[A Case of Multicentric HER2-Positive Breast Cancer with Alterations of the Intrinsic Subtype]

In cases where there are 2 or more tumors, it is crucial to conduct core needle biopsies on each of them. A 39-year-old woman presented at our hospital with pain in her left breast. Ultrasonography(US)revealed the presence of 2 contiguous tumors: a 35 mm tumor(tumor 1)and a 20 mm tumor(tumor 2)in the AC area of the left breast. US-guided core needle biopsies(CNB)were performed. The histological findings confirmed an invasive ductal carcinoma, characterized by ER(-)/ PR(-)/HER2(3+). Neoadjuvant chemotherapy indicated tumor 1 as PD and tumor 2 as PR, and surgery was subsequently performed(Bt plus SLN). Upon histopathological examination, the findings demonstrated a non-pCR invasive ductal carcinoma, featuring an ER(+)/PR(-)/HER2(-)profile. Depending on the specific subtype identified, post-operative treatment included HER2-targeted therapy or ER/PR-targeting hormone therapy in conjunction with chemotherapy.

[A Case of Splenectomy for Isolated Splenic Metastasis after Surgery for Gastric Cancer]

Splenic metastasis of gastric cancer is rare. Cases of long-term survival after the resection of metachronous solitary splenic metastasis have been reported, and proactive resection should be performed. A 77-year-old man was presented to our hospital with anorexia. Further investigation showed type 2 gastric cancer in the greater curvature of the stomach in the lower body. Subsequently distal gastrectomy was performed on October 2018. The pathological stage was T3N2M0, Stage ⅢA, and the patient was treated with S-1 as adjuvant chemotherapy for 1 year. Two years after surgery, enhanced computed tomography(CT)showed a solitary splenic tumor with a diameter of 10 mm. Six months later, the tumor had grown to 25 mm, and PET-CT revealed no other tumors. Thus we diagnosed the patient as metachronous solitary splenic metastasis of gastric cancer, and splenectomy was performed on June 2021. Histopathological diagnosis was a metastasis of gastric cancer. The patient was treated with S-1 and remains recurrence-free for 1 year after the second operation.

[A Case of Long-Term Survival of Anaplastic Transformation of Thyroid Cancer in Lymph Node Metastasis Due to Radiation Therapy and Lenvatinib]

An 82-year-old woman who underwent total thyroidectomy and left cervical lymph node dissection 21 years ago admitted our hospital because of left cervical pain. Neck CT scan showed a 6 cm tumor on the left clavicle. Pathological diagnosis by needle biopsy revealed poorly differentiated to undifferentiated carcinoma, positive for TTF-1, and diagnosed as thyroid cancer lymph node metastasis anaplastic transformation. Administration of lenvatinib was started after radiation therapy. Since thrombocytopenia was observed, lenvatinib was gradually reduced from 14 mg and the dose was continued at 4 mg. The tumor shrinked and the effect of chemotherapy was partial response. She survived for 3 years while continuing lenvatinib. We reported long-term survival due to radiation therapy and lenvatinib of anaplastic transformation of thyroid cancer in lymph node metastasis due to radiation therapy and lenvatinib.

[A Case of Hepatectomy for Primary Hepatic Neuroendocrine Tumor, Preoperatively Diagnosed with Hepatocellular Carcinoma]

A 65-year-old man has pointed out a hepatic tumor when he was rushed to the hospital because of disturbance of consciousness associated with hypoglycemia. Abdominal dynamic CT images showed a tumor, 2.5 cm in diameter, in S2/3 close to the umbilical portion of the portal vein, and it had enhancement in the arterial phase and became washout in the portal phase. We performed left lateral segmentectomy with a diagnosis of hepatocellular carcinoma. The tumor was histopathologically diagnosed as a Grade 1 neuroendocrine tumor(NET). As additional examinations could not detect a primary lesion in any other site, the tumor was considered as a primary hepatic NET(PHNET). PHNETs are rare and because of the possibility that an unknown primary lesion exists, we have to observe for years carefully.

[A Case of Retroperitoneal Primary Well-Differentiated Liposarcoma Treated by Laparoscopic Surgery]

A 76-year-old woman visited the hospital due to occult blood in her urine. An abdominal CT scan showed a low-density tumor inside the left iliopsoas muscle in the retroperitoneum, and a well-differentiated liposarcoma was suspected. Therefore, laparoscopic tumor resection was performed. The tumor was on the inside of the left iliopsoas muscle, without any invasion around it. The macroscopic appearance of the resected tumor showed a yellow, fat-like, solid mass and it was histopathologically diagnosed as a well-differentiated liposarcoma. We conclude that a retroperitoneal primary well-differentiated liposarcoma can be treated by laparoscopic surgery, as in our case.

[A Case of Curative Resection of Locally Advanced Gastric Cancer after Nutrition Therapy and Chemotherapy with S-1 and Oxaliplatin Using Elemental Diet Tube]

We report a case of advanced gastric cancer with stenosis under severe malnutrition, in which nutritional treatment along with chemotherapy using an elemental diet(ED)tube led to complete resection of the tumor. A 66-year-old man who presented with difficulty in dietary intake came to our hospital. He was emaciated with a body mass index(BMI)score of 13.5 and a prognostic nutritional index(PNI)score of 33.8 and was admitted to the hospital for an emergency. He was diagnosed with advanced gastric cardia cancer invading the distal pancreas, spleen, and left diaphragm(U, type 3, tub2, cT4bN3M0, cStage ⅢC, HER2 score 0). There was obstruction of the passage of food due to the tumor, we performed nutrition therapy and chemotherapy consisting of 3 courses of S-1 and oxaliplatin using an ED tube. After chemotherapy, the primary tumor and lymph nodes were reduced, and we performed total gastrectomy with D2 lymph node, distal pancreas, spleen, and left partial diaphragm dissection. Histopathological diagnosis was ypT4aN1M0, ypStage ⅢA, indicating a pathological partial response(Grade 1). Adjuvant chemotherapy was performed for 6 months, and there has been no relapse for 3 years since the operation.

[A Case Report of Lung Resection for Lung Metastasis from Pancreatic Cancer]

A 66-year-old man had an elevated CEA level. Further examinations showed a pancreatic head tumor. A pancreaticoduodenectomy was then performed. The histopathological examination showed a mixed tumor of papillary adenocarcinoma and neuroendocrine cancer. In addition, a tumor in the upper lobe of the right lung was found 18 months after the initial pancreatic resection, and the bronchoscope indicated lung metastasis. The patient underwent partial pneumonectomy. After the pneumonectomy, he received S-1 chemotherapy. Thirty -nine months after the pneumonectomy, CEA was slightly elevated. We changed the chemotherapy to gemcitabine and nab-paclitaxel without further examinations to confirm the recurrence. The patient discontinued chemotherapy after CEA fell within the normal range. He has been alive without tumor relapse for 64 months since the second operation for the lung metastasis. We report a successful case of lung resection for lung metasta- sis from pancreatic cancer.

Huge mucinous carcinoma of the breast in which doubling time was observed by computed tomography during 3 years without treatment

Here we report the case of a 77-year-old woman with a huge cancer of the right breast for which size was measured on computed tomography in our hospital preoperatively and in other hospital 3 years earlier. During the 3-year untreated interval, the tumor grew from 4 cm to 13 cm in maximum diameter, and the tumor-volume doubling time (TVDT) was calculated as 209 days. The patient underwent mastectomy with axillary lymph node dissection, with the large skin defect covered by autologous skin graft. The pathological diagnosis was pure mucinous carcinoma (MC) of the breast with a low MIB-1 index, no vessel invasion, and no lymph node metastasis. Breast MC has been known to show a slow growth rate, but the TVDT of this current tumor was not markedly different from that of common breast cancers described in previous reports. This short TVDT notwithstanding the low aggressiveness may be due to abundant mucin occupying the majority of the tumor volume. To the best of our knowledge, no previous reports have provided accurate TVDTs for breast MC.

