Coexistence of perineural invasion and lymph node metastases is a poor prognostic factor in patients with locally advanced rectal cancer after preoperative chemoradiotherapy followed by radical resection and adjuvant chemotherapy

To determine the role of lymph node metastases [ypN] and perineural invasion [PNI] in patients with locally advanced rectal cancer [LARC]. Eighty-eight LARC patients receiving preoperative chemoradiotherapy from April 2006 to November 2011 were enrolled in this study. Univariate and multivariate analyses were conducted to determine the association between clinicopathologic features and clinical outcome. The presence of ypN [p = 0.011] and PNI [p = 0.032] was a significant adverse prognostic factor for disease-free survival [DFS]. High histologic grade [p = 0.015], PNI+ [p = 0.043] and ypN+ [p = 0.041] were adverse prognostic factors for overall survival [OS]. Positive PNI was significantly associated with a higher risk of distant failure [odds ratio = 6.09; 95% CI: 1.57-27.05; p = 0.008]. Moreover, patients with a coexistence of ypN+ and PNI+ had the significantly worst DFS [p < 0.001] and OS rates [p < 0.001] compared with other phenotypes. The presence of either PNI or ypN was a significant prognostic factor for predicting poor survival rates in LARC patients, especially those with a coexistence of both factors. Accordingly, we recommend an intensive follow-up and therapeutic programs for LARC patients with simultaneous PNI+ and ypN+

FOLFIRI combined with bevacizumab as first-line treatment for metastatic colorectal cancer patients with hyperbilirubinemia after UGT1A1 genotyping

To report a metastatic colorectal cancer patient with hyperbilirubinemia treated with a combination of bevacizumab and FOLFIRI [5-fluorouracil, leucovorin, and irinotecan] using uridine diphosphate glucuronosyl transferase [UGT1A1] genotyping.Clinical Presentation and Intervention: A 46-year-old male was diagnosed with rectosigmoid colon cancer with liver metastases and hyperbilirubinemia presenting with severe jaundice. UGT1A1 genotyping was used before therapy to ascertain whether genotype-adjusted dosages of irinotecan plus bevacizumab could alleviate the toxicity. Then, the patient was treated with FOLFIRI. The FOLFIRI regimen was successfully used in this patient without concerns regarding toxicity

Cholesteryl ester transfer protein B1B1 genotype is associated with a parental history of cardiovascular diseases in Taiwanses people

To investigate the association between family history of cardiovascular disease [CVD] and cholesteryl ester transfer protein [CETP] TaqIB polymorphism in Taiwanese subjects. In this cross-sectional study, 240 subjects [115 men and 125 women] were divided into two groups based on whether or not they had a parental history of CVD. Polymerase chain reaction/restriction fragment length polymorphism was used to analyze the genotype of the subjects for the TaqIB polymorphism of CETP in intron 1. The frequency of the B1B1 genotype was significantly higher in Taiwanese subjects with a family history of CVD than in those without it [31.2 vs. 18.8%, odds ratio = 1.97, 95% confidence interval = 1.084-3.579, p = 0.035]. Siblings with the B1B1 genotype had lower levels of serum high-density lipoprotein cholesterol [HDL-C] than siblings with either B1B2 [46.7 +/- 11.0 vs. 52.5 +/- 11.1 mg/dl, p = 0.034] or B2B2 genotypes [46.7 +/- 11.0 vs. 55.2 +/- 9.6 mg/dl, p = 0.01]. CETP TaqIB polymorphism is associated with plasma HDL-C levels. The CETP B1B1 genotype may influence the susceptibility to CVD in Taiwan

Oxaliplatin/5-fluorouracil/leucovorin [FOLFOX4] regimen as an adjuvant chemotherapy in the treatment of advanced jejunal adenocarcinoma: a report of 2 cases

To present our clinical experience of 5-fluorouracil/leucovorin/oxaliplatin [FOLFOX4] regimen administered as an adjuvant chemotherapy to 2 patients with advanced jejunal adenocarcinoma. Case Presentation and Intervention: A 55-year-old woman presented with recurrent upper abdominal pain, nausea and vomiting. A small bowel series as well as the abdominal computed tomography scan revealed an irregular narrowing lesion at the proximal jejunum. The patient then underwent an exploratory laparotomy and the jejunal adenocarcinoma with localized peritoneal metastasis was found [R0 resection, T3N1M1, stage IV]. Chemotherapy with FOLFOX4 regimen of 12 cycles was initiated after the curative resection. No adverse event was observed during the period of chemotherapy. She has been well without evidence of recurrence for over 20 months postoperatively. The second case was a 77-year-old female presenting with mechanical ileus. Surgical exploration revealed a proximal jejunal adenocarcinoma with regional lymph node involvement [R0 resection, T3N1M0, stage III]. She also received the FOLFOX4 chemotherapy of 12 cycles with an uneventful course. No obvious toxicity developed except for temporary grade I peripheral neuropathy and skin eruption. This patient has survived well and has been free of this disease for over 12 months since the operation. This report showed that adjuvant chemotherapy with FOLFOX4 regimen seems effective and well tolerated in these 2 patients with advanced jejunal adenocarcinoma. Further investigation of a large number of patients with long-term follow-up is needed to confirm these findings