Impact of malnutrition on cancer recurrence, colorectal cancer-specific death, and non-colorectal cancer-related death in patients with colorectal cancer who underwent curative surgery

AIM

This study aimed to examine how malnutrition, as reflected by the Geriatric Nutritional Risk Index (GNRI), is associated with colorectal cancer (CRC) recurrence and cause of death.

METHODS

Consecutive stage I-III CRC patients (n = 601) were divided into two groups using GNRI 98 as the cutoff. The relationship of GNRI with overall survival (OS) and recurrence-free survival (RFS) was evaluated, followed by competing risk analysis to determine prognostic factors of non-CRC-related death, and hazard function analysis to examine changes in the risk of recurrence and death.

RESULTS

Median body mass index was lower in the low GNRI group than in the high GNRI group (19.8 vs. 23.5; p < 0.001). After adjusting for known prognostic factors, a low GNRI was independently associated with reduced OS/RFS, and was a significant predictor of non-CRC-related death. The risk of recurrence was higher and peaked earlier in the low GNRI group than in the high GNRI group, although after 3 years, both groups had a similar risk. Meanwhile, the low GNRI group had a higher risk of non-CRC-related death over the course of 5 years.

CONCLUSION

It is important to consider preoperative nutritional status along with the cancer stage when developing strategies to improve outcomes for CRC patients.

Level of Inferior Mesenteric Artery Ligation in Sigmoid Colon and Rectal Cancer Surgery: Analysis of Apical Lymph Node Metastasis and Recurrence

INTRODUCTION

Whether high or low ligation of the inferior mesenteric artery (IMA) is optimal for treating sigmoid colon and rectal cancers is controversial. The present study aimed to compare outcomes of high and low ligation of the IMA and determine the adequate extent of IMA lymph node dissection.

METHODS

Subjects were 455 consecutive stage I-III colorectal cancer patients who underwent curative surgery between 2011 and 2019. We assessed the association between the level of IMA ligation and overall survival and recurrence-free survival (RFS) by propensity score matching analysis. Clinicopathological features of IMA lymph node metastasis and recurrence patterns were analyzed.

RESULTS

After propensity score matching, the low ligation group had a significantly worse prognosis than that of the high ligation group for RFS (p = 0.039). Positive IMA lymph nodes were associated with pathological T3 or T4 stage and N2 stage. IMA lymph node recurrences in the high ligation group occurred at the superior left side of the IMA root. In contrast, all recurrences in the low ligation group occurred at the left colic artery bifurcation.

CONCLUSION

High ligation of IMA is oncologically safe. However, even with high ligation, care must be taken to ensure adequate lymph node dissection.

Immunohistochemical expression of HER-1 and HER-2 in extrahepatic biliary carcinoma

The clinicopathological significance of HER-1- and HER-2-overexpressions (OE) (HercepTest score 2+ or 3+) in biliary cancer and their relationship to the efficacy of adjuvant chemotherapy (ACT) were assessed. In 72 biliary cancer (28 gallbladder and 44 bile duct cancer), HER-1 and HER-2 were stained immunohistochemically in formalin-fixed, paraffin-embedded specimens. The ACT included uracil and tegafur (UFT)-based chemotherapies. Out of the 72 cancer, OE was observed in 31 specimens (43%) for HER-1 and 47 (65%) for HER-2. However, their OEs were not correlated with each other. HER-2-OE was inversely correlated with the clinical stage (p=0.0482). HER-1-OE was correlated with distant metastasis (p=0.0263), but not with the clinical stage. Neither the OE of HER-1 or HER-2, nor their co-expression, showed any significant effect in term of patient survival. In the HER-1-OE (-) patients, the survival rate of the ACT group was significantly higher than that of the surgery-alone (SA) group (p=0.0423), but in the HER-1-OE (+) patients, there was no statistical difference in survival rate between the ACT and the SA group. In contrast, HER-2-OE had no significant effect on the efficacy of ACT. Multivariate analysis also demonstrated that the histological grade and ACT were significant variables, but T, N, M and HER-1 and HER-2 were not significant variables. In conclusion, neither HER-1-OE or HER-2-OE were prognostic factors of the biliary cancer. However, HER-1-OE may be a useful marker for the indication of ACT.

