Shuji Takiguchi

Osaka City University, Ōsaka, Ōsaka, Japan

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Publications (219)550.56 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The efficacy and feasibility of laparoscopic surgery (LAP) for gastric GISTs >5 cm has not been adequately assessed. Here we investigated the clinical outcomes of these patients. Twenty-seven consecutive patients who underwent resection for gastric GISTs >5 cm were enrolled in this retrospective study. We assessed the tumor characteristics, surgical outcomes, tumor recurrence, and patient survival in the open surgery (OPEN) group and in the LAP group. The tumor size in the OPEN group was larger than that in the LAP group, but there were no differences in the mitotic count. There were no differences in operative complications. Finally, there were no differences in the disease-free and no patients in the LAP group died. In patients with gastric GISTs >5 cm, LAP can be performed with outcomes equivalent to those of OPEN if patient selection and intraoperative judgment are appropriate.
    Surgical laparoscopy, endoscopy & percutaneous techniques 04/2014; · 0.88 Impact Factor
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    ABSTRACT: Various kinds of molecular targeted drugs to inhibit receptor tyrosine kinases (RTKs) have been recently developed. The relationship between the expression status of major RTKs and prognosis in gastric cancer remains unclear. We conducted a multicenter study to evaluate the prognostic impact of the expression of epidermal growth factor receptor (EGFR), c-Met, platelet-derived growth factor receptor (PDGFR), and c-Kit in gastric cancer. This study included 153 gastric cancer patients who underwent gastrectomy at 9 institutions between 2000 and 2006. Expression status of EGFR, c-Met, PDGFR, and c-Kit were evaluated with immunohistochemistry (IHC) centrally. Overall survival based on RTK expression status was statistically compared. Cox multivariate analysis was conducted to adjust for potentially confounding factors. The positive rates for EGFR, c-Met, PDGFR, and c-Kit were 14.4, 24.8, 41.2, and 11.1 %, respectively. Significant interactions with expression status were observed for pathological N stage with EGFR; HER2-status with c-Met; tumor location, histology, and pathological N stage with PDGFR; and no examined variables with c-Kit. Concomitant HER2 positivity was observed for 0.7 % of tumors positive for EGFR, 3.9 % for c-Met, 4.6 % for PDGFR, and 1.3 % for c-Kit. There were some differences in overall survival between patients with or without RTK expression, but only c-Kit expression showed a significant survival difference in Cox multivariate analysis (P = 0.046). Our multicenter study indicated that IHC expression of 4 RTKs had some prognostic impact and that c-Kit-positive status may be a significant indicator of good prognosis in gastric cancer patients.
    Annals of Surgical Oncology 04/2014; · 3.94 Impact Factor
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    ABSTRACT: The 7th edition of the Union for International Cancer Control-TNM (UICC-TNM) classification for esophageal carcinoma made considerable modifications to the definition of N-staging by the number of involved lymph nodes and the regional node boundary. There were few validations of the regional boundary. We evaluated the nodal status of this classification for esophageal squamous cell carcinoma (ESCC). There were 665 patients reviewed who had ESCC and underwent esophagectomy between 1997 and 2012. We evaluated the impact of the location of lymph node metastasis on overall survival. There were 414 patients (61.7 %) who had lymph node metastases. The overall 5-year survival rate was 54.7 %. There were no significant differences in survival among N2, N3, and M1 patients. Cox regression analysis revealed that common hepatic or splenic node involvements (P = 0.001), pT stage (P = 0.0002), and pN stage (P < 0.0001) were independent predictors of survival, but supraclavicular node involvement (P = 0.29) was not. We propose a modified nodal status that designates supraclavicular node as regional: m-N0 (5-year survival = 79 %; n = 251); m-N1 (5-year = 56 %; n = 212); m-N2 (5-year = 30 %; n = 114); m-N3 (5-year = 18 %; n = 52); m-M1 (5-year = 6.2 %; n = 36). This modified nodal staging predicts survival better than the current staging system. The modification of supraclavicular lymph node from nonregional to regional in the 7th UICC classification of ESCC may allow for better stratification of overall survival.
