Toshiro Okuyama

Postoperative immunochemotherapy including streptococcal lysate OK-432 is effective for patients with gastric cancer and serosal invasion

The effects of postoperative immunochemotherapy including the streptococcal preparation OK-432 on the rate of peritoneal recurrence and survival time after curative resection were studied in 36 patients with gastric cancer. Patients randomized to group B received 18 months of a therapy that is widely used in Japan for patients with gastric cancer: mitomycin C (MMC) and UFT, a combination of tegafur and uracil in a molar ratio of 1:4. Patients randomized to group A received the same drugs given to group B plus an intraperitoneal injection of OK-432 on postoperative day 0 and intradermal injections of OK-432 for 18 months at 2-week intervals. There were no differences between the two groups in any known prognostic factor or dose of any drug received, except for OK-432. There was no difference in the toxicity rates between the groups. The concomitant administration OK-432 and anticancer drugs significantly decreased the rates of peritoneal recurrence and lengthened survival time (P < 0.05).

Prophylactic lymph node dissection in patients with advanced gastric cancer promotes increased survival time

Background. There is no consensus of opinion regarding the efficacy of lymph node dissection.

Expression of glutathione s‐transferasepi and sensitivity of human gastric cancer cells to cisplatin

Background. The authors examined the correlation between the expression of glutathione S‐transferase‐pi (GSTπ) and the sensitivity of gastric cancer to anticancer agents.

Combined Evaluation of Expressions of p53 and p21 Proteins as Prognostic Factors for Patients with Gastric Carcinoma

Background: The tumor suppressor gene p53 is a nuclear protein which plays a key role in tumor progression by regulating DNA repair, cell division and apoptosis. One major function of wild-type p53 is to control the onset of DNA replication at the G1-S boundary by inducing p21 protein, which promotes cell cycle arrest by inhibiting the phosphorylation of the cyclin-dependent kinases’ complexes and blocking cell cycle progression to the S-phase. Methods: 195 human gastric cancer specimens were prepared for immunohistochemical staining, using antibodies against p53 and p21. Clinicopathological factors and the clinical prognosis were examined for each indicator. Results: Of those 195, positive rates of p53 and p21 were 37.9% (74/195) and 42.6% (83/195), respectively. p53-negative patients had a better 5-year survival rate compared with positive ones (p < 0.05), and p21-positive cases had better 5-year survival rate compared with negative ones (p < 0.05). Four separate groups were prepared, based on expressions of p53 and p21, and the prognoses were compared. The incidence of the p53(–)/p21(+) group was 27.2% (53/195 cases) and that of the p53(–)/p21(–), p53(+)/p21(–) and p53(+)/p21(+) groups was totally 72.8% (142/195 cases). The 5-year survival time of the former group was 67.5% and was significantly longer than the combined 5-year survival time of the latter groups of 45.9% (p < 0.05). Conclusions: The incidence in cases where functions of either or both of p53 and p21 proteins were diminished exceeded 70% of all the cases. The survival time for the p53(–)/p21(+) group with proper functions of both proteins and the signal pathway was significantly longer. The combined evaluation of expressions of p53 and p21 proteins in gastric cancer tissues aids in predicting the clinical prognosis for surgically treated gastric cancer patients.

A simple classification of lymph node level in gastric carcinoma

BACKGROUND Because insufficient lymph node examination can cause erroneous listing of earlier-nodal-stage gastric carcinoma (stage migration phenomenon), surgical results must be evaluated based on a highly accurate examination of the dissected lymph nodes. To establish a simple and useful classification of lymph node level, we analyzed the frequency and distribution of lymph node metastasis by using curatively treated node-positive gastric carcinoma. PATIENTS AND METHODS Various clinicopathologic data were analyzed with reference to the degree of lymph node metastasis by using 240 patients with curatively resected node-positive gastric carcinoma. The cases were divided into the following three groups: 142 with positive level I (perigastric) nodes, 71 with positive level II (intermediate) nodes, and 27 with positive level III (distant) nodes, irrespective of the location of tumors. RESULTS The level of lymph node metastasis clearly correlated with the survival of patients, with the 5-year survival rates for level I, II, and III cases being 67%, 35%, and 26%, respectively (P < 0.01). The degree of lymph node metastasis was determined by the number of positive nodes (P < 0.01), the depth of invasion (P < 0.01), the size of tumors (P < 0.01), and the location of tumors (P < 0.05). CONCLUSION This simple classification of lymph node level (level I, II, and III) is useful for the evaluation and prediction of surgical results in gastric carcinoma.

