Risk Factors and Efficacy of Adjuvant Therapy After Surgery of Elderly Colon Cancer Patients 70 Years of Age or Older

BACKGROUND: Colon cancer affects largely elderly populations. Elderly patients treated with adjuvant chemotherapy is lower than younger patients in colon cancer. We aim to evaluate the survival and prognostic factors in accordance with adjuvant chemotherapy in elderly colon cancer patients undergoing curative resection. METHODS: We retrospectively reviewed 86 patients 70 years of age or older with stage II, III colon cancer who were underwent surgical resection between 2005 and 2013 at single-center. We examined demographic factors, comorbidities at the time of diagnosis, factors associated with colon cancer, and factors associated with treatment, and analyzed associations survival and these factors divided into adjuvant chemotherapy group (chemotherapy group) and the conservative treatment group (observation group). RESULTS: Among 86 patients 70 years of age or older, 58 patients (67.4%) administered adjuvant chemotherapy and 28 patients (32%) underwent conservative treatment. There are significant differences in respect to the age of 75 in order to select conservative treatment or adjuvant chemotherapy for patients with surgery (p=0.008). There was no significant difference of median overall survival between both groups (chemotherapy group versus observation group: 20 months vs. 24 months, p=0.000). Poor ECOG PS score was independent prognostic factor for overall survival (95% confidential interval 0.016-0.205; hazard ratio, 0.58; p<0.001). CONCLUSION: Adjuvant chemotherapy did not affect the overall survival in stage II, III elderly colon cancer after surgical resection. There was the tendency to determine whether undergoing adjuvant chemotherapy according to chronologic age. It is thought to be necessary to perform a comprehensive geriatric assessment for decision of adjuvant chemotherapy in elderly patients.

A Metastatic Granulocyte Colony-Stimulating Factor Producing Sarcomatoid Carcinoma of the Lung Causing Jejunal Intussusception: Report of a Case

A 75-year-old man was referred to our hospital with intestinal obstruction caused by intussusception. Abdominal computed tomography (CT) revealed seven polypoid masses in the small intestine, while chest CT revealed a mass in the right lower lobe. Preoperative laboratory tests showed white blood cell (WBC) and neutrophil differential counts of 63,630/mm3 and 95%, respectively. The serum granulocyte colony-stimulating factor (G-CSF) was 114 pg/mL, which was elevated (normal range, <18.1 pg/mL). After resection of the small bowel, the WBC count decreased to 20,510/mm3. The pathology showed a poorly differentiated carcinoma with sarcomatous components confirmed by positive immunostaining of cytokeratin (AE1/AE3) and vimentin in the small intestine. Furthermore, immunohistochemistry with specific monoclonal antibodies against G-CSF was positive. A lung biopsy revealed the same histological findings as the small intestine lesion. Therefore, the patient was diagnosed as having a G-CSF producing sarcomatoid carcinoma of the lung with metastasis to the small intestine.

Double Intussusception in a Preterm Infant / 대한주산의학회잡지

Intussusception is a common surgical disorder in infancy. Intussusception in preterm infant is very rare and about 40 cases have been reported. Furthermore, double intussusception is extremely rare in children and there seems to be no such a case reported in preterm infant. We report a case of idiopathic double intussusception in the preterm infant, who was born at 25 weeks' gestation, underwent an explolaparotomy for bowel perforation on 39 days of life, and during the operation, an ileo-ileo-colic intussusception was found without a leading point.

Laparoscopic Approach to a Case of Appendicular Schwannoma

Appendicular schwannoma is a rare tumor originating from Schwann's cells in the Auerbach plexus. The preoperative diagnosis is difficult because the clinical features are nonspecific, and it is mostly found accidentally via a radiologic image as a tumor, mimicking malignancy. We report a case of an appendicular schwannoma coexisting with an adenocarcinoma in the lung. A laparoscopic appendectomy was done with a clear resection margin, and the immunohistochemical staining showed positive S-100 protein, which confirmed the schwannoma. The patient also underwent a left upper lobectomy of the lung. The patient has been free of recurrence for the 6 months since the operation. The laparoscopic approach could be available for treatment of an appendicular schwannoma, thus avoiding an unnecessary laparotomy.

