Prognostic and clinical impact of sarcopenia in esophageal squamous cell carcinoma

Recently, depletion of skeletal muscle mass (sarcopenia) has been linked to poor prognosis in several types of cancers, but has not been investigated in esophageal squamous cell carcinoma (ESCC). This retrospective study investigates the relationship between sarcopenia and clinical outcome in ESCC patients treated by surgical resection or definitive chemoradiation therapy (dCRT). The study was retrospectively conducted in a single academic hospital in Kumamoto, Japan, and involved 325 ESCC patients (256 surgical cases and 69 dCRT cases) treated between April 2005 and April 2011. Skeletal muscle mass was quantified by radiologic measures using standard computed tomography scans. The skeletal muscle tissue in the 325 ESCC patients was distributed as follows: mean: 47.10; median: 46.88; standard deviation (SD): 7.39; range: 31.48-71.11; interquartile range, 46.29-47.90. Skeletal muscle tissue was greater in male patients than in female patients (P < 0.0001), but was independent of other clinical and tumor features. Sarcopenia was not significantly associated with overall survival (log rank P = 0.54). Lymph node involvement significantly altered the relationship between sarcopenia and survival rate (P for interaction = 0.026). Sarcopenia significantly reduced the overall survival of patients without lymph node involvement (log rank P = 0.035), but was uncorrelated with overall survival in patients with lymph involvement (log rank, P = 0.31). The anastomosis leakage rate was significantly higher in the sarcopenia group than in the non-sarcopenia group (P = 0.032), but other surgical complications did not significantly differ between the two groups. Sarcopenia in ESCC patients without lymph node involvement is associated with poor prognosis, indicating sarcopenia as a potential biomarker for identifying patients likely to experience an inferior outcome. Moreover, sarcopenia was associated with anastomosis leakage but no other short-term surgical outcome.

Modified high dorsal procedure for performing isolated anatomic total caudate lobectomy (with video)

Background

Isolated anatomic total caudate lobectomy is indicated in patients who have liver tumors limited to the caudate lobe. However, isolated caudate lobe resection is a challenging surgical procedure that required safe and reliable techniques. All portal and hepatic veins that connect this area originate from the first branch of the portal vein or vena cava; therefore, the operator must be cautious of the potential for massive bleeding.

Methods

The important points regarding the safety of our procedure include creating an optimal surgical view and preparing for accidental bleeding before parenchymal dissection. Sufficient mobilization and removal of Spiegel’s lobe from the left to the right side of the vena cava allows the operator to perform parenchymal dissection under a right- or front-side view.

Results

We have performed this technique in two patients with HCC and one patient with primary cystadenocarcinoma. The average operative time and amount of blood loss were 435 min and 1137 ml, respectively. No operative mortalities or postoperative complications were observed in any of the patients. Our three patients are currently doing well without any recurrence.

Conclusion

Our modified high dorsal resection procedure can be used to safely remove the entire caudate lobe.

Electronic supplementary material

The online version of this article (doi:10.1186/s12957-016-0896-3) contains supplementary material, which is available to authorized users.

[A Case of Adult Invagination Caused by Rectal Cancer]

An 87-year-old man visited our hospital with a chief complaint of melena. Invagination caused by rectal cancer or sigmoid colon cancer was suspected as a result of physical and radiological examinations. Since there were no subjective symptoms, laparoscopic surgery was planned electively. As an operative finding, a tumor was found in the rectosigmoid colon and caused invagination. The invagination was released during an operation, and high anterior resection with D3 dissection was performed laparoscopically. The operation time was 108 minutes and the amount of blood loss was 22 mL. Although anastomotic leakage occurred as a postoperative complication, recovery was achieved conservatively by percutaneous drainage. In many cases, invagination of adults is caused by a solid tumor such as bowel carcinoma, which commonly occurs at the cecum or sigmoid colon. Although invagination of the rectosigmoid colon fixed to the retroperitoneum is relatively rare, the fragility of the supporting tissues in the pelvis accompanied by aging is considered to be a cause. In cases of a large tumor occupying the lumen of the intestine, appropriate preoperative diagnosis is needed and the method of operation should be chosen carefully.

