[Significance of Inflammatory/Nutritional Index in Pathological Stage â ¡-â ¢ Colorectal Cancer].

The aim of this study was to evaluate the inflammatory/nutritional index in patients with colorectal cancer. A total of 600 patients with pStage Ⅱ-Ⅲ colorectal cancer who underwent radical resection at our hospital between January 2008 and September 2022 were retrospectively reviewed. Onodera's prognostic nutritional index(OPNI), CRP-to-albumin ratio, modified Glasgow prognostic score, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio were measured preoperatively. Clinical and pathological data were assessed using univariate and multivariate analysis to determine prognostic factors for overall survival(OS), relapse-free survival(RFS)and post-relapse overall survival (PROS). Moreover, these patients were divided into high and low groups based on OPNI, these survival outcome for OS, RFS and PROS were assessed using Kaplan-Meier analysis with the logrank test. In multivariate analysis, the independent prognostic factors were gender, age, OPNI, histological type, pStage for OS, gender, OPNI, venous invasion and pStage for RFS, and OPNI, histological type and resection of recurrent site for PROS. In Kaplan-Meier analysis, patients in the low OPNI group had significant poor prognosis for OS, RFS and PROS. OPNI is a useful prognostic factor in colorectal cancer.

[A case of advanced esophageal cancer with no recurrence treated biweekly with postoperative docetaxel/nedaplatin combined chemotherapy after non-curative surgery].

We report a case of non-curatively resected esophageal cancer with no recurrence biweekly treated with postoperative docetaxel/nedaplatin combined chemotherapy. A 59-year-old woman underwent non-curative resection with esophagectomy for advanced esophageal cancer with direct invasion to the descending aorta in August, 2007. Postoperatively, she was treated biweekly with docetaxel/nedaplatin combined chemotherapy 32 times. In this period, there was no finding in the enhanced CTs, and clinically she was free from recurrence. The quality of life of this patient was also good. Thus, postoperative biweekly docetaxel/nedaplatin combined chemotherapy could be effective for advanced esophageal cancer after non-curative surgery and might be promising for long-term survival. This combined chemotherapy could be carried out on an outpatient basis, and the quality of life could also be preserved. More experience must be accumulated using this chemotherapy.

[A case of advanced gastric cancer with peritoneal metastasis successfully treated over 19 months with postoperative chemotherapy after non-curative surgery].

We report a case of non-curatively