Munetsugu Hirata

B7‐H3 expression in gastric cancer: A novel molecular blood marker for detecting circulating tumor cells

The clinical significance of B7‐H3 expression in gastric cancer remains unclear, although the B7 ligand family plays a critical role in the T cell‐mediated immune response. We therefore investigated B7‐H3 expression as a blood marker of circulating tumor cells and determined correlations with tumor progression in patients with gastric cancer. B7‐H3 expression in gastric cell lines was initially evaluated by immunocytochemistry. Furthermore, we used quantitative RT‐PCR to assess B7‐H3 mRNA expression in four cell lines and in 95 blood specimens from patients with gastric cancer, as well as in 21 samples of peripheral blood lymphocytes from healthy volunteers. B7‐H3 expression in cell lines was identified by immunocytochemistry and quantitative RT‐PCR. Blood specimens from patients with gastric cancer contained significantly more copies of B7‐H3 mRNA than those from healthy volunteers without cancer (P < 0.0001). Levels of B7‐H3 expression significantly correlated with overall stage (P = 0.013). The 5‐year survival rate was significantly lower in patients with high B7‐H3 expression than with low expression (P = 0.02). Multivariate analysis demonstrated that B7‐H3 expression was an independent prognostic factor (P = 0.046). Our results indicate that B7‐H3 appears to be a useful blood marker for predicting tumor progression in gastric cancer. (Cancer Sci 2011; 102: 1019–1024)

Clinical implication of HLA class I expression in breast cancer

BackgroundHuman leukocyte antigen (HLA)-class I molecules on tumor cells have been regarded as crucial sites where cytotoxic T lymphocytes (CTL) can recognize tumor-specific antigens and are strongly associated with anti-tumor activity. However, the clinical impact of HLA class I expression in breast cancer has not been clarified.MethodsA total of 212 breast cancer patients who received curative surgery from 1993 to 2003 were enrolled in the current study. HLA class I expression was examined immunohistochemically using an anti-HLA class I monoclonal antibody. The correlation between HLA class I positivity and clinical factors was analyzed.ResultsThe downregulation of HLA class I expression in breast cancer was observed in 69 patients (32.5%). HLA class I downregulation was significantly associated with nodal involvement (p < 0.05), TNM stage (p < 0.05), lymphatic invasion (p < 0.01), and venous invasion (p < 0.05). Patients with preserved HLA class I had significantly better disease-free interval (DFI) than those with loss of HLA class I (p < 0.05). However, in multivariable analysis, HLA class I was not selected as one of the independent prognostic factors of disease-free interval.ConclusionThe examination of HLA class I expression is useful for the prediction of tumor progression and recurrent risk of breast cancer via the antitumor immune system.

Clinical significance of circulating tumor cells in peripheral blood from patients with gastric cancer

The authors hypothesized that circulating tumor cells (CTCs) in patients with gastric cancer are associated with prognosis and disease recurrence. In this study, they evaluated CTCs in gastric cancer and clarified the clinical impact of CTCs.

Expression of B7‐H4 in blood of patients with gastric cancer predicts tumor progression and prognosis

B7‐H4 is a novel molecular B7 ligand that plays an important role as a negative regulator of the T cell‐mediated immune response. However, the clinical significance of B7‐H4 expression in gastric cancer remains uncertain. Here, we assessed B7‐H4 expression in blood of patients with gastric cancer to determine whether or not it can predict tumor progression and prognosis.

Number of Axillary Lymph Node Metastases Determined by Preoperative Ultrasound is Related to Prognosis in Patients with Breast Cancer.

Objective: To analyze the impact on prognosis of the number of axillary lymph node metastases (LNM) detected by ultrasound (US) in patients with breast cancer. Methods: One-to-one comparison of LNM was performed between the ultrasound and histologic diagnosis in 380 patients. Results: The accuracy of preoperative ultrasound diagnosis was 79.7%. According to the subdivision of number of LNM (0, 1–3, 4–9, 10+), the accuracy rates associated with LNM were 82%, 49%, 34%, and 86%, respectively. The disease-free-survival curves according to the number of LNM were similar in them. Conclusion: Preoperative ultrasound can determine axillary involvement and may be useful for predicting prognosis.

Immediate reconstruction using thoracodorsal adipofascial flap after partial mastectomy.

BCT (breast conserving therapy) has become a standard strategy for breast cancer and ensures local control and acceptable cosmetic results. However, an insufficient resection margin may increase local recurrence if too much attention is paid to cosmesis. Here, we describe a simple technique for reconstruction of the defect on the outer upper part of the breast with early breast cancer using thoracodorsal adipofascial flap.

