Masao Miyaji

Immunotherapy and combined assay of serum levels of carcinoembryonic antigen and acute-phase reactants.

Abstract Our previous studies have revealed that gastric and esophageal cancer patients with abnormal sialic acid levels had a better response than those with normal levels if they received polysaccharide K (PSK), a nonspecific immunomodulator. Serum levels of carcinoembryonic antigen (CEA) and acute-phase reactants (APR) such as immunosuppressive acidic protein, acid-soluble glycoproteins, α1-antichymotrypsin, and sialic acid were analyzed in 872 gastric cancer patients who had undergone resection from March 1979 to September 1993 at the Department of Surgery of Tokai University. The patients were categorized into four groups according to the preoperative serum levels: group A had normal levels of both CEA and APR, group B had abnormal CEA and normal APR levels, group C had a normal CEA level and normal levels of one or more APR, and group D had abnormal levels of both CEA and of one or more APR. Patients in group D who received PSK showed significantly better survival than those without PSK (29.3% versus 6.9%; log-rank test, P = 0.0015; Breslow test, P = 0.0042). CEA-positive patients receiving PSK therapy exhibited a significantly better survival rate than those without PSK (38.1% versus 18.6%; log-rank test, P = 0.0136; Breslow test, P = 0.0125). Cox’s regression analysis showed that PSK therapy was significantly related to survival in group D, but not in the other groups. We conclude that the combined assay of tumor-associated factors (such as CEA) and various nonspecific reactants to the presence of cancer (such as immunosuppressive acidic protein, α1-antichymotrypsin, acid-soluble glycoproteins and sialic acid) provides a good set of preoperative indicators on which to base the selection of treatment for individual gastric cancer patients.

Small mucosal carcinoma of the stomach with para-aortic lymph node metastasis: a case report and review of the literature.

A 38-year-old woman presented with a mucosal gastric carcinoma measuring 0.7 x 0.5 cm and para-aortic lymph node metastasis. Radiographic and endoscopic studies showed a small depressed lesion on the anterior border of the gastric angle, which was classified as a type II c + III lesion. Histological examination of the biopsy specimen revealed a signet-ring cell carcinoma. Distal gastrectomy with wide lymph node excision was performed. Detailed study of the resected specimen revealed that the tumour was limited to the mucosa, but metastasized to both the perigastric and para-aortic lymph nodes. The patient received adjuvant immunochemotherapy postoperatively. However, multiple bone metastases developed at 3 years and she died 4 years after the operation.

Gastric Acid Secretion and Serum Gastrin Levels in Gastric Cancer

We investigated the association between gastric acid secretion, serum gastrin levels, and the differentiation of tumor cells in gastric cancer.Gastric acid output after stimulation by tetragastrin, and serum gastrin levels after stimulation by a test meal were, examined in 128 primary gastric cancer patients, in whom the tumor had invaded the mucosa. After tumors were histologically confirmed as adenocarcinomas, the patients underwent gastrectomy. Gastric ulcer patients showed decreases in both integrated gastrin response (T-IGR) after a test meal, and in gastric acid secretion related to their age. On the other hand, early gastric cancer patients showed decrease in acid secretion but an increase in T-IGR.

Immunosuppressive Acidic Protein and Postoperative Immunotherapy in Gastric Cancer

One hundred ninety-five gastric cancer patients who underwent total gastrectomy were examined for serum immunosuppressive acidic protein (IAP). Multivariate analysis utilizing Cox’s model was performed with seven variables including as age, sex, pTNM stage, postoperative adjuvant therapy, preoperative serum levels of IAP and histopathological grading. Postoperative chemotherapy with or without PSK was a significant prognostic factor in patients with abnormal levels of IAP. These results indicate that if patients with abnormal levels of IAP who had immunosuppressive status, they showed good results with postoperative immunotherapy, probably in combination with splenectomy.

HLA antigens and lymph node metastasis in gastric cancer can HLA antigens be indicators of local resection of tumor with preservation of regional lymph node

239例の胃癌切除例の術前にHLA抗原とPPD皮膚皮内反応, 急性相反応物質, NK細胞, リンパ球サブセットを測定し, リンパ節転移と対比検討したところ, HLAB40, Bw61, Cw3抗原はリンパ節転移抑制抗原, A9 (24) 抗原はリンパ節促進抗原であると考えられた. 深達度m-sm症例では, HLA抗原を測定することによってリンパ節転移の状態が106例中89例 (84.0%) 同定可能であった. リンパ節転移陰性症例のPPD皮膚皮内反応, 急性相反応物質, NK細胞, リンパ球サブセットの検討から, B40抗原陽性例では急性相反応物質が低値, OKT4が高値, OKT8が低値, Leu7が低値をA9 (24) では急性相反応物質が高値, OKT4/8が低値, Leu7, Leu11が高値を示した. 以上より, 胃癌の病態, 特にリンパ節転移に関与する遺伝的因子が主要組織適合性複合体遺伝子に強いかかわりをもつ可能性が考えられた. 術前のHLA抗原測定によりリンパ節転移が予測され, 胃癌の縮小手術が可能と思われる.