[Successful Treatment of Stenosis of the Portal Vein Using an Expandable Metallic Stent after Extended Right Hepatectomy--A Case Report]

We report successful treatment of stenosis of the portal vein caused by enlargement of the remnant liver after extended right hepatectomy with interventional radiology using an intraportal expandable metallic stent (EMS). A 75-year-old man underwent extended right hepatectomy after percutaneous transhepatic right portal embolization for advanced gallbladder cancer. His portal vein branched out into the anterior, posterior, and left branches. The main portal vein and left branch formed a sharp angle by nature. We ligated the posterior branch and sutured the cut line of the anterior branch during surgery. Several days after the surgery, icterus and massive ascites developed. Computed tomography (CT) and portography showed thrombi and stenosis of the cut line of the right branches due to enlargement of the remnant liver. A covered EMS was placed at the stenosis with interventional radiology. After stent placement, the icterus and massive ascites resolved. The patient remains well and EMS has caused no difficulty for 19 months. Intraportal EMS placement is effective in treating perioperative portal venous complications.

Prognostic impact of hepatectomy for patients with non-hepatitis B, non-hepatitis C hepatocellular carcinoma

BACK GROUND/AIM: The purpose of the present study was to clarify the clinicopathological features of non-hepatitis B and -C (NBNC) hepatocellular carcinoma (HCC), the incidence of which has been increasing.

PATIENTS AND METHODS

Two hundred and eighty-four patients with HCC were classified into three groups according to viral hepatitis status, namely NBNC, hepatitis B, and hepatitis C. We compared the three groups and studied related risk factors.

RESULTS

Patients without cirrhosis who had increased number of platelets and diabetes mellitus, and a serum alpha-feto-protein (AFP) level <100 ng/dl were more common in the NBNC group. The cumulative survival and disease-free survival were better in the NBNC group than in the other groups. The tumor size and hepatitis B or C viral status were found to be independent risk factors of disease-free survival and the presence of multiple lesions was the only independent risk factor of survival.

CONCLUSION

Close follow-up of NBNC liver cirrhosis and early detection of NBNC-HCC can improve the prognosis after surgery.

Modified gastric pull-up reconstructions following pharyngolaryngectomy with total esophagectomy

Reconstruction following pharyngolaryngectomy with total esophagectomy is a challenging surgery to perform. Between April 2008 and August 2012, three types of modified gastric pull-up reconstruction procedures, including a gastric tube creation combined with a free jejunal transfer (n = 7), elongated gastric tube creation with vascular anastomoses (n = 2) and pedunculated gastric tube creation with Roux-en-Y anastomosis (n = 5), were performed after pharyngolaryngectomy with total esophagectomy. To clarify feasibility of these reconstructive methods, we retrospectively analyzed the short-term outcomes. There were no graft failures. Salivary fistulae were observed in two cases after high pharyngoenteral anastomoses due to oropharyngeal extension of hypopharyngeal cancers. Overall morbidity rate was 21.4%, and no deaths occurred. Although the operation time was shortest for pedunculated gastric tube reconstructions, morbidity rates were similar among all methods. All three types of modified gastric pull-up reconstruction procedures can be performed safely. We can choose one of these methods according to the tumor status and the patient condition, understanding advantages and disadvantages of each procedure.

Plasma CD147 reflects histological features in patients with lupus nephritis

OBJECTIVE

A glycosylated transmembrane protein, CD147, has been implicated in regulating lymphocyte responsiveness and leukocyte recruitment. As lupus nephritis (LN) often follows a relapsing-remitting disease course, accurate understanding of the disease activity would be extremely helpful in improving prognosis. Unfortunately, neither clinical nor serological data can accurately reflect the histological features of LN. The present study investigated whether CD147 can accurately predict pathological features of LN.

METHODS

Plasma and spot urine samples were collected from 64 patients who underwent renal biopsy between 2008 and 2011. Disease activity for LN tissues was evaluated using the biopsy activity index, and compared to levels of biomarkers including CD147.