Immediate breast reconstruction using autologous free dermal fat grafts provides better cosmetic results for patients with upper inner cancerous lesions

PurposeAlthough breast-conserving therapy (BCT) is the standard form of treatment for early-stage breast cancer, in patients with small breasts cosmetic results can be poor, especially when the lesion is located on the inner upper quadrant area. This study analyzes our use of autologous free dermal fat grafts (FDFGs) for immediate breast reconstruction.MethodsA total of 23 patients who received a partial mastectomy for an inner upper quadrant lesion from 1992 to 2006 at Kagoshima University Hospital were retrospectively divided into three groups according to the reconstructive procedure that was used for the defect after partial mastectomy: immediate reconstruction using an autologous FDFG from the lower abdomen (group FDFG); patients receiving only rotation and fixation of the parenchymal adipose tissue or gland to repair the defect (group GL); and a third group who underwent immediate reconstruction using a miniflap of the latissimus dorsi (group LD).ResultsThe total duration of surgery in group FDFG was significantly shorter than in group LD (P < 0.01). The mean volume of blood lost in group FDFG was significantly lower than in group LD (P < 0.01). The breast retraction assessment (BRA) of group FDFG was significantly better than for the patients in groups GL and LD (P < 0.01). The total score using the ABNSW system for cosmetic assessment was significantly better in group FDFG than in group GL (P < 0.01). Similarly, the total score in group FDFG using the assessment by the Japanese Breast Cancer Society was significantly higher than that in group GL (P < 0.01).ConclusionImmediate breast reconstruction for a defect after a partial mastectomy of an upper inner quadrant malignant lesion using FDFG can be especially useful for patients with small breasts.

Oncoplastic surgery combining partial mastectomy with breast reconstruction using a free nipple-areola graft for ductal carcinoma in situ in a ptotic breast: Report of a case

We report a case of early breast cancer, which was treated successfully by oncoplastic surgery. A 65-year-old Japanese woman was referred to us for investigation of a grouped calcification on mammography of her left breast, detected during mass screening for breast cancer. No mass lesion was palpated, but we suspected that the grouped calcification seen on the mammography was a malignant lesion in the lower area of the left breast. Ultrasonography and magnetic resonance imaging revealed ductal carcinoma in situ, restricted to the inner quadrant of the left breast. Achieving a good symmetrical outcome after partial mastectomy would have been made difficult by the degree of ptosis. Thus, we performed partial mastectomy followed by an amputation-type reduction operation with free nipple-areola complex grafting, which achieved good cosmetic and oncologic results.

Clinical and pathologic evaluation of implanted free dermal fat grafts after breast cancer surgery: a retrospective analysis.

PURPOSE The efficacy of immediate breast reconstruction using a free dermal fat graft (FDFG) was evaluated clinically. PATIENTS AND METHODS A total of 22 breasts in 21 patients who underwent partial mastectomy for early breast cancer involving mainly the inner upper quadrant were enrolled in this study. The defect was reconstructed immediately by filling it with an autologous FDFG. At 6 months and 1, 2, 3, 4, and 5 years postoperatively, the width (horizontal length) and thickness (distance perpendicular to skin) of the FDFG on computed tomography (CT) scans were measured. Histologic samples from the implanted FDFG were collected by core needle biopsy (CNB). The correlations between clinical findings and volume of the FDFG on CT and the proportion of fatty tissue in the CNB were examined statistically. Cosmetic results were also evaluated. RESULTS On CT, the mean width of the FDFG was 95%, 81%, 79%, 73%, 68%, and 47% and the mean thickness were 125%, 121%, 120%, 115%, 104%, and 103% at 6 months, and 1-5 years postoperatively, respectively. In the CNB samples, the mean fatty tissue distribution was 76%, 63%, and 54% at 1 year, 1-4 years, and >4 years postoperatively, respectively. The percent change in the width of the FDFG at 6 months after the operation displayed a significant negative correlation with the postmenopausal period and a significant positive correlation with the maximum surgical margin. On CT, thickness was negatively correlated with the size of the resected breast tissue, and thickness of the implanted FDFG. No clinicopathologic factors or technical factors were related to FDFG outcome and the proportion of fat tissue in the CNB sample, except for axillary dissection. Nineteen of 21 patients had good to excellent cosmesis. CONCLUSION FDFG implanted into breast defects after partial mastectomy undergo mild resorption and degeneration to fibrous tissue, but most patients have good to excellent cosmesis.

Utility of the GeneSearch breast lymph node assay for the rapid evaluation of sentinel lymph nodes in breast cancer

The potential for reducing the need for second surgery for axillary lymph node dissection (ALND) has made the intraoperative evaluation of sentinel lymph nodes (SLNs) attractive. The goal of the current study was to evaluate the clinical application of the breast lymph node (BLN) assay, a real‐time reverse transcriptase‐polymerase chain reaction assay for SLN metastases, by comparing this test with routine pathologic examination.