[A Case of Rectal Gastrointestinal Stromal Tumor(GIST)with Long-Term Survival Treated with Multidisciplinary Therapy]

We report a case of gastrointestinal stromal tumor(GIST)with long-term survival treated by multidisciplinary therapy, including surgery and imatinib to prevent repeated recurrence. A 76-year-old woman visited our hospital with difficulty in defecation and bloody bowel discharge. She was diagnosed with rectal GIST and underwent transanal partial resection of the rectum. Local recurrence occurred 1 year after the operation, and the tumor was resected transanally. Hepatic metastasis occurred 8 months after the second operation. The patient was administered imatinib for 2 months, which caused the tumor to shrink, and extended left lobectomy was performed. Imatinib was administered for 2 years after hepatectomy. After another 2 years, metastasis to the liver and thoracic and lumbar vertebrae occurred. The recurrent tumors reverted to cystic lesions after 6 months of imatinib treatment. She has been alive without tumor progression during re-treatment with imatinib for 7 years(13 years after the first surgery).

[A Case of Treated with Laparoscopic Surgery for Intussusception Up to the Splenic Flexion Region Due to Cecum Cancer]

A 93-year-old woman was admitted to the hospital because of respiratorydiscomfort. A chest CT scan indicated aspiration pneumonitis and, simultaneously, intussusception was observed in the splenic flexure region. Abdominal enhance CT scan revealed a tumor in the advanced region of intussusception. Laparoscopy-assisted ileocecal resection was performed. Since the intussusception was difficult to reduce laparoscopically, the ileocecum was mobilized and the intussusception was reduced manually. In the resected specimen, a type 1 tumor was observed in the cecum and histopathologic ally diagnosed as cercal cancer. We report a case with intussusception due to colorectal cancer treated bylaparoscopic surgery.

[A Case of Paget-Type Recurrence 20 Years after Breast Conserving Surgery for Invasive Ductal Carcinoma]

We report an 85-year-old female suffered Paget-type recurrence at right remnant breast. The patient had undergone breast conserving surgery(BCS)20 years ago in another hospital for invasive ductal carcinoma of the right breast(pT1N0M0, Stage I ). Her chief complain was a skin ulcer of the right nipple. The pathological diagnosis for biopsy specimen from the areola was Paget's disease. She underwent total mastectomy. Paget cells were detected pathologically in the epidermis of the nipple and nearby mammary duct connected with fibrous tissue after BCS, suggesting Paget-type recurrence of invasive breast carcinoma.

Doublecortin and CaM kinase-like-1 as an independent prognostic factor in patients with resected pancreatic carcinoma

AIM

To elucidate the effect of expression of doublecortin and CaM kinase-like-1 (DCLK1) in patients with pancreatic ductal adenocarcinoma (PDAC).

METHODS

Tumor specimens were obtained from 136 patients with pancreatic cancer who had undergone resection without preoperative therapy between January 2000 and December 2013 at the Department of Surgical Oncology, Osaka City University. The resected specimens were analyzed for associations with clinicopathological data, including DCLK1 expression, epithelial mesenchymal transition (EMT) marker expression, and cancer stem cell (CSC) marker expression. Univariate and multivariate survival analyses were performed and we assessed the association between DCLK1 expression and clinicopathological factors, including the EMT marker and CSC marker.

RESULTS

In total, 48.5% (66/136) of the pancreatic cancer samples were positive for DCLK1. Patients with DCLK1-positive tumors had significantly shorter survival times than those with DCLK1-negative tumors (median, 18.7 mo vs 49.5 mo, respectively; P < 0.0001). Positive DCLK1 expression correlated with histological grade (P = 0.0290), preoperative CA19-9 level (P = 0.0060), epithelial cell adhesion molecule (EpCAM) expression (P = 0.0235), and the triple-positive expression of CD44/CD24/EpCAM (P = 0.0139). On univariate survival analysis, five factors were significantly associated with worse overall survival: histological grade of G2 to G4 (P = 0.0091), high preoperative serum SPan-1 level (P = 0.0034), R1/2 (P < 0.0001), positive expression of DCLK1 (P < 0.0001) or CD44 (P = 0.0245). On multivariate survival analysis, R1/2 [odds ratio (OR) = 2.019, 95% confidence interval (CI): 1.380-2.933; P = 0.0004] and positive DCLK1 expression (OR = 1.848, 95%CI: 1.2854-2.661; P = 0.0009) were independent prognostic factors.

CONCLUSION

DCLK1 expression was found to be an independent prognostic factor and it may play a crucial prognostic role by promoting acquisition of stemness.

Preoperative predictors for early recurrence of resectable pancreatic cancer

Background

The first-line treatment for resectable pancreatic cancer (RPC) is surgical resection. However, our patients have often experienced early recurrence after curative resection for RPC, with desperately poor prognosis. Some reports indicated that minimally distant metastasis not detected at operation might cause early recurrence. The present study aimed to identify preoperative clinicopathological features of early recurrence after curative resection of RPC.

Methods

Ninety RPC patients who underwent curative resection between 2000 and 2014 at our institution were retrospectively analyzed.

Results

Of the 90 patients, 32 had recurrence within 1 year. Univariate analysis demonstrated that preoperative serum carbohydrate antigen (CA19-9) ≥529 U/mL (P = 0.0011), preoperative serum s-pancreas-1 antigen (SPan-1) ≥37 U/mL (P = 0.0038), and histological grades G2–G4 (P = 0.0158) were significantly associated with recurrence within 1 year after curative resection. Multivariate analysis demonstrated that preoperative serum CA19-9 ≥ 529 U/mL (P = 0.0477) and histological grade G2–G4 (P = 0.0129) were independent predictors of recurrence within 1 year. Recurrent cases within 1 year postoperatively had significantly more distant metastasis than cases with no recurrence within 1 year (P < 0.001).

Conclusions

Preoperative serum CA19-9 ≥ 529 U/mL and histological grades G2–G4 were independent predictive factors for recurrence within 1 year after pancreatectomy for RPC. Furthermore, recurrent cases within 1 year had more frequent distant metastasis than cases with no recurrence within 1 year. These results suggest that RPC patients with preoperative serum CA19-9 ≥ 529 U/mL should receive preoperative therapy rather than surgery.

Additional surgical resection after endoscopic mucosal dissection for early gastric cancer: A medium-sized hospital's experience

PURPOSE

In Japan, the majority of early gastric cancers (EGCs) are now treated with endoscopic submucosal dissection (ESD). Patients with non-curative lesions treated by ESD are advised to undergo additional surgical resection (ASR) based on guidelines from the Japan Gastroenterological Endoscopy Society (JGES) and Japanese Gastric Cancer Association (JGCA). However, many studies have demonstrated that residual cancer and lymph node metastasis are only rarely found in ASR specimens. Here we retrospectively analyzed the conditions that could enable the avoidance of unnecessary ASR.

METHODS

The ESD data for 114 absolute indication lesions and 26 lesions of expanded indication lesions were analyzed. The indications and the curability were evaluated according to the JGES/JGCA guidelines.

RESULTS

The rates of non-curative resection and ASR were significantly higher in the expanded indication group compared to the absolute indication group (26.9% and 19.2% vs. 7.9% and 0.9%, respectively). ASR was performed for six patients. Three of their ARS specimens contained neither residual cancer nor lymph node metastasis, and the pathological findings of the preceding ESD specimens deviated slightly from the curative criteria defined by the guidelines. The conditions of the lesions that did not meet the curative criteria were as follows: (1) sm1 invasion of undifferentiated-type lesion <10 mm dia., (2) 21-25 mm dia. mucosal undifferentiated-type lesion, or (3) peacemeal resection with a horizontal margin positive for the mucosal differentiated-type.

CONCLUSIONS

These data suggest that a close follow-up without ASR might be appropriate for patients in the above-mentioned three categories after non-curative ESD for EGC.

Establishment and characterization of new cell lines of anaplastic pancreatic cancer, which is a rare malignancy: OCUP-A1 and OCUP-A2

BACKGROUND

Anaplastic pancreatic cancer (APC) cell lines have been scarcely established.