RESULTS

In LN tissues, CD147 induction was striking in injured glomeruli and infiltrating inflammatory cells, but not in damaged tubules representing atrophy. Plasma CD147 levels accurately reflected the histological disease activity. However, prediction using a single molecule would be quite difficult because of the complex pathogenesis of LN. The diagnostic accuracy of multiplex parameters indicated that the combination including plasma CD147 might yield excellent diagnostic abilities for guiding ideal LN therapy.

CONCLUSION

Plasma CD147 levels might offer useful insights into disease activity as a crucial biomarker in patients with LN.

Radiofrequency ablation for pulmonary metastases from esophageal squamous cell carcinoma

Radiofrequency ablation (RFA) is increasingly being used for the treatment of intrathoracic malignancies. Although RFA has been found to be promising in the treatment of lung metastases from some types of neoplasms, little is known concerning its clinical significance in the treatment of pulmonary metastasis from esophageal squamous cell carcinoma (ESCC). This retrospective study evaluated the feasibility, safety, and effectiveness of computed tomography-guided RFA for pulmonary metastasis from ESCC. A series of 10 ESCC patients with 17 pulmonary tumors were included. Correct placement of the ablation device into the target tumor proved to be feasible in all tumors (100%). The mean visual analog scale score, with values that ranged from 0 (no pain) to 10 (worst pain possible), was 1. This suggested that this procedure was well tolerated. No procedure-related deaths occurred. A pneumothorax needing drainage was a major complication in two patients. Local control of ablated tumor lasting for at least 1 year was achieved in 10 (83%) of 12 assessable tumors. Although locoregional recurrences developed in two tumors, these lesions could be recontrolled by repeat treatment with RFA. Three patients died of recurrent disease. The predicted 1- and 2-year overall survival rates after lung RFA were 77.8% and 62.2%, respectively. Percutaneous computed tomography-guided RFA yielded relatively high levels of local control in patients with pulmonary metastases from ESCC and was associated with an acceptable level of complications. It was concluded that a prospective study will be necessary to evaluate the effectiveness of a combination of systemic therapy and RFA for ESCC lung metastases.

CD44s signals the acquisition of the mesenchymal phenotype required for anchorage-independent cell survival in hepatocellular carcinoma

Background:

Circulating tumour cells (CTCs) have an important role in metastatic processes, but details of their basic characteristics remain elusive. We hypothesised that CD44-expressing CTCs show a mesenchymal phenotype and high potential for survival in hepatocellular carcinoma (HCC).

Methods:

Circulating CD44⁺CD90⁺ cells, previously shown to be tumour-initiating cells, were sorted from human blood and their genetic characteristics were compared with those of tumour cells from primary tissues. The mechanism underlying the high survival potential of CD44-expressing cells in the circulatory system was investigated in vitro.

Results:

CD44⁺CD90⁺ cells in the blood acquired epithelial–mesenchymal transition, and CD44 expression remarkably increased from the tissue to the blood. In Li7 and HLE cells, the CD44^high population showed higher anoikis resistance and sphere-forming ability than did the CD44^low population. This difference was found to be attributed to the upregulation of Twist1 and Akt signal in the CD44^high population. Twist1 knockdown showed remarkable reduction in anoikis resistance, sphere formation, and Akt signal in HLE cells. In addition, mesenchymal markers and CD44s expression were downregulated in the Twist1 knockdown.

Conclusions:

CD44s symbolises the acquisition of a mesenchymal phenotype regulating anchorage-independent capacity. CD44s-expressing tumour cells in peripheral blood are clinically important therapeutic targets in HCC.

E2F5 as an independent prognostic factor in esophageal squamous cell carcinoma

BACKGROUND

E2F Transcription Factor 5 Protein (E2F5) is considered to act primarily as a transcriptional repressor in the cell cycle. However, its expression and role in esophageal squamous cell carcinoma (ESCC) have not been investigated. We examined whether the expression of E2F5 is related to the clinicopathological features and prognosis of patients with ESCC.

