Perioperative Allogeneic Blood Transfusion Does not Influence Patient Survival After Hepatectomy for Hepatocellular Carcinoma: A Propensity Score Matching Analysis

BACKGROUND

Whether perioperative allogeneic blood transfusion (PABT) negatively influences patient survival after hepatectomy (HR) for hepatocellular carcinoma (HCC) remains controversial.

METHODS

Five hundred two patients who underwent HR for initial HCC between 1994 and 2015 were enrolled in this study. All patients were divided into two groups: the PABT group and the non-PABT group. Differences of clinicopathological factors, overall survival (OS), recurrence-free survival (RFS), and the recurrence pattern between the two groups were evaluated. Using propensity score matching for tumor-related factors, liver functions, and surgical factors (total 11 factors), the survival impact of PABT was also analyzed.

RESULTS

In the entire cohort, 78 patients (15.5%) received PABT such as red cell concentrate, fresh-frozen plasma, or platelets. OS (5-year OS: 55% vs. 76%; p = 0.0005) and RFS (2-year RFS: 47% vs. 56%; p = 0.0131) were significantly worse in the PABT group. The extrahepatic recurrence happened more frequently in the PABT group (15% vs. 5.4%; p = 0.0039). There were many significant clinicopathological differences between the two groups: more advanced tumor stage (tumor diameter, stage III or IV, microvascular invasion), worse liver functions (albumin, indocyanine green retention rate at 15 min), and more surgical stress (blood loss, operation time) in the PABT group. After propensity score matching, 43 pairs of patients were extracted. In this matched cohort, the survival curves of the PABT and non-PABT groups almost completely overlapped both in OS (5-year OS: 62% vs. 62%; p = 0.4384) and in RFS (2-year RFS: 49% vs. 47%; p = 0.8195). The significant difference of the extrahepatic recurrence rate disappeared in the matched cohort (p = 0.5789).

CONCLUSION

Using propensity score matching, we found that PABT does not influence patient survival after HR for HCC.

A Case of 15-Year Recurrence-free Survival After Microwave Coagulation Therapy for Liver Metastasis from Gastric Cancer

A 70-year-old man with a growing liver tumor had undergone subtotal gastrectomy with pancreaticoduodenectomy for gastric cancer (T4b P0 H0 N1, Stage IIIB) 30 months before admission to our hospital. Enhanced computed tomography revealed two hypervascular nodules in segments 4 and 8. After histological diagnosis of small liver metastases from gastric cancer in segment 8, the patient underwent open microwave coagulation therapy (MCT) for the tumor (diameter: 30 mm) in segment 4. MCT was performed by using 1.5-cm and 3-cm monopolar needle electrodes with 22 times of puncture under the condition of 100 W × 60 sec. Liver abscess developed at the MCT site; however, it was decreased with percutaneous drainage. The patient is alive, without tumor recurrence even after 15 years since the MCT. This successful case proves that appropriate MCT is a promising treatment for patients with gastric liver metastases.

Abstract 5000: A stromal liver gene signature predictive of HCC risk across all liver disease etiologies

Background & Aims: HCC risk-predictive biomarkers will enable identification of patients who most need close monitoring and cancer preventive intervention. We previously reported a stromal liver gene signature predictive of HCC risk in multiple independent patient cohorts mainly affected with HCV (Hoshida 2008, Hoshida 2013, King 2014). We aimed to determine whether the gene signature is similarly prognostic in HBV, alcohol abuse, and NAFLD/NASH patients. Methods: The liver gene signature was analyzed using an FDA-approved diagnostic platform (NanoString), and an independent cohort of curatively resected early-stage HCC patients (n=223, median follow up 4.5 years, HCV [n=67, 30%], HBV [n=39, 17%], alcohol [n=51, 23%], NAFLD [n=66, 30%], and NASH [n=52, 23%, a subset of 66 NAFLD patients]) were analyzed. Complete surgical resection was radiologically and histologically confirmed, and HCC recurrence in the cohort was confirmed to be mainly late recurrence, i.e., de novo carcinogenesis, based on a recurrence hazard plot. Prognostic prediction was performed by using a previously developed model without making any modification, and evaluated for association with de novo HCC recurrence in multivariable modeling and subgroup analyses. Results: The gene signature assay classified the patients into high- (n=49, 22%), intermediate- (n=127, 57%), and low- (n=47, 21%) risk groups. The high-risk prediction was associated with higher HCC recurrence (HR=4.8, p&lt0.001) as well as overall death (HR=4.8, p&lt0.001) in multivariable modeling. The association with HCC risk remained significant in subgroups of patients with HCV (HR=3.0, p=0.028), HBV (HR=6.1, p&lt0.001), alcohol (HR=6.1, p=0.023), and NASH (HR=10.9, p=0.03) in multivariable models including cirrhosis and AJCC stage 2/3. The association was diminished in NAFLD patients (HR=3.02, p=0.16), suggesting that presence of active inflammation and/or fibrosis is critical for the signature to predict HCC risk in NAFLD. Established cirrhosis was less frequent in NAFLD/NASH (23%/21%) compared to other etiologies (50%). Conclusions: The prognostic liver gene signature was implemented in a clinically applicable assay, and successfully validated for de novo HCC recurrence after curative resection of early-stage HCC in all major etiologies of chronic liver disease and HCC. The assay will enable prioritization of patients for HCC surveillance and enrichment of high risk patients for more cost-effective clinical trials of new HCC chemopreventive therapies.

Citation Format: Shigeki Nakagawa, Naoki Umesaki, Takanobu Yamao, Yuki Kitano, Kensuke Yamamura, Kota Arima, Tatsunori Miyata, Takayoshi Kaida, Yujin Hoshida, Katsunori Imai, Daisuke Hashimoto, Yo-ichi Yamashita, Akira Chikamoto, Hideo Baba. A stromal liver gene signature predictive of HCC risk across all liver disease etiologies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5000. doi:10.1158/1538-7445.AM2017-5000

[A Case of Intestinal Diverticular Perforation in Roux-en-Y Reconstruction after Laparoscopic Distal Gastrectomy]

An 81-year-old woman who had undergone laparoscopic distal gastrectomy complained of abdominal pain 21 days after the operation.Blood tests showed a strong inflammatory reaction.Abdominal CT revealed a perforation in the small intestinal diverticula.Partial jejunectomy including the diverticulum was performed.The diverticular perforation was attributed to the presence of undigested food in the diverticulum.The patient had an uneventful postoperative course, and she was discharged on postoperative day 32.