METHODS

The morphology, gene expressions, karyotyping and epithelial-mesenchymal transition markers of newly established APC cell lines OCUP-A1 and OCUP-A2 were analyzed. Their abilities of proliferation under normoxia and hypoxia, migration and invasion were compared to 4 commercially available pancreatic ductal adenocarcinoma (PDA) cell lines. Their induction of angiogenesis, stem-like cell population and subcutaneous tumor growth in nude mice were estimated, comparing 2 PDA cell lines examined here.

RESULTS

OCUP-A1 and OCUP-A2 cells continuously grew with spindle and polygonal shapes, respectively. Gene analysis revealed 9 gene mutations including KRAS and TP53. Karyotyping clarified numerical structural abnormalities in both cells. Loss of E-cadherin and expression of vimentin in both cell lines were observed. The doubling time of both cell lines was approximately 20 h. Proliferation, migration and invasion abilities were not notable compared to other PDA cell lines. However stem-like cell population of both cell lines was superior to a part of PDA cell lines. Moreover OCUP-A1 showed stronger hypoxia tolerance and induction of angiogenesis than other PDA cell lines. The tumorigenicity in vivo of OCUP-A2 was stronger than conventional PDA cell lines.

CONCLUSIONS

The OCUP-A1 and OCUP-A2 cell lines of rare malignancies might be useful for investigating the biology of pancreatic cancer.

[Complete Response to Chemotherapy after Resection of Rectal Cancer with Virchow's Lymph Node Metastasis]

A 62-year-old woman was admitted to our hospital because of bloody stool. Colonoscopy revealed stenosis by a type 2 tumor of the recto-sigmoid colon. A biopsy specimen contained moderately differentiated adenocarcinoma. Thoraco-abdominal computed tomography (CT) showed liver metastasis (S7, 10 mm) and enlargement of Virchow's lymph node (17 mm) and several para-aortic lymph nodes (15 mm on average). Because of oozing from the tumor and severe stenosis of the recto-sigmoid colon, we performed laparoscopic-assisted high anterior resection of the primary lesion. After surgery, 3 courses of mFOLFOX6, 20 courses of mFOLFOX6 plus bevacizumab, and 5 courses of infusional 5-FU plus Leucovorin plus bevacizumab were administered. Thoraco-abdominal CT demonstrated complete response to the 1 year 2 months of chemotherapy. The patient has been alive without relapse for 2 years after surgery.

Salvage surgery after chemotherapy with S-1 plus cisplatin for α-fetoprotein-producing gastric cancer with a portal vein tumor thrombus: a case report

BACKGROUND

Patient with α-Fetoprotein (AFP)-producing gastric cancer usually has a short survival time due to frequent hepatic and lymph node metastases. Gastric cancer with portal vein tumor thrombus (PVTT) is rare and has an extremely poor prognosis.

CASE PRESENTATION

A 63-year-old man was found to have a huge Type 3 gastric cancer with a PVTT and a highly elevated serum AFP level. Chemotherapy with S-1 plus cisplatin was given to this patient with unresectable gastric cancer for 4 months. The serum AFP level decreased from 6,160 ng/mL to 60.7 ng/mL with chemotherapy. Since the PVTT disappeared after the chemotherapy, the patient underwent total gastrectomy. Histological findings of the primary tumor after chemotherapy showed poorly differentiated adenocarcinoma without hepatoid cells and viable tumor cells remaining in less than 1/3 of the neoplastic area of mucosa and one lymph node. The cancerous cells were immunohistochemically stained by anti-AFP antibody. The patient has survived for 48 month without recurrence.

CONCLUSIONS

AFP-producing gastric cancer with a PVTT has an extremely poor prognosis, but long-term survival was achieved for this dismal condition by salvage surgery after chemotherapy.

Clinical and pathological features of five-year survivors after pancreatectomy for pancreatic adenocarcinoma

BACKGROUND

Clinical factors determining short-term survival after pancreatectomy have been well studied, but factors predicting long-term survival with curative resection are poorly understood in pancreatic carcinoma. Our objective was to identify clinical and pathological features of five-year disease-free survivors after surgical resection of pancreatic adenocarcinoma.

METHODS

The clinical and pathological data from 147 patients who underwent a potentially curative resection for pancreatic adenocarcinoma at our institution between 1988 and 2012 were retrospectively analyzed.

RESULTS

Of 147 patients, 18 survived for more than five years after surgery without disease recurrence. A univariate analyses demonstrated that: two or fewer lymph node metastases (P=0.014), a preoperative serum carbohydrate antigen 19-9 (CA19-9) level of 40 U/mL or less (P=0.0018), an absence of intrapancreatic nerve invasion (P=0.028), and undergoing an R0 resection (P=0.011) were significantly associated with five-year survival. A logistic regression model identified the following independent cancer-related predictors of five-year survivors: having two or fewer lymph node metastases (odds ratio (OR): 6.02; 95% confidence interval (CI): 1.08 to 112.98; P=0.0385), a preoperative serum CA19-9 level of 40 U/mL or less (OR: 5.02; 95% CI: 1.68 to 16.48; P=0.0036), and undergoing an R0 resection (OR: 3.63; 95% CI: 1.12 to 14.28; P=0.0316).

CONCLUSIONS

We conclude that number of lymph node metastases being two or less, a preoperative serum CA19-9 level of 40 U/mL or less, and undergoing an R0 resection may be independent predictive factors to identify actual five-year survivors after pancreatectomy for pancreatic adenocarcinoma.

[A case of a villous tumor of the rectum with electrolyte depletion syndrome]

We report a case of a villous tumor of the rectum with electrolyte depletion syndrome (EDS). A 76-year-old woman developed general fatigue, and on investigation, we found a large laterally spreading tumor of the rectum using bowel enema and colon fiber. Pathologically, the biopsy specimen was graded Group 4. We intended to perform a laparoscopy-assisted low anterior resection in the patient. However, the operation was interrupted by a short-run type of ventricular premature contraction (VPC) due to EDS-induced hypokalemia. After treating the hypokalemia, low anterior resection or laparotomy was performed. The tumor was 19 × 13 cm in size and occupied the circumference of the rectum. Histological examination revealed well differentiated tubular adenocarcinomas with tubulovillous adenoma. Pathological staging was pTis, pN0, M0, stage 0 according to the Japanese Classification of Colorectal Carcinoma (8th edition). It is now 6 months after the operation and hypokalemia has not recurred in the patient.

Predictive factors for change of diabetes mellitus status after pancreatectomy in preoperative diabetic and nondiabetic patients

INTRODUCTION

This study aimed to determine risk factors for exacerbation of diabetes mellitus (DM) after pancreatectomy.

METHODS

Medical records of 167 patients with benign and malignant pancreaticobiliary diseases who underwent pancreaticoduodenectomy or distal pancreatectomy were retrospectively analyzed. DM was diagnosed by diabetic history or American Diabetes Association criteria. Worsened and improved DM after pancreatectomy was defined when treatment intensity or insulin/oral antidiabetic drug dosage increased or decreased, respectively, postoperatively. Long-standing DM was defined as a duration of >2 years.

RESULTS

In 76 preoperative diabetic patients, worsened and improved DM was observed postoperatively in 46 (60.5 %) and 9 (11.8 %) patients, respectively. In 91 preoperative nondiabetic patients, 22 (24.2 %) developed new-onset DM after pancreatectomy. Multivariate logistic analysis of the preoperative diabetic patients demonstrated long-standing DM and malignancy as independent predictors for postoperative worsened DM. No patients with long-standing DM or insulin treatment experienced improved DM after pancreatectomy. Multivariate logistic analysis of the preoperative nondiabetic patients showed body mass index of ≥25 and hard pancreatic texture as independent risk factors for new-onset postoperative DM.

CONCLUSIONS

These results may enable preoperative evaluation of risk factors for worsened or new-onset DM after pancreatectomy and may help plan intensive care for patients at a high risk of postoperative worsened DM.

MUC1 and HER2 might be associated with invasive phenotype of intraductal papillary mucinous neoplasm

BACKGROUND/AIMS

The purpose of this study was to clarify the biomarkers which distinguish invasive Intraductal papillary mucinous neoplasms (IPMNs) from noninvasive IPMNs.