MATERIALS AND METHODS

The expression of E2F5 was analyzed by immunohistochemistry in 64 primary tumor samples obtained from patients with ESCC who had undergone curative esophagectomy between 1998 and 2009. According to the expression of E2F5 in tumor cells, cases were divided into E2F5-positive (27 cases) and -negative groups (37 cases). The relationship of various clinicopathological features and prognosis with the E2F5 status, were analyzed.

RESULTS

In the clinicopathological analysis, the proportion of poorly-differentiated tumors was significantly higher in the E2F5-positive group than in the E2F5-negative group (p=0.027). The 5-year survival rate of the E2F5-positive group was 39.3%, which was significantly poorer than that of the E2F5-negative group (83.8%) (p=0.006). In multivariate analysis, the expression of E2F5 was one of the most important independent prognostic factors after radical esophagectomy.

CONCLUSION

The expression of E2F5 in ESCC may be correlated with a worse prognosis of patients with ESCC.

[Laparoscopic lateral lymph node dissection technique and short-term results in our hospital]

We perform preoperative chemoradiotherapy for patients with advanced lower rectal cancer in our department. In April 2012, we started laparoscopic lateral lymph node dissection for preventive dissection in patients without lateral lymph node enlargement on preoperative diagnosis. We compared the short-term results of laparoscopic lateral dissection with those of laparotomy.

SUBJECTS

The subjects comprised 43 patients undergoing lateral dissection by laparotomy( open group) and 5 patients undergoing laparoscopic lateral dissection (lap group).

RESULTS

There were no significant differences in the baseline characteristics of patients between the lap group and the open group. However, operative time (min) was significantly longer( 536.2 vs 324.8) and the volume of blood loss( g) was significantly lower( 139.0 vs 697.8) in the lap group. No significant differences were observed in the number of dissected lymph nodes, postoperative complications, or the duration of hospital stay.

CONCLUSION

Although the operative time was longer with laparoscopy-assisted lateral lymph node dissection, this procedure was safely performed with minimal blood loss. Our findings confirmed that there were no problems with standardization of this technique or oncological outcomes, and hence, we are examining the indications for therapeutic dissection.

[An appropriate distal resection margin for lower rectal cancer after preoperative chemoradiotherapy]

In recent years, with the increase in the adoption of anus-preserving surgery, understanding of residual lower rectal cancer distribution to the anal side after chemoradiotherapy (CRT) has become an increasingly important issue. We aimed to clarify the pathological safe distal resection margin for lower rectal cancer after preoperative CRT. This study included 36 patients with lower third rectal cancer, who underwent preoperative CRT. We classified the gross tumor appearance as type 0-II like, Borrmann type 2, and Borrmann type 5. Whole-mount sections were used for pathological examination. We examined all slides and measured the extent of residual cancer spread. In many cases, residual cancer was observed in the deeper layers of the lesion, and in none of the cases was the cancer limited to the superficial layer. With regard to lateral distribution, tumors with a type 0-II like appearance showed a wider extent of lateral cancer spread from the optimal margin. In conclusion, although CRT contributes to tumor reduction, attention should be paid to both circumferential and lateral residual cancer spread. Our results suggest that the lateral distribution of residual cancer spread could be predicted by gross tumor appearance. This is an ongoing study.

Influence of preoperative docetaxel, cisplatin, and 5-fluorouracil on the incidence of complications after esophagectomy for resectable advanced esophageal cancer

A limited number of patients with resectable advanced esophageal cancer can be cured by surgery alone. Although a regimen that consists of docetaxel, cisplatin, and 5-fluorouracil (DCF) is a potential preoperative chemotherapy (PCT) option for squamous cell carcinoma of the esophagus, the influence of DCF on subsequent esophagectomies remains unclear. A total of 80 patients who received preoperative DCF chemotherapy, and 174 patients who did not receive any preoperative treatment were retrospectively analyzed. There were no treatment-related deaths. No delays in surgery due to adverse events related to DCF were reported. Although patients who received PCT had significantly more advanced cancers and worse preoperative conditions, the incidence rates of complications did not increase. Although the frequency of severe complications was significantly higher in patients who received PCT, this treatment was not an independent factor for the occurrence of severe complications. PCT with DCF did not negatively affect subsequent esophagectomies with regard to the frequency of complications.