Impact of three-dimensional (3D) ultrasonography and power Doppler angiography in the management of cervical cancer

PURPOSE

To evaluate the potential role of three-dimensional (3D) ultrasound, and to assess its diagnostic performance and ability to predict therapeutic efficacy in cervical cancer.

METHODS

Thirty patients with cervical cancer and 35 normal controls were studied by transvaginal 3D power Doppler ultrasound before treatment. Eleven patients who received neoadjuvant chemotherapy (n = 6), radiation (n = 3), or chemoradiation (n = 2), had further measurements taken one month and two months after treatment.

RESULTS

From the receiving operating characteristics curve analysis, the best vascularization index (VI) cutoff value of 5.24 distinguished cervical cancer from the normal cervix, with a sensitivity of 73.3% and a specificity of 94.3%. Cervical tumor volume measured by magnetic resonance imaging was positively correlated with the tumor volume measured by 3D ultrasonography (r = 0.91, p < 0.0001). In six patients who received neoadjuvant chemotherapy, the percent change in tumor volume during the second month of treatment was positively correlated with the percent change in flow index (FI) during the first month of treatment (r = 0.83, p < 0.05).

CONCLUSIONS

VI may be a diagnostic marker and FI may be a predictive marker of treatment response in cervical cancer.

The incidence, treatment and prognosis of cervical carcinoma in young women: a retrospective analysis of 4,975 cases in Japan

OBJECTIVE

To determine the clinical characteristics of patients (young women) with cervical carcinoma aged less than 35 years.

METHODS

Data from patients who were treated for cervical carcinomas from 1990 to 2000 in the Kinki District were retrospectively investigated for clinical stage, histologic type, treatment procedure and prognosis.

RESULTS

Of a total of 4,975 cases, 441 patients were aged less than 35 years old. The incidence of cervical carcinoma in these women was 7.9% from 1990 to 1995, 9.1% from 1996 to 2000, and 9.5% from 2001 to 2005. FIGO Stage I included 374 cases, followed by, 49 in Stage II, 11 in Stage III, and seven in Stage IV. Squamous cell carcinoma incidence was 80.7% and non-squamous cell carcinoma incidence was 19.3%. Several types of surgery were performed in patients with Stage I and II, while patients with Stage III and IV were treated with radiotherapy and/or chemotherapy without any type of surgery. In patients who underwent lymphadenectomy, 21.1% cases had nodal involvement. The 5-year survival rate was 95% for Stage I disease, 73% for Stage II, 68% for Stage III, and 19% for Stage IV.

CONCLUSION

The incidence of cervical carcinoma in young women slightly increased from 1990 to 2005. The prognosis of cervical carcinoma tends to be better in young women than in older patients, especially in Stage III disease.

Clinical outcome and prognostic factors in borderline tumors of the ovary. Results from 17 years' experience in the Kinki District of Japan (1990-2006)

PURPOSE OF INVESTIGATION

The clinical characteristics and long-term prognostic factors of borderline ovarian tumors (BOTs) were evaluated.

METHODS

Data from patients who were treated for BOTs in the Kinki District of Japan from 1990 to 2006 were revieved. Two hundred and twenty-two cases were retrospectively investigated for stage, surgical procedure, histopathological features, adjuvant chemotherapy and prognosis.

RESULTS

FIGO stages included 212 patients with Stage I disease, three with Stage II and seven with Stage III. One hundred and sixty-nine cases were diagnosed as mucinous tumor, 47 were serous, and six were others. Radical surgery was performed in 136 patients and conservative surgery in 86 patients. Only two patients showed invasive peritoneal implants. Forty patients received adjuvant chemotherapy. The survival rate was 95% at ten-years. Statistical analysis showed that earlier stage, absence of residual tumors, peritoneal implants, ovarian stromal involvement, and negative peritoneal cytology were associated with significantly better overall survival.

CONCLUSION

The prognosis of patients with BOT is excellent. There are insufficient data to support a role for aggressive surgery and adjuvant chemotherapy for the possibility of prolonged survival.

Complete remission of OC-resistant catamenial shoulder joint pain and inguinal pain associated with extraperitoneal endometriosis following personalized GnRH agonist therapy

BACKGROUND

Patients with severe extraperitoneal endometriosis require rapid remission and cannot wait for the effects of oral contraceptive hormones (OCs) to appear.

CASE

We successfully achieved personalized gonadotropin-releasing hormone agonist (GnRHa) therapy for a patient with catamenial right shoulder joint pain and right inguinal pain associated with extraperitoneal endometriosis, which was completely unable to be suppressed by OCs. A total of 15 subcutaneous GnRHa depot injections over a period of 19 months was performed according to the serum estradiol and LH levels, in order to maintain long-term amenorrhea without any estrogen-deprivation effects. No recurrence of the catamenial symptoms has been observed for more than 35 months after the final GnRHa depot injection.

CONCLUSION

Personalized GnRHa therapy should become the first-choice therapy for OC-resistant inoperable extraperitoneal endometriosis.

Factors affecting bone mineral density of young women and predictive factors of low bone mineral density

PURPOSE OF INVESTIGATION

We investigated various factors affecting bone mineral density (BMD) in young women and predictive factors of low BMD.

METHODS

Subjects were 105 nursing school students aged from 19 to 24 years old. Body weight (BW), pituitary hormones, sex steroid hormone and bone turnover markers were selected as factors. BMD was measured at the lumbar spine at L2-L4 by dual-energy X-ray absorptiometry (DXA).

