N(1),N(12)-Diacetylspermine as a sensitive and specific novel marker for early- and late-stage colorectal and breast cancers

PURPOSE

N(1),N(12)-diacetylspermine (DiAcSpm) in the urine of colorectal and breast cancer patients was examined to establish its usefulness as a novel diagnostic tool for detecting these cancers at clinically early stages.

EXPERIMENTAL DESIGN

Urine samples from 248 colon cancer patients and 83 breast cancer patients as well as 51 patients with benign gastrointestinal diseases treated in Tokyo Metropolitan Komagome Hospital during the period of August 1999 to January 2004 were collected. DiAcSpm was analyzed by ELISA and its sensitivity for malignant conditions was compared with that of serum carcinoembryonic antigen (CEA), CA19-9, and CA15-3.

RESULTS

The sensitivity of urinary DiAcSpm for colon cancer patients (n = 248) was 75.8% (mean +/- 2 SD for 52 healthy controls as a cutoff value), which was markedly higher than the sensitivities of serum CEA (39.5%, P < 0.0001) and CA19-9 (14.1%, P < 0.0001). DiAcSpm was elevated in 60% of tumor-node-metastasis cancer stage 0 + I patients, whereas only 10% (P < 0.0001) and 5% (P < 0.0001) of these patients were CEA- and CA19-9-positive, respectively. The sensitivity of urinary DiAcSpm for 83 cases of breast cancer (60.2%) was higher than the sensitivities of CEA (37.3%, P = 0.0032) and CA15-3 (37.3%, P = 0.0032). DiAcSpm was elevated in 28% of tumor-node-metastasis stage I + II patients, whereas only 3% (P = 0.0064) and 0% (P = 0.001) of these patients were CEA- and CA15-3-positive, respectively.

CONCLUSION

The observations indicate that urinary DiAcSpm is a more sensitive marker than CEA, CA19-9, and CA15-3 and that it can efficiently detect colorectal and breast cancers at early stages.

[Urinary diacetylspermine: its analysis and performance as a novel tumor marker]

N1,N12-Diacetylspermine (DiAcSpm) is excreted in the urine of healthy persons as a minor component of urinary polyamine. It is a promising tumor marker, since its excretion is frequently elevated in patients with various types of cancers. DiAcSpm was first detected and characterized by HPLC fractionation followed by enzymatic detection, but more recently, antibodies highly specific for DiAcSpm was prepared, and an ELISA system applicable to determination of urinary DiAcSpm was established. Measurement of urinary DiAcSpm using this ELISA system revealed that DiAcSpm is able to detect early stage (m and sm) colon cancers which CEA and CA19-9 cannot detect. DiAcSpm may also serve as a prognostic indicator and a marker for recurrence of colon cancer. Urinary DiAcSpm is elevated in metastatic and primary brain tumors including grade 3 and 4 gliomas and primary central nervous system lymphoma. In these primary brain tumors changes in urinary DiAcSpm were well correlated with the efficacy of treatments, recurrence of disease and increased malignancy of a tumor. DiAcSpm may be useful as a comprehensive indicator of the activeness of a brain tumor lesion in a patient. DiAcSpm was elevated in hepatocellular carcinoma, but patients with liver cirrhosis also showed considerably elevated levels of DiAcSpm.

[The significance of urine di-acetyl spermine level as a cancer marker for colorectal cancer]

We analyzed the significance of the measurement of urine di-acetyl spermine (DiAcSpm) as a cancer marker for colorectal cancer treatment. We measured both the urine DiAcSpm(ELISA, normal range: 0-0.25 mumol/creatinine) and serum CEA (normal range: 0-5.0 ng/ml) of preoperative and postoperative colorectal cancer patients every month. We compared the positive rate from the cancer stage and the power of prognostic prediction. We divided the colorectal cancer patients into 4 groups: Group A: both levels were high; Group B: only the CEA level was high; Group C: only the DiAcSpm level was high; Group D: both levels were within a normal range. The positive rates of DiAcSpm and CEA from cancer staging were as follows: Stage 0: 62% and 9.5%, Stage I: 60% and 10%, Stage II: 70% and 42%, Stage III: 82% and 47%, and Stage IV: 88% and 63%, respectively. There was a significant difference (p < 0.0001) between both levels, especially for early-stage cases. The two-year survival rate was 0% in Group A, 100% in Group B, 72.7% in Group C and 100% in Group D. The difference among the 4 groups was significant (p < 0.0001). This showed that urine DiAcSpm predicted the prognosis after colorectal cancer surgery more exactly than serum CEA.

