Kiyoshi Nishiyama

Randomized, controlled study on adjuvant immunochemotherapy with PSK® in curatively resected colorectal cancer

A randomized, controlled trial of adjuvant immunochemotherapy with PSK®(Kureha Chemical Industry Co., Tokyo, Japan) in curatively resected colorectal cancer was studied in 35 institutions in the Kanagawa prefecture. From March 1985 to February 1987, 462 patients were registered. Four hundred forty-eight of those patients (97.0 percent) satisfied the eligibility criteria. The control group received mitomycin C intravenously on the day of and the day after surgery, followed by oral 5-fluorouracil (5-FU) administration for over six months. The PSK®group received PSK®orally for over three years, in addition to mitomycin C and 5-FU as in the control group. At the end of February 1990, the median follow-up time for this study was four years (range, three to five years). The disease-free survival curve and the survival curve of the PSK®group were better than those of the control group, and differences between the two groups were statistically significant (disease-free survival,P=0.013; survival,P=0.013). These results indicate that adjuvant immunochemotherapy with PSK®was beneficial for curatively resected colorectal cancer.

Feasibility of a novel weekday-on/weekend-off oral UFT schedule as postoperative adjuvant chemotherapy for colorectal cancer

Purpose: When oral anticancer agents are used for adjuvant chemotherapy of colorectal cancer, compliance and feasibility become issues because of the long treatment time. Appropriate studies of these issues are lacking. We investigated compliance and feasibility during a weekday-on/weekend-off schedule of oral UFT (uracil-tegafur) over a period of 1 year administered as adjuvant chemotherapy to patients with colorectal cancer. Patients and methods: A UFT dose of 600 mg/day was prescribed according to a weekday-on/weekend-off schedule to 87 patients after potentially curative resection. Compliance was investigated in three ways: physician interview, patient self-report, and chemical analysis of urine. The results were compared with the dose prescribed. Feasibility was evaluated on the basis of two indices: relative performance (RP), which was the ratio of the actual total dose taken to the total dose planned, and individual dose intensity (IDI), which was the ratio of the actual dose taken to the dose planned during a given period. Results: The compliance assessed by physician interview and by patient self-report conformed well with the prescribed dose, the rate of agreement among the three compliance measures being more than 94%. Chemical analysis of urine in 38 of the patients revealed that they were actually taking the drug. The RP was 0.72, and the IDI was 0.8. Conclusion: From these results, the feasibility of the weekday-on/weekend-off schedule was judged to be good. It is suggested that the feasibility would be even better if the dose of UFT was set according to body surface area.

Human Monoclonal Antibodies against Cytokeratin 18 Generated from Patients with Gastric Cancer

By co‐culturing regional lymph node B‐cells and HAT‐sensitive mutant cells obtained from RPMI‐1788 cells, no less than 20,000 Epstein‐Barr (EB)‐transformed colonies were obtained from 32 patients with gastric cancer. From B‐cell cultures generating antibodies reactive with gastric cancer tissues as well as cultured gastric cancer cells, two EB‐transformed cell clones termed C418–59 and C1218–39 were isolated. Both of them produced human IgM‐class antibodies, termed Mab418–59 and Mab 1218–39, respectively. Both antibodies reacted with an antigen with a molecular weight of 45 kd existing in gastric cancer MKN‐45, MKN‐1, and Kato‐III cells, and also with all of 4 adenocarcinomas of the stomach in paraffin sections. The antigen recognized by both antibodies was identified as a kind of cytoskeletal protein, cytokeratin 18, In this study, it was confirmed that B‐cell clones generating autoantibodies against cytokeratin 18 were present in some patients with gastric cancer.

Differential diagnosis for the cystic lesion of the pancreas with a special references to analysis of intracystic fluids.

過去20年間の自験膵嚢胞性疾患20例中, 仮性嚢胞は9例, 真性嚢胞は11例であった. 腹痛は仮性嚢胞の全例にみられたのに対し, 真性嚢胞では6例が腹痛を伴わない腹部腫瘤を主訴とした. 血清アミラーゼ値は仮性嚢胞の9例中8例が229～1,580IU/lと高値を示した. 嚢胞の存在診断にはCTおよび超音波検査が有用であったが, 質的診断には不十分であった. 嚢胞内容液のアミラーゼ値は真性嚢胞が4.398±9.1311U/lであるのに対して仮性嚢胞では199, 360±135,58IIU/lと著しく高値であった. また, 細胞診では悪性例6例中4例がclass IV, またはclass Vであった. 内容液のCEA値は, 悪性例では50,278±83,948ng/mlで, 良性例の256±141ng/mlと比べ有意に高値を示した. 以上より, 嚢胞内容液のアミラーゼ値, 細胞診, CEA値は膵嚢胞性疾患の質的診断に有用と考えられた.

DETERMINATION OF CEA IN THE DIAGNOSIS OF RECTAL CANCER AND THE RECURRENCE

血中CEA値 (z-gel法) 5.0ng/ml以上を陽性とした場合, 直腸癌再発例の陽性率は, 88.0% (22/25) と著しく高い.局所および肝シンチグラム等の臨床的再発発見より, CEA陽性化が先行する場合がしばしば認められる.直腸癌治癒手術後, CEAが高値となったときには, 臨床的に再発が確認されなくても, 化学療法, 再手術などの積極的な治療を行うことがすすめられる.