    Annals of Surgical Oncology 04/2014; · 3.94 Impact Factor
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    ABSTRACT: Gastroduodenal stents for gastric outlet obstruction due to unresectable advanced gastric cancer are increasingly used; however, their effects have not been fully evaluated. A multicenter prospective observational study was performed. Patients were eligible if they had stage IV gastric cancer with a gastric outlet obstruction scoring system (GOOSS) score of 0 (no oral intake) or 1 (liquids only). Self-expandable metallic stents were delivered endoscopically. The effects of stents were evaluated. Twenty patients were enrolled and 18 were eligible (15 men, three women; median age, 70 years). Stent placement was successfully performed in all patients, with no complications. After stenting, a GOOSS score of 2 (soft solids only) or 3 (low-residue or full diet) was achieved in 13 (72%) patients. An improvement in the GOOSS score by one or more points was obtained in 16 (94%) patients. The median duration of fasting and hospital stay was 3 (range, 0-9) days and 18 (6-168) days, respectively. Chemotherapy was performed after stenting in 13 (72%) patients. Gastroduodenal stents are thought to be feasible, safe, and effective for gastric outlet obstruction due to unresectable advanced gastric cancer, with rapid clinical relief and a short hospital stay. J. Surg. Oncol. 2014 109:208-212. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 03/2014; 109(3):208-12. · 2.84 Impact Factor
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    ABSTRACT: Background Visceral fat is one of the causes of metabolic syndrome. Among the various types of bariatric surgery, duodenal–jejunal bypass is one of the most common procedures. However, the effect of duodenal bypass on fat changes is not completely understood. We examined the effect of duodenal bypass on visceral fat changes by comparing Billroth I (BI) and roux-en Y (RY) reconstruction in distal gastrectomy. Methods This retrospective study used data from 221 patients registered for a prospective randomized trial that compared BI to RY in distal gastrectomy with lymphadenectomy to treat gastric cancer. With a software package, we first quantified the visceral fat area (VFA) on cross-sectional computed tomography scans obtained at the level of the umbilicus before and 1 year after surgery, and then determined the impact of duodenal bypass on visceral fat changes. Results Clinicopathological background data did not differ between BI and RY. Rates of BMI reduction for BI and RY also did not differ. The VFA reduction rate for RY (47.2 ± 25.5%) was greater than for BI (36.8 ± 34.2%, P = .0104). Adjuvant chemotherapy (chemotherapy versus no chemotherapy, P = .0136), type of reconstruction (BI versus RY, P < .0001), and pathologic stage (p stage I versus p stage II–IV, P = .0468) correlated significantly with postoperative visceral fat loss. Multivariate logistic regression analysis identified reconstruction (BI versus RY, P = .0078) as a significant determinant of visceral fat loss. Conclusion Visceral fat loss after distal gastrectomy was greater for RY than for BI, and duodenal bypass may be associated with reduction of visceral fat.
    Surgery 03/2014; 155(3):424–431. · 3.11 Impact Factor
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    ABSTRACT: Patients with adventitia-invading (T3) tumors, which account for the majority of esophageal cancers, are indicated for surgery but still have a poor prognosis. Subclassifying T3 tumors based on clinical outcome would be useful for selecting adequate adjuvant therapies. Using 268 esophageal cancer specimens from patients without preoperative treatment, the length of the vertical and longitudinal tumor invasion, entire esophageal wall thickness, and interruption of the outer muscle layer were measured. These morphological parameters correlated with clinico-pathological factors and outcome.Patients were classified as T1 (38.4 %), T2 (11.9 %), T3 (38.4 %), and T4 (11.2 %) and T stage correlated well with the four morphological parameters (p p = 0.009). T3 tumors with p = 0.019).T3 esophageal cancer can be classified into subgroups according to the length of MLI. Additional local treatment would be indicated for T3 tumors with >20 mm MLI.