A case of drug-induced hypersensitivity syndrome showing transient immunosuppression before viral reactivation during treatment for pemphigus foliaceus

Drug-induced hypersensitivity syndrome (DIHS) is one of the most severe drug adverse reactions, with characteristic biphasic symptoms. Reactivation of human herpesvirus-6 (HHV-6) is frequently observed, although the cause of DIHS is still unknown. A patient developed DIHS during treatment with diaminodiphenylsulphone for pemphigus foliaceus. The number of lymphocytes in his peripheral blood, and titres of serum total IgG and IgM and anti-desmoglein1 antibody transiently decreased just before reactivation of HHV-6, cytomegalovirus and Epstein-Barr virus. This observation suggests that transient suppression of both cellular and humoral immunity may trigger viral reactivation, which leads to the development of the second phase of DIHS.

Problems in the N-classification of the new 1997 UICC TNM stage classification for gastric cancer: an analysis of over 10 years' outcome of Japanese patients

BACKGROUND

One of the major changes in the new TNM classification (5th edition, 1997) for gastric cancer was made in the classification of N category: the 5th edition employs the number of involved nodes and a minimum of 15 examined nodes is required for N0 classification. The validity of the new TNM classification was assessed by comparing the survivals according to the number of nodal involvement and especially the cut-off point of number of involved nodes and the problems in N0 classification in T1 were focused.

PATIENTS AND METHODS

Between 1982 and 1999, a total of 641 patients underwent gastrectomy for gastric cancer in our department. The stage and the degree of subcategories were classified according to the pathological assessment after surgery, and the survival and its correlation with clinicopathological factors were statistically analyzed.

RESULTS

pT classification included 325 pT1, 103 pT2, 102 pT3 and 111 pT4 cases, while pN classification included 448 pN-classifiable cases (223 pNO, 149 pN1, 52 pN2 and 24 pN3); 193 were unclassifiable (pNx), 123 of which were classified pNx due to the examined lymph nodes being less than 15. In 448 pTNM-classifiable cases the pN2 and pN3 groups showed almost the same survivals, while the pN1 included subgroups with a significant difference in prognosis. The pN1 category should be classified into two categories: pN1a, 1-3 involved nodes and pN1b, 4-6 involved nodes. Furthermore, out of 325 pT1 cases, 151 (46.5%) were pN-unclassifiable (pNx): 123 were due to the examined number being less than 15 for pN0 classification and 28 where the number of examined nodes were not reported. Although the mean number of examined nodes in pT1 was 24.7 for pN0 and 8.3 for pNx, there were no differences in survival rates between the pT1pN0 group and the pT1pNx group. This suggests the over-requirement of the number of examined nodes for pN0 classification in pT1 cases. We propose that pN0 classification in pT1 should be required for a minimum of 6 examined nodes.

CONCLUSION

The pN1 category should be subclassified into pN1a and pN1b. Furthermore, pN0 classification in pT1 should be required for a minimum of 6 examined nodes.

Quiet MRI with novel acoustic noise reduction

Fast scan techniques, which are used to reduce scanning times, have raised scanning noise levels in magnetic resonance imaging (MRI) systems, resulting in greater patient discomfort and stress. It is well known that this noise is caused by vibration of the gradient coil due to the Lorentz forces generated by the current in the gradient coil, which is placed in a static magnetic field. We have confirmed that MRI noise can be substantially reduced by sealing the gradient coil in a vacuum chamber to block airborne vibration propagation, by supporting the gradient coil independently to block solid vibration propagation and by decreasing the eddy currents induced in RF coils, the RF shield and the static-field-magnet cryostat. Based on these findings, we have developed a silent MRI system in which scanning noise is markedly reduced under a wide range of scanning conditions.

[Ask-Upmark kidney: a case report]

A case of Ask-Upmark kidney is presented. An 18-year-old male patient referred to this facility presented with symptoms of hypertension, microscopic hematuria and proteinuria. A hormonal study revealed a high plasma renin activity level. Intravenous pyelography and abdominal computed tomography revealed thinning of the cortex with calyceal dilatation. Arteriography revealed a deep cortical groove in the middle portion of the kidney without renal arterial stenosis. Plasma renin activity of the left renal vein was significantly higher than that of the right renal vein. A left simple nephrectomy was performed under the diagnosis of Ask-Upmark kidney. Postoperatively, plasma renin activity returned to the normal range and a decrease in blood pressure was noted. Recent reports have suggested Ask-Upmark kidney to be a consequence of vesicoureteral reflux rather than a true congenital malformation. Our case indicated no evidence of vesicoureteral reflux and suggests that the lesion was congenital rather than acquired.

Accumulation of hypotaurine in tissues and urine of rats fed an excess methionine diet

Hypotaurine increased in some tissues, especially in muscle, and urine of rats fed methionine excess diet. The significant depression of the body weight and food intake of rats caused by excess methionine was remarkably alleviated as previous reports and hypotaurine content in muscle and urine increased further by supplement with glycine to the excess methionine diet.