Risk Factors for Complications Following Resection of Gastric Cancer

PURPOSE: Operative morbidity and mortality from gastric cancer have decreased in recent years, but many studies have demonstrated that its prevalence is still high. Therefore, we investigated the risk factors for morbidity and mortality considering the type of complication in patients with gastric cancer. MATERIALS AND METHODS: A total of 259 gastrectomies between 2004 and 2008 were retrospectively reviewed. RESULTS: Overall morbidity and mortality rates were 26.6% and 1.9%, respectively. A major risk factor for morbidity was combined resection (especially more than two organs) (P=0.005). The risk factors for major complications in which a re-operation or intervention were required were type of gastrectomy, upper location of lesion, combined resection, and respiratory comorbidity (P=0.042, P=0.002, P=0.031). Mortality was associated with preexisting neurologic disease such as cerebral stroke (P=0.016). In the analysis of different complication's risk factors, a wound complication was not associated with any risk factor, but combined resection was associated with bleeding (P=0.007). Combined resection was an independent risk factor for a major complication, surgical complication, and anastomotic leakage (P=0.01, P=0.003, P=0.011, respectively). Palliative resection was an independent risk factor for major complications and a previous surgery for malignant disease was significantly related to anastomosis site leakage (P=0.033, P=0.007, respectively). CONCLUSIONS: The risk factors for gastrectomy complications of gastric cancer were combined resection, palliative resection, and a previous surgery for a malignant disease. To decrease post-gastrectomy complications, we should make an effort to minimize the range of combined resection, if a palliative gastrectomy is needed for advanced gastric cancer.

Effects of Three Different Types of Anti-adhesive Agents in a Rat Abdominal Wall Defect Model

PURPOSE: Postsurgical adhesion formation is a significant clinical problem within every surgical specialty. Several adhesion barriers have been developed in the form of solution, membrane or film in an attempt to solve these problems. The purpose of the present study is to compare the efficacy of antiadhesive agents in the prevention of postsurgical adhesion formation in a standardized rat adhesion model. METHODS: We examined forty Sprague-Dawley rats, which is a cecal abrasion with partial peritonectomy model. Three treatment groups (Group I: Film-type Surgiwrap(R), Group II: Solution-type Guardix-sol(R), Group III: Membrane-type Interceed(R)), each consists of 10 rats, and a control group of 10 rats were used by saline. Ten days after surgery, the rats were killed, and the levels of adhesion were graded. Immunohistochemical staining for microvessel density (CD34, MVD) and macrophage (ED1) were performed in adhesion tissue. RESULTS: The peritoneum adhesion mean scores are as follows: control group: 2.2+/-0.78, Group I: 1.0+/-1.06, Group II: 0.9+/-0.99, Group III: 0.6+/-0.84. All treatment groups showed significantly less peritoneum adhesion (P=0.006), while there was no significant difference in each group. The intraperitoneal organs adhesion mean scores are as follows: control group: 2.8+/-0.91, Group I: 2.6+/-1.06, Group II: 1.4+/-0.84, Group III: 1.0+/-0.81. Group I had no significant difference about intraperitoneal organs adhesion with control group, but Group II and Group III showed less intraperitoneal organs adhesion. The mean numbers of microvessel density are as follows: control group: 42.5+/-4.83, Group I: 40.8+/-6.53, Group II: 30.9+/-6.15, Group III: 15.60+/-4.37, from which there was a significant difference between Group II and Group III with control group (P<0.001). The mean numbers of macrophage are as follows: control group: 223.3+/-33.12, Group I: 211.25+/-10.96, Group II: 171.60+/-23.96, Group III: 147.0+/-12.22, from which there was a significant difference between Group II and Group III with control group (P<0.001). CONCLUSION: In our animal model, three different types of antiadhesive agents (Surgiwrap(R), Guardix-sol(R), Interceed(R)) were effective in adhesion prevention, but Surgiwrap(R) had less antiadhesive effect for intraperitoneal organs adhesion. Membrane-type Interceed(R) had a better effect for microvessel density (MVD) and macrophage than solution-type Guardix-sol(R).

