer care hospitals are responsible for constructing a local communication system between hospitals, clinics and nursing homes. Their team approaches are essential in a consistent medical care for cancer patients. Clinical pathway sheets shared by them will promote their collaboration and keep the consistency of medical care. Counseling and supporting section, palliative care unit and palliative care team in the designated cancer care hospital play an important role improving the quality of medical care for cancer patients.
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Nagano A, Naka M, Nasu J, Ishihara S. Electric polarization, magnetoelectric effect, and orbital state of a layered iron oxide with frustrated geometry. Phys Rev Lett 2007; 99:217202. [PMID: 18233245 DOI: 10.1103/physrevlett.99.217202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2007] [Indexed: 05/25/2023]
Abstract
A layered iron oxide RFe2O4 (R denotes rare-earth-metal elements) is an exotic dielectric material with charge-order (CO) driven electric polarization and magnetoelectric effect caused by spin-charge coupling. In this paper, a theory of electronic structure and dielectric property in RFe2O4 is presented. Charge frustration in paired-triangular lattices allows a charge imbalance without inversion symmetry. Spin frustration induces reinforcement of this polar CO by a magnetic ordering. We also analyze an orbital model for the Fe ion which does not show a conventional long-range order.
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Affiliation(s)
- A Nagano
- Department of Physics, Tohoku University, Sendai 980-8578, Japan
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Kobayashi N, Saito Y, Sano Y, Uragami N, Michita T, Nasu J, Matsuda T, Fu KI, Fujii T, Fujimori T, Ishikawa T, Saito D. Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth? Endoscopy 2007; 39:701-5. [PMID: 17661244 DOI: 10.1055/s-2007-966587] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND STUDY AIMS Assessment of the invasion depth of colorectal neoplasia is important in deciding between endoscopic and surgical resection treatment methods. Prior to attempting endoscopic resection, the lesion is lifted by submucosal injection, and a positive "non-lifting sign" is usually considered to indicate deeper submucosal infiltration. The purpose of this prospective multicenter study was to assess the predictive value of the non-lifting sign for differentiating between adenoma and early cancer (up to discrete submucosal infiltration [sm1]) and cancer with deeper infiltration (sm2). PATIENTS AND METHODS During an 11-month period, a total of 271 colorectal neoplastic lesions in 239 patients were included in the study. Apart from the location, size, and macroscopic type of the lesion, the presence or absence of the non-lifting sign was recorded and compared with the endoscopic assessment of invasion depth. RESULTS The non-lifting sign had a sensitivity of 61.5 %, a specificity of 98.4 %, a positive predictive value of 80.0 %, a negative predictive value of 96.0 %, and an accuracy of 94.8 %. Endoscopic diagnosis of deeper infiltration had a sensitivity of 84.6 %, a specificity of 98.8 %, a positive predictive value of 88.0 %, a negative predictive value of 98.4 %, and an accuracy of 97.4 %. Statistically significant differences were found in terms of sensitivity and accuracy. CONCLUSION Because of its lower sensitivity and accuracy, the non-lifting sign will not replace endoscopic assessment. If a lesion does not lift, this can make resection technically difficult, but does not reliably predict deeper cancerous invasion.
