Kohei Akazawa

Quality of life after laparoscopy-assisted Billroth I gastrectomy.

OBJECTIVEnTo evaluate the quality of life of patients who had undergone laparoscopy-assisted Billroth I gastrectomy (LAG) for cure of cancer.nnnSUMMARY BACKGROUND DATAnIn 1994, the authors reported the first case of LAG for early gastric cancer, and this approach quickly has been adopted by Japanese surgeons. However, little is known about the subjective clinical results of this less invasive surgery.nnnMETHODSnQuality of life was estimated using the 24-item questionnaire with a scoring system of 1, 2, and 3 and was compared between 41 consecutive patients with LAG and 35 with conventional open gastrectomy. All patients underwent Billroth I gastrectomy for early gastric cancer from January 1993 to July 1997 and were alive without recurrence.nnnRESULTSnPatients who had undergone LAG were taking a normal diet (100%) with >66% of volume at each meal (90%), showed no decreased performance status (90%), and were satisfied with their surgical results (88%). Patients with LAG, when compared with open gastrectomy, showed significantly better results with regard to weight loss, difficulty in swallowing, heartburn and belch, early dumping syndrome, and total score. LAG was better accepted by the patients.nnnCONCLUSIONSnQuality of life after Billroth I gastrectomy was significantly better in patients in whom a laparoscopic technique was used than in those who underwent a conventional method. LAG is less invasive and better accepted by patients and is the procedure of choice for the treatment of early gastric cancer.

Role of Transforming Growth Factor-β1 in Invasion and Metastasis in Gastric Carcinoma

PURPOSEnTransforming growth factor-beta1 (TGF-beta1) is a major modulator of cellular proliferation and extracellular matrix formation. We determined the role of TGF-beta1 in invasion and metastasis in gastric cancer.nnnMATERIALS AND METHODSnWe detected TGF-beta1 expression in primary and lymph node metastatic lesions of gastric cancer, using an antibody and in situ hybridization. The plasma TGF-beta1 levels in the peripheral vein and in the tumor drainage vein were assayed.nnnRESULTSnIn the cytoplasm of cancer cells, TGF- beta1 was immunostained in 35.9% (78 of 217) of primary gastric carcinomas, and this expression was confirmed by in situ hybridization. Of 59 gastric carcinomas with a TGF-beta1-negative primary tumor, metastatic lymph nodes were positive for TGF-beta1 staining in 32 cases (54.2%). Positive staining of TGF-beta1 in gastric cancer tissues was closely related to serosal invasion, infiltrative growth, and lymph node metastasis. Multivariate analysis showed that the expression of TGF-beta1 was an independent risk factor for serosal invasion and infiltrative growth of the tumor. The plasma level of TGF-beta1 did not differ between TGF-beta1-negative and -positive groups. There were also no differences in plasma TGF-beta1 levels among each tumor stage, between the peripheral and the tumor drainage veins, and between preoperative and postoperative testings.nnnCONCLUSIONnTransforming growth factor-beta1 is closely related to the invasion and metastasis of gastric cancer, and production of TGF-beta1 in the tumor does not contribute to the total amount of TGF-beta1 in the blood circulation. We interpret our observations to mean that in a tumor microenvironment, TGF-beta1 alters the biologic behavior of the tumor.

Recurrences and related characteristics of gastric cancer.

We analysed data on 1117 patients with gastric cancer who were treated by curative resection. Attention was focused on invasion and a recurrence of the cancer. Based on a univariate analysis, death following a recurrence and prognosis were related to age of the patients, size of the tumour, tumour location, tumour tissue differentiation, growth pattern, depth of invasion, lymphatic and vascular invasion and lymph node metastasis. In proportion to the growth potential, determined by the level of proliferating cell nuclear antigen (PCNA) labelling, the death related to a recurrence was increased and the prognosis was poorer. Multivariate analysis showed that the three factors of serosal invasion, PCNA labelling index and lymph node dissection were independent prognostic factors. When sites of recurrence were analysed regarding each depth of invasion, haematogenous recurrence, in particular in the liver, occurred even in cases of an early invasion and many types of recurrences, including peritoneal recurrence, were noted in patients with an advanced state of invasion.