[Narrowing of the dental pulp cavity in patients undergoing long-term administration of steroids]

The purpose of this study was to examine narrowing of the dental pulp cavity in patients undergoing long-term administration of steroids, by means of intraoral radiographs. The subjects were 20 patients under long-term steroid treatment (the steroid group), and 15 patients who were not receiving steroids (the non-steroid group), who visited the Clinic for Persons with Disabilities, University Hospital, Faculty of Dentistry, Tokyo Medical and Dental University, between April 1994 and March 2000. The dental pulp cavity was divided into the coronal area and the root area. Narrowing of each area was classified into three stages by means of intraoral radiographs (0, none; 1, moderate; 2, severe). Maxillary and mandibular dentition was divided, for purposes of analysis, into anterior, premolar, and molar areas, respectively. The narrowing of each part was statistically compared between the steroid group and the non-steroid group, using the Mann-Whitney U-test. Mean age +/- SD of the steroid group and the non-steroid group was 50.5 +/- 17.3 and 51.8 +/- 14.1, respectively. There was no significant difference in mean age between the steroid group and the non-steroid group (t-test). Narrowing of the dental pulp cavity in the steroid group was significantly greater than in the non-steroid group, except in the root area of the molar part. Since there was no significant difference in mean age between the steroid group and the non-steroid group, the greater narrowing in the steroid group was concluded to be attributable to the long-term administration of steroids.

[Effectiveness of a new toothbrush with irrigation and suctioning capabilities (ty e-Brush) for removing supragingival plaque]

Patients with dysphagia typically have poor oral health. Because of improper swallowing, they cannot easily and safely clean their mouths. As a solution for such a problem, a manual toothbrush with both irrigation and suctioning functions has been developed, called the "e-Brush". The purpose of this study was to evaluate the cleaning effectiveness of the new e-Brush (9 mm and 11 mm in bristle length) for removing supragingival plaque, compared with a conventional toothbrush, GUM # 211 by Butler. In this study, 12 subjects (12 female of average age 20.6) were selected, and plaque control record (PCR) and scrubbing method were used. The following results were obtained: 1. Significant differences (p < 0.05) were recognized between e-Brush/9 mm (55.54 +/- 18.27%) and the others (e-Brush/11 mm: 30.88 +/- 8.14%, GUM # 211: 35.42 +/- 9.32%). 2. Bristles 9 mm in length were more effective than 11 mm bristles (p < 0.05). 3. Irrigation/suctioning function is more effective than the conventional tooth-brushing method. 4. The irrigation function of e-Brush was meritorious in making almost all users comfortable. These results suggest that this new oral hygiene device, "e-Brush/9 mm", is effective for improving oral care management for patients with dysphagia.

[A case of gastric cancer with multiple liver metastases that were completely responsive to hepatic arterial infusion chemotherapy]

A 70-year-old male was hospitalized with a diagnosis of gastric cancer. Multiple liver metastases were detected by CT scan and ultrasonography, but no other metastases were found. After distal gastrectomy with lymphadenectomy, an intra-arterial catheter was inserted and hepatic arterial infusion (HAI) chemotherapy was started with the following regimen: epirubicin, 40 mg (once in 4 weeks); MMC, 4 mg (once in 2 weeks); and 5-FU, 500 mg (once a week). Oral administration of 300 mg/day of tegafur-uracil (UFT) was given concurrently. The metastatic liver tumors were gradually reduced, and then disappeared. The patient has been free from recurrence after HAI. As gastric cancer tends to spread (e.g. peritoneal dissemination) more than colorectal cancer, the indication for HAI in cases of gastric cancer is limited. However, the present case suggests that it may be useful in achieving long-term survival for patients with metastases localized in the liver.

[Hepatic arterial infusion chemotherapy for unresectable liver metastasis of gastrointestinal cancers]

Thirty-two patients with colorectal cancer, eleven with gastric cancer and two with pancreatic cancer were treated by hepatic arterial infusion chemotherapy from March 1988 to December 1999. A single administration of 5-FU, MMC and epirubicin (FAM group), or intermittent continuous infusion of 5-FU 500 mg/2 h (5-FU continuous group) was used for each patient once a week. Overall survival rates were not significantly different between the gastric and colorectal cancer patients. In patients with colorectal cancer, there was a significant prolongation in overall survival for the response group. With gastric cancer, however, there was no significant difference. For both of the two patients with pancreatic cancer, although they were responsive to the therapy, there was no prolongation of survival. In conclusion, intermittent continuous infusion was more effective for the patients with colorectal cancer. In patients with gastric and pancreatic cancer, hepatic intra-arterial infusion could control the progression of liver metastasis.

The mesh plug technique for adult inguinal herniation

We studied 112 adult patients who underwent the mesh plug method for inguinal hernia at our clinical division from August 1996 to September 1998. We compared the mesh plug method with conventional sutured repair, such as the Bassini method, the ileopubic tract repair method and the McVay method, according to the duration of operation, postoperative white blood cell count, postoperative CRP, the frequency of analgesics after surgery, and the recurrence rate. The duration of operation in patients with the mesh plug method was significantly short. According to postoperative white blood cell count and CRP, there was no significant difference between the two groups. Frequency of analgesics after surgery was 0.8 times in a patient with conventional sutured repair and 0.4 times in a patient with the mesh plug method, suggesting that it was significantly low in patients with the mesh plug method. The recurrence rate in patients with the mesh plug method was 3.57% (4 cases). All the recurrences had developed within 1 year after surgery, and all of the cases were repaired with the mesh plug method. We conclude that the mesh plug method for adult inguinal hernia was a useful operative procedure with shorter duration of operation, less postoperative wound pain, and almost the same recurrence rate compared with conventional sutured repair.