The Effectiveness of Chemotherapy with Cisplatin and 5-Fluorouracil for Recurrent Small Cell Neuroendocrine Carcinoma of the Rectum: Report of a Case

We report herein the case of a 46-year-old-man with small cell neuroendocrine carcinoma (NEC) concomitant with large villous adenoma of the rectum, who underwent abdominaoperineal resection with regional lymphnode dissection. The resected specimen was histologically found to contain a small lesion of NEC confined to the submucosa in the large adenoma. A computed tomography scan done 4 months postoperatively revealed recurrences in the liver, lymph nodes, and bone. Therefore, two cycles of sequential intravenous combined chemotherapy with standard doses of cisplatin and 5-fluorouracil (5-FU) were administered, after which the size of each tumor decreased remarkably. Nevertheless, the patient died 8 months after the operation. As there was a fair response of this tumor to the combined chemotherapy of cisplatin and 5-FU, this regimen against NEC of the colon and rectum should be given consideration.

Sex hormone-receptor-negative tumors have a higher proliferative activity than sex hormone-receptor-positive tumors in human adenocarcinomas of the gastrointestinal tract

To determine whether a correlation exists between hormone receptors and their proliferative activities, the levels of estrogen receptors (ER) and progesterone receptors (PgR) in surgical specimens from 23 patients with gastric cancer and from 32 patients with colorectal cancer were investigated using an enzyme immunoassay. These values were examined in relation to the parameters of cell kinetics determined by DNA flow cytometry. When the cutoff value was determined as 2.0 fmol/mg of cytosolic protein, ER and PgR were found in 13 (56%) and 6 (26%) of the 23 patients with gastric cancer, respectively, and in 10 (31%) and 10 (31%) of the 32 patients with colorectal cancer, respectively. There was a significant correlation in the expressions of ER between the cancer tissues and normal mucosa (P=0.040). Although the expressions of ER or PgR were apparently not related to pathological status, better correlations of hormone receptor-negative tumors with increased hyperaneuploid levels were evident. According to a multiple regression analysis, ER levels significantly correlated with changes in the DNA index (P=0.041) and in the heterogeneity index score (HIS) (P=0.034). Thus, sex hormone receptors proved to be relevant factors associated with the proliferative activity of adenocarcinoma of the gastrointestinal tract. These findings indicate that the expression of hormone receptors provides pertinent biological information required to determine adequate therapeutic regimens in patients with gastrointestinal cancer.

Gastric carcinoma with pyloric stenosis.

BACKGROUND The surgical outcome of gastric carcinomas with pyloric stenosis and their prognostic factors are sparsely documented. METHODS A clinicopathologic study of gastric carcinoma with pyloric stenosis (PS group, n = 122) was done and findings were compared with the cases involving the antrum (A group, n = 695). Independent prognostic factors for survival of the patients with PS were determined by Coxs proportional hazard model. RESULTS There were no differences in age and gender between the two groups. The PS group was characterized by an infiltrating growth pattern and undifferentiated adenocarcinoma. The incidence of serosal invasion, direct invasion into neighboring organs, peritoneal dissemination, lymph node metastasis, and liver metastasis of the PS group was higher than those of the A group (p < 0.01). The resection rate and 5-year survival of the PS group were 78% and 22%, respectively; these values were significantly lower than 98% and 58% of the A group (p < 0.01). Multivariate analyses showed that operative curability, resection of the stomach, liver metastasis, serosal invasion, and histologic type were the independent prognostic factors of the PS group. CONCLUSIONS In cases of gastric carcinoma with pyloric stenosis, efforts should be made to do a curative operation, but for other patients with poor prognostic factors, intensive surgery and adjuvant therapy should be considered.

The effect of overweight status on the short-term and 20-y outcomes after hepatic resection in patients with hepatocellular carcinoma

BACKGROUND We aimed to evaluate the impact of body mass index (BMI) on the short- and long-term outcomes of hepatic resection in patients with hepatocellular carcinoma (HCC). METHODS We performed 371 hepatic resections in HCC patients whom we categorized into two groups based on BMI: BMI ≥ 25 (n = 77) and BMI <25 (n = 294). We compared surgical outcomes between groups. RESULTS The incidence of postoperative complications in the BMI ≥ 25 group was comparable to those in the BMI <25 group. However, patients in the BMI <25 group showed a significantly worse long-term prognosis than those in the BMI ≥ 25 group (P < 0.01). The results of multivariate analyses showed that BMI <25 was an independent and prognostic indicator of long-term outcome after hepatic resection in HCC patients. CONCLUSIONS A BMI ≥ 25 is not a risk factor for mortality or postoperative complications, and is considered to provide a better long-term prognosis (>20 y) than a BMI <25 in patients with HCC after hepatic resection. Further studies are needed to determine whether these results apply to other patient populations outside Japan where BMI ≥ 30 is more prevalent.

Quality of life following surgery for vertebral metastases from breast cancer

The quality of life of patients with vertebral metastases from breast cancer treated with surgery was evaluated.