Age-related changes in pattern visual evoked potentials: differential effects of luminance, contrast and check size

We recorded visual evoked potentials (VEPs) to checkerboard pattern-reversal stimulation in 109 normal subjects (51 males and 59 females; aged 19-84 years) in order to study the aging effect on the multiple channels of the visual system in humans. Transient VEPs to 3 check sizes (15, 30 and 50) were obtained by monocular stimulation. Two test conditions were employed: (1) a high luminance (180 cd/m2) and a low luminance (11 cd/m2) both with a fixed contrast (90%), and (2) a high contrast (85%) and a low contrast (10%) both at a fixed luminance (57 cd/m2). The major features of our results included: (1) the presence of a curvilinear relationship between P100 latency and age for all conditions, while the P100 amplitude did not show any such aging effect, (2) the age-latency function was similar between the two luminance conditions, while it was different between the two contrast conditions, and (3) the differential age effect on the P100 latency caused by changes in contrast depended on the check size. These results suggest that age-related changes in the human visual system are not uniform, but rather are different in the specific functional subdivisions. It is thus hypothesized that aging may differentially influence the separate channels of the human visual system.

Long-term survival in Japanese patients with far advanced carcinoma of the stomach

Among 1,220 Japanese patients with gastric carcinoma who had undergone resection in the Department of Surgery II, Kyushu University Hospital, Fukuoka, Japan from 1965 to 1980, there were 432 (35.4%) with far advanced carcinoma, designated as a lesion with factors such as peritoneal dissemination, hepatic metastasis, widespread nodal involvement extending to tertiary (hepatoduodenal, retropancreatic, and mesenteric) or quaternary (middle colic and paraaortic) nodes, or direct invasion to adjacent organs. The overall 5-year survival rate in these 432 patients was 10.2%. The 5-year survival rate in patients with a single factor was 16.3%, being significantly higher than the 2.8% or less in cases with more than 2 factors (p<0.01). Patients with tertiary nodal involvement or directly invaded organs alone survived at a rate of 26.1% and 21.8% in the 5-year follow-up, respectively. Radical procedures such as extensive lymphadenectomy and combined resection of the invaded organs further lengthened the survival time. The 5-year survival rates were less than 10% in patients with other factors, singly or more than 2 factors in combination. There appear to be 2 subgroups in whom the rates of survival differ: potentially curable and noncurable patients. More intensive therapeutic regimens corresponding to both groups need to be considered.RésuméParmi 1,220 japonais atteints de cancer de lestomac qui ont subi une résection dans le Département de Chirurgie II de lhÔpital Universitaire Kyushu, Fukuoka, Japan de 1965 à 1980, 432 (35.4%) présentaient des lésions avancées quil sagisse de dissémination péritonéale, de métastases hépatiques, dune extension ganglionnaire importante intéressant les groupes tertiaires (hépatoduodénal, rétro-pancréatique, et mésentérique) ou quaternaires (coliques moyens et paraaortiques) ou encore linvasion directe dorganes voisins. Le taux de survie totale à 5 ans de ces 432 malades a été de 10.2%. Ce taux a été de 16.3% en présence dun seul des facteurs et 2.8% ou moins en présence de plus de 2 facteurs (p<0.01). Le taux de survie à 5 ans fut respectivement de 26.1% et de 21.8% selon quexistait un envahissement ganglionnaire tertiaire ou linvasion isolée dun organe voisin. Les techniques radicales: lymphadénectomie élargie et résection combinée des organes envahis sont suivies dun allongement du temps de survie. Les taux de survie à 5 ans furent inférieurs à 10% chez les malades atteints dautres facteurs isolés ou supérieurs à deux. Il apparaÎt ainsi que dans le cancer de lestomac deux sous-groupes, dont le temps de survie est différent, sont à distinguer: les malades potentiellement curables et les malades incurables. Il est donc nécessaire de mettre au point des méthodes thérapeutiques efficaces en fonction des 2 groupes individualisés.ResumenEntre 1,220 pacientes japoneses con carcinoma gástrico sometidos a resección en el Departamento de Cirugía II, Hospital de la Universidad de Kyushu, Fukuoka, Japan entre 1965 y 1980, hubo 432 (35.4%) con carcinoma avanzado, entendiéndose como tal una lesión con hallazgos tales como diseminación peritoneal, metástasis hepáticas, extensión ganglionar amplia hasta los ganglios terciarios (hepatoduodenales, retropancreáticos, y mesentéricos) o cuaternarios (cólicos medios y paraaórticos), o invasión directa de órganos adyacentes. La tasa global de supervivencia a 5 años en estos 432 pacientes fue 10.2%. La tasa de supervivencia a 5 a~nos en pacientes con uno solo de tales hallazgos fue 16.3%, que es significativamente mayor que la de 2.8% o menos en pacientes con más de 2 de tales hallazgos (p<0.01). Los pacientes con invasión ganglionar terciaria o con invasión directa de órganos solamente, sobrevivieron a una tasa de 26.1% y 21.8%, respectivamente, en el seguimiento a 5 años. Procedimientos radicales tales como la linfadenectomía amplia y la resección combinada de los órganos afectados resultó en prolongación del periodo de supervivencia. Las tasas de supervivencia a 5 años fueron menores de 10% en pacientes con otros hallazgos en combinaciones Únicas o de más de 2. Parece haber 2 subgrupos en quienes las tasas de supervivencia difieren: los pacientes potencialmente curables y los no curables. Regimenes terapéuticos correspondientes a los 2 grupos deben ser considerados.

