The clinical significance of SWI/SNF complex in pancreatic cancer.

Chromatin remodeling factors have been the subject of great interest in oncology. However, little is known about their role in pancreatic cancer. The objective of this study was to clarify the clinical significance of the SWItch/sucrose non-fermentable (SWI/SNF) complex in patients with pancreatic cancer. A total of 68 patients with pancreatic cancer who underwent R0, 1 resection were enrolled. Cancer tissues were processed to tissue microarray, then stained immunohistochemically by using antibody of SWI/SNF components; BRM, BRG1, BAF250a, BAF180 and BAF47. The correlation of expression levels and clinicopathological outcomes were analyzed, followed by the multivariate analysis of prognostic factors for overall survival. The expression levels of the SWI/SNF components were categorized as low or high according to the median value of Histoscore. Statistical analysis revealed that BRM expression was related to tumor size, T factor, M factor, lymphatic invasion and stage BRG1 expression to histology and stage BAF180 expression to tumor size and BAF47 expression to lymphatic invasion, respectively. Multivariate Cox proportional hazard analysis showed that high BRM and low BAF180 expression levels were independent predictors of worse survival in patients with pancreatic cancer. High BRM, and low BAF180 were also independent prognostic factors for poor survival in the subgroup with adjuvant gemcitabine. These results suggest that the specific cofactors of SWI/SNF chromatin remodeling complex certainly have roles in pancreatic cancer. High BRM, and low BAF180 are useful biomarkers for poor prognosis in pancreatic cancer.

[A case of abdominal wall metastasis from pancreatic cancer].

A 74-year-old woman underwent laparotomy for pancreatic cancer, which revealed peritoneal dissemination. Then, gastrojejunostomy was performed. After the operation, multiple liver metastases were detected by CT scanning. However, there were no findings suggestive of peritoneal dissemination. The patient was treated with chemotherapy of gemcitabine plus S-1. At the end of five courses, the primary lesion and liver metastases decreased in size. Nevertheless, a painful hard tumor was noticed at the scar of the previous operation in the upper abdomen. Biopsy examination revealed adenocarcinoma. Accordingly, abdominal wall metastasis from pancreatic cancer was diagnosed. We speculated that the abdominal wall metastasis grew by implantation into the scar because good control of the primary lesion and liver metastasis was maintained. As no effective secondary therapy was established, chemotherapy with gemcitabine plus S-1 was continuously administered. At the end of 7 courses, the patient died of progressive peritoneal dissemination. Metastasis to the abdominal wall has been rarely reported. Moreover, the available literature contains only two reports on such metastasis from pancreatic cancer. We report herein this rare case, together with some bibliographical comments.

[Intraoperative radiotherapy (IORT) for unresectable stage IVb pancreatic cancer].

We evaluated the efficacy of IORT for unresectable Stage IVb (Japan Pancreas Society classification) pancreatic cancer. Twelve patients were treated with IORT, 17 with external beam radiotherapy (ERT) and 17 with chemotherapy (CHT, 8 patients doxorubicin-based, 7 patients 5-FU-based). Survival, hospital-free survival and pain relief were compared among the three groups. In the IORT group, 7 patients underwent bypass surgery, 3 celiac plexus blockade, 3 ERT, 2 hyperthermia and 2 CHT. In the ERT group, 1 patient underwent bypass surgery, 7 hyperthermia and 14 CHT. Distant metastases were more frequently found in the CHT group than in the IORT group. Median survival and median hospital-free survival were 208 and 79 days in the IORT group, 125 and 32 days in the ERT group and 76 and 9 days in the CHT group, respectively. Pain relief was obtained in 45% (5/11) of symptomatic patients after IORT and in 27% (4/15) after ERT. No patient (0/13) in the CHT group experienced pain relief. In conclusion, our experience suggests that IORT can reduce pain and improve QOL in patients with unresectable pancreatic cancer.