Methylation levels of LINE-1 in primary lesion and matched metastatic lesions of colorectal cancer

Background:

LINE-1 methylation level is a surrogate marker of global DNA methylation. LINE-1 methylation in primary colorectal cancers (CRCs) is highly variable and strongly associated with a poor prognosis. However, no study has examined LINE-1 methylation levels of metastatic CRCs in relation to prognosis or assessed the heterogeneity of LINE-1 methylation level within the primary CRCs.

Methods:

Pyrosequencing was used to quantify LINE-1 methylation level in 42 liver metastases, 26 matched primary tumours, and 6 matched lymph node (LN) metastases. KRAS, BRAF, and PIK3CA mutation status and microsatellite instability (MSI) status were also examined.

Results:

The distribution of LINE-1 methylation level in liver metastases was as follows: mean, 67.3; range, 37.1–90.1. Primary tumours showed LINE-1 methylation levels similar to those of matched liver and LN metastases. The difference in LINE-1 methylation level between superficial areas and invasive front areas was within 7.0 in all six cases evaluated. Prognostic impact of LINE-1 hypomethylation in liver metastases on overall survival was not observed. The concordance rate was 94% for KRAS, 100% for BRAF, 88% for PIK3CA, and 97% for MSI.

Conclusion:

Alteration of LINE-1 methylation level may occur in early CRC tumorigenesis, and the LINE-1 methylation level is relatively stable during CRC progression.

XB130 as an independent prognostic factor in human esophageal squamous cell carcinoma

BACKGROUND

Adaptor proteins, with multimodular structures, can participate in the regulation of various cellular functions. A novel adaptor protein XB130 has been implicated as a substrate and regulator of tyrosine kinase-mediated signaling and in controlling cell proliferation and apoptosis in thyroid and lung cancer cells. However, its expression and role in gastrointestinal cancer have not been investigated. We sought to determine the role of XB130 in cell cycle progression of esophageal squamous cell carcinoma (ESCC) cells and to examine its expression and effects on the prognosis of patients with ESCC.

METHODS

Expression of XB130 in human ESCC cell lines was analyzed by Western blot testing and immunofluorescent staining. Knockdown experiments with XB130 small interfering RNA (siRNA) were conducted, and the effect on cell cycle progression was analyzed. Immunohistochemistry of XB130 for 52 primary tumor samples obtained from patients with ESCC undergoing esophagectomy was performed.

RESULTS

XB130 was highly expressed in TE2, TE5, and TE9 cells. In these cells, knockdown of XB130 with siRNA inhibited G1-S phase progression and increased the expression of p21, the cyclin-dependent kinase inhibitor. Immunohistochemistry showed that 71.2% of the patients expressed XB130 in the nuclei and/or cytoplasm of the ESCC cells. Further, nuclear expression of XB130 was an independent prognostic factor of postoperative survival.

CONCLUSIONS

These observations suggest that the expression of XB130 in ESCC cells may affect cell cycle progression and impact prognosis of patients with ESCC. A deeper understanding of XB130 as a mediator and/or biomarker in ESCC is needed.

[Lumbar spinal nerve roots imaging using balanced sequence with inversion recovery (IR) pulse]

We devised a method for visualizing the distal portion of lumbar spinal nerve roots in the direction of the long axis using a three-dimensional balanced sequence with inversion recovery pulse, and we established the imaging parameters. This pulse sequence was used with the following parameters: 260 mm field of view, 4.8 ms repetition time, 2.4 ms echo time, 90 degree flip angle, 1.5 mm slice thickness (0.75 mm overlap), and low-high radial k-space profile order. We assessed the signal intensity and contrast for the phantom and healthy volunteer images with different inversion times (TI). Moreover, we evaluated this method by using the optimal TI in clinical cases. The optimal TI obtained from the phantom and human studies was 600 ms. In clinical cases, this method with 600 ms of TI provided the best definition in images of abnormal pathway and compression of the lumbar spinal nerve roots. Our imaging method makes it possible to clearly and noninvasively visualize the lumbar spinal nerve roots.