Postoperative Adjuvant Therapy With Tamoxifen, Tegafur Plus Uracil, or Both in Women With Node-Negative Breast Cancer: A Pooled Analysis of Six Randomized Controlled Trials

PURPOSEnThis article reports the results of a pooled analysis of six randomized trials conducted to study the efficacy of uracil and tegafur (UFT) in the adjuvant treatment of node-negative breast cancer patients.nnnPATIENTS AND METHODSnSix randomized controlled trials on node-negative breast cancer patients were conducted from 1992 through 1995 in Japan that included the three, three-arm trials (control [no adjuvant], UFT, and tamoxifen [TAM] groups) and the three, four-arm trials (control, UFT, TAM, and UFT plus TAM groups). Pooled analysis was performed on the data obtained from these six trials (involving 2,934 patients).nnnRESULTSnOverall survival was compared between the UFT group (including both the UFT group and the TAM plus UFT group) and the non-UFT group (control group and TAM group). A significant difference (P = .04) was observed in 5-year survival rates between the UFT (95.9%) and the non-UFT (94.0%) groups. Overall survival was also compared between the TAM group (TAM group and TAM plus UFT group) and the non-TAM group (control group plus UFT group). The 5-year survival rate (95.2%) in the TAM group was not significantly different from that (93.9%) in the non-TAM group, but the subset analysis showed a significant (P = .01) improvement in the estrogen receptor-positive subset.nnnCONCLUSIONnAdjuvant UFT improves the overall survival of node-negative breast cancer patients. Given that UFT has milder adverse effects, it is suggested that UFT can be a useful alternative to doxorubicin and cyclophosphamide, or cyclophosphamide, methotrexate, and fluorouracil in the adjuvant treatment for node-negative breast cancer.