METHODOLOGY

In tumor specimens from sixty patients with IPMNs (42 noninvasive IPMNs and 18 invasive IPMNs) who underwent surgical resection at our institute, we analyzed the correlation between the immunohistochemical expression level of MUC1, MUC2, MUC4, MUC5AC, p53, VEGFR2, HER2, and HER3.

RESULTS

The 5-year survival rate was 100% in noninvasive IPMNs, while that of invasive IPMNs was only 36.5%. MUC1, MUC4, HER2 and HER3 were significantly associated with invasive IPMNs in univariate analysis. Multivariate analysis revealed that MUC1 and HER2 were significantly associated with invasive IPMNs. The 5-year survival of IPMN patients with either MUC1-positive and/or HER2-positive (54.5%) is significantly poorer than that of IPMN patients with MUC1 negative and HER2 negative (100%).

CONCLUSIONS

MUC1 and HER2 might be closely associated with invasive phenotype of IPMNs.

[A case of obstruction due to right-sided colon cancer in which good quality of life was achieved after colonic stenting]

We report a case of a 60-year-old woman with abdominal distension who was treated with self-expandable metal stent (SEMS) placement in the proximal transverse colon. She was found to have severe bowel obstruction due to advanced transverse colon cancer on plain computed tomography (CT) and colonoscopy. We performed colonic stenting safely, and the symptom promptly improved. Defecation and flatus were observed on the same day of stenting, and the patient was able to start drinking and eating on the next day. Enhanced abdominal CT revealed multiple liver metastasis, peritoneal dissemination, ascites, and cystic ovarian tumor. After treatment with 1 course of 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6), the patient was discharged on day 14 after admission. The rapidly enlarging ovarian tumors and primary colonic lesion with SEMS were surgically removed after treatment with mFOLFOX6 for 4 months in an outpatient basis. The patient has been alive with a good quality of life (QOL) and being treated with bevacizumab plus mFOLFOX6/Leucovorin, 5-fluorouracil, and irinotecan( FOLFIRI) for 6 months. SEMS placement could be safe and effective for the treatment of obstruction of the right colon, and could maintain a good QOL in patients.

In vitro effects of lapatinib with gemcitabine for pancreatic cancer cells

BACKGROUND/AIMS

We investigated whether lapatinib plus gemcitabine has synergistic or antagonistic effects on the pancreatic cancer cell lines MiaPaca-2 and PANC-1. Furthermore, the changes of gemcitabine sensitivity-related genes by lapatinib treatment were examined.

METHODOLOGY

The effects of lapatinib, gemcitabine, and combined treatment with both agents on cell viability were examined by methyl thiazolyl tetrazolium analysis. Synergy between lapatinib and gemcitabine was assessed by median effect analysis. The mRNA amounts of human equilibrative nucleoside transporter (hENT1), deoxycytidine kinase (dCK) and ribonucleotide reductase subunit M1 (RRM1) genes were measured by quantitative real-time polymerase chain reaction in cells exposed to lapatinib for 48 h, as compared with untreated cells.

RESULTS

No synergistic effects were observed with combined treatment in either cell line. In contrast, antagonistic effects occurred on MiaPaca-2 cells with the two agents. Specific changes in gemcitabine sensitivity-related genes induced by lapatinib were not detected in either MiaPaca-2 or PANC-1.

CONCLUSIONS

Lapatinib may not enhance the anti-tumor effects of gemcitabine for pancreatic cancer.

Prognostic indicator for the resection of liver metastasis of colorectal cancer

PURPOSE

We investigated the predictive indicator for a good prognosis of surgical resection for liver metastasis of colorectal cancer.

METHOD

Between 1990 and 2009 at our institute, 117 patients underwent 132 hepatic resections for liver metastasis of colorectal cancer. The clinical, pathological, and outcome parameters affecting their prognoses were analyzed. The extent of the liver metastases was subdivided according to the Japanese Classification of Colorectal Carcinoma (JCCRC), and the patients were classified into different grades based on the JCCRC classification and the status of the nodal involvement of the primary tumor.

RESULT

The median survival time (MST) of the 117 patients was 58 months, and the actuarial survival rates at 1, 3, and 5 years were 92.3, 60.0, and 46.1 %, respectively. A multivariate analysis revealed that the JCCRC Grade classification was an independent prognostic indicator (Grade A vs. B vs. C: MST, 72 vs. 41 vs. 23 months; 5-year survival, 59.0 vs. 38.6 vs. 0 %: p < 0.0001).

CONCLUSION

Our findings indicate that the JCCRC Grade classification for liver metastasis of colorectal cancer is a significant prognostic indicator and may be useful for making decisions regarding the treatment of liver metastasis.

IGF-1 receptor and IGF binding protein-3 might predict prognosis of patients with resectable pancreatic cancer

BACKGROUND

The present study aimed to elucidate the clinicopathologic role of insulin-like growth factor-1 receptor (IGF1R) and IGF binding protein-3 (IGFBP3) in patients with pancreatic cancer. The function of IGFBP3 is controversial, because both inhibition and facilitation of the action of IGF as well as IGF-independent effects have been reported. In this study, IGF1R and IGFBP3 expression was examined, and their potential roles as prognostic markers in patients with pancreatic cancer were evaluated.

METHODS

Clinicopathological features of 122 patients with curatively resected pancreatic cancer were retrospectively reviewed, and expression of IGF1R and IGFBP3 was immunohistochemically analyzed.

RESULTS

Expression of IGF1R and IGFBP3 was observed in 50 (41.0%) and 37 (30.3%) patients, respectively. IGF1R expression was significantly associated with histological grade (p = 0.037). IGFBP3 expression had a significant association with tumor location (p = 0.023), and a significant inverse association with venous invasion (p = 0.037). Tumors with IGF1R-positive and IGFBP3-negative expression (n = 32) were significantly frequently Stage II and III (p = 0.011). The prognosis for IGF1R positive patients was significantly poorer than that for IGF1R negative patients (p = 0.0181). IGFBP3 protein expression did not correlate significantly with patient survival. The subset of patients with both positive IGF1R and negative IGFBP3 had worse overall survival (8.8 months versus 12.6 months, respectively, p < 0.001).

CONCLUSION

IGF1R signaling might be associated with tumor aggressiveness, and IGFBP3 might show antiproliferative effects in pancreatic cancer. Both high IGF1R expression and low IGFBP3 expression represent useful prognostic markers for patients with curatively resected pancreatic cancer.

Impact of preoperative diabetes mellitus on clinical outcome after pancreatectomy

PURPOSE

The goal of this study was to review published literature regarding the impact of preoperative diabetes mellitus (DM) in patients undergoing pancreatectomy.

METHODS

Ovid Medline(®) of a biomedical database was used on subjective literature research.

RESULTS

The prevalence of preoperative DM was 30.9-54.9% in patients with pancreatic cancer and was 5.3-10.8% in patients with chronic pancreatitis. There were few reports that described the relationship between preoperative DM status and postoperative morbidity/mortality, or long-term survival after pancreatectomy. The incidence of pancreatic fistula of Grade B and C [defined by International Study Group on Pancreatic Fistula Definition (ISGPF)] was similar when comparing patients with and without preoperative DM. Furthermore, the incidence of death and various morbidities (e.g., infections, cardiovascular complications, clinically significant level of acute renal failure after pancreatectomy, and delayed gastric emptying after pancreaticoduodenectomy) were not significantly different when comparing patients with and without preoperative DM. It is unclear whether preoperative DM has an impact on long-term survival after pancreatectomy, and the difficulty in assessing this parameter may be due to different definitions of DM, different surgical methods, and different comorbidities when comparing different studies.

CONCLUSIONS

The occurrence rates of postoperative mortality and morbidities including pancreatic fistula and renal failure of moderate to severe degrees were almost same between patients with and without preoperative DM. The influence of preoperative DM on long term survival after pancreatectomy should be elucidated by future studies under accurate and consistent definitions of DM.

