- [Show abstract] [Hide abstract] ABSTRACT: Oral adjuvant chemotherapy without hospitalization might reduce the physiological and psychological burden on patients if effectiveness could be guaranteed. We conducted a multicenter feasibility study using S-1, an oral derivative of 5-fluorouracil, as postoperative adjuvant chemotherapy in patients with curatively resected pathologically stage IB-IIIA non-small-cell lung cancer. Adjuvant chemotherapy comprised 8 courses (4-week administration, 2-week withdrawal) of S-1 at 80-120 mg per day. Fifty-one patients from 7 institutions were enrolled in this pilot study, from June 2005 to March 2007. The primary end point was the completion rate of scheduled adjuvant chemotherapy. Secondary end points were the incidence and grade of adverse reactions. Fifty patients were eligible. The completion rate for the planned 8 courses of S-1 administration was 72.0% (36 patients). Total percentage administration amount was 71.1%. Grade 3 adverse reactions such as neutropenia (4.0%), anorexia (4.0%), thrombopenia (2.0%), anemia (2.0%), elevated total bilirubin (2.0%), hypokalemia (2.0%), nausea (2.0%), and diarrhea (2.0%) were observed, but no grade 4 adverse effects were encountered. Overall and relapse-free survival rates at 3 years were 87.7% and 69.4%, respectively. Postoperative 1-year administration of S-1 seems feasible as oral adjuvant chemotherapy for lung cancer. The oral formulation and low incidence of adverse reactions permit treatment on an outpatient basis. The present study would be reasonable to follow up with a properly powered phase III trial.
- [Show abstract] [Hide abstract] ABSTRACT: This study was designed to provide quantitative analysis using flow cytometry (FCM) and immunohistochemical analysis (IH) for p53 protein in 85 patients who underwent pulmonary resection for non-small cell lung carcinoma (NSCLC). We also examined the relationship among numerical aberrations of chromosome 17 and p53 locus, clinicopathological parameters and patient prognosis in NSCLC. PAb 1801 was used as the primary antibody for p53 and the Fluorescence Index (F.I.) was calculated by FCM. Fifty-six patients (66%) showed a higher F.I. (?0.5), and had a higher rate of lymph node metastasis, more advanced stage and poor survival, while a positive expression of p53 protein by IH was associated with no clinicopathologic factors or patient survival. The F.I. of p53 protein was significantly higher in cases with imbalanced numbers between chromosome 17 and the p53 locus, particularly in patients with higher F.I. This indicated that quantitative analysis by FCM was the most useful method to detect the over-expression of p53 protein compared to that by IH. Higher F.I. (?0.5) is a prognostic indicator for predicting malignant behavior and poor survival in patients with NSCLC
- [Show abstract] [Hide abstract] ABSTRACT: The expression of Cathepsin B (CB) and matrix metalloproteinase-9 (MMP-9) in extirpated tissues of adenocarcinomas in non-small cell lung cancer from 90 cases was investigated immunohistologically, and the correlations between the extent of the expression and the clinicopathological features were assessed for investigaiting the process of tumor metastasis. It is important to reveal the mechanisms of destruction of the basal membrane and infiltration of tumor cells at the primary lesion. Sections were obtained from 10%-formalin-fixed and paraffin-embedded tissues. They were reacted with an anti-human CB polyclonal antibody or an anti-human MMP-9 polyclonal antibody. Of 90 patients, 58 (64.4%) and 39 (48.3) cases were found to be positive for CB and MMP-9 expression, respectively. A significantly higher extent of the CB expression was observed in the tissues of patients who showed postoperative recurrence of the tumor (P=0.013). Especially, a similar observation was obtained among early cases of T1N0 (P=0.023). In contrast, no such tendency was demonstrated in the expression profile of MMP-9. Furthermore, the enzyme expressions were compared among different types of metastases. Patients with higher extents of CB expression tended to show significantly higher rates of hematogenous and intrapulmonary metastases (P=0.023 and P=0.010, respectively). However, there was no significant correlation between MMP-9 expression and the prognostic factor of the patients. Therefore, we suggested that evaluation of CB expression in the tumor tissue might be useful as a postoperative prognostic factor of pulmonary adenocarcinoma. Especially, early cancer of T1N0 cases showing higher expression of CB may need postoperative adjuvant chemotherapy.
- [Show abstract] [Hide abstract] ABSTRACT: We reported a 71-year-old male patient with multiple liver recurrence of hepatocellular carcinoma, who responded to arterial infusion chemotherapy using CDDP and 5-FU. The patient was administered 10mg/body CDDP and 250 mg/body 5-FU on day 1-5./1 course. As a result, the tumor decreased and AFP was decreased to 50.8 ng/ml (from 93099 ng/ml). The patient is alive 13 months after the beginning of therapy in a condition of partial response (PR).
- [Show abstract] [Hide abstract] ABSTRACT: To examine the relationship between the incidence of p53 gene deletion in each nucleus and the clinicopathological features in colorectal cancers, we performed a cytogenetic study using fluorescence in situ hybridization (FISH). FISH was performed on 5 adenomas and 38 colorectal cancers that had been resected surgically. The nucleus, in which the copy number of the p53 signal was lower than that of chromosome 17, was determined as a deletion of the p53 gene. The mean frequency of the deletion of p53 in adenomas and cancers were 7.8% +/- 3.0% and 57.0% +/- 19.0%, respectively. Numerical aberrations of chromosome 17 or a deletion of p53 were also detected in DNA diploidy. The mean frequency of the deletion of p53 in 32 cases with aneusomy of chromosome 17 (65.7% +/- 14.5%) was significantly higher than that in cases of disomy (51.1% +/- 19.3%, P < 0.05). Even though this frequency was high in the early stage, it was not associated with any specific histopathological features. This frequency was also higher in double primary cancers (70.4% +/- 16.7%) compared with single colorectal cancers (53.4% +/- 18.1%) (P < 0.05). Using FISH, our results demonstrated that the clonal deletion of the p53 locus is an early genetic event of colorectal cancers and that a high incidence of p53 deletion may influence the occurrence of double primary cancers.