Comparative Clinical Analysis of 111 Laparoscopic Cholecystectomy Cases Converted to Open Procedures

PURPOSE: While laparoscopic cholecystectomy can be successfully performed in the majority of patients, conversion to open procedure is still necessary in certain cases. The purpose of this study was to identify the discerning factors that helped to predict the need for conversion to open cholecystectomy. METHODS: A retrospective review was conducted on the data for 2,523 laparoscopic cholecystectomies performed at Chung-Ang University Hospital between January 2002 and July 2007. Patient sex, age, height, weight, body mass index (BMI), duration of preoperative hospital stay, preoperative physical examination, laboratory data, radiologic findings, and reasons for conversion to open procedure were evaluated. RESULTS: Adhesion was perceived to be the most critical factor for conversion in 56 of 111 total cases (50.5%). Bleeding (22.5%), bile duct injury (11.7%), inflammation (9.0%), and uncertain anatomy (6.3%) followed sequentially in incidence. Factors found to significantly increase the risk of conversion on univariate analysis were patient age >70 years, male sex, previous abdominal operation, preoperative common bile duct stone, tenderness in the right upper quadrant, distended shape of the gallbladder, and pericholecystic fluid collection. On multivariate analysis, the following factors were found to be associated with a higher risk: patient age >70 years (p=0.002), male sex (p=0.012), previous abdominal operation (p<0.0001), and preoperative common bile duct stone (p=0.041). CONCLUSION: In the case of operations with such discerning factors, surgeons should be more cautious and delicate in all procedures throughout the operative period. Furthermore, to reduce the risk of additional severe complications, surgeons need to decide early on if they will perform a conversion.

Correlation between the Expression of Nuclear Factor-kappaB p65 Protein with the Expression of Nuclear Factor-kappaB p50 Protein and the Clinicopathologic Factors in Colorectal Cancer

PURPOSE: Nuclear Factor-kappaB p65 (NF-kappaB p65) and nuclear Factor-kappaB1 p50 (NF-kappaB p65) have been shown to play roles in cell proliferation, apoptosis, cytokine production and oncogenesis. This study was designed to investigate the expressions of NF-kappaB p65 and NF-kappaB p50 proteins in premalignant lesions and colorectal adenocarcinoma. METHODS: Paraffin sections of 20 normal mucosa specimens, 20 low grade tubular adenoma specimens, 20 high grade tubular adenoma specimens and 64 adenocarcinoma specimens were analyzed immunohistochemically for the expressions of NF-kappaB p65 and NF-kappaB p50 proteins. RESULTS: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins were significantly higher in the adenocarcinoma tissue compared with that in the normal mucosa, the low grade tubular adenoma and the high grade tubular adenoma tissues. The frequency of a NF-kappaB p50 expression was higher in the poorly differentiated histologic grade specimens, in the presence of nodal metastasis and in the high stage specimens. There were significant correlations between the NF-kappaB p65 and NF-kappaB p50 proteins. CONCLUSION: The expressions of NF-kappaB p65 and NF-kappaB p50 proteins may play a role in the pathogenesis of colorectal carcinoma.

The Efficacy of the Alvarado Score in the Diagnosis of Acute Appendicitis

PURPOSE: Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.

Prediction of Invasiveness by the Expressions of CD105 (Endoglin), D2-40 and Vascular Endothelial Growth Factors A and D in the Endoscopic Biopsy Tissue of Stomach Cancer Patients

PURPOSE: CD105 (endoglin) has been shown to be a more useful marker to identify the proliferating endothelium involved in tumor angiogenesis than are the panendothelial markers. The monoclonal antibody D2-40 is a specific lymphatic endothelial marker. METHODS: We investigated CD105, lymphatic vessel marker (D2-40), vascular endothelial growth factor (VEGD)-A and the VEGF-D expressions as possible prognostic markers in the endoscopic biopsy tissue of stomach cancer patients. The pre-operative endoscopic biopsies and surgical biopsies from 73 patients were immunostained for CD105, D2-40, VEGF-A and VEGF-D. Positively stained microvessels were counted in densely vascular foci (hot spots) at a x200 field in each specimen. RESULTS: The microvessel density (MVD) and lymphatic vessel density (LVD), according to the CD105 and D2-40 expressions of the endoscopic biopsies, showed a statistically significant correlation with the surgical biopsies. The MVD via CD105 a showed statistically significant correlation with the histologic differentiation, T-stage, nodal metastasis and stage in the endoscopic biopsies and surgical biopsies, respectively. The lympathic vessel density (LVD) via D2-40 showed a statistically significant correlation with T-stage, nodal metastasis and stage in the endoscopic biopsies. The expressions of VEGF-A and VEGF-D showed a statistically significant correlation with the MVD and LVD. CONCLUSION: The MVD, as determined by the CD105 expression and the LVD as determined by the D2-40 expression may be useful markers for predicting the invasiveness with using a pre-operative endoscopic biopsy of stomach cancer.