    Esophagus 01/2014; 11(2). · 0.74 Impact Factor
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    ABSTRACT: Various surgical procedures are used to treat early gastric cancers in the upper third of the stomach (U-EGCs). However, there is no general agreement regarding the optimal surgical procedure. The medical records of 203 patients with U-EGC were collected from 13 institutions. Surgical procedures were classified as Roux-en-Y esophagojejunostomy after total gastrectomy (TG-RY), esophagogastrostomy after proximal gastrectomy (PG-EG), or jejunal interposition after PG (PG-JI). Patient clinical characteristics and perioperative and long-term outcomes were compared among these three groups. TG-RY, PG-EG, and PG-JI were performed in 122, 49, and 32 patients, respectively. Tumors were larger in TG-RY patients than in PG-EG and PG-JI patients, and undifferentiated-type gastric adenocarcinoma tended to be more frequent in TG-RY than in PG-EG. The operative time was shorter for PG-EG than for PG-JI and TG-RY. Hospital stay and early postoperative complications were not different for the three procedures. With respect to gastrectomy-associated symptoms, a "stuck feeling" and heartburn tended to be more frequent in PG-EG patients, while dumping syndrome and diarrhea were more frequent in TG-RY patients. Post-surgical weight loss was not different among the three groups, however, serum albumin and hemoglobin levels tended to be lower in TG-RY patients. Three surgical procedures for U-EGC did not result in differences in weight loss, but PG-EG and PG-JI were better than TG-RY according to some nutritional markers. In U-EGC, where patients are expected to have long survival times, PG-EG and PG-JI should be used rather than TG-RY.
    World Journal of Surgery 12/2013; · 2.35 Impact Factor
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    ABSTRACT: Peritoneal recurrence is the most common type of recurrence in gastric cancer. Although cytological examination of peritoneal lavage fluid has been used to predict peritoneal spread, peritoneal recurrences often occur even in patients with negative cytology. Our previous retrospective study suggested that reverse transcriptase-polymerase chain reaction (RT-PCR) using peritoneal lavage fluid may be useful for predicting peritoneal recurrence in patients with negative cytology. This prospective study was conducted to validate the clinical impact of this RT-PCR method. From July 2009 to June 2012, a total of 118 cT2-4 gastric cancer patients underwent surgery. Since 14 patients were ineligible because they had incurable factors, the remaining 104 eligible patients were evaluated for carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) messenger RNA (mRNA) using RT-PCR. If either CEA or CK20 mRNA was detected by RT-PCR, the patient was defined as PCR-positive as in our previous study. The association between recurrence-free survival (RFS) and background factors was analyzed using Cox proportional hazards models. Of 104 patients, 16 (15.4 %) were positive for either CEA or CK20. PCR-positive patients had significantly worse RFS than PCR-negative patients (log-rank p = 0.007). Regarding the pattern of recurrence, 4 of 16 (25 %) PCR-positive patients and 2 of 88 (2 %) PCR-negative patients had peritoneal recurrence (p < 0.001), but there were no significant differences in recurrence at other sites. Cox multivariate analysis indicated only PCR-positivity as a significant predictor of poor RFS (p = 0.029). This prospective study demonstrated that CEA and CK20 PCR results could predict peritoneal recurrence after curative surgery.
    World Journal of Surgery 12/2013; · 2.35 Impact Factor
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    ABSTRACT: Secondary solid tumors that occur after hematopoietic stem cell transplantation (HSCT) are late complications of HSCT. Previously, secondary solid tumors were considered to be recipient-derived cells because transplanted cells do not contain epithelial cells. Recently, however, not only donor‑derived epithelial cells but also donor-derived secondary solid tumors have also been reported in mice and humans. It means that circulating bone marrow-derived stem cells (BMDCs) including hematopoietic stem cells include the stem cells of many tissue types and the precancerous cells of many solid tumors. In most reports of donor-derived secondary solid tumors, however, tumors contained a low proportion of BMDC-derived epithelial cells in mixed solid tumor tissues. To our knowledge, there are only five known cases of completely donor-derived tumor tissues, i.e., four oral SCCs and a pharyngeal SCC. In this study, we analyzed five human clinical samples of solid tumors, i.e., two esophageal squamous cell carcinomas (SCCs), two oral SCCs and a tongue carcinoma. In the oral and tongue, completely donor-derived tissues were not observed, but in esophagus a completely donor-derived esophageal epidermis and SCC were observed for the first time. In addition, in another esophageal SCC patient, a completely donor-derived dysplasia region of esophageal epidermis was observed near recipient-derived SCC. This study suggests that BMDC-derived cells include the stem cells of esophageal epidermis and the precancerous cells of esophageal SCC and can differentiate into esophageal epithelium and esophageal SCC.