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Affiliation(s)
- N Kobayashi
- Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
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Hayashi H, Beppu T, Nasu J, Masuda T, Mizumoto T, Ishiko T, Takamori H, Kanemitsu K, Hirota M, Baba H. Clinical benefit of liver hanging maneuver for right-side major hepatectomy. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15171 Background: Liver hanging maneuver is a new technique in anterior approach of major hepatectomy. However, the impact of the maneuver has never been fully investigated in patients with liver tumors. To evaluate the surgical benefits of liver hanging maneuver, we set up a comparative study in right-side major hepatectomy. Methods: From 2000 to 2006, 326 hepatectomy were performed in our institution. Fifty-eight patients with liver tumor (hepatocellularcarcinoma in 36, metastatic liver tumor in 13, and the others in 9) considered for right-side major hepatectomy were prospectively analyzed. Right-side hepatectomy included 26 right hepatectomy, 24 extended right hepatectomy, and 8 tri-segmentectomy. The patients were devided into a group with conventional approach (n = 21), a group with anterior approach without hanging maneuver (n = 19), and a group with approach with liver hanging maneuver (n = 18). In the three groups, age, body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, tumor size, resected liver weights, intraoperative blood loss, frequency of transfusion and surgical time were analyzed. Results: In conventional approach, anterior approach without hanging maneuver, and approach with liver hanging maneuver, mean age was 55, 59, and 65 years, and mean tumor size was 65, 75, and 108mm, respectively. Patients with liver hanging maneuver were significantly elder (p<0.05) and have larger tumor size (p<0.01). There were no significant differences in body mass index, child-pugh classification, type of liver tumor, staging in hepatocellularcarcinoma, and resected liver weights. Mean intraoperative blood loss was 1771, 805, and 704g, and mean surgical time was 562, 483, and 435minutes, and the frequency of red blood cell transfusion was 33, 21, and 17%, respectively. Patients with liver hanging maneuver had significantly less intraoperative blood loss (P=0.0001) and surgical time (P=0.002). The frequency of red blood cell transfusion in the liver hanging maneuver group was significantly lower than that of the conventional group (p<0.05). Postoperative morbidity rate were 33.3, 15.8, and 16.7%, respectively. Conclusions: Liver hanging maneuver is less invasive and a quite useful method for right-side major hepatectomy. No significant financial relationships to disclose.
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Affiliation(s)
| | - T. Beppu
- Kumamoto University, Kumamoto, Japan
| | - J. Nasu
- Kumamoto University, Kumamoto, Japan
| | - T. Masuda
- Kumamoto University, Kumamoto, Japan
| | | | - T. Ishiko
- Kumamoto University, Kumamoto, Japan
| | | | | | - M. Hirota
- Kumamoto University, Kumamoto, Japan
| | - H. Baba
- Kumamoto University, Kumamoto, Japan
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Kajiwara T, Nishina T, Hyodo I, Moriwaki T, Endo S, Nasu J, Hori S, Iguchi H, Hiasa Y, Onji M. Impact of gene expression of orotate phosphoribosyl transferase for complete response to chemoradiotherapy in patients with squamous cell carcinoma of the esophagus. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4566 Background: Chemoradiotherapy (CRT) is a potential alternative to surgery in patients with squamous cell carcinoma of the esophagus. Complete response (CR) to CRT is essential for a good prognosis and there is a need for a predictive method of CR in CRT. Methods: The pretreatment formalin-fixed, paraffin-embedded endoscopic tumor biopsy material was obtained from 41 patients treated with a definitive concurrent CRT (5-FU/CDDP and 60 Gy) for esophageal cancer (cStage II or III). cDNA was derived from tumor cells of biopsy specimens by the laser capture microdissection and analyzed to determine mRNA expression relative to an internal reference gene (β-actin) using fluorescence-based, real-time reverse transcription PCR. Gene expression levels of thymidylate synthase, thymidine phosphorylase, dihydropyrimidine dehydrogenase, orotate phosphoribosyl transferase (OPRT), metylenetetrahydrofolate reductase, dihydrofolate reductase (DHFR), excision repair cross-complementing gene 1, vascular endothelial growth factor, epidermal growth factor receptor and matrix metalloproteinase 9 (MMP-9) were measured. Results: Median gene expression levels of OPRT and DHFR were significantly higher in CR patients (p=0.0206 and 0.0191, respectively). MMP-9 was significantly lower in CR patients (p=0.0436). When the median values of the gene expression levels were selected as the cutoff values, CR rate was significantly higher in the high OPRT group and high DHFR group (p=0.0104 and 0.0104, respectively). However, there was no statistical difference in CR rate between the low MMP-9 group and the high MMP-9 group. Multivariate analysis, including clinical stage and biomarkers, revealed that high OPRT gene expression was an independent predictive factor of CR (p=0.0329, relative risk=6.65, 95% confidence interval, 1.17–37.89%). Conclusions: The measurement of OPRT gene expression in tumor biopsies may be a predictive factor of CR to CRT in patients with squamous cell carcinoma of the esophagus. No significant financial relationships to disclose.