Immunohistochemical study on cathepsin-B and cathepsin-d in pancreatic-cancer

Lysosomal enzymes, cathepsin B and D, have been studied in their possible relationship to the ability of malignant cells to invade and metastasize. In the current investigation, these cathepsins were detected immunohistochemically using avidin-biotin-peroxidase complex method in the pancreatic cancer cells of 21 patients. The positive rate of identification of cathepsin B and D was 43% and 81%, respectively. Cathepsin D stained more strongly than cathepsin B and the plasma membrane stained quite strongly in two instances. A correlation between the presence of cathepsin B or D in cancer cells and the degree of metastasis to lymph nodes, liver, or lung was not recognized.

Combined evaluation of urokinase-type plasminogen activator and plasminogen activator inhibitor-2 expression in gastric carcinoma

Urokinase-type plasminogen activator (UPA) is a serine protease implicated in cancer invasion and metastasis. There are at least two kinds of specific inhibitor which act on UPA: plasminogen activator inhibitor-1 (PAI-1) and plasminogen activator inhibitor-2 (PAI-2). It has been reported that both UPA and PAI-1 antigen levels are associated with short survival in patients with breast cancer. In this study, we investigated the correlation between the expression of UPA, PAI-2 and prognosis in gastric carcinoma. One hundred and twenty specimens resected from patients with gastric carcinoma were investigated by staining with monoclonal antibodies against UPA and PAI-2. UPA positive rate was significantly higher in patients with liver metastases than in those without such metastases, There was no significant association between PAI-2 expression and clinicopathologic factors. However, patients with UPA-positive and PAI-2-negative tumors had more advanced cancer than other patients. According to the prognosis, the patients with UPA-positive and PAI-2-negative tumors had a significantly poorer prognosis than other patients. In conclusion, the combined evaluation of UPA and PAI-2 expression is associated with tumor progression in gastric cancer.

New radioimmunoassay for pancreatic cancer-associated antigen span-1 with reference to differential-diagnosis and monitoring in pancreatic-cancer

Sera from patients with various malignant benign disorders, as well as from a large number of healthy blood donors (2197). were analyzed with a newly developed SPan-1 coated bead radioimmunoassay. Only 0.9% of the healthy patients had SPan-1 levels above the cut-off value. SPan-1 antigen levels were elevated in 89.2% of sera from pancreatic cancer patients and in 75% of T1 and T2 cancers. High diagnostic accuracy was also recognized in differentiating benign pancreatic diseases from pancreatic cancers. SPan-I levels decreased after pancreatic resection and rose again at recurrence of disease. SPan-1 could be distinguished from other tumor markers such as DU-PAN-2 and OC-125 by competition radioimmunoassays and was elevated in individuals with malignant gastrointestinal diseases who had normal levels of either or both CEA and CA 19-9 antigens. This rapid. reproducible and sensitive assay for SPan-I appears to be a useful procedure for the detection and follow-up of pancreatic cancer.

Association between hsp60 messenger-RNA levels and Cisplatin resistance in human head and neck-cancer cell-lines

Development of resistance to cisplatin (cDDP) is a major obstacle in the cure of many cancers. Recently, a cDNA from cDDP-resistant human ovarian carcinoma cells was identified as the mitochondrial hsp60 chaperonin. The aim of this study was to determine the changes in expression of hsp60 during selection for cDDP resistance in two head and neck cancer cell lines, UMSCC5 and UMSCC10b and whether the emergence of resistance could be correlated with the level of hsp60 expression. We have selected cDDP-resistant variants of two squamous cell carcinoma cell lines, the UMSCC5 and UMSCC10b with levels of resistance varying from 1.5 to 6-fold. Concomitant with the emergence of resistance, the basal level of hsp60 increased 2 to 3-fold. In addition, less cDDP resistance as well as lower hsp60 levels were detected in cDDP resistant variants of the UMSCC10b cell line when selected in the presence of tamoxifen, suggesting a correlation between the intrinsic level of hsp60 expression and cDDP resistance. Using linear regression analysis both UMSCC5 and UMSCC10b cell lines demonstrated a high degree of correlation with coefficients of 0.91 and 0.90, respectively. In conclusion, the expression of hsp60 was closely related to the development of cDDP resistance and could be used as a marker for the emergence of cDDP resistance.

Predictive value of expression of ERCC 1 and GST-p for 5-fluorouracil/oxaliplatin chemotherapy in advanced colorectal cancer

BACKGROUND/AIMS

The aim of this study was to determine whether expression of the excision repair cross complementing protein (ERCC1), glutathione S-transferase pi (GST-p) and thymidylate synthase (TS) predict response in patients with advanced colorectal cancer treated with 5-fluorouracil/oxaliplatin chemotherapy.

METHODOLOGY

The study population consisted of 39 patients with advanced colorectal cancer (median age, 65 years). Patients were treated with the modified FOLFOX 6 regimen. The expression of ERCC-1, GST-p and TS of primary tumors were examined by immunohistochemistry.

RESULTS

The response rate of modified FOLFOX 6 chemotherapy was 51.3%. The positive rates of ERCC-1, GST-p and TS were 43.6%, 33.3% and 66.7%, respectively. The patients without ERCC-1 (p=0.0248) or GST-p? (p=0.0019) expression were more likely to respond to chemotherapy. TS expression did not correlate with chemotherapeutic response.

CONCLUSIONS

Immunohistochemical studies for ERCC-1 and GST-p may be useful in prediction of the response to 5-fluorouracil/oxaliplatin chemotherapy in advanced colorectal cancer patients.

Abstract 3380: Comparison proteome analysis of scirrhous gastric carcinoma stem cell-like SP and hypoxia-resistant cell lines

Intro Cancer stem cells (CSCs) are considered to be responsible for cancer metastasis, and hypoxia is supposed to be an important regulator of CSCs differentiation. Furthermore, tumor hypoxia was reported to be associated with more aggressive tumor phenotypes such as high metastatic ability and resistance to various anti-cancer therapies which may lead to a poorer prognosis. This raises the question of whether there might be proteins representing similar alterations which are responsible for the correlation between hypoxic and CSCs phenotypes. We have established a diffuse-type of gastric carcinoma cell line (OCUM-12), and a hypoxia-resistant cancer cell line (OCUM-12/Hypo) cloned from parent OCUM-12 cells by continuous exposure to 1% oxygen. The side population (SP), as evaluated by a flow cytometric analysis using Hoechst 33342, has been known as CSC-rich population. To investigate and compare the proteomes of the hypoxic (OCUM-12/Hypo), stem cell (OCUM-12SP) and parent OCUM-12 diffuse-type gastric carcinoma cell lines, protein lysates from those cell lines were analyzed using QSTAR Elite LC MS/MS. Method Triplicate pooled samples (10 ug protein each) from stomach cancer cell lines were prepared and labeled with iTRAQ reagents. MS/MS data were searched against the Swiss Protein database (HUMAN) using ProteinPilot™ 2.0 software (AB Sciex). The Ingenuity Pathway analysis program was utilized, to assign biological significance, and to identify networks of interacting differentially expressed proteins, functional groups and pathways. Result In both OCUM-12SP and OCUM-12/Hypo cells, significant overexpression of Wnt signaling pathway was obvious. Furthermore, elevation of MTHFD1, a protein controlling histidine and purine nucleotide metabolism, cytokeratins 18 (CK18), and 19 (CK19) regulating cell cycle, apoptosis and angiogenesis, transcriptional regulator ANP32A, and cellular chaperones heat shock proteins A9 and STIP was observed as compared to the parent OCUM-12 cell line. Furthermore, anterior gradient homolog 2 (AGR2)was down-regulated in both cell lines. Conclusion Wnt signal, MTHFD1, CK18, CK19, ANP32A, HSPA9 and STIP, AGR2 might be responsible for the stem-like phenotype, hypoxia resistance and higher invasiveness of gastric cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3380. doi:1538-7445.AM2012-3380

Abstract 708: Clinical significance of insulin-like growth factor 1 receptor (IGF1R) expression in pancreatic cancer