    International Journal of Oncology 12/2013; · 2.77 Impact Factor
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    ABSTRACT: The relationship between the epithelial-mesenchymal transition (EMT) and resistance to anticancer treatment has attracted attention in recent years. However, to date, there is no direct clinical evidence for a link between the mesenchymal phenotype and chemoresistance in human malignancies. The expression of EMT-related markers, including E-cadherin, Snail, vimentin, ZEB1, β-catenin and N-cadherin was examined immunohistochemically in 185 tissue samples from patients with esophageal cancer (including 93 patients who received preoperative chemotherapy followed by surgery and 92 patients who underwent surgery without preoperative therapy). The relationship between the expression of the above markers and clinical outcome including prognosis and response to chemotherapy was also examined. The expression of E-cadherin, a marker of epithelial cells, was significantly lower in residual tumors than chemo-naive tumors (P=0.003). The expression of Snail (P=0.028), ZEB1 (P<0.001) and N-cadherin (P=0.001), markers of mesenchymal cells, was higher in residual tumors than in chemonaive tumors. The expression of E-cadherin correlated inversely with that of Snail (P<0.001). Reduced expression of E-cadherin and increased expression of Snail in residual tumors from patients who received chemotherapy correlated significantly with poor response to chemotherapy and short survival time. Multivariate analysis identified Snail expression as an independent prognostic factor, along with tumor depth, in patients who received preoperative chemotherapy for esophageal cancer. The results suggest transition of residual esophageal cancer cells to mesenchymal phenotype after chemotherapy and this contributes to resistance to chemotherapy and poor prognosis in patients with esophageal cancer.
    Oncology Reports 11/2013; · 2.19 Impact Factor
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    ABSTRACT: (18)F-FDG-PET is potentially useful for evaluating response to neoadjuvant therapy for esophageal cancer. However, the optimal (18)F-FDG-PET parameter for evaluating the response to therapy and survival has not been established. This study aimed to select the best of the two parameters of fluorodeoxyglucose ((18)F-FDG)-positron emission tomography (PET): decreased ratio of maximal standardized uptake (SUVmax-DR) or absolute value of posttreatment SUVmax (post-SUVmax), in predicting response and survival of patients with esophageal cancer who underwent neoadjuvant chemotherapy. The study subjects were 211 consecutive patients with esophageal cancer who received neoadjuvant chemotherapy followed by surgery. (18)F-FDG-PET was performed before and 2-3 weeks after completion of neoadjuvant chemotherapy in assessment with pretreatment SUVmax (pre-SUVmax), post-SUVmax and SUVmax-DR. The mean SUVmax decreased during neoadjuvant chemotherapy from 11.4 to 5.8, and the mean SUVmax-DR was 49.4 %. Both post-SUVmax and SUVmax-DR correlated significantly with pathological response, although neither post-SUVmax nor SUVmax-DR could distinguish pathological complete response from pathological good response. The 5-year survival rate was significantly higher in patients with SUVmax-DR of >50 % than those with <50 % (56.5 vs. 39.6 %, p = 0.0137), and also significantly higher in patients with post-SUVmax of <3.5 than those with >3.5 (62.2 vs. 35.1 %, p < 0.0001). Multivariate analysis identified post-SUVmax value, but not SUVmax-DR, as an independent prognostic factor in patients who underwent neoadjuvant chemotherapy. Post-SUVmax is more useful for predicting survival of patients with esophageal cancer who undergo neoadjuvant therapy followed by surgery, although both SUVmax-DR and post-SUVmax equally correlate with pathological response.