Morgagni Hernia with Cecal Perforation

Morgagni hernia is known as the smallest form of diaphragmatic hernia and it is usually asymptomatic. However, almost all the cases reported in the Korean literature have been symptomatic and they were surgically repaired. The authors report here on a case of Morgagni hernia that was found accidentally during the preoperative workup of a patient who suffered from panperitonitis with cecal perforation. The patient was transferred from the local hospital with complaints of pain in the entire abdomen. On the preoperative CT, a large paracardial mass and a collection of intra-peritoneal free air were identified. After reduction of the hernia contents, the hernia was repaired with using mesh. The patient showed a rapid recovery without any complication.

Expression of Survivin and HSP90 in Colorectal Cancer and its Relationship with Clinicopathologic Factors

PURPOSE: Survivin is an inhibitor of apoptosis protein and it is overexpressed in most human cancers. Recent data demonstrated that survivin-HSP90 complex regulate apoptosis. We assessed expression of survivin and HSP90 by using immunohistochemistry with colorectal cancer tissue and correlate it with clinicopathologic prognostic parameters. METHODS: Using immunohistochemistry, survivin and HSP90 expression were evaluated on paraffin sections of fifty-six colorectal carcinomas. Various clinicopathologic parameters including histologic differentiation grade, T-stage, nodal metastasis, stage were obtained from pathologic records. RESULTS: Survivin expression were observed in 30 cases (53.6%). The expression of survivin showed no statistically significant correlation with histologic differentiation grade, T-stage, nodal metastasis, stage. HSP90 expression were observed in 31 cases (55.4%). The expression of HSP90 showed a statistically significant correlation with histologic differentiation grade (P=0.035) and stage (P=0.017). There were a significant correlation between survivin expression and HSP90 expression (P=0.018). CONCLUSION: Survivin and HSP90 was expressed in colorectal cancer. The expression of HSP90 correlates with histologic differentiation grade, stage. The above results suggest that HSP90 could be a prognostic marker of poor outcome in colorectal carcinoma.

Correlation of C-erbB-2 Oncogene Amplification by Chromogenic in situ Hybridization and Expressions of Cell Cycle Regulatory Proteins in Infiltrating Duct Carcinoma of the Breast

PURPOSE: Gene amplification and/or over-expression of the c-erbB-2 are linked with poor prognosis in breast cancer. There has been only a few reports about the connection of c-erbB-2 oncogene amplification with cell regulatory proteins such as p27(kip1), cyclin D1, Rb, and E2F-1. The purpose of this study is to determine the correlation the amplification of the c-erbB-2 oncogene and protein expressions of p27(kip1), cyclin D1, Rb, and E2F-1. METHODS: Using Chromogenic in situ Hybridization (CISH) the amplification the c-erbB-2 oncogene were determined from paraffin sections of 48 infiltrating duct carcinomas (IDC). The protein expressions of p27(kip1), cyclin D1, Rb, and E2F-1 were studied immunohistochemically. RESULTS: Among the 48 evaluated IDC patients, amplifications of the c-erbB-2 oncogene by CISH were observed in 14 cases (29.1%). The amplification of the c-erbB-2 oncogene showed a significant correlation with tumor size and stage (P=0.0001 and P=0.001). The proteins of p27(kip1), cyclin D1, Rb, and E2F-1 were expressed by IHC in 23 cases (47.9%), 17 cases (35.4%), 27 cases (56.3%), and 22 cases (45.8%), respectively. Down- regulation of protein expressions showed a significant correlation with tumor size (P=0.031) in p27(kip1) and estrogen and progesterone receptor status (P=0.026 and P=0.001) in Rb. The expression of the E2F-1 protein showed a significant correlation with tumor size, stage, and histologic grade (P=0.003, P=0.030, and P=0.036). The amplification of the c-erbB-2 oncogene between down-regulation of p27(kip1) protein and E2F-1 protein showed a statistically significant correlation. CONCLUSION: The amplification of the c-erbB-2 oncogene may be correlation with cell cycle regulatory proteins such as p27(kip1) and E2F-1.