Introduction: Insulin like growth factor 1 receptor (IGF1R) reported to be overexpressed in some types of human carcinomas, including lung cancer, and breast cancer. However no report of the significance of IGF1R expression was available in pancreatic cancer. Most patients with pancreatic cancer die within 2 years at diagnosis even after curative resection. The objective of this study was to evaluate the significance of IGF1R expression in human pancreatic cancer. Material and Methods: A total 122 patients with pancreatic cancer was studied. Paraffin embedded species of pancreatic cancers were stained with antibodies against IGF1R. IGF1R expression was evaluated by intensity of staining. Semi-quantitative scores of zero (no staining), 1+ (weak staining), 2+ (moderate staining), or 3+ (strong staining) were assigned to each sample based on the intensity of staining. Scores of 2+ or 3+ were defined as IGF1R-positive staining. The association between IGF1R expression and clinicopathologic variables was examined. Results: IGF1R expression was positive in 50 (40.1%) of 122 cases. Kaplan-Meier analysis demonstrated the prognosis of IGF1R-positive patients was significantly (p=0.0076) poorer than that of IGF1R-negative, and median survival time of patients with IGF1R-positive was 37.3 months, while that of patients with IGF1R-negative samples was 60.8 months. There were no associations between IGF1R overexpression and clinicopathological factors, including tumor location, tumor size, tumor differentiation, and T/N categories according to the International Union against Cancer. Multivariate analysis showed IGF1R expression and lymph node metastasis were independent predictors of worse prognosis in pancreatic cancer. Conclusion: The expression of IGF1R might be a novel predictive prognostic marker for patients with pancreatic cancers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 708. doi:1538-7445.AM2012-708

Abstract 3440: Effect of neoadjuvant therapy for the number of lymph node micrometastasis in esophageal squamous cell carcinoma

[Introduction] Esophageal squamous cell carcinoma (ESCC) often develops lymph node metastasis. Several study demonstrated that micrometastasis (MM) in lymph nodes was an independent prognostic factor for ESCC. Recently effect of neoadjuvant therapy including chemotherapy and chemoradiontherapy has been reported. The aim of this study was to investigate the affect of on MM in lymph nodes for ESCC. [Materials and methods] We retrospectively reviewed clinical data of consecutive162 patients with ESCC who underwent esophagectomy accompanied with systemic lymphadectomy in our institution from 2000 to 2010. Firstly, we analyzed the relapse free survival of 90 patients who underwent surgical resection without neoadjuvant therapy and assessed the impact of MM in lymph nodes on prognosis of ESCC by immunohistochemistry using anti-cytokeratin antibody. Next we examined MM in lymph nodes of 72 patients who underwent surgical resection with neoadjuvant therapy and evaluate the effect of neoadjuvant therapy on MM in lymph nodes. [Results] Of 5414 lymph nodes from 90 patients with cStage II/III (surgery group), we detected 311(5.1%) of overt metastasis detected by H&E staining and 124(2.3%) of MM in lymph nodes. The clinicopathological factors related to the postoperative relapse included pTNM Stage and number of lymph node metastasis with MM. Otherwise, in neoadjuvant Group, Of 3466 lymph nodes from 72 patients, we detected 154(4.4%) of overt metastasis and 19(0.4%) of MM. In neoadjuvant group, the rate of MM was decreased from 2.3% to 0.4% as compared to that of surgery group. Importantly, the rate of MM in upper mediastinal region was decreased by neoadjuvant therapy. [Conclusion] We demonstrated the significance of micrometastasis in lymph nodes for prognosis of esophageal cancer. Our findings suggested that neoadjuvant therapy may reduce the number of micrometastasis. Neoadjuvant therapy should be estimated as the standard therapy against esophageal squamous cell carcinoma.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3440. doi:1538-7445.AM2012-3440

Abstract 711: The expression of human equilibrative nucleoside transporter 1 (hENT1) is associated with overall survival in advanced biliary tract carcinoma (BTC) treated with gemcitabine

[Introduction] The outcome of patients with unresectable and postoperative recurrent biliary tract carcinoma (BTC) is mostly miserable and most patients are possible candidates for palliative chemotherapy. Gemcitabine is a pyrimidine nucleoside analogue that is commonly used chemotherapeutic agent for advanced BTC. Gemcitabine is transported into the cell mostly by human equilibrative nucleoside transporter 1(hENT1). The hENT1 expression has been demonstrated to play an important role in predicting clinical outcome after gemcitabine chemotherapy for several types of cancer. The aim of the present study was to investigate a predictive marker for good prognosis of gemcitabine chemotherapy for unresectable and postoperative recurrent BTC. [Materials and methods] The analysis was performed on samples from 25 patients with unresectable (6 patients) and postoperative recurrent (19 patients) BTC treated with gemcitabine at the host institute between January 1997 and January 2011. The hENT1 expression levels in tumors were evaluated by immunohistochemistry. The clinical and histopathological variables were analyzed to evaluate predictive values for survival. [Results] Of the 25 tumor specimens, 18 (72%) specimens had positive hNET1 immunostaing, while 7 (28%) specimens were classified as negative. No statistical significant differences were found between the expression of hENT1 and patient characteristics (gender, age, tumor stage, lymph node stage, lymph duct invasion, vascular invasion, perineural invasion). In the univariate analysis, hENT1 expression was significantly correlated with overall survival (OS). The median OS was 15.3 versus 4.2 months, respectively in patients with positive versus negative hENT1 staining (p=0.006). As a result of multivariate analysis, hENT1 expression was useful as a predictive marker for good prognosis with significant difference (p&lt;0.001). [Conclusions] Patients with positive hENT1 expression in BTC have a significantly longer survival after gemcitabine chemotherapy than patients with negative hENT1 expression. Our results suggest that hENT1 expression in advanced BTC patients treated with gemcitabine is a prognostic predictive indicator and is useful to decide gemcitabine chemotherapy.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 711. doi:1538-7445.AM2012-711

Spontaneously complete regression of pseudolymphoma of the remnant pancreas after pancreaticoduodenectomy

BACKGROUND

Pancreatic pseudolymphoma is extremely rare.

METHOD

We present multiple pseudolymphomas in the head and body of the pancreas. The hypoechoic lesions observed by endoscopic ultrasound were enhanced in late-phase angio-computed tomography and homogeneously hypointensive in T1-weighted magnetic resonance imaging (MRI). (18)F-fluorodeoxyglucose positron emission tomography showed strong accumulation in the lesions. The lesions were suspected to be non-functioning islet cell carcinoma. The intraoperative pathological diagnosis for the specimen obtained by a pylorus-preserving pancreaticoduodenectomy was non-neoplastic lymphoid cells. The remnant lesion in the pancreatic body was preserved.

RESULTS

Macroscopically, the mass was well-circumscribed gray-white colored lesion. The pathological diagnosis was pancreatic pseudolymphoma. The lesion in the remnant pancreas spontaneously disappeared within one year after the operation.

CONCLUSION

The differential diagnosis of pancreatic pseudolymphoma from malignant tumor is very difficult, however, the image findings demonstrated here may be informative. The spontaneous disappearance of pancreatic pseudolymphoma was firstly observed in the present case.

HER3 overexpression as an independent indicator of poor prognosis for patients with curatively resected pancreatic cancer

OBJECTIVE

The association between human epidermal growth factor receptor 3 (HER3) overexpression and survival in patients with curatively resected pancreatic cancer was investigated.

METHODS

Tissue samples from 126 pancreatic cancers without hematogenous or peritoneal metastases recovered from macroscopically curative resection were fixed with formalin, embedded in paraffin and subjected to immunohistochemical staining. Semiquantitative scores of zero (no staining or staining in less than 10% of cancer cells), 1+, 2+, or 3+ were assigned to each sample based on the intensity of staining. Scores of 2+ or 3+ were defined as HER3-positive staining, i.e., HER3 overexpression.

