The Prognostic Value of CA19-9 in Patients with Colorectal Cancer

PURPOSE: There has been much debate about the significance of the CA19-9 level for predicting the prognosis of colorectal cancer patients. This study aimed to evaluate the prognostic value of the preoperative serum CA19-9 level and the CA19-9 expression in the tumor tissues of colorectal cancer patients METHODS: One hundred patients with colorectal cancer and who had been treated by resection were studied. We assessed the correlations of the preoperative serum CA19-9 level and the status of the CA19-9 immunohistochemical staining with the clinicopathologic features, including the prognosis of the patients. RESULTS: The preoperative serum CA19-9 level had significant correlation with the status of CA19-9 immunohistochemical staining. The presence of distant metastasis was significantly correlated with an elevated level of serum CA19-9. The depth of tumor, the presence of lymph node metastasis, the TNM stage and tumor cell differentiation were significantly correlated with the status of the CA19-9 immunohistochemical staining. In addition, the gross morphology, depth of tumor, the presence of lymph node metastasis, the TNM stage, the status of the CA19-9 immunohistochemical staining and the serum CEA level were correlated with survival on univariate analysis. However, multivariate analysis did not validate the status of CA19-9 immunohistochemical staining as a significantly independent predictor of the prognosis. CONCLUSION: The CA19-9 expression was frequently observed in advanced stage tumor tissue, yet its expression in tumor tissue or the preoperative CA19-9 serum level did not show independent prognostic value for colorectal cancer patients.

Prognostic Value of Erythrocyte Sedimentation Rate in Patients with Colorectal Cancer

PURPOSE: Prognostic indicators are used increasingly in clinical trials and to guide surveillance for patients with colorectal cancer (CRC). The significance of a preoperative, elevated erythrocyte sedimentation rate (ESR) as a predictive indicator for malignancy and for prognosis in colorectal cancer has not been elucidated. Hence, the current study was conducted to evaluate the ESR as a prognostic indicator in patients with CRC. METHODS: This study enrolled 232 patients who underwent surgery in our hospital between 1997 and 2004. ESR with clinicopathologic features and overall survival were evaluated retrospectively. RESULTS: The ESRs of 139 patients were elevated, and those of 93 patients were normal. Elevated ESR was associated with the male gender, decreased hemoglobin, increased platelet count, high preoperative CEA, high preoperative CA19-9, tumor size (> or =5 cm), T stage, and TNM stage. Patients with elevated ESR had poorer survival (P=0.001), but a multivariate analysis did not reveal an elevated ESR as an independent factor for prognosis. CONCLUSIONS: Preoperative elevation of ESR in patients with CRC suggests the presence of a tumor with aggressive behavior and a poor outcome.

CD40 and CD154 Expression in Hepatocellular Carcinomas

PURPOSE: CD40 expression has been reported in a variety of cells, including antigen presenting cells (dendritic cells), B lymphocytes, monocytes, and many epithelial malignancies (breast, lung, ovary, bladder, and melanoma). The interaction of CD40 and its natural ligand (CD154) is well known in the adaptive immune response. The CD40-CD154 pathway appears to have diverse effects in malignant disease. In this study, we investigated the expression of CD40 and CD154 and evaluated their clinical implication in hepatocellular carcinomas (HCC). METHOD: Immunohistochemical staining was performed for CD40 and CD154 in 96 surgically resected HCCs using the tissue microarray method. The clinicopathological data and outcomes were reviewed and compared to the expression of CD40 and CD154. RESULTS: Positive expression of CD40 and CD154 was observed in 64.2% and 37.5% of cases, respectively. Overexpression, defined by the stain intensity and area of CD40 staining had a positive correlation with tumor cell proliferation activity as measured by the Ki-67 labeling index (p=0.013) and CD154 had a similar tendency (p=0.094). CD40 overexpression was observed frequently in small sized HCCs (p=0.046). There were no other clinicopathological factors that were significantly correlated with CD40 and CD154 expression. CD40 overexpression was correlated with a poor overall survival according to the univariate analysis (p=0.054) and multivariate analysis (p=0.035). CD154 overexpression was not correlated with the overall survival rate. CONCLUSION: The results of this study showed that CD40 expression correlated with a more aggressive tumor potential in patients with HCC. CD 40 overexpression might provide a novel prognostic marker for survival in patients with HCC.

Neutropenic Enterocolitis after Chemotherapy for Colon Cancer

Neutropenic enterocolitis is observed in approximately 10~46% of patients with acute leukemia, as well as in patients with other diseases, like acquired immunodeficiency syndrom (AIDS), that lead to profound neutropenia. Patients who become neutropenic after combined chemotherapy are at special risk of developing neutropenic enterocolitis. With the recently increasing numbers of patients with solid tumors treated with high-dose chemotherapy, the frequency of this disease is expected to increase. However, this disease has been rarely reported in patients with colon cancer treated with leucovorin and 5-fluorouracil for adjuvant chemotherapy. We report a case of neutropenic enterocolitis after a treatment of 5-fluorouracil and leucovorin for sigmoid colon cancer.

A Case of Heterotopic Pancreas in the Ampulla of Vater that Mimicked Distal Common Bile Duct Cancer

Heterotopic pancreas can be defined as the occurrence of pancreatic tissue at aberrant anatomic sites that lack vascular, neural and anatomic community with the pancreas. A minority of heterotopic pancreas elicit clinical signs or symptoms that can vary according to its location and size, and the involvement of the overlying mucosa. We report here on a case of heterotopic pancreas that was removed by pancreatoduodenectomy under the erroneous diagnosis of distal common bile duct cancer.