Expressions of Galectin-3 and HBME-1 in Nodular Lesions of the Thyroid

PURPOSE: Galectin-3 and HBME-1 have been recognized as useful markers for the diagnosis of the thyroid lesions. In this study, we investigated whether they have a diagnostic value for nodular lesions of the thyroid. METHODS: We investigated the galectin-3 and HBME-1 expressions in 14 nodular hyperplasias, 30 papillary carcinomas, 17 follicular adenomas and 8 follicular carcinomas with using immunochemistry. RESULTS: Galectin-3 was positive in 96.7% of the papillary carcinomas and this incidence was significantly higher (P=0.0001) than that of nodular hyperplasia, 7.1%. However, the galectin-3 expressions of follicular adenoma and follicular carcinoma were not significantly different. HBME-1 was positive in 50.0% of the follicular carcinomas and this incidence was significantly higher (P=0.0001) than that of follicular adenoma. CONCLUSION: Galectin-3 and HBME-1 may be useful markers to diagnose papillary carcinoma. Although HBME-1 contributes to differential diagnosis of follicular adenoma and follicular carcinoma, further study is required.

Correlation of EGFR and c-erbB-2 Gene Amplifications and Expression of COX-2 Protein in Invasive Ductal Carcinomas of the Breast

PURPOSE: Abnormalities of epidermal growth factor receptor (EGFR) and c-erbB-2 have been actively investigated in breast cancer. Cyclooxygenase-2 (COX-2) seems to be involved in critical steps of cancer onset and progression. The purpose of this study is to determine the correlation between the gene ampilfications of the EGFR and c-erbB-2 and expression of the COX-2. METHODS: Using Chromogenic in situ Hybridization (CISH) the gene amplification of the EGFR and c-erbB-2 were studies on paraffin sections of 47 invasive ductal carcinomas. The expression of COX-2 was studied immunohistochemically (IHC). RESULTS: Of the 47 invasive duct carcinomas, gene amplifications of the EGFR and c-erbB-2 by CISH were observed in 21 cases (44.7%) and 14 cases (29.8%), respectively. The gene amplification of EGFR was significantly correlated with tumor size, nodal metastasis, and stage. The gene amplification of c-erbB-2 showed a statistically significant correlation with tumor size and stage. The protein of COX-2 was expressed by IHC in 30 cases (63.8%). The expression of the COX-2 protein showed a statistically significant correlation with tumor size, nodal metastasis, and stage. The gene amplifications of the EGFR and c-erbB-2 between expression of COX-2 protein showed a statistically significant correlation. CONCLUSION: The gene amplification of the EGFR and c- erbB-2 may be correlated with expression of COX-2 protein in the breast cancer.

The Comparative Analysis between Laparoscopic Inguinal Herniorrhaphy and Open Inguinal Herniorrhaphy

PURPOSE: Published evidence comparing laparoscopic and open herniorraphy is contraversial. Laparoscopic surgery has became or is being tried as a standard in most of abdominal surgery due to its advantages. But disadvantages of laparoscopic surgery include the need for general anethesia, a problem particularly in over increasingly aged population, limit its more use. This study aimed to investigate the availability and indication of both laparoscopic and open herniorraphy. METHODS: The records and data of 85 inguinal hernia patients who underwent laparoscopic herniorrhaphy (n=20) or open herniorrhaphy (n=65), with similiar sex and age distribution, were retrospectively analyzed. Laparoscopic herniorrhaphy equated to totallly extraperitoneal approach (TEP) repair and open herniorrhaphy to Bassini repair and Lichtenstein repair. As statistical method, the one way Anova Tests and Post Hoc Tests was used. RESULTS: There was no significant difference noted between the groups in relation to sex, age, site, complication rate, or recurrence rate in both group. The laparoscopic group has a shorter mean postoperative hospital day than open group. However there was no statistical significance. Postoperative analgesic administration is significantly decreased in mesh applied group. CONCLUSION: The advantages of laparoscopic herniorrhaphy is not revealed in all patients. Indications for laparoscopic herniorrhaphy are being restricted to recurrent, bilateral hernia. Patient selection has been stepped up. Thus elderly patients and patients with significant morbidity who may well require monitoring after procedure are being advised to undergo open tension free repair with local anethesia. These recommendation apply similarly young patients with small, simple primary defects. After studying more cases, a reevaluation must be done concerning the advantage of both laparoscopic and open herniorraphy.

Multiple Gastrointestinal Stromal Tumors of the Small Intestine

Gastrointestinal stromal tumors (GISTs) are a heterogeneous group of mesenchymal neoplasms of the gastrointestinal tract. A great majority of GISTs occur in the stomach and small intestine, but multiple GISTs of the jejunum are rare. We experienced a case of multiple GISTs of the jejunum. A 57 year old woman was admitted due to general weakness and abdominal pain. The computer tomography of the abdomen revealed solid tumor in the jejunum. We removed tumor from jejunum by resection. Histological and immunohistochemical studies revealed a gastrointestinal stromal tumor of the intermediate malignant type.