    Annals of Surgical Oncology 11/2013; · 3.94 Impact Factor
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    ABSTRACT: Partial gastrectomy is a relatively simple procedure that involves perigastric mobilization and gastric resection/closure with surgical staplers. This procedure has been considered to be feasible using the transvaginal natural orifice translumenal endoscopic surgery (NOTES) approach. In this communication, we describe our clinical experience with transvaginal NOTES gastrectomy for gastric submucosal tumors. With the assistance of two transabdominal ports, "oncologically acceptable" partial gastrectomy was successfully performed. Transvaginal specimen delivery resulted in the prevention of morbid abdominal wall destruction, contributing to better cosmesis and reduced postoperative pain. To gain wider clinical acceptance, NOTES requires further evaluation of its indications, feasibility, and safety. Continuous research/developmental efforts are also essential to optimize its instrumentation. Its theoretical "minimal invasiveness" should be assessed in detail through further research, ideally in randomized trials.
    Nippon Geka Gakkai zasshi 11/2013; 114(6):303-7.
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    ABSTRACT: We report a case of advanced esophageal cancer infiltrating into the trachea that was treated by chemoradiation therapy. The patient was a 49-year-old man who complained of dysphagia and dyspnea. Various examinations revealed an esophageal cancer with direct invasion into the trachea( cT4b[ Tr], N2[ 106recR, 106recL, 106pre, 1], M0, cStage IIIc). He underwent radiotherapy. Simultaneously, he was administered morphine to relieve dyspnea and steroid to prevent tracheal edema. From the eight day of radiation therapy, chemotherapy was initiated( DCF; docetaxe[l DTX] +cisplatin[ CDDP] + 5-fluorouracil[ 5-FU]). This chemoradiation therapy considerably reduced the esophageal tumor size. Thereafter, the patient underwent 2 additional courses of chemotherapy( FAP; 5-FU+adriamycin[ ADM] +CDDP). The therapeutic effect was judged as complete response. The patient is still alive without recurrence for 3 years and 6 months after the first treatment. There are some reports about airway stenting and adjuvant therapy for airway obstruction caused by esophageal cancer. However, there are few reports on chemoradiotherapy for esophageal cancer invading into the trachea with administration of steroids to prevent tracheal edema. We believe that this is an effective treatment.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2124-6.
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    ABSTRACT: In the present report, we describe a case of a woman who underwent esophagectomy for esophageal carcinosarcoma in October 2008. Computed tomography (CT) and endoscopy indicated lymph node recurrence with invasion into adjacent organs and oropharyngeal carcinoma in September 2009. She subsequently received 2 courses of chemotherapy (5-fluorouracil+ cisplatin+adriamycin) plus radiotherapy with a total dose of 60 Gy. Although a partial response was achieved after this treatment, CT still indicated the presence of residual lesions. Therefore, surgical excision was performed at the site of the lymph node recurrence and for oropharyngeal carcinoma. Thus, we performed a radical operation by resecting the skin, sternum, clavicle, ribs, innominate vein, bronchus, oropharyngeal, larynx, and lymph node; transplanted a free thigh flap; and performed a mediastinal tracheostomy. She has been alive without recurrence for 3 years and 4 months after the operation.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2115-7.
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    ABSTRACT: A 51-year-old female with esophageal stricture was referred to our hospital. She was diagnosed to have mixed connective tissue disease and had been placed on steroid and immunosuppressant treatment. She presented with passage disturbance and free reflux of the gastric contents when in the supine position. Pneumatic dilatation and medication resulted in partial relief of her symptoms. Preoperative imaging studies demonstrated a shortened esophagus with severe stricture of the esophagogastric junction and a moderate hiatal hernia. A DeMeester's score of 140.1 was noted on 24-h pH monitoring. Under a diagnosis of stricturing reflux esophagitis, surgical treatment was indicated. Laparoscopic transhiatal mediastinal dissection with crural repair and fundoplication was offered instead of thoracotomy and/or laparotomy, since she had a high risk due to immunosuppression. The esophagus was extensively dissected through the hiatus up to the level of the tracheal bifurcation, and fundoplication was completed without Collis gastroplasty. Her postoperative course was rapid and uneventful. Postoperatively, her clinical symptoms were resolved with anatomical/functional improvement.
