Shunsuke Shibata

Clinicopathologic differences between carcinoma in the gastric remnant stump after distal partial gastrectomy for benign gastroduodenal lesions and primary carcinoma in the upper third of the stomach

Background. This study evaluated the prognosis of patients with carcinoma in the gastric remnant stump after distal gastrectomy for benign disease (stump cancer).

CA72-4 Compared with Carcinoembryonic Antigen as a Tumour Marker for Gastric Cancer

Serum levels of a newly identified, tumour-associated antigen, CA72-4, were measured in 86 patients with histologically proven gastric carcinoma. Preoperative levels of CA72-4 in serum tended to be higher with increased dissemination of the cancer. Elevated levels of CA72-4 (above 5.0 U/ml) were significantly more frequent than those of carcinoembryonic antigen (CEA) (above 5.6 ng/ml) in patients with stage III or IV (P less than 0.01) carcinoma, in patients with Borrmann type 4 (P less than 0.01), and in patients with peritoneal metastasis (P less than 0.01). No correlation was seen between serum levels of CA72-4 and those of CEA. Serum levels of CA72-4 were lower 1 month after gastrectomy in 25 of 39 patients with resected cancers. In each of 4 patients with recurrence, lower levels of CA72-4 after gastrectomy were replaced by elevated levels on detection of the recurrence of cancer. These results indicate that CA72-4 is highly specific to gastric cancer and may be more reliable as a tumour marker than CEA for gastric cancer.

Does the extent of lymph node dissection affect the postoperative survival of patients with gastric cancer and disseminating peritoneal metastasis

For patients with gastric cancer and either P, or P2 peritoneal metastasis, no definite consistent policy with respect to the extent of lymph node dissection has yet been established. In palliatively gastrectomized patients, we analyzed the relationship between the extent of lymphadenectomy and postoperative survival. In patients with P1, an R2 or R3 lymphadenectomy was associated with a significantly improved postoperative survival as compared to an Rl dissection, while this, however, was not the case in patients with P2. As this study was not intended to be a prospective randomized study, a definite conclusion should be avoided. However, our findings suggest that in patients with PI, surgery should not be confined to a resection of the primary lesion, but should also include an R2 or R3 lymphadenectomy.

Are argyrophilic nucleolar organizer regions good prognostic indicators of survival of patients with esophageal cancer with lymph node metastasis

Argyrophilic nucleolar organizer regions (AgNORs) were evaluated in 95 samples from primary esophageal squamous cell carcinomas and 75 samples from metastatic lymph nodes. The number of AgNORs per nucleus in primary tumors with positive nodes (n = 53, 6.1 ± 1.8) was greater than that in primary tumors with negative nodes (n = 42, 3.8 ± 1.1, P < 0.001). In 39 of 53 patients with positive nodes, the numbers of AgNORs per nucleus in metastatic lymph nodes were lower than those in primary tumors. The 5‐year survival rate of these patients was 23.7%. However, the numbers of AgNORs per nucleus in metastatic lymph nodes were greater than those of primary tumors in 14 of 53 patients with positive nodes, and 11 of these 14 patients died from recurrence of cancer within 3 years after surgery. These observations suggest that the proliferative activity of cancer cells might be suppressed in the regional lymph nodes. However, cancer cells with higher proliferative activity in the regional lymph nodes than in the primary tumors might overcome immunological defenses and subsequent further metastasis might occur.

A STUDY ON PERTINENCE OF NON-CURATIVE GASTRIC RESECTION FOR STAGE IV GASTRIC CANCER

治癒切除不能のStage IV胃癌に対して,胃切除術を行った70症例を対象に,予後,術後在院期間からみた手術の妥当性について検討した.試験開腹,あるいはバイパス手術に終わった12症例と生存率を比較したところ,そのMSTは252日と119日で,胃切除例で有意に延長していた(p<0.01).非治癒切除因子が1因子の症例(n=51)のMSTは367日であり,2因子の症例 (n=19) の141日と比較して有意に長かった(P<0.01).1因子のみで予後を比較すると, P因子のMSTがN因子, H因子に比較して短かったが,いずれも非切除より生存期間の延長を認めた.非治癒切除因子が2因子ある場合は,胃切除による生存期間の延長を認めなかった(p=0.53).非治癒切除因子が2因子ある場合,在院死亡率は47.4%, 在院率は73.6%と高く,殊にP因子を含む症例で高かった.従って,非治癒切除因子が2因子ある場合は原則的に胃切除の適応はないものと考えられた.

Thermochemotherapy Using a Radiofrequency Capacitive Heating System in the Treatment of Unresectable Bile Duct and Pancreatic Cancers

非手術例を除く胆道癌非切除例4例と膵癌非切除例6例の計10例に対し, 8MHzのradiofrequency (RF) 誘電加温装置を用いて局所温熱化学療法を施行した.RF加温は腫瘍内温度42℃ ・30分を目標に週1回施行した.最高腫瘍内温度とRF最大出力との間には有意な正の相関が認められ, RF最大出力1,000W以上で腫瘍内温度は有効な42℃ 以上に上昇した.腫瘍縮小効果は5例に, P.S.の改善と血清腫瘍マーカー値の低下はおのおの6例に認められ, 膵癌の有痛例5例中3例に除痛効果が得られた.腫瘍縮小が得られた5例中3例が1年以上, うち1例が2年以上生存中である.温熱化学療法施行例の遠隔成績は従来の化学療法単独施行例の成績よりも良好であった.以上より, 切除不能胆道・膵癌に対する温熱化学療法は, 高い抗腫瘍効果とともにquality of lifeの改善が得られ, 有効な治療法になる可能性が示唆された.