RESULTS

BW (p = 0.002), serum N-terminal telopeptide of type 1 collagen (NTx) (p = 0.006) and bone specific alkaline phosphatase (BAP) (p = 0.02) were significantly correlated with BMD. For identification of the low BMD group, all subjects were divided into four groups on the basis of BW and NTx concentrations. In the group with BW under 51 kg and Ntx concentrations over 11 nMBCE/1, BMD was significantly (p = 0.0013) decreased compared with the other three groups. In this group, the ratio of women with a low BMD was significantly higher (p = 0.004) than the other groups.

CONCLUSION

In young women, BW and bone turnover markers significantly affected BMD. Low BMD can be indicated using BW and NTx concentrations without measurement by DXA.

Structural change of crystalline and amorphous-Ge(2)Sb(2)Te(5) by reverse Monte Carlo analysis of x-ray diffraction data and extended x-ray absorption fine structure data

Reverse Monte Carlo analyses of crystalline and amorphous Ge(2)Sb(2)Te(5) thin films were carried out using x-ray diffraction data and three spectra from extended x-ray absorption fine structure measurements. To produce a crystal model, we employed a large system with 12 800 Ge, 12 800 Sb and 32 000 Te atoms. The obtained model for the crystal structure was used for the initial configuration of the amorphous model. As a result of a series of reverse Monte Carlo analyses with various constraints, we found that the partial pair distribution function in the amorphous state with the largest deviation from the crystal state is a Ge-Sb pair and the distance is less than 2.7 Å. This suggests that Sb atoms in amorphous Ge(2)Sb(2)Te(5) thin film have a four-coordinate within 3.2 Å.

Two-dimensional pattern reverse Monte Carlo method for modelling the structures of nano-particles in uniaxial elongated rubbers

Two-dimensional pattern reverse Monte Carlo (2D pattern RMC) analysis is performed to model the structures of nano-particles in uniaxially elongated rubbers using two-dimensional patterns of structure factor of the nano-particles obtained by time-resolved two-dimensional ultra-small angle x-ray scattering. Four spot patterns are observed for a large elongation ratio and the shapes change with increasing elongation ratio. We performed the 2D pattern RMC method for the uniaxial system in order to make a model of the structures from the two-dimensional structure factors. The preliminary results of the 2D pattern RMC analysis of the two-dimensional structure factors of silica particles in a uniaxially elongated styrene-butadiene rubber are presented.

Phase II study of irinotecan plus doxorubicin for early recurrent or platinum-refractory ovarian cancer: interim analysis

The aim of this study was to evaluate the efficacy and toxicity of irinotecan and doxorubicin in the treatment of patients with early recurrent or platinum-refractory ovarian cancer. Nineteen woman from five different institutions were treated. Two patients had platinum-refractory cancer, 11 had platinum-resistant disease, and 6 had platinum-sensitive tumors. An intravenous infusion of Irinotecan (50 mg/m(2)) was given on days 1, 8, and 15, while doxorubicin (40 mg/m(2)) was administered as an intravenous bolus on day 3. This treatment schedule was repeated every 4 weeks. Among the 13 patients defined as having platinum-refractory/platinum-resistant disease, 4 patients achieved a clinical response (30.8%, 95% CI: 9.1-61.4), while only one of 6 patients defined as having platinum-sensitive disease achieved a clinical response (16.7%, 95% CI: 0.4-64.1). Leukopenia and neutropenia were the major dose-limiting toxicities. Grade 3 or 4 leukopenia and neutropenia were noted in 24 (48%) and 33 (66%) of the courses, while febrile neutropenia occurred in 2 courses. Five patients (26%) had grade 2 or worse diarrhea during 7 courses. Our data demonstrated that this regimen might be comparable to standard approved agents in patients with early recurrent or platinum refractory ovarian cancer.

Clinical outcomes of uterine sarcomas: results from 14 years worth of experience in the Kinki district in Japan (1990-2003)

To review clinical outcomes and therapeutic varieties, we were invited to submit data from the patients who were treated for uterine sarcomas in Japan from 1990 to 2003. Uterine sarcomas were defined as leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), and carcinosarcoma (CS). Of a total of 97 patients, 36 (37.1%) were diagnosed with LMS of the uterine corpus, 15 (15.5%) with ESS, 46 (47.4%) with CS. Median age at diagnosis was 59 (21-85) years. Clinical stages based on FIGO were 41 (42.3%) with stage I disease, 6 (6.2%) with staged II, 34 (35.1%) with stage III, and 16 (16.5%) with stage IV. The median follow-up period for all patients was 13 (1-108) months and median disease-free period was 9 (0-96) months. The 1-year survival rate and disease-free survival (DFS) rate were calculated in patients with all sarcomas (overall survival [OAS], 61.3%; DFS, 46.6%). Statistical analysis showed that younger age (less than 50 years), early stage (stages I and II), and surgical procedure (extended hysterectomy [EH] and radical hysterectomy [RH]) were associated with significantly better OAS. Histologic types did not affect the survival period. In conclusion, aggressive surgery including EH or RH at the time of initial operation offers the possibility of prolonged survival.

Radiation reduces carboplatin sensitivity and enhances nedaplatin sensitivity in cervical squamous cell carcinoma in vitro

BACKGROUND

The study was performed to examine how the platinum anticancer drugs other than cisplatin, such as carboplatin (CBDCA) and nedaplatin (NEP) can be effectively used in chemoradiotherapy for cervical squamous cell carcinoma patients.

MATERIALS AND METHODS

The radiosensitive human cervical squamous cell carcinoma cell line ME180 was examined to investigate the radiation effects on CBDCA and NEP sensitivities of the cells.

RESULTS

Irradiation significantly reduced cellular CBDCA sensitivity. There were no significant changes in CBDCA sensitivity between the cells concurrently irradiated and those treated with CBDCA 8 h before or 8 h after irradiation. However NEP sensitivity of the cells treated 8 h before or 8 h after irradiation was significantly higher than that in cells concurrently irradiated.

CONCLUSIONS

Although CBDCA sensitivity in the concurrently irradiated cells is reduced, NEP sensitivity is enhanced by irradiation. NEP, but not CBDCA, therefore, may be a candidate anticancer drug for concurrent chemoradiotherapy for cervical cancer. For the greatest efficacy, NEP should be administered to patients several hours before or after irradiation.