RESULTS

HER3 overexpression was observed in 52 of the 126 tissue samples (41.3%). There were no associations between HER3 overexpression and clinicopathological factors, including tumor location, tumor size, tumor differentiation, T/N categories according to the International Union against Cancer, and serum carbohydrate antibody 19-9 level (CA19-9). Univariate analysis demonstrated the median survival time of patients with HER3 overexpression was 37.2 months, while that of patients with HER3-negative samples was 58.6 months (p = 0.008). HER3 overexpression, lymph node metastasis, and elevated serum CA19-9 level were independent predictors of poor prognosis based on multivariate survival analysis.

CONCLUSION

A new prognostic predictor, HER3 overexpression, was identified for resected pancreatic cancer.

[A case of long-term survival after undergoing S-1 based multidisciplinary therapy for liver metastasis of gastric cancer]

We encountered a case of gastric cancer accompanied with liver metastasis, which had a good response to chemotherapy of S-1. A 68-year-old female was admitted to our hospital due to further examination of gastric tumor detected by an outpatient physician. She was found to have a type-3 gastric cancer in upper gastrointestinal endoscopy and a metastatic tumor of the liver in abdominal CT. Although chemotherapy of S-1 was inducted for the lesions, both the primary and liver tumors were dramatically reduced. We subsequently performed total gastrectomy and partial hepatectomy. Abdominal CT scan at 11 months after the initial operation revealed metachronous liver metastasis. She received combination chemotherapy of S-1 and CDDP. After 5 courses of the combination chemotherapy, the liver tumor disappeared. She has survived for 8 years without a recurrence after the initial operation. There was negative findings of immunostaining with thymidylate synthetase (TS), which was target enzyme for 5-FU at a biopsy sample of the primary gastric tumor before chemotherapy of S-1. TS immunostaining may be a useful marker for S-1 combined therapy for gastric cancer associated with liver metastases.

[Our experience of the treatment with XELOX±Bevacizumab for unresectable advanced colorectal cancer]

XELOX for unresectable advanced colorectal cancer has been approved in Japan. We report here an experience of the treatment with XELOX±bevacizumab in our department. We thought that the regimen has some merits in the patient's quality of life. Forty-five patients were treated with XELOX±bevacizumab. In evaluable 23 cases, partial response (PR) was obtained in 13 cases and stable disease (SD) and progressive disease (PD) were in 5 and 5 cases, so that the response rate and disease control rate were 56.5% and 78.2%, respectively. In the first-line administration of 19 cases, the response rate and disease control rate were respectively 80.0% and 90.0%. Hand-foot syndrome was observed in 13.2% (grade 2) and 6 .6% (grade 3). We think that it is important to control hand-foot syndrome for a continuation of XELOX±bevacizumab.

Abstract 3136: c-Kit / CD117 is a predictive prognostic marker for patients with basal-like breast cancer

Purpose: The mortality of breast carcinoma is decreasing because of recent developments in diagnostic techniques and therapies; however, the mortality of the basal-like breast cancer (BLBC) remains poor. BLBC a poorly characterized subtype of tumor with no validated clinical assay to identify them. In breast cancer, although there were some reports of survival analysis regarding c-Kit expression, the significance of c-Kit expression is controversial. In addition, little is known about the c-Kit expression levels of BLBC. The aim of this study is to clarify the correlation between c-Kit and BLBC.

Experimental Design: A total of 667 patients who had undergone resection of a primary breast cancer at our institute were enrolled. ER, PR, HER2, EGFR, CK5/6 and c-Kit expression were assessed by immunohistochemistry. We examined the association between BLBC and other clinicopathologic variables, and evaluated the significance of c-Kit expression.

Results: Of informative 667 breast cancer cases, basal-like phonotype was 149 (78.4%) of 190 cases of triple-negative phenotype. c-Kit expression was found in 111 patients (16.6%), and it was significantly many results in BLBC (42/149, 28.2%) (p&lt;0.001). The c-Kit positive patients experienced significantly poorer outcomes in terms of overall survival (p&lt;0.001). In 149 patients with BLBC, a statistically significant difference was observed between c-Kit positive and negative in regard to the degree of high age (p=0.037), lymph node metastasis (p=0.008) and lymphatic invasion (p=0.017). In BLBC, cases with c-Kit expression showed a poor overall survival time (p&lt;0.001), and disease-free interval period (p&lt;0.001), and it was an independent indicator of a poor prognosis by multivariate analyses (p=0.024, OR=2.291).

Conclusions: c-Kit is one of predictive prognostic marker and molecular targets in BLBC.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3136. doi:10.1158/1538-7445.AM2011-3136

Abstract 2265: Clinical significance of HER3 expression in curatively resected pancreatic cancer

Introduction: HER3 (erbB-3) is a member of the epidermal growth factor receptor (EGFR) family. After dimerization with other members of the EGFR family several signal transduction cascades can be activated.HER2/HER3 heterodimer is likely to be the most effective complex for activating downstream pathways.Because of special importance of HER2/HER3 heterodimer in tumorgenesis, the signaling pathways and downstream effectors of the HER family become key molecules in the strategy of cancer therapy.HER3 is overexpressed in diverse human cancers, and has been associated with poor prognosis in breast, lung, and ovarian cancer.The objective of this study was to evaluate the significance of HER3 expression in pancreatic cancer cells.

Material and Methods: A total 86 patients were enrolled.The pancreatic cancers were stained with antibodies against HER3 by immunohistochemistry. HER3 expression was evaluated by intensity of staining.Intensity was given scores 0-3 (score 0:no staining, score1+:barely perceptible staining, score2+:moderate staining, score3+:strong staining). Scores of 0 and 1+ were considered to be negative for HER3 expression, while 2+ and 3+ were considered to be positive (overexpression).We examined the association between HER3 expression and other clinicopathologic variables.

Results: HER3 expression was positive in 36 (41.9%) cases.There were no significant correlation between HER3 expression and other clinicopathological factors. The prognosis of HER3 positive patients was significantly poorer than that of HER3-negative patients (p=0.002). A univariate survival analysis revealed that HER3 overexpression, intrapancreatic nerve invasion and T category were significantly correlated with patient survival. A multivariate analysis showed HER3 overexpression was an independent predictor of worse prognosis in resectable pancreatic cancer.

Conclusion: The expression of HER3 might be a novel predictive prognostic marker for patients with pancreatic cancers.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2265. doi:10.1158/1538-7445.AM2011-2265

Abstract 1796: The impact of adjuvant immunochemotherapy using protein-bound polysaccharide-K on overall survival of gastric cancer

Protein-bound polysaccharide (PSK) has been approved as an anti-cancer agent to be used in combination with chemotherapeutic drug for adjuvant therapy against gastric cancer. Several clinical studies have demonstrated that PSK has antitumor and immunomodulating properties. However, there is little evidence about the effectiveness of PSK in clinical practice. The aim of this study was to evaluate the impact of PSK on overall survival of patients with gastric cancer and predict the suitable case selection for postoperative adjuvant immunochemotherapy. The patients with stage II/III gastric cancer who underwent surgical curative resection between 2000 and 2007 at Deptarment of Surgical Oncology, Osaka City University were included in this retrospective study. All patients received oral fluorinated pyrimidine anti-metabolites with or without PSK after surgical operation. We analyzed clinicopathological features and evaluated the impact of PSK on postoperative survival rate of resectable gastric cancer. We identified 254 patients with a median follow-up of 33 months (range, 7-110 months). 138 patients received oral anti-metabolized alone (control group) and 115 patients received anti-metabolites plus PSK (PSK group). 139 patients of the cohort experienced postoperative recurrence. No significant difference between control and PSK group in overall survival or relapse free survival was detected over the 8-year period. In patients with early tumor recurrence, PSK group increased overall survival significantly (p&lt;0.023). Among patients with pN3 lymph nodes metastasis, PSK group had better median overall survival of 28 months compared with 22 months with oral chemotherapeutics alone. After multivariate Cox regression analysis, duration of PSK administration was associated with an increased overall survival (p=0.002, HR 0.964, 95%CI 0.942 to 0.987). Our results suggested that adjuvant immunochemotherapy with PSK increased overall survival for patients with pN3 and early tumor recurrence. A population with lymph nodes metastasis might be a suitable to combine PSK with oral chemotherapeutic agents for postoperative adjuvant therapy against gastric cancer.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1796. doi:10.1158/1538-7445.AM2011-1796

Phase II trial of S-1 plus low-dose cisplatin for unresectable and recurrent gastric cancer (JFMC27-9902 Step2)

AIMS

The efficacy and the toxicity of oral fluorouracil derivative S-1 plus low-dose cisplatin in unresectable or recurrent gastric cancer were evaluated by a phase II study.