The Immunohistochemical Expression of DNA Topoisomerase II-alpha and E2F-1 in the Breast Carcinoma and Their Relationship with Clinicopathologic Factors

PURPOSE: Clinical courses of breast cancer are very different, and concern for finding a predictable marker of breast carcinomas has increased. This study focused on the relationship between the expressions of DNA topoisomerase II-alpha as a proliferative marker, and E2F-1 as a transcription factor, with clinicopathological factors of infiltrating duct carcinomas of the breast. METHODS: We investigated the expressions of E2F-1 and DNA topoisomerase II-alpha in 43 patients with infiltrating ductal carcinomas using immunohistochemical staining, and the results were analyzed with regard to clinicopathological parameters. RESULTS: Among 43 infiltrating ductal carcinomas, 24 (55.8%) were immunohistochemically negative on E2F-1 and 19 (44.2%) were positive. The expression of E2F-1 correlated with increased tumor size, positive axillary lymph node meta stasis and high stage. The topoisomerase II-alpha index correlated with increased tumor size, positive lymph node metastasis, high stage, high histological grade and negative estrogen receptor. The expression of E2F-1 and the topo II-alpha index were significantly correlated. CONCLUSION: These results suggest that the expressions of DNA topoisomerase II-alpha and E2F-1 play some role as prog nostic factors for infiltrating duct carcinomas of the breast, but much more study will be required.

Expression of p16(INK4A), Rb and E2F-1 Proteins in Colorectal Carcinoma

PURPOSE: An altered cell cycle regulation may underline the development and progression of human malignancies. The purpose of this study was to determine whether the degree of p16(INK4A), Rb and E2F-1 expressions are related to certain parameters such as histologic differentiation, T-stage, lymph node metastasis and TNM stage in colorectal carcinoma. The correlation between the above proteins were compared. METHODS: Immunohistochemical stain was perfomed, for p16(INK4A), Rb and E2F-1 on 84 formalin-fixed paraffin-embedded tissue sections of colorectal adenocarcinomas. RESULTS: The overall expression frequencies of the p16(INK4A), Rb and E2F-1 were 54.8 (46/84), 76.2 (64/84) and 48.8% (41/84), respectively. Loss of the p16(INK4A) expression frequency was higher with a poorly differentiated histologic grade, the presence of nodal metastasis and higher TMN stage. The expression of Rb was not correlated with any of the parameters studied. The frequency of the E2F-1 expression was higher with a poorly differentiated histologic grade, the presence of nodal metastasis and higher TNM stage. A highly significant inverse correlation between the expressions of p16(INK4A) and E2F-1 was observed. CONCLUSION: These data suggest that the loss of p16(INK4A) expression and the expression E2F-1 may play roles in the progression of colorectal adenocarcinomas and could possibly be used as prognostic factors. Further studies to determine the relationships in the expressions of p16(INK4A), Rb and E2F-1 will be required.

The Effect of COX-2 Inhibitor on the Growth and Metastasis of Gastric Cancer Xenograft

PURPOSE: Tumor invasion and metastasis are known to be extremely important factors in the prognosis of cancer patients. Although recent studies have demonstrated that cyclooxygenase-2 (COX-2) is overexpressed in various cancers including gastric cancer, the mechanisms underlying the contribution of COX-2 to tumorigenesis and tumor promotion remain unclear. METHODS: In order to determine the role of COX-2 in tumor growth and metastasis, we investigated COX-2 expression, apoptosis and the expression of E-cadherin, CD44v6, MMP-2 and TIMP-2 in gastric cancer xenografts treated with meloxicam (a selective COX-2 inhibitor). RESULTS: Cells from the MKN45 gastric cancer cell line that overexpress COX-2 were inoculated subcutaneously into athymic mice. Oral administration with meloxicam reduced the tumor volume (P<0.01), induced apoptosis of cancer cells (P<0.01), suppressed the proliferation rates (P<0.01), increased the expression of E-cadhrin (P<0.05) and reduced the expression of MMP-2 and TIMP-2. CONCLUSION: The above data showed that COX-2 inhibitors can inhibit tumor growth and suppress metastatic potential by expression of adhesion molecules and suppression of metalloproteinases, suggesting that this inhibitor can be used as an additive anti-cancer drug in cases of stomach cancer with radical resection, although further evaluation is required.