Irradiation reduces bleomycin sensitivity in cervical squamous cancer cells in vitro

PURPOSE OF INVESTIGATION

The study was performed to examine how bleomycin (BLM) and peplomycin (PEM) should be effectively used in radiotherapy for cervical squamous cancer patients.

METHODS

The effects of BLM on radiosensitivity and the effects of radiation on the sensitivity to BLM of cancer cells were investigated using the radiosensitive human cervical squamous cell carcinoma cell line ME180.

RESULTS

BLM treatment did not affect radiosensitivity. However, irradiation significantly reduced cell BLM sensitivity in a dose-dependent manner. There was no significant difference in BLM sensitivity and PEM sensitivity between cells concurrently irradiated and those treated with BLM or PEM 8 h before or 8 h after irradiation.

CONCLUSION

Since sensitivity to BLM is reduced during irradiation, BLM should be administered to cervical cancer patients as an adjuvant chemotherapeutic drug after completion of radiotherapy.

Effective chemoradiotherapy protocol with 5-fluorouracil for cervical squamous cell carcinoma in vitro

PURPOSE OF INVESTIGATION

5-Fluorouracil (5FU) is frequently used in concurrent chemoradiotherapy for patients with advanced cervical cancer, although its optimal chemoradiotherapy protocol has not yet been established. In search of an optimal chemoradiotherapy protocol, some in vitro experiments were carried out.

METHODS

The radiosensitive human cervical squamous cell carcinoma cell line ME180 was examined to investigate the effects of 5FU on radiosensitivity and the effects of irradiation on 5FU-sensitivity.

RESULTS

5FU dose-dependently enhanced cellular radiosensitivity at therapeutic concentrations. Although high doses of y-ray irradiation significantly reduced the 5FU-sensitivity, a low dose of irradiation at therapeutic doses (< 2.5 Gy) had no effect on 5FU-sensitivity of the irradiated cells. Cells pretreated with 5FU eight hours before irradiation showed significantly higher 5FU-sensitivity than cells concurrently treated with 5FU and irradiation. In contrast, cells treated with 5FU eight hours after irradiation showed significantly lower 5FU-sensitivity than cells concurrently treated with 5FU and irradiation. Moreover, all four post-irradiation surviving subclones obtained from repeatedly irradiated ME180 cells showed significantly lower 5FU-sensitivity than the non-irradiated parent cells.

CONCLUSION

5FU acts as a radiosensitizer for cervical squamous cell carcinoma and 5FU-sensitivity is reduced in irradiated cells. Therefore, 5FU administration immediately before irradiation may be a more effective treatment than concurrent chemoradiotherapy or post-irradiation chemotherapy with 5FU.

Clinical outcomes of uterine sarcomas: results from 14 years worth of experience in the Kinki district in Japan (1990–2003)

To review clinical outcomes and therapeutic varieties, we were invited to submit data from the patients who were treated for uterine sarcomas in Japan from 1990 to 2003. Uterine sarcomas were defined as leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), and carcinosarcoma (CS). Of a total of 97 patients, 36 (37.1%) were diagnosed with LMS of the uterine corpus, 15 (15.5%) with ESS, 46 (47.4%) with CS. Median age at diagnosis was 59 (21–85) years. Clinical stages based on FIGO were 41 (42.3%) with stage I disease, 6 (6.2%) with staged II, 34 (35.1%) with stage III, and 16 (16.5%) with stage IV. The median follow-up period for all patients was 13 (1–108) months and median disease-free period was 9 (0–96) months. The 1-year survival rate and disease-free survival (DFS) rate were calculated in patients with all sarcomas (overall survival [OAS], 61.3%; DFS, 46.6%). Statistical analysis showed that younger age (less than 50 years), early stage (stages I and II), and surgical procedure (extended hysterectomy [EH] and radical hysterectomy [RH]) were associated with significantly better OAS. Histologic types did not affect the survival period. In conclusion, aggressive surgery including EH or RH at the time of initial operation offers the possibility of prolonged survival.

Effects of mitomycin C on radiation-induced cell death in human cervical squamous cell carcinomas

In order to find an effective protocol for chemoradiotherapy with mitomycin C (MMC) for advanced cervical cancer patients, effects of both MMC and irradiation on chemoradiosensitivity were examined using the radiosensitive human cervical squamous cell carcinoma cell line ME180. MMC and low doses of irradiation did not affect radiosensitivity of the cells. A high dose of gamma-ray irradiation (10 Gy) significantly reduced MMC sensitivity of the cells. All of the four post-irradiation surviving subclones that were established from repetitively irradiated ME180 cells, demonstrated significantly higher MMC sensitivity than that of the non-irradiated parent cells. However, there was no difference in MMC sensitivity among three groups of irradiated cells; (1) cells treated with MMC eight hours before irradiation, (2) cells concurrently treated with MMC and irradiation and (3) cells treated with MMC eight hours after irradiation. These results indicate that MMC injections after completion of radiotherapy may be a better therapy than concurrent chemoradiotherapy with MMC.

Radiation enhances cisplatin-sensitivity in human cervical squamous cancer cells in vitro

PURPOSE AND METHODS OF INVESTIGATION: Cisplatin (CDDP) is regularly used in concurrent chemoradiotherapy in patients with advanced cervical cancer although an effective protocol of chemoradiotherapy with CDDP has not yet been established. In search of a better chemoradiotherapy protocol, we investigated both CDDP effects on radiosensitivity and irradiation effects on CDDP-sensitivity using the radiosensitive human cervical squamous cell carcinoma cell line ME180.

RESULTS

We found that CDDP did not affect cellular radiosensitivity, and that irradiation significantly enhanced CDDP-sensitivity. Moreover, all the four post-irradiation surviving subclones obtained from repetitively irradiated ME180 cells showed significantly higher CDDP sensitivities than those of the non-irradiated parent cells.

CONCLUSION

These results suggest that an effective protocol would involve the concurrent administration of CDDP with radiotherapy and further administration following completion of radiotherapy in order to achieve higher CDDP-sensitivities.

