Gastric cancer mortality related to direct radiographic and endoscopic screening: A retrospective study.

BACKGROUND: Despite its decreased incidence in Japan, gastric cancer continues among the leading causes of cancer-related deaths in both men and women. Accordingly, efforts are still required to lower the mortality rate of gastric cancer in Japan. Maebashi City introduced endoscopic gastric cancer screening in 2004, and participants are able to choose between direct radiography and endoscopy. Hence, we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening methods. AIM: To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City, Japan. METHODS: Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography (n = 11155) or endoscopy (n = 10747) were included. Participants were followed until March 31, 2012, by cross-referencing their data against the Gunma Prefecture cancer registry data. We compared the detection rate of gastric cancers. Then, we compared the mortality rate between the two groups. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of gastric cancer death. Finally, the reduction in gastric cancer mortality rate associated with each screening method was evaluated. RESULTS: Gastric cancer was detected in 22 participants undergoing direct radiography (detection rate, 0.20%) and in 52 participants undergoing endoscopy (detection rate, 0.48%). However, most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in death. We found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do not. When the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis, the HR of gastric cancer death was 1.368 (95%CI: 0.7308-2.562) in the overall group of participants. The results showed no significant difference between the two screening methods in any of the analysis groups. CONCLUSION: Although endoscopic screening detected more gastric cancer than direct radiographic screening, no significant difference in the reduction of gastric cancer mortality rate between the two screening methods was found.

Novel large-scale deletion (whole exon 7) in the ABCC2 gene in a patient with the Dubin-Johnson syndrome.

The Dubin-Johnson syndrome (DJS) is an inherited liver disorder characterized by conjugated hyperbilirubinemia and caused by ABCC2 gene mutations resulting in deficiency of multidrug resistance associated-protein 2 (MRP2) function. A 76-year-old woman with serious jaundice was referred to our hospital. She was clinically diagnosed with DJS with hepatic congestion, due to constrictive pericarditis. We analyzed all exons and exon-intron junctions of the ABCC2 gene by DNA sequencing and identified a new large-scale deletion, 1008 bp, including the whole exon 7, as homozygosity. Some mutations in the ABCC2 gene associated with splicing errors have been reported in intronic regions; however, this is a new type of large-scale deletion detectable in the genomic DNA sequence. Severe hyperbilirubinemia is rare in patients with constrictive pericarditis and this case suggests that MRP2 may play a crucial role in compensating for the serum bilirubin in congestive hepatopathy.

[A case of advanced hepatocellular carcinoma effectively treated with 5-fluorouracil and high-concentration cisplatin suspended in lipiodol by short-term hepatic arterial infusion chemotherapy].

A 75-year-old Japanese man was admitted to our hospital for treatment of advanced hepatocellular carcinoma (HCC) with HCV-related liver cirrhosis. He had been treated earlier with transarterial chemoembolization (TACE) in both another and our own hospital before this admission. At this time, abdominal CT revealed multiple HCCs (maximum 4.0 cm in diameter) located in hepatic S6, S5, and S8. An infused port system had been subcutaneously implanted, and he was treated with hepatic arterial infusion chemotherapy with 3 days' FPL (5-FU at a dose of 500 mg/m2 on days 1-3 and cisplatin (CDDP/IA call)-Lipiodol (LPD) suspension (10 mg/mL) at a dose of 50 mg/body on day 2) every 6-10 weeks. He was also treated with selective TACE for HCC that was supplied by extra-hepatic arterial branches. He had been treated with 3 courses of 3 days' FPL, and the selective TACE, HCCs in S6, S5 and S8 disappeared completely and multiple HCCs almost entirely vanished. During the 3-day treatment with FPL, his performance status (PS) was maintained and no severe side effects were observed. Although multiple recurrent HCC is potentially fatal and QOL is lost, hepatic arterial infusion chemotherapy with 3 days' FPL was effective and contributed to improve the patient's prognosis and QOL.