    Surgery Today 11/2013; 43(11):1305-1309. · 1.21 Impact Factor
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    ABSTRACT: Recurrent esophagus cancer has an extremely poor prognosis in spite of systemic chemotherapy. Herein, we report cases of long survival after recurrence owing to topical treatment. The first patient was a 75-year-old man. He was diagnosed with clinical stage IIA esophagus cancer and underwent subtotal esophagectomy. The pathological stage was IIIB. Liver metastases appeared in S8 and S5, 8 months after surgery. Systemic chemotherapy and transcatheter arterial chemoembolization were performed. He had kept CR but died due to brain metastasis 1 year and 4 months after the recurrence. The second patient was a 68-year-old man. He underwent esophagectomy for clinical stage IIIB esophagus cancer. The pathological stage was also IIIB. Five metastases were seen in the bilateral lobes of the liver 8 months after surgery. Transcatheter arterial chemoembolization and stereotactic irradiation were performed and he has been in complete remission for a year. Topical treatment may represent an important strategy for treating liver metastasis from esophagus cancer.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2158-60.
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    ABSTRACT: Although SILS has become an increasingly popular type of surgery, its application for gastric submucosal tumors (SMT) has been only sporadically reported. We herein describe 12 recent cases with gastric SMT located in the greater curvature or anterior wall. The aim is to validate technical feasibility and safety of single-incision laparoscopic partial gastrectomy. Thus far, this is one of the largest series of patients with gastric SMT who underwent SILS. From July 2009 to April 2013, single-incision laparoscopic partial gastrectomy was attempted in 12 consecutive patients with gastric SMT. Three trocars were assembled in the umbilical incision, and the lesion was mobilized and staple-resected with endoscopic stapling devices. SILS surgery was successfully completed without any additional trocars. The median operating time was 96.5 min, and median blood loss was 7.5 mL. The median tumor size was 30 mm, with histopathologic diagnosis of gastrointestinal stromal tumor (10) and schwannoma (2). There was no immediate postoperative morbidity. During a median follow-up of 12 months, all patients were on full regular diet without any gastrointestinal symptoms. SILS with transumbilical gastric stapling is a safe and practical alternative to conventional multiport laparoscopy in patients with gastric SMT, except for cases originating in the lesser curvature and close to the cardia/ pylorus.
    Asian Journal of Endoscopic Surgery 10/2013;
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    ABSTRACT: Cholesteryl pullulan (CHP) is a novel antigen delivery system for cancer vaccines. This study evaluated the safety, immune responses and clinical outcomes of patients who received the CHP-NY-ESO-1 complex vaccine, Drug code: IMF-001. Patients with advanced/metastatic esophageal cancer were enrolled and subcutaneously vaccinated with either 100 mug or 200 mug of NY-ESO-1 protein complexed with CHP. The primary endpoints were safety and humoral immune responses, and the secondary endpoint was clinical efficacy. A total of 25 patients were enrolled. Thirteen and twelve patients were repeatedly vaccinated with 100 mug or 200 mug of CHP-NY-ESO-1 with a median of 8 or 9.5 doses, respectively. No serious adverse events related to the vaccine were observed. Three out of 13 patients in the 100-mug cohort and 7 out of 12 patients in the 200-mug cohort were positive for anti-NY-ESO-1 antibodies at baseline. In the 100-mug cohort, an antibody response was observed in 5 out of 10 pre-antibody-negatives patients, and the antibody levels were augmented in 2 pre-antibody-positive patients after vaccination. In the 200-mug cohort, all 5 pre-antibody-negative patients became seropositive, and the antibody level was amplified in all 7 pre-antibody-positive patients. No tumor shrinkage was observed. The patients who received 200 mug of CHP-NY-ESO-1 survived longer than patients receiving 100 mug of CHP-NY-ESO-1, even those who exhibited unresponsiveness to previous therapies or had higher tumor burdens. The safety and immunogenicity of CHP-NY-ESO-1 vaccine were confirmed. The 200 mug dose more efficiently induced immune responses and suggested better survival benefits. (Clinical trial registration number NCT01003808).