Preoperative chemotherapy with irinotecan and mitomycin for FIGO stage IIIb cervical squamous cell carcinoma: a pilot study

PURPOSE OF INVESTIGATION

Patients with FIGO Stage IIIb cervical cancer show cancer propagation to pelvic side walls from the uterus, and the tumors cannot be completely removed by radical hysterectomy. Here, we examined the effects of preoperative irinotecan HCl (CPT-11)-combined chemotherapy on patients with unresectable Stage IIIb cervical squamous cell carcinoma.

METHODS

Eleven patients agreed to participate in the pilot study and received preoperative chemotherapy.

RESULTS

Cervical tumors of all 11 patients showed partial responses in tumor reduction, and radical hysterectomy was successfully performed in ten patients treated with CPT-11 and mitomycin C (MMC). One patient treated with CPT-11 and cisplatin had a 68% reduction of the primary cervical lesion but could not undergo radical surgery because of retroperitoneal cancer progression during chemotherapy.

CONCLUSION

These results indicate that chemotherapy with CPT-11 and MMC could be a useful preoperative treatment for unresectable Stage IIIb cervical squamous carcinoma.

Usefulness of positron emission tomography for diagnosis of malignancy in a calcified lesion: a case report

When calcified lesions in the liver or spleen are found during follow-up of patients who have undergone debulking surgery and chemotherapy for advanced ovarian carcinoma, it is very difficult to differentiate recurrent cancer from secondary change after chemotherapy. We present here a patient in whom calcified lesions in the liver and spleen were diagnosed as malignancy on the basis of a preoperative PET study. Malignancy was confirmed by histologic examination after surgery.

Production of activin A in hyperplasia and adenocarcinoma of the human endometrium

OBJECTIVES

To examine the possible localization and production of activin A in human normal endometrium, endometrial hyperplasia, and adenocarcinoma tissues.

METHODS

Human endometrial tissues were collected from 45 patients who were undergoing abdominal hysterectomy. Tissue sections were stained with monoclonal antibodies against the inhibin/activin alpha- and beta A-subunits and activin A using an avidin-biotin-peroxidase complex technique. Concentrations of activin A and inhibin A in tissue extracts of the endometrial tissues were measured using enzyme-linked immunosorbent assays (ELISAs). The expressions of the inhibin alpha-subunit and activin beta A-subunit messenger RNA (mRNA) in the endometrial tissues were demonstrated by reverse transcription-polymerase chain reaction (RT-PCR) analysis.

RESULTS

No immunostaining with an antibody against the inhibin alpha-subunit was observed in human normal endometrium, endometrial hyperplasia, and adenocarcinoma. By contrast, immunostaining for the activin beta A-subunit and activin A was observed in the cytoplasm of glandular cells in normal endometrium, endometrial hyperplasia, and tumor cells of endometrial adenocarcinoma. The percentages of stained cells in endometrial adenocarcinoma were higher than those in normal endometrium. Also, the percentages of stained tumor cells with poor differentiation were higher than those with good and moderate differentiation of the endometrium. The stromal cells in normal endometrium, endometrial hyperplasia, and adenocarcinoma were weakly immunoreactive with antibodies against the beta A-subunit and activin A. Immunoreactivity of activin A in tissue extracts from normal endometrium and endometrial adenocarcinoma was detected by the two-site ELISA. Immunoreactivity of activin A was significantly higher in adenocarcinoma than in normal endometrium. On the other hand, the immunoreactive inhibin A was not detected. The expression of the alpha-subunit mRNA in endometrial tissues was demonstrated as the RT-PCR products migrated at 905 bp and the PCR products of the beta A-subunit showed a band at 366 bp.

CONCLUSIONS

It is suggested that activin A, but not inhibins, are produced by endometrial tissues. The amounts of produced activin A were higher in adenocarcinoma tissues than in normal endometrium. Activin A might be involved in human endometrial tumorigenesis.

Mutational analysis of BRCA1 and BRCA2 and clinicopathologic analysis of ovarian cancer in 82 ovarian cancer families: two common founder mutations of BRCA1 in Japanese population

We analyzed genetic alterations in BRCA1 and BRCA2 genes among 82 ovarian cancer families in Japan. The clinical characteristics of BRCA-associated ovarian cancer patients were compared with cases carrying no mutations as well as with population controls. Using a direct sequencing method, 45 of the 82 ovarian cancer families were found to carry BRCA1 or BRCA2 germ-line mutations (40 with BRCA1 and 5 with BRCA2). In 24 independent mutations of BRCA1, 5 recurrent mutations were found and 2 of them, the L63X and Q934X mutations, were detected in seven and eight independent families, respectively. In addition, 16 mutations of BRCA1 and 3 mutations of BRCA2 have never been described previously. In consideration of clinicopathological features, there was a significantly higher proportion of tumors with serous adenocarcinoma and of cases of advanced stages in the BRCA1 or BRCA2 cases than in those of the controls. On the other hand, there were no differences of mean age at diagnosis between patients with BRCA1 or BRCA2 mutation and those of the controls. Our results indicate that the features of BRCA-associated ovarian cancer in Japan appear to be similar to those in Western countries, and the L63X and Q934X mutations of BRCA1 appear to be common founder mutations unique to the Japanese population.

Epidermal growth factor inhibits 8-Br-cAMP-induced decidualization of human endometrial stromal cells

The effects of epidermal growth factor (EGF) on human endometrial stromal cells have not been characterized well, although production of EGF in endometrial epithelial and stromal cells and expression of EGF receptors in endometrial stromal cells have been reported. We investigated the effects of EGF on endometrial cell viability, 8-Br-cAMP-induced stromal decidualization, and prolactin secretion from decidualized endometrial stromal cells using an in vitro decidualization activity assay of human endometrial stromal cells. EGF did not show any significant effects on viable cell numbers of nondecidualized and 8-Br-cAMP-induced decidualized cells. Prolactin release from the 8-Br-cAMP-induced decidualized cells was not affected by EGF. However, EGF dose-dependently inhibited prolactin release from the stromal cells that were in the process of decidualization by co-stimulation with 8-Br-cAMP and EGF, though there was no significant change in viable cell numbers of the 8-Br-cAMP-stimulated decidualizing cells. Flow cytometric analysis revealed that 8-Br-cAMP enhanced EGF receptor expression on the endometrial stromal cells. These results indicate that endometrial EGF inhibits decidualization through autocrine/paracrine mechanisms.