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Affiliation(s)
- T. Kajiwara
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - T. Nishina
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - I. Hyodo
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - T. Moriwaki
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - S. Endo
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - J. Nasu
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - S. Hori
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - H. Iguchi
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - Y. Hiasa
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
| | - M. Onji
- National Hospital Organization Shikoku Cancer Cent, Matsuyama, Japan; University of Tsukuba, Tsukuba, Japan; Ehime University Graduate School of Medicine, Toon, Japan
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Abstract
BACKGROUND AND STUDY AIMS Endoscopic mucosal resection (EMR) of early gastric cancer is a minimally invasive procedure. The incidence and characteristics of metachronous multiple gastric cancers were investigated in a retrospective study in patients with early gastric cancer after EMR treatment. PATIENTS AND METHODS A total of 143 patients with early gastric cancer who had undergone EMR treatment were periodically followed up with endoscopic examinations for 24 months or longer. RESULTS The median period of endoscopic follow-up was 57 months (range 24 - 157 months). None of the patients died of gastric cancer, and there were no treatment-related deaths. Five patients died of other diseases. Of 20 patients (14 %) with metachronous multiple gastric cancers, 15 were treated by EMR. One patient with differentiated submucosal cancer and four with undifferentiated cancers underwent surgery. Sixteen patients (11 %) had synchronous multiple early gastric cancer lesions within 1 year of the initial EMR. About half of the multiple lesions were located in the same third of the stomach as the primary lesion, and most lesions were similar in macroscopic type to the primary lesions. Most multiple lesions were of the differentiated type. CONCLUSIONS Annual endoscopic examinations can preserve the whole stomach in most patients with early gastric cancer after successful EMR.
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Affiliation(s)
- J Nasu
- Dept. of Internal Medicine, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.
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Tomita J, Okada H, Mizuno M, Nasu J, Nishimura M, Nakamura S, Kobayashi Y, Kawamoto H, Nouso K, Iwasaki Y, Sakaguchi K, Shiratori Y, Iwagaki H, Morimoto Y. [A case of ulcerative colitis successfully treated with low-dose warfarin for portal vein thrombosis after colectomy]. Nihon Shokakibyo Gakkai Zasshi 2005; 102:25-30. [PMID: 15682812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Junko Tomita
- Department of Medicine and Medical Sciences, Okayama University Graduate School of Medicine and Dentistry
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Takenaka R, Okada H, Mizuno M, Nasu J, Toshimori J, Tatsukawa M, Shiratori Y, Wato M, Tanimoto Y. Pneumocystis carinii pneumonia in patients with ulcerative colitis. J Gastroenterol 2004; 39:1114-5. [PMID: 15580408 DOI: 10.1007/s00535-004-1454-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2003] [Accepted: 04/05/2004] [Indexed: 02/04/2023]