    Journal of Translational Medicine 10/2013; 11(1):246. · 3.99 Impact Factor
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    ABSTRACT: Several studies have examined the clinical significance of metabolic response in primary tumours by [(18) F]fluorodeoxyglucose positron emission tomography ((18) F-FDG-PET) in patients with oesophageal cancer who undergo neoadjuvant therapy. The relevance of the metabolic response in lymph nodes is unclear. Consecutive patients with oesophageal cancer who underwent neoadjuvant chemotherapy followed by surgery were studied. (18) F-FDG-PET was performed before and 2-3 weeks after completion of neoadjuvant chemotherapy, assessing FDG uptake in primary tumours and lymph nodes considered to be metastatic. Before therapy, 156 (73·9 per cent) of 211 patients had PET-positive nodes, of whom 89 (57.1 per cent) had no evidence of metabolic activity in these lymph nodes following chemotherapy. There was a significant relationship between post-treatment lymph node status assessed by FDG-PET and numbers of pathologically confirmed metastatic lymph nodes. Patients with post-treatment PET-positive nodes had shorter survival than those without (5-year survival rate 25 versus 62·6 per cent; P < 0·001). There was no difference in survival between patients with PET-positive nodes before but not after therapy and patients who had PET-negative nodes throughout (5-year survival rate 59 versus 71 per cent respectively; P = 0·207). Multivariable analysis identified post-treatment nodal status assessed by FDG-PET and tumour depth as independent prognostic factors. Identification of PET-positive lymph nodes after completion of chemotherapy is a predictor of poor prognosis of patients with oesophageal cancer scheduled for surgery. FDG-PET lymph node status after neoadjuvant chemotherapy is more important than that before chemotherapy.
    British Journal of Surgery 10/2013; 100(11):1490-7. · 4.84 Impact Factor
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    ABSTRACT: The concentration of ghrelin, which can affect body weight by influencing appetite, is thought to decrease after sleeve gastrectomy. However, no detailed investigations have examined ghrelin expression in the stomach. The purpose of the present study was to assess localized ghrelin expression and its clinical significance in obese patients. A total of 52 obese patients who underwent sleeve gastrectomy with or without duodenojejunal bypass were enrolled in the study. The number of ghrelin-positive cells (GPCs) was counted using immunohistochemistry of the gastric mucosa at the fundus. The obese patients were compared with 14 nonobese patients treated for gastric cancer. Ghrelin mRNA expression was also measured in 22 obese patients using a quantitative reverse transcription polymerase chain reaction. The number of GPCs was significantly higher in obese patients than in nonobese controls (33.2 ± 18.3 vs. 14.1 ± 6.1; p < 0.001) and correlated with ghrelin mRNA expression. The obese patients were divided into two groups with high and low ghrelin levels based on the number of GPCs. The percent excess body weight loss was significantly greater in the high-ghrelin group, without differences in the patient backgrounds between the two groups (p = 0.015). The number of GPCs was higher in obese patients than in nonobese patients and varied individually regardless of body weight. These results suggest that ghrelin expression in gastric mucosa might be a prognostic factor after surgery.
    World Journal of Surgery 10/2013; · 2.35 Impact Factor

Publication Stats

2k Citations
550.56 Total Impact Points

Institutions

  • 2005–2014
    • Osaka City University
      • Department of Gastroenterological Surgery
      Ōsaka, Ōsaka, Japan
  • 2000–2014
    • Osaka University
      • • Division of Gastroenterological Surgery
      • • Department of Mechanical Science and Bioengineering
      • • Department of Integrated Medicine
      • • School of Medicine
      Suika, Ōsaka, Japan
  • 2012
    • Osaka National Hospital
      Ōsaka, Ōsaka, Japan
  • 2011
    • Sakai City Hospital
      Sakai, Ōsaka, Japan
    • Toyonaka Municipal Hospital
      Toyonaka, Ōsaka, Japan
  • 2010
    • Kogakuin University
      Edo, Tōkyō, Japan