Human endometrial stromal interleukin-1 beta: autocrine secretion and inhibition by interleukin-1 receptor antagonist

Decidualization of human endometrial stromal cells is suppressed by endometrial IL-1 in an autocrine or paracrine manner, indicating that constant suppression of stromal decidualization by IL-1 requires a neutralizing mechanism for IL-1 action to accept embryo implantation. Since production of IL-1ra in human endometrium is reported to be 10- to 30-fold higher than that of IL-1 alpha/beta, we investigated whether endogenous IL-1 beta secreted from human endometrial stromal cells can be inhibited by IL-1ra by using an in vitro decidualization culture. Human stromal cells were cultured with 8-Br-cAMP to induce decidualization, and concentrations of IL-1 beta, IL-8, and prolactin in the culture supernatants were assayed before and after decidualization. There was no significant difference in mean IL-1 beta concentrations measured before and after decidualization. Addition of IL-1ra to endometrial stromal cell cultures strongly inhibited endogenous IL-8 secretion from the cells. Although IL-1 beta showed a biphasic effect on cell proliferation and a suppressive effect on decidualization of stromal cells, these effects were completely inhibited by IL-1ra. The results imply that a high in vivo concentration of IL-1ra in human endometrial tissues may regulate IL-1 effects on decidualization and cell proliferation of human endometrial stromal cells.

Interleukin-11 enhances cell survival of decidualized normal human endometrial stromal cells

High expression of interleukin-11 (IL-11) and the IL-11 receptor alpha chain in developing decidual cells in mice has been reported, and mice lacking IL-11 receptor expression have been reported to show impaired implantation owing to defective decidualization. However, the direct effect of IL-11 on endometrial stromal cells has not been studied. In this study, we examined the direct effects of IL-11 on normal human endometrial stromal cells using an in vitro decidualization assay system. IL-11 enhanced cell viability and prolactin secretion of 8-Br-cAMP-induced decidualized cells but not of non-stimulated stromal cells. IL-11 dose-dependently enhanced the viability of stromal cells co-stimulated with 8-Br-cAMP and IL-11 without any significant effect on prolactin secretion from the cells. The extracellular matrix did not affect the effect of IL-11 on the viability of 8-Br-cAMP-stimulated stromal cells. These results indicate that IL-11 enhances the viability of 8-Br-cAMP-stimulated stromal cells and of decidualized stromal cells, and that the cell survival signals generated by IL-11 are independent of those generated by the extracellular matrix. IL-11 produced locally in decidual tissues may enhance the viability of decidualized stromal cells and possibly protect against cell damage during embryo implantation and trophoblastic invasion.

Combined diagnostic imaging for retroperitoneal schwannoma

Retroperitoneal tumors are occasionally encountered by gynecologists, and differential diagnosis from adnexal tumors is important, however, it is difficult in many cases. We report a case in which we preoperatively diagnosed a benign solid tumor in the retroperitoneum of the pelvic cavity on the basis of a variety of diagnostic images, including FDG-PET. Postoperative histological examination showed a benign schwannoma in the pelvis. We discuss the usefulness of FDG-PET combined with MRI and other diagnostic images as a means of differentiating between the characteristics of retroperitoneal tumors.

Localization of a novel susceptibility gene for familial ovarian cancer to chromosome 3p22-p25

We performed genome-wide linkage analysis in 58 patients and nine unaffected members among 28 families with no mutation in BRCA1 or BRCA2, employing a set of 410 microsatellite markers. We initially screened the whole genome, including the X chromosome, by a non-parametric method using the GENEHUNTER program. As a result, chromosome 3p22-p25 showed a suggestive score for linkage [LOD = 3.49 and non-parametric LOD (NPL) = 2.77 at D3S3611] based on a multipoint analysis. Additionally, based on a two-point analysis using dense markers, this 3p22-p25 region showed a P-value < 0.05 at 10 markers and there is suggestive evidence for linkage at two markers within approximately 19 cM (NPL = 2.60 and 2.49 at D3S1597 and D3S3611, respectively). To explore whether the candidate gene in this 3p22-p25 region contributed to carcinogenesis of familial ovarian cancer in a similar fashion to the tumor suppressor gene, we performed loss of heterozygosity (LOH) analysis. It was observed that the frequency of LOH at four markers in this region was >50% only in tumor tissues from patients with no mutation in BRCA1 or BRCA2, not in those with a BRCA1 mutation.

Regulation of human endometrial stromal decidualization by macrophage colony-stimulating factor

Decidualized human endometrial stromal cells and human decidual CD56+ cells are reported to produce macrophage colony-stimulating factor (M-CSF), although its physiological roles remain unclear. In this study, the effects of M-CSF on cell viability and 8-Br-cAMP-stimulated decidualization of normal human endometrial stromal cells are examined by using an in vitro decidualization activity assay system. M-CSF alone affected neither the viable cell numbers nor PRL release of nonstimulated stromal cells, while high concentrations of M-CSF strongly suppressed the viable cell numbers and PRL secretion of stromal cells costimulated with 8-Br-cAMP and M-CSF. However, M-CSF did not suppress the viable cell numbers and PRL secretion of 8-Br-cAMP-induced decidualized cells. These results indicate that high concentrations of M-CSF can suppress the cell viability of stromal cells in the decidualization process, and inhibit decidualization of endometrial stromal cells. Thus, nonpregnant decidual M-CSF may autoregulate decidualization and the viable cell numbers of endometrial stromal cells in a paracrine manner.

Positron emission tomography using 2-[(18)F] fluoro-2-deoxy-D-glucose in the diagnosis of uterine leiomyosarcoma: a case report

The preoperative diagnosis of uterine leiomyosarcoma (LMS) is very difficult. Magnetic resonance (MR) imaging is usually used for it; however, precise diagnosis by MR imaging is limited to typical LMS with coagulative tumor cell necrosis. We presented a case of LMS that was diagnosed preoperatively by positron emission tomography (PET) using 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG).