- [Show abstract] [Hide abstract] ABSTRACT: The biological characteristics associated with the morphological diversity of colorectal cancers were investigated to elucidate the causes of this diversity. We examined the proliferative and infiltrating activity of tumor cells, indicated by the mean number of Ag nucleolar organizer region associated proteins (NORs) per nucleus (MNA) and the immunohistochemical response to cathepsin B(CB), in various morphological types of early and advanced colorectal cancers. We examined 73 colorectal cancers obtained by endoscopic and surgical resection. MNA values for sessile and flat-elevated cancers were greater than the values for pedunculate, subpedunculate, and flat-or-depressed early cancers (sessile,P<0.05). In advanced cancers invading the muscularis propria, protruding cancers showed significantly higher MNA values than small ulcerative cancers (P<0.01). CB expression increased significantly with the progression of colorectal cancers (P<0.01), but was not related to morphological diversity in early and advanced cancers. In both sessile and flat cancers, CB expression was higher in moderately differentiatiated than in well differentiated adenocarcinomas. These results indicate that, in colorectal cancers, protruding early cancers without stalks and protruding advanced cancers have higher proliferative activity than pedunculate or flat early cancers and small ulcerative advanced cancers, respectively, and that CB expression is not associated with morphological diversity, but with depth of invasion and histological differentiation.
- [Show abstract] [Hide abstract] ABSTRACT: Seventeen patients with 10 synchronous and 7 metachronous double cancers with carcinomas of the esophagus were surgically treated in the First Department of Surgery, Nagasaki University School of Medicine. All patients were men with an average of age 68.5. The incidence of double cancers with carcinoma of the esophagus accounted for 12.7% in a total of 134 of this series. The three triple cancers were included. Of the three, one was synchronous triple cancers in the esophagus, the stomach and the colon. The outcome was not necessarily satisfactory. Two had recurrence 3 and 5 months after surgery, but one is still alive for 33 months, free from carcinoma
- [Show abstract] [Hide abstract] ABSTRACT: En bloc resections for patients with left atrium involved by lung cancers were evaluated in the 8 patients in terms of the operative procedure, the indication and the outcome. In one patient, application of extracorporeal circulation was accomplished to perform a complete resection and also to permit patch plasty to compensate volume diminution. En bloc resection on extracorporeal circulation is recommended for patients with limited cancer extension of squamous cell carcinomas without nodal involvement. In addition, emphasis has been placed in the genesis of double cancer in follow-up study according to improvement of surgical result in reflection of susceptibility to carcinomas in other organs
- [Show abstract] [Hide abstract] ABSTRACT: The results of aspiration biopsy cytology were clinically evaluated on the basis of clinical experience with 608 patients with breast cancer at the First Department of Surgery, Nagasaki University School of Medicine. Aspiration biopsy is of clinical value in making a diagnosis of small-sized tumors. There was no detrimental outcome to promote tumor-cell spread locally as well as to give rise to distant metastasis into the other organ. One should be aware of a no cell finding in relation to scirrhous carcinoma and intraductal papillomatosis. Emphasis is placed on recommendation of open biopsy without repeated aspiration maneuver
- [Show abstract] [Hide abstract] ABSTRACT: Twenty-five patients with gastric cancer were clinically evaluated in terms of a clinicopathological pattern in younger patients. 1) Female was more predominant than male. 2) The main tumor location was the cardia and the gross appearance was Borrmann IV of undifferentiated carcinoma in the majority. 3) Less hepatic metastases were seen in younger patients, whereas, the common extension in younger patients was peritoneal dissemination and serosal invasion. 4) The surgical outcome was satisfactory as far as a curative operation be performed. On the contrary, the result of non-curative operation was extremely pessimistic. Recently great strides in the surgical outcome of gastric cancer have been achieved in combination with adjuvant therapy of immunochemotherapy. Improvement of surgical outcome is attributable to the standarized operative procedure with reasonable node dissection. It is common that carcinomas in various organs affect older patients, not usually younger ones. The purpose of this study is to clarify the clinicopathologic features of gastric cancer in younger patients on the basis of our result of clinical experience
- [Show abstract] [Hide abstract] ABSTRACT: Surgery for complications of colonic diverticulum was evaluated on the basis of a result of clinical experience for the 15 patients. 1) Average age was 48.9 years, and right-side oriented lesions were more often seen in younger patients. The men and women ratio was 1.5 to 1.0. 2) The reasons for surgery were disticulitis in 7 (46.7%), perforation in 3 (20.0%) and abscess and fistula formation in 2 (13.3%), respectively. 3) Complications on the left side were much more severe than those on the right side and also seen more often in older patients
- [Show abstract] [Hide abstract] ABSTRACT: Surgery for tracheal stenotic lesions in older patients over age 70 was evaluated in comparison with younger patients under age 69 on the basis of our clinical experience. The causes of tracheal lesions were mainly malignant diseases in spite of varying variety of etiology in the younger patients. The outcome of surgical treatment in the older ones was not inferior to that in the younger ones as far as postoperative complications were prevented. In conclusion, it is emphasized that the surgical treatment of choice is essential for palliation of symptoms and expectance of high quality of life
Nagasaki, Nagasaki, Japan
- Department of Surgical Oncology