METHODS

S-1 was administered orally for 28 days following 14 days' rest at 80-120 mg/body/day, depending on body surface area. During administration of S-1, cisplatin was given twice a week at the recommended dose (10 mg/m(2)), which was determined by a phase I study. Data from 34 patients in phase II and 8 patients treated with the recommended dose of cisplatin in phase I were analyzed. The primary endpoint was objective response.

RESULTS

The response rate was 47.1%. The median survival time was 11.0 months and the median progression-free survival was 6.9 months. The grade 3/4 toxicities observed in 10% or more of the treated patients were neutropenia (16.7%), anemia (16.7%) and anorexia (11.9%). The serum concentration of cisplatin was 794 ± 341 ng/ml at day 25 of the first course.

CONCLUSIONS

S-1 plus low-dose cisplatin may be a clinically useful regimen for unresectable or recurrent gastric cancer because of its infrequent adverse events in spite of considerable efficacy and its convenience of no hydration and no hospitalization.

[Two cases of the primary small intestine cancer successfully treated with S-1 and UFT/LV therapy]

The primary small intestinal cancer is rare in gastrointestinal cancer, and there are much advanced/recurrent cases. However, there were a few case reports about chemotherapy for advanced or recurrent small intestinal cancer, and a treatment resume was inconsistent. We reported that S-1 and UFT/LV therapy was effective with the two cases as an oral chemotherapy for the primary small intestinal cancer.

[The outcome of chemotherapy by sorafenib in advanced hepatocellular carcinoma]

We analyzed the treatment outcome and effect of sorafenib in advanced hepatocellular carcinoma. Nine patients were received the therapy of sorafenib between June 2009 and October 2009. The overall incidence of treatment-related adverse events was 87.5%. Grade 3 drug-related adverse events included a hand-foot skin reaction (two patients) and fatigue (one patient). Grade 2 hypertension (three patients), grade 1 diarrhea (two patients) and anorexia (four patients) occurred at this study. The response rate was 0% (CR/PR 0, SD 2, PD 6) and median overall survival length was 101 days. Now there are two patients undergoing the therapy of sorafenib. Effect of sorafenib in advanced hepatocellular carcinoma was not good in this study, and drug-related adverse events had a high rate. However, the continuous treatment was possible with dose modified chemotherapy.

[A case of type 4 gastric cancer with positive peritoneal lavage cytology, which relapsed at the peritoneum at the time of seven years and eight months after resection]

A 55-year-old woman was admitted to our hospital with a complaint of appetite loss and body weight loss. Upper digestive endoscopy showed a giant fold at the greater curvature stomach and diffused edematous gastric mucosa. Abdominal contrast CT demonstrated a significant thickening of the gastric wall and a large number of lymph node swelling. A clinical finding was Stage IIIB (T3N2M0) Type 4 gastric cancer of poorly differentiated adenocarcinoma. Total gastrectomy, splenectomy and D2 lymph node dissection were performed. Although there was no peritoneal dissemination, peritoneal lavage cytology was positive. After the operation, S-1 alone chemotherapy was administered for four years. No recurrence had occurred for about seven years and eight months after resection. However, the patient was pointed out the signs of recurrence (ascites and induration) by CT. Now, S-1 alone chemotherapy was performed again, and the patient has been in good health.

[Docetaxel with concurrent radiotherapy in patients with inoperable or relapsed oesophageal cancer]

INTRODUCTION

In vivo studies have shown docetaxel, a new chemotherapeutic agent, enhances radio-sensitivity by causing a cell cycle arrest in the G2/M phase. We report here to evaluate the efficacy and tolerability of weekly docetaxel concurrent with radiotherapy in advanced or relapsed oesophageal cancer patients.

MATERIAL AND METHODS

A total of 8 esophageal cancer patients with relapsed mediastinal lymph nodes (6 patients), psychological disease (1 patient) and local advanced tumor (cT4) after initial 5-FU/CDDP therapy (1 patients) received docetaxel (10 mg/m2 weekly) plus concurrent radiotherapy (2 Gy daily, a total dose of 60 Gy).

RESULTS

2 patients achieved a complete response and 5 patients achieved a partial response, for an overall response rate of 87.5%. Median survival length was 13. 3 months and time to disease progression was 6.6 months. No patient experienced grade 3-4 hematological adverse event. There was esophago-mediastinal fistula in 1 patient.

CONCLUSIONS

Docetaxel with concurrent radiotherapy was very effective for relapsed or local advanced esophageal cancer. This therapy had no high grade adverse event and a quality of life in esophageal cancer patients could be maintained.

[A case of multicentric breast cancer in which an effect of neoadjuvant chemotherapy had a disparity]

A 61-year-old woman was visited our hospital for a left breast tumor. Ultrasonography (US) demonstrated two tumors comprising a tumor 3.3 cm in diameter in the A area and another one 0.9 cm in diameter in the C area of the left breast, and US-guided core needle biopsy (CNB) was performed. The histological findings showed invasive ductal carcinoma, ER (+)/PR (-)/HER2 (+) in the A lesion and ER (+)/PR (+)/HER2 (-) in the C lesion. At this point in time, US demonstrated a new tumor 1.9 cm in diameter in the outside C area of the left breast, and CNB was performed. The histological findings showed invasive ductal carcinoma, ER (+)/PR (+)/HER2 (-) in the outside C lesion. Chemotherapy was estimated as PD, and an operation was performed (Bt + Ax). Histopathological examination showed pCR in the A lesion, invasive lobular carcinoma in the C lesion and solid-tubular carcinoma in the outside C new lesion. Depend on each subtype, HER2/new targeting trastuzumab therapy, radiation therapy and ER/PR targeting hormone therapy were tried as a post operative treatment.

Abstract 4748: Identification of HLA-A*0201 and A*2402-restricted epitope peptides derived from mucin 5AC (MUC5AC) gene expressed in human pancreatic cancer as a potential target for immunotherapy

MUC5AC was previously identified to be de novo expressed in the majority of pancreatic ductal adenocarcinoma. For the development of pancreatic cancer immunotherapy, we studied the significance of MUC5AC expressed in pancreatic ductal adenocarcinoma and the capability of MUC5AC as a target for immunotherapy of pancreatic cancer. By immunohistochemical analysis of 102 specimens, MUC5AC is absent from all cell types of the normal pancreas, but arise de novo in 85% of invasive ductal adenocarcinoma. Clinicopathlogically, tumors with lymph node metastasis had significantly higher expression of MUC5AC than those without node metastasis. To validate the potentiality of cancer vaccine, we have searched for possible epitope peptides that can elicit cytotoxic T lymphocytes (CTL) to MUC5AC. We screened 20 candidate peptides derived from MUC5AC gene sequence for each of human leukocyte antigen (HLA) - A*0201 and A*2402. As a result, we successfully established CTL clones stimulated by MUC5AC-A02-1398 (FLNDAGACV) and MUC5AC-A24-716 (TCQPTCRSL) peptide that have specific cytotoxic activities against each of the HLA-A*0201 and A*2402-positive target cells pulsed with the candidate peptide. Subsequent analysis of each CTL clones also revealed their cytotoxic activities against pancreatic cancer cells expressing MUC5AC. A cold target inhibition assay further confirmed that each CTL clones specifically recognized the major histocompatibility complex (MHC) class I-peptide complex. Our results suggested that MUC5AC is a novel tumor-associated antigen recognized by CTL, and MUC5AC-A02-1398 (FLNDAGACV) and MUC5AC-A24-716 (TCQPTCRSL) are HLA-A*0201 and A*2402-restricted epitope peptides that can induce potent and specific immune responses against pancreatic cancer cells expressing MUC5AC.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4748.