Camptothecin and mitomycin combination chemotherapy on ovarian clear cell carcinoma with multiple systemic metastases

Ovarian clear cell carcinoma is known for decreased responsiveness to most anticancer drugs, and the prognosis of patients with ovarian clear cell tumors is very poor. We report such a patient with multiple systemic metastases who showed a complete response to combined camptothecin and mitomycin chemotherapy. During therapy, clinical drug-resistance was observed transiently, but response was restored by intermittent administrations of camptothecin. Such combination chemotherapy may be a useful alternative regimen for advanced and/or metastatic ovarian clear cell carcinoma.

Anti-endometrial IgM autoantibodies in endometriotic patients: a preliminary study

Japanese herbal medicines (Kampo medicines) are usually the third most popular choice among medicines for treatment of endometriosis in Japan. This traditional therapy is used to improve various signs and symptoms of endometriosis without decreasing serum estradiol levels or causing menstrual disorders. We used flow cytometry to examine and compare the effects of the Kampo therapy and danazol on anti-endometrial humoral immunity. Autoantibodies against endometrial epithelial cell lines and endometrial stromal cells were detectable in all the examined sera of men and women irrespective of the presence of endometriosis. Moreover, no significant increase in anti-endometrial antibodies was found in endometriotic patients. Anti-endometrial antibodies included Ig-gamma chain, Ig-mu chain, Ig-kappa chain, and Ig-lambda chain indicating polyclonal B cell activation in the endometriotic patients. Absorption tests of nonspecific antibodies with cervical cancer cells or ovarian cancer cells revealed that endometriotic patients had higher levels of endometrium-specific autoantibodies than did non-endometriotic healthy women. IgM fractions from endometriotic patients and healthy women differed in their effect on growth of endometrial adenocarcinoma cells. Therapy with the herbal compounds Keishi-bukuryo-gan but not danazol therapy, gradually decreased the tissue-specific anti-endometrial IgM antibody levels. These results indicate that tissue-specific anti-endometrial IgM may be a useful therapeutic marker for endometriotic patients treated with Keishi-bukuryo-gan and that endometrial tissue-specific immune disorders play specific roles in the pathogenesis or development of endometriosis.

New method of the chemical state imaging by EPMA-EXEFS

A novel two dimensional imaging technique of the chemical bonding state was developed by combining the extended X-ray emission fine structure method with an electron probe X-ray microanalyzer mapping technology. With this method, chemical state images of some aluminum standard samples were obtained. It was confirmed that the obtained images provide correct information of chemical states.

Positron emission tomography with (18)F-fluorodeoxyglucose of uterine sarcoma: a comparison with magnetic resonance imaging and power Doppler imaging

OBJECTIVE

The effectiveness of positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) for diagnosis of uterine sarcoma was evaluated in comparison to the effectiveness of magnetic resonance (MR) imaging and power Doppler imaging.

METHOD

The cases of five Osaka City University Hospital patients diagnosed with uterine sarcoma based on histopathological examination, in whom FDG-PET, MR imaging, and power Doppler imaging studies had been performed preoperatively, were reviewed. A comparative study of the usefulness of these three imaging modalities for diagnosis of sarcoma was conducted. Tumors comprised three leiomyosarcomas, one endometrial stromal sarcoma, and one carcinosarcoma.

RESULTS

FDG-PET examinations were 100% positive for the five sarcomas; MR imagings were 80% positive (four of five cases), and US was 40% positive (two of five cases). The mean standardized uptake value of the sarcomas was 4.5 +/- 1.3.

CONCLUSION

The sarcoma lesions were clearly imaged by FDG-PET. FDG-PET may be a most useful diagnostic method for uterine sarcoma.

X-ray induced reduction of rare earth ion doped in Na2O-Al2O3-B2O3 glasses

5Na2O-10Al2O3-85B2O3 glasses doped with 0.05 mol% Sm2O3 or 0.05 mol% Eu2O3 turn to orange after irradiation by focussed femtosecond pulsed laser or x-ray irradiation. To know the mechanism of photo-induced coloring, the glasses were studied by Sm or Eu L(III) XANES before and after x-ray or UV irradiation. XANES in both edges showed that a part of trivalent ion converted to divalent ion upon the irradiation of x-ray. These facts reveal that photoreduction of rare earth ion is the mechanism of photo-induced coloring. However no photoreduction upon UV irradiation occurred in both glasses.

Effect of adjuvant chemotherapy using pirarubicin, cisplatin, and etoposide (PEP) for stage IVB endometrial carcinoma: a case report

Prognosis of patients with stage IVB endometrial adenocarcinoma is quite poor. Combination therapy of radiation with surgery or chemotherapy is a common therapy for advanced endometrial cancers. However, radiation therapy is effective only for localized cancer, and the chemotherapeutic effect on stage IVB endometrial cancers is very low. We present a patient with stage IVB endometrial adenocarcinoma, whose tumor was not resected completely at the first surgery. She showed a remarkable response to a PEP (pirarubicin, etoposide, cisplatin) regimen and has survived without disease over 8 years. This case suggests that reduction surgery following PEP therapy is a new therapeutic modality for stage IVB endometrial carcinoma.

Production and physiological function of granulocyte colony-stimulating factor in non-pregnant human endometrial stromal cells

Effects of granulocyte colony-stimulating factor (G-CSF) on proliferation and differentiation of normal human endometrial stromal cells were investigated in an in vitro decidualization culture of stromal cells. Unstimulated stromal cells secreted little prolactin and G-CSF, whereas 8-Br-cAMP-stimulated stromal cells secreted higher levels. There was no relationship, however, between the levels of prolactin and G-CSF secreted from the stimulated cells. Detectable levels of prolactin secretion were not found in two of six stromal cell cultures stimulated with 8-Br-cAMP; however, these two culture supernatants contained high concentrations of G-CSF. Co-stimulation of the stromal cells with 8-Br-cAMP and G-CSF enhanced prolactin secretion from the stimulated cells in a G-CSF concentration-dependent manner without any change in viable cell numbers. However, G-CSF did not affect prolactin secretion or viable cell numbers of 8-Br-cAMP-stimulated decidualized cells. These results indicate that G-CSF enhances cAMP-mediated decidualization of human endometrial stromal cells in an autocrine or paracrine fashion.

