Mikiyo Miyata

Endoscopic screening of early esophageal cancer with the Lugol dye method in patients with head and neck cancers

The poor prognosis for esophageal cancer could be improved if lesions were detected at an early stage. To detect early esophageal cancer, endoscopic screening of the esophagus with the Lugol dye method was performed in patients with head and neck cancers who were asymptomatic but regarded as being at high risk for synchronous or metachronous esophageal cancer. of 178 patients screened, 9 had esophageal cancer (5.1%). Eight of these patients (89%) were at early stages with no lymph node metastasis. Most of the lesions (9 of 13 lesions) were not detectable by barium studies or ordinary endoscopic study. the epidemiologic statistical analysis of the patients confirmed that they had a significantly high observed and expected number (O/E) ratio (39.7; P < 0.001). These results demonstrate the value of endoscopic screening of the esophagus with the Lugol dye method in patients with head and neck cancers and imply that endoscopic screening with the Lugol dye method may be useful for detecting early esophageal cancer in individuals at risk for other causes.

Prognostic significance of transforming growth factor-α in human esophageal carcinoma : implication for the autocrine proliferation

Background. The authors recently used immunostaining to demonstrate that patients with epidermal growth factor receptor (EGFR) overexpression have poor survival after surgery. However, the clinical significance of transforming growth factor (TGF)‐α, one of the ligands of EGFR, has not been demonstrated in esophageal carcinoma.

Prognostic value of dna ploidy in squamous cell carcinoma of esophagus. Analyzed with improved flow cytometric measurement

Background. The prognostic value of flow cytometric DNA analysis on paraffin‐embedded tumor samples has been controversial in esophageal cancer. To clarify its true significance, the authors developed an improved method that excludes the possibility of contamination by lymphocytes in tumor sample.

Phenotypic characteristics of tumour-infiltrating lymphocytes in human oesophageal cancer tissues defined by quantitative two-colour analysis with flow-cytometry.

Phenotypic subpopulations of tumourinfiltrating lymphocytes (TIL) separated from human oesophageal cancer tissues were defined by quantitative two-colour analysis with flow-cytometry (FACScan), and their characteristics were investigated by comparison with peripheral blood lymphocytes (PBL) and intra-oesophageal lymphocytes from noncancerous tissue (IEL) as the controls. Fifteen patients (13 males and 2 females) with squamous cell carcinoma of the oesophagus were entered into the study. Lymphocytes were analyzed by FACScan and the frequencies of the subpopulations were determined using monoclonal antibodies for surface markers. Single colour analysis revealed a predominance of T cells among TIL and a significant reduction of natural killer (NK) cells compared with the controls. Two-colour analysis showed that CD4+Leu8− (helper T cells) and CD8+CD11b− (cytotoxic T cells) were significantly increased among TIL when compared with the controls. This significant increase of both helper and cytotoxic T cells, which are indispensable components of cellular immunity, strongly implies that TIL are performing a role in the expression of antigen-specific cellular immunity against the tumours. This is the first report of a phenotypic study of human oesophageal cancer that clearly indicates the significance of the TIL and suggests their potential for use as a source of adoptive immunotherapy.

Principal lymphocyte subpopulation in local host response to human oesophageal cancer

We investigated what subpopulations of tumour-infiltrating lymphocytes (TIL) play a key role in in vivo function and what determines the degree of local host response represented by lymphocyte infiltration in human oesophageal cancer. We examined the increased subpopulation of TIL in “good responders” (GR) (patients with intensively TIL infiltrated tumours) when compared with “poor responders” (PR) (patients with weakly TIL infiltrated tumours). The frequency of each subpopulation was determined by quantitative flow-cytometric measurement on TIL separated from fresh tumours. Of TIL in GR, the frequency of CD3+ cells increased significantly (P<0.05) but the frequencies of CD16+, Leu7−, and CD16+ Leu7− cells were low and did not increase significantly compared with those in PR. With respect to T-cell subsets of TIL in GR, the frequency of CD8+ cells was significantly higher than that in PR (P<0.01), and CD4+/CD8+ ratio was lower than that in PR (P< 0.025). On two-colour analyses, most of CD8+ cells (cytotoxic/suppressor T-cells: Tc/s) did not co-express CD11b and the frequency of CD8+ CD11b− cells (cytotoxic T-cell: Tc) increased significantly compared with that in PR. Clinicopathological and phenotypic analysis of peripheral blood lymphocytes revealed that there are no major differences in general immunocompetence between GR and PR. These results suggest that Tc/s, especially Tc, might play a key role in local host response. They also suggest that not only the general immune status of the host but also the identification of class I major histocompatibility complex antigens by the host at the tumour site may strongly affect the degree of host response in oesophageal cancer.

Correlation Between Expression of E-Cadherin and Metastasis and Invasion in Human Esophageal Cancer

Cadherins are Ca2+-dependent cell-cell adhesion molecules which are possibly involved in the process of metastasis in cancer cells. We have investigated the expression of E-cadherin (E-CD), which is a subclass of cadherin expressed on cell membranes in normal esophageal epithelium. Sixty-two human esophageal cancers were studied with immunoblotting (5 cases) and immunohistochemical staining (62 cases) using monoclonal antibody for human E-CD (HECD-1) on frozen surgical specimens, and the correlation between E-CD expression and incidence of clinical lymph node metastasis and cancer invasion was investigated.

Comparison of the prognosis of surgical treatment and endoscopic injection sclerotherapy for esophageal varices.

過去13年間に当科で108例の食道静脈瘤に対して直達手術療法 (食道離断術50例, 胃上部切除50例, 胃上部静脈郭清ならびに摘脾8例) を行った. また過去7年間に95例の内視鏡的硬化療法を行った. 肝硬変患者に限っての生存率は, 手術療法では3生率79.2%, 5生率72.2%, 10生率57.5%, 内視鏡的硬化療法 (非手術既往例42例) では3生率71.2%, 5生率53.4%であり, 両者の間には有意差は認められなかった. しかし, 硬化療法では静脈瘤の再発率が高いので, 耐術適応のある患者には, 手術療法が第1選択と考えられる.(肝障害が重度で, 手術適応外で, 硬化療法でも対処し難いものには食道静脈瘤の原疾患である肝臓に対する根治療法としての肝移植が必要かもしれない.)