Takahiro Ezaki

Prognostic Nutritional Index: A Tool to Predict the Biological Aggressiveness of Gastric Carcinoma

PurposeThe prognostic nutritional index (PNI), which is calculated based on the serum albumin concentration and the peripheral blood lymphocyte count, has been used to assess the immunological and nutritional condition of patients with digestive diseases. However, its value as an indicator of aggressiveness in gastric carcinoma has not been fully investigated.MethodsTwo hundred and forty-eight cases of gastric carcinoma were studied with regard to the relationship between the preoperative PNI value and the clinicopathological characteristics of the patients.ResultsA lower preoperative PNI value significantly correlated with greater tumor depth, lymph node metastasis, lymphatic permeation, and venous invasion. Moreover, the PNI value proved to be an independent prognostic indicator in gastric carcinoma.ConclusionThe PNI value can be a useful tool to predict the prognosis of patients with gastric carcinoma.

Specific gene-expression profiles of noncancerous liver tissue predict the risk for multicentric occurrence of hepatocellular carcinoma in hepatitis C virus-positive patients.

BackgroundHepatitis C virus (HCV) infection produces chronic hepatitis, cirrhosis, and, ultimately, hepatocellular carcinoma (HCC). A molecular analysis of the damaged liver tissues infected with HCV may identify specific gene-expression profiles associated with a risk for liver carcinogenesis.MethodsForty patients with HCV-positive HCC were classified into two groups: single nodular HCC group (n = 28) and multicentric HCC group (n = 12). Using a complementary DNA microarray, we compared the gene-expression patterns of the noncancerous liver tissue specimens between the two groups. We also identified the differentially expressed genes related to multicentric recurrence in the liver remnant. We then evaluated whether a specific gene-expression profile can accurately estimate the risk for multicentric hepatocarcinogenesis.ResultsWe selected the 230 differentially expressed genes in the multicentric HCC group. A hierarchical clustering analysis identified a cluster that might be closely associated with the multicentric occurrence of HCC. On the basis of the gene-expression profiling of the 36 genes commonly associated with both multicentric HCC and multicentric recurrence, we created a scoring system to estimate the risk for multicentric hepatocarcinogenesis. The prediction score of patients in the multicentric HCC group with multicentric recurrence (19.9 ± 9.2) was significantly higher (P < .05) than that in the single nodular HCC group without multicentric recurrence (−1.8 ± 12.7).ConclusionsSpecific gene-expression signatures in noncancerous liver tissue may help to accurately predict the risk for developing HCC.

DNA analysis of hepatocellular carcinoma and clinicopathologic implications

Cell nuclear DNA content was microspectrophotometrically measured in 60 specimens of clinical hepatocellular carcinoma (HCC). The DNA distribution pattern was classified into two types, diploid and nondiploid, according to the degree of dispersion on the DNA histogram. Among these 60 specimens, 26 had an HCC of less than 5 cm in diameter. In these 26, 17 (65%) had the diploid pattern and 9 (35%) had the nondiploid pattern. In the remaining 34 specimens with a large HCC exceeding 5 cm in diameter, the diploid pattern was seen in only six (18%), and the nondiploid pattern was seen in 28 (82%). Following increase in tumor size, the number of cases of nondiploid increased. The DNA pattern closely correlated with the morphologic grading and age of patients, yet there was no correlation among DNA pattern and presence of hepatitis B surface antigen (HBsAg) or presence of liver cirrhosis. Regarding the prognosis of patients with HCC, there was no statistic difference between DNA pattern and prognosis. The present study suggests that the DNA pattern relates to the biologic characteristics of the growth pattern of HCC. However, the DNA pattern showed no significant correlation with survival rates of patients with HCC who underwent hepatic resection.

Significance of modified Glasgow prognostic score as a useful indicator for prognosis of patients with gastric carcinoma

BACKGROUND The significance of the Glasgow prognostic score (GPS), an inflammation-based prognostic score, as an indicator of aggressiveness in gastric carcinoma has not been investigated fully. METHODS Two hundred thirty-two patients with gastric carcinoma were enrolled. Patients who had both an elevated C-reactive protein (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a traditional GPS (TGPS) of 2. Patients who had one of these abnormal values were allocated a TGPS of 1, and patients who had neither were allocated a TGPS of 0. RESULTS There existed a significant difference between the survival of adjacent groups of patients when examined using the TGPS (P = .05 for TGPS 0 vs 1 and P = .006 for TGPS 1 vs 2). Multivariate analysis based on TGPS demonstrated that TGPS (P = .020) and tumor stage (P = .0007) proved to be independent prognostic indicators for worse prognosis. CONCLUSIONS The preoperative measurement of an inflammation-based prognostic score can demonstrate a strict stratification for the prognosis of patients with gastric carcinoma.

Preoperative Elevation of Serum C-Reactive Protein as an Independent Prognostic Indicator of Colorectal Carcinoma

PurposeThe preoperative elevation of serum C-reactive protein (CRP) is thought to be a prognosticator of carcinomas of the digestive tract. We conducted this study to investigate the clinical importance of the preoperative elevation of serum CRP in patients with colorectal carcinoma (CRC).MethodsWe investigated the correlation between an elevated preoperative serum CRP level and the clinicopathologic factors, including prognosis, of 116 patients who underwent resection of CRC.ResultsForty-seven (40.5%) patients had an elevated serum CRP value preoperatively (group H) and 69 (59.5%) did not (group L). There were significant differences in the tumor size, proportion of poorly differentiated tumors, depth of invasion, lymph node metastasis, lymphatic invasion, and tumor stage between the two groups. Survival was significantly lower in group H than in group L (P < 0.0001). Multivariate analysis showed that the preoperative elevation of serum CRP (P = 0.0007), as well as poor differentiation (P = 0.027) and advanced tumor stage (P = 0.007) were independent prognostic factors in patients with CRC.ConclusionWe found the preoperative elevation of serum CRP to be an independent prognostic indicator of CRC.