The role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG-PET) in the diagnosis of recurrence and lymph node metastasis of cervical cancer

The usefulness of positron emission tomography with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG-PET) in diagnosing recurrence and lymph node metastasis of uterine cervical cancer was evaluated as a preliminary study. The FDG uptake of 13 cervical cancer patients, including 4 patients with recurrence, was evaluated. The FDG uptake of the cervices of 5 patients who underwent PET studies for non-cervical tumors were used as control. In 2 patients who had undergone radical hysterectomy, we compared the diagnosis of lymph node metastasis based on FDG-PET and magnetic resonance imaging. The FDG uptake in the 9 primary cervical cancers was greater than that in normal cervices (p=0.025). Examination of the 4 recurrent tumors revealed a higher FDG uptake than that in normal cervices (p=0.0022). Metastatic lesions in lymph nodes showed an accumulation of FDG on the PET scan. In conclusion, FDG-PET may be an effective diagnostic tool for detecting recurrence and lymph node metastasis of uterine cervical cancers.

Power Doppler findings of adenoma malignum of uterine cervix

Adenoma malignum (minimum deviation adenocarcinoma) is a rare neoplasma of the uterine cervix, the diagnosis of wich cannot be determined by cervical smear. Recently, magnetic resonance imaging (MRI) was reported as useful for its diagnosis, but differentiation of adenoma malignum from deep-seated nabothian cysts remains problematic. We report here a case of adenoma malignum of the uterine cervix, for which MRI findings could not neglect deep-seated nabothian cysts. However, transvaginal power Doppler ultrasonography clearly showed richness of small vessels, whose arterial flow had higher velocity in the diastolic phase, around the cystic lesion of the uterine cervix. These findings indicate that, at least in the case reported here, transvaginal power and pulsed Doppler ultrasonography is a useful tool for the diagnosis of adenoma malignum of the uterine cervix.

Altered sensitivity to anti-endometriosis medicines in an adenomyosis patient with thyroid dysfunction

We report the rare case of a patient with adenomyosis who showed thyroid dysfunction of unknown etiology during treatment for endometriosis. She responded to nafarelin acetate and danazol when she was euthyroid but not to buserelin acetate when she was hyperthyroid. This suggests that the response to anti-endometriotic medicine in our patient was altered by impaired thyroid function and that this could occur in other such patients.

Sonographic characteristics of massive ovarian edema

Massive ovarian edema (MOE) is a very rare disease characterized by a tumor-like enlargement of the ovary. The ultrasound findings have been reported as a solid tumor-like mass or as a solid mass containing a cystic component. Recent reports using magnetic resonance imaging of MOE have demonstrated that multiple ovarian follicles situated around the periphery of the cortex of the enlarged ovary is the most important diagnostic indicator of MOE. This finding was first demonstrated by ultrasound in the case we present here. Thus we suggest that the ultrasound detection of multiple peripheral ovarian follicles in a solid ovarian tumor-like mass may make the preoperative diagnosis of MOE possible by ultrasound alone.

Combined diagnostic imaging of uterine carcinosarcoma: A case report

The diagnostic imaging characteristics of uterine carcinosarcoma have not been established because the tumor is very rare. We studied magnetic resonance (MR) imaging, power Doppler ultrasonography, and positron emission tomography (PET) in one such carcinosarcoma to define its imaging characteristics. On T1-weighted MR images, the tumor mass in the uterus was low-signal intensity and had a slight inhomogeneous appearance. On T2-weighted images, it had a heterogeneous appearance and was of medium- or high-signal intensity; marked flow void was apparent from the myometrium to the tumor mass. The MR flow void was also detected by power Doppler ultrasonography. Increased glucose metabolism was detected on PET images, suggesting a malignant tumor in the endometrial cavity. Combined diagnostic images with MR, power Doppler ultrasonography, and PET is recommended as the diagnostic method for uterine carcinosarcoma.

Postoperative adjuvant chemotherapy with cisplatin, etoposide, and pirarubicin for endometrial carcinoma patients with lymph node metastasis: A pilot study

We evaluated the effects of a combined chemotherapy regimen on endometrial carcinoma in 14 patients with lymph node metastasis. After surgery, the patients were treated with 3 cycles of chemotherapy (PVP regimen) every 4 weeks. The PVP regimen consisted of 75 mg/m2 cisplatin on day 1, 40 mg/m2 pirarubicin (P) on day 1, and 75 mg/m2 etoposide (VP-16: V) on days 2, 3 and 4. The effect of adjuvant chemotherapy was evaluated based on progression-free survival (PFS), overall survival (OS), and adverse effects. The 5-year PFS rate was 52% [95% confidence interval (CI), 10-94%], and the 5-year OS rate was 50% (95% CI, 16-84%). The major toxicity was myelosuppression. One hundred percent of patients had neutropenia above grade 3, but all recovered from myelosuppression. PVP therapy may be an effective adjuvant therapy for endometrial carcinoma patients with lymph node metastasis used as an alternative to radiation therapy.

Intermittent cisplatin therapy for stage-III ovarian cancer patients following clinical remission

Intermittent cisplatin (CDDP) administration as consolidation therapy for stage-III ovarian cancer was studied. No patients with residual disease at surgery or at second-look operation or patients with <8 U/ml of CA125 after remission induction chemotherapy were enrolled in this study. Fifteen subjects received intermittent chemotherapy, and 10 control patients did not. CDDP of 20 mg/m2 for 5 days was administered every 3-4 months for 5 years. A significant increase in 5-year survival rate was found in the intermittent chemotherapy group when compared with the control group. Side effects from the intermittent chemotherapy were controllable. Intermittent CDDP therapy seems to be an effective consolidation therapy for stage-III ovarian cancer patients.