Surgical treatment and outcome for node-negative gastric cancer

BACKGROUNDnThe clinicopathologic characteristics and prognosis for patients with node-negative gastric cancer have heretofore remained to be determined.nnnMETHODSnWe analyzed data on 730 of our patients with node-negative gastric cancer who underwent curative gastric resection in the Department of Surgery II, Kyushu University Hospital, between 1965 and 1990, with reference to prognostic factors. The presence of lymph node metastasis was determined by means of routine hematoxylin-eosin staining of excised tissues.nnnRESULTSnThe 5-year survival rate was 91.7% and the 10-year rate was 88.5%; thus the prognosis was good for patients with node-negative gastric cancer. When the prognosis was analyzed by stratification of each clinicopathologic factor, the survival time was shorter for older patients when the size of the tumor was larger, when the tumor involved the entire stomach, and when-tissues revealed infiltrative growth, serosal invasion, and lymphatic invasion. Extensive lymph node dissection was performed for 86.6% of the patients, and for these patients the prognosis was better, with a statistical difference. In a multivariate analysis, tumor size, serosal invasion, and extensive lymph node dissection proved to be independent prognostic factors for patients with node-negative gastric cancer.nnnCONCLUSIONSnProphylactic lymph node dissection for patients with gastric cancer will prolong the survival time.

Loss of motility-related protein 1 (MRP1/CD9) and integrin α3 expression in endometrial cancers

MRP1/CD9 and integrin α3 have played crucial roles in cell adhesion, motility, and signaling events. The loss of MRP1/CD9 and integrin α3 has been involved in tumor growth and metastasis of cancer cells. The aim of the current study was to clarify the clinical significance of MRP1/CD9 and integrin α3 in endometrial cancer.

Lymph node metastasis and relation to tumour growth potential and local immune response in advanced gastric cancer

To evaluate the relation between the degree of lymph node metastasis and the growth potential of tumour cells and the local immune function in gastric cancer, we analyzed data on 444 patients with advanced serosally invasive gastric cancer who underwent curative gastrectomy. Tumour growth potential was evaluated based on the value proliferating cell nuclear antigen (PCNA) in the primary tumour, and dendritic cell infiltration into the tumour was determined as an indicator of local immune function. The values of PCNA labeling in the primary tumour increased and the infiltration of dendritic cells into the tumour decreased in relation to the extent of lymph node metastasis. High growth potential and low immune function were seen in cases with n3 lymph node metastasis. There was a reverse relation between the PCNA labeling index and dendritic cell infiltration. A variety of forms of recurrence was noted in patients with lymph node metastasis while the prognosis was less favorable, in relation to the degree of lymph node metastasis. Thus, the potential for nodal spread appears to be associated with the growth potential of tumour cells and with the local immune status of the tumour. Int. J. Cancer 74:224‐228, 1997.

Excised Human Neoplastic Tissues Are More Sensitive to Heat than the Adjacent Normal Tissues

In tissues from patients subjected to gastrectomy or colectomy, the heat sensitivity was determined in the case of 23 neoplastic, 15 gastric, 8 colorectal, and the adjacent normal tissues, using the in vitro succinate dehydrogenase inhibition test. The succinate dehydrogenase (SD) activity of tissue fragments was assayed, following exposure to heat at 43 degrees C (heat treatment) or 37 degrees C (control) for 5, 10, 15 or 20 h. The sensitivity to heat treatment was estimated by the percentage of SD activity of the heat-treated cells, compared to that of control cells. The decrease in SD activity varied in the tumor tissue, following exposure to heat. The SD activity decreased to a greater extent in the tumor tissue than in the adjacent normal tissue, in each case. The mean +/- standard deviation of SD activity, following exposure to heat treatment for 20 h, was 32.1 +/- 14.0% for the tumour tissues and 52.4 +/- 10.4% for the adjacent normal tissues, with a statistically significant difference (p less than 0.01). These results show that the assay of heat sensitivity is meaningful for prediciting the effectiveness of hyperthermia and that hyperthermia has a selectivity for treating a malignant lesion.