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Hyodo I, Nishina T, Moriwaki T, Endo S, Terao T, Hirao K, Nasu J, Hirasaki S, Endo H, Masumoto T, Tajiri H, Kurita A. A phase I study of S-1 combined with weekly cisplatin for metastatic gastric cancer in an outpatient setting. Eur J Cancer 2003; 39:2328-33. [PMID: 14556924 DOI: 10.1016/s0959-8049(03)00626-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A dose-escalation study was conducted for patients with metastatic gastric cancer to determine the recommended dose of weekly intravenous (i.v.) cisplatin combined with a fixed dose of a new oral dihydropyrimidine dehydrogenase-inhibitory fluoropyrimidine, S-1, on an outpatient basis. Secondary endpoints were to define the toxicity profile and to determine tumour responses. S-1 was fixed at a dose of 70 mg/m(2)/day and was administered for 2 weeks followed by a 1-week rest. Three dose levels of cisplatin (10, 15 and 20 mg/m(2)) were studied. Cisplatin was infused over 30 min on days 1 and 8. 20 patients were enrolled. No dose-limiting toxicities (DLTs) were recorded during the administration of cisplatin up to 20 mg/m(2), except for grade 3 diarrhoea and stomatitis in one patient at dose level 3. No grade 4 adverse events occurred. However, grade 2 gastrointestinal adverse reactions, such as nausea and anorexia, were seen in 7 of 13 patients at dose level 3 within the first two treatment cycles. This was determined to be the maximum acceptable level that would not negate the advantages observed with use of an oral drug such as S-1. An objective tumour response was seen at all dose levels, and the overall response rate in the 18 patients evaluated was 61%. A higher response rate of 78% was observed in 9 patients who had received no prior chemotherapy. Oral S-1 with weekly cisplatin is a feasible and promising combination regimen that is appropriate for an outpatient setting. A randomised phase II study comparing this combination with S-1 alone in chemo-nai;ve patients is warranted.
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Affiliation(s)
- I Hyodo
- Department of Internal Medicine, National Shikoku Cancer Center, 13 Horinouchi, 790-0007, Matsuyama, Japan.
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Kiso T, Mizuno M, Nasu J, Shimo K, Uesu T, Yamamoto K, Okada H, Fujita T, Tsuji T. Enhanced expression of decay-accelerating factor and CD59/homologous restriction factor 20 in intestinal metaplasia, gastric adenomas and intestinal-type gastric carcinomas but not in diffuse-type carcinomas. Histopathology 2002; 40:339-47. [PMID: 11943018 DOI: 10.1046/j.1365-2559.2002.01350.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Variable expression of the complement regulatory proteins, decay-accelerating factor, CD59/homologous restriction factor 20 (HRF20) and membrane cofactor protein has been shown in human gastrointestinal malignancies, but their expression in gastric cancer has not been fully described. Thus, we immunohistochemically defined the distribution of these proteins in human normal gastric mucosa, intestinal metaplasia, adenomas and gastric cancers. METHODS AND RESULTS Gastric tissues were obtained by endoscopic biopsy or surgical resection and stained with mouse monoclonal antibodies to decay-accelerating factor, CD59/HRF20, and membrane cofactor protein. In the normal gastric mucosa, membrane cofactor protein was diffusely stained on the basolateral surface of epithelial cells, whereas the expression of decay-accelerating factor and CD59/HRF20 was inconspicuous. In intestinal metaplasia, adenoma and intestinal-type gastric carcinoma cells, decay-accelerating factor and HRF20 were intensely stained on the apical surface; membrane cofactor protein retained its location on the basolateral surface. In diffuse-type gastric carcinomas, the expression of decay-accelerating factor, CD59/HRF20 was lost, but membrane cofactor protein was present on the tumour cell surface. CONCLUSIONS These findings suggest that membrane cofactor protein plays a primary role in the regulation of complement activation in normal and neoplastic gastric cells and that the expression pattern of the complement regulatory proteins is closely related to gastric carcinoma development.
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Affiliation(s)
- T Kiso
- Department of Medicine and Medical Science, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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Takeuchi K, Mizuno M, Uesu T, Nasu J, Kawada M, Hori S, Okada H, Endo Y, Fujita T, Tsuji T. Epidermal growth factor induces expression of decay-accelerating factor in human colonic cancer cells via the mitogen-activated protein kinase pathway. J Lab Clin Med 2001; 138:186-92. [PMID: 11528371 DOI: 10.1067/mlc.2001.117405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The expression of decay-accelerating factor (DAF), a complement regulatory protein, is enhanced in colorectal cancer. In this study, to elucidate mechanisms for enhanced DAF expression, we studied the effects of growth factors on DAF expression in HT-29 human colonic cancer cells. Cells were treated with epidermal growth factor (EGF), insulin-like growth factor-I, platelet-derived growth factor, and transforming growth factor-beta. DAF protein expression and mRNA expression were determined with enzyme immunoassay and Northern blot analysis. The signaling pathways that target DAF expression in response to growth factor stimulation were characterized by using various inhibitors of the signal transduction pathway. EGF induced significant increases in DAF protein and mRNA expression in HT-29 cells; the other growth factors had a weak effect or no effect. The EGF-induced DAF expression was inhibited by mitogen-activated protein (MAP) kinase kinase inhibitor PD 98059 but not by phosphatidylinositol-3 kinase inhibitor, phospholipase Cgamma inhibitor, or protein kinase C inhibitor. When we analyzed the phosphorylation state of the MAP kinase by immunoblot analysis, phosphorylated p44/p42 MAP kinase was detected in EGF-stimulated HT-29 cells, and the addition of PD 98059 abrogated the phosphorylation. These results indicate that EGF regulates DAF expression in HT-29 cells via the signaling pathway that depends on the activation of MAP kinase.
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Affiliation(s)
- K Takeuchi
- First Department of Internal Medicine, Okayama University Medical School, Japan
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Miyoshi M, Mizuno M, Ishiki K, Nagahara Y, Maga T, Torigoe T, Nasu J, Okada H, Yokota K, Oguma K, Tsuji T. A randomized open trial for comparison of proton pump inhibitors, omeprazole versus rabeprazole, in dual therapy for Helicobacter pylori infection in relation to CYP2C19 genetic polymorphism. J Gastroenterol Hepatol 2001; 16:723-8. [PMID: 11446878 DOI: 10.1046/j.1440-1746.2001.02526.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM The genetic polymorphism of cytochrome P450 (CYP) 2C19 has been shown to influence the efficacy of Helicobacter pylori eradication therapy with a proton pump inhibitor (PPI) and amoxicillin (so-called dual therapy). Omeprazole, a widely used PPI, and rabeprazole, a new PPI, are metabolized in different pathways in terms of CYP2C19 genetic polymorphisms. In this study, we compared the efficacy of omeprazole and rabeprazole in a 2-week dual therapy in relation to CYP2C19 polymorphism. METHODS One hundred and ninety-nine patients with peptic ulcer disease were randomly assigned to receive one of the following regimens: 500 mg t.i.d. amoxicillin together with either 20 mg b.i.d. omeprazole or 10 mg b.i.d rabeprazole. The eradication of H. pylori was evaluated by using a bacterial culture and a [(13)C]-urea breath test at 1--2 months after completion of treatment. Cytochrome P4502C19 polymorphism was analyzed by using polymerase chain reaction-restriction fragment length polymorphism. RESULTS Intention-to-treat-based cure rates for the omeprazole or rabeprazole regimens were 66.3% (95% CI, 56--75) and 62.4% (95% CI, 52--71), respectively, without significant difference. Cytochrome P4502C19 genetic polymorphism did not influence the cure rates in either of these regimens. We analyzed various factors associated with treatment failure (PPI, CYP2C19 genotype, and smoking habit) by using multiple logistic regression; smoking was the only significant independent factor for treatment failure. CONCLUSION Omeprazole and rabeprazole were equally effective in combination with amoxicillin in eradicating H. pylori, irrespective of the PPI used (omeprazole or rabeprazole) and CYP2C19 genetic polymorphism. Smoking significantly decreased the cure rate of H. pylori infection in the dual therapy.
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Affiliation(s)
- M Miyoshi
- First Department of Internal Medicine, Okayama University Medical School, Okayama, Japan
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