Preoperative elevation of serum C-reactive protein as an independent prognostic indicator for gastric cancer

PurposePreoperative elevation of serum C-reactive protein (CRP) is a prognostic indicator for some malignant tumors. We investigated the clinicopathologic importance of an elevated preoperative serum CRP value in gastric carcinoma patients.MethodsWe studied the relationship between the preoperative serum CRP value and clinicopathologic characteristics in 204 patients who underwent curative resection of gastric carcinoma.ResultsThe patients with preoperative CRP elevation had significantly poorer survival than those without CRP elevation (P < 0.0001). According to multivariate analysis, the factors independently associated with an unfavorable prognosis were a high preoperative CRP value (P = 0.024), lymphatic invasion (P = 0.017) and advanced tumor stage (P = 0.016).ConclusionPreoperative serum CRP elevation can be an independent prognostic indicator in patients with gastric carcinoma.

Increased incidence of proximal colon cancer in the elderly.

To define the characteristics of colorectal cancer with regard to site distribution, age, and sex, due to the significantly increased incidence of colorectal cancer in Japan, we investigated 1,205 Japanese patients with colorectal cancer between 1975 and 1994. When we compared site distribution for age and sex in the entire 20-year period, tumors in the proximal colon were more frequent in elderly patients than in young ones (p < 0.05); this tendency was true only for females (p < 0.01), but not for males. The increased incidence of proximal colon cancer in elderly patients was also found in the second 10-year period (p < 0.05). Because elderly patients are characterized by an increasingly high incidence of proximal colon cancer in recent years, more concerted efforts for the early detection of proximal colon cancer, particularly in the elderly, are called for.

Limited Hepatic Resection for Hepatocellular Carcinoma in the Caudate Lobe

The most appropriate approach to treating hepatocellular carcinoma (HCC) in the caudate lobe has not yet been determined. A series of 197 patients who had undergone curative hepatic resection for HCC were analyzed. Fifteen patients had HCC in the caudate lobe: three in the Spiegel lobe (SP), three in the caudate process (CP), and nine in the paracaval portion (PC). Patients with HCCs in the SP and CP underwent partial hepatectomy. HCCs in the PC were approached in one of three ways: anterior approach and partial hepatectomy of the PC (Ant+PHx-PC), partial hepatectomy, or left lobectomy. Clinicopathologic variables, including the underlying liver disease, the mean tumor size, and the pathologic characteristics of HCC, did not differ between surgery of the caudate lobe and that of other segments. The overall survival was 88.9% at 3 years and 66.7% at 5 years after resection of HCC in the caudate lobe; the corresponding figures were 86.1% at 3 years and 68.6% at 5 years for the other segments. The recurrence-free survival rate was 51.9% at 3 years and 34.6% at 5 years for the caudate lobe, and it was 52.1% at 3 years and 32.8% at 5 years for the other segments. Clinicopathologic characteristics of HCCs originating in the caudate lobe were not different from those in the other segments. Limited resection of HCC in the caudate lobe confers a similar prognostic value as in other segments.

Elevation of alpha‐fetoprotein level without evidence of recurrence after hepatectomy for hepatocellular carcinoma

Seven Japanese patients showed a gradual rise in serum alpha‐fetoprotein (AFP) levels for periods of 4 to 14 weeks after partial hepatectomy for hepatocellular carcinoma. These levels then gradually decreased, but not always to a normal level, and various procedures after surgery failed to detect tumor recurrence. All the cases were complicated with liver cirrhosis. It is suggested that the postoperative elevation in the AFP level may have been caused by hepatic regeneration as a result of the intervention chemotherapy and/or surgery, but it does not exclude the possibility of a tumor recurrence.

Postoperative recurrence of solitary small hepatocellular carcinoma

The prognosis of hepatocellular carcinoma after hepatic resection remains poor. The major cause is postoperative recurrence, most frequently intrahepatic. During the past 7 years, we conducted a detailed study of recurrence after hepatectomy in 34 patients with solitary small hepatocellular carcinoma measuring no larger than 4 cm in diameter, in which 13 cases had postoperative recurrent tumors. and two cases were considered multicentric. Eighty‐five percent of recurrences were diagnosed at 6–18 months after the operation. The cumulative recurrence rates were 61% at 5 years after operation. When analyzing the factors affecting recurrence, a significant difference was observed regarding tumor diameter. After recurrence, most patients underwent percutaneous ethanol injection treatment and/or transcatheter arterial chemoembolization and lipiodolization. Four patients died of progressive disease within 1 year after recurrence; the treatment thus seemed to have no effect. The other patients with recurrence remain alive with the disease. The overall cumulative survival rates in this series were 76% at 3 years and 60% at 5 years after operation. To obtain better results after hepatectomy, even for small hepatocellular carcinoma, careful, long‐term follow‐up evaluation is therefore necessary for the multidisciplinary treatment of the postoperative recurrence, as well as the early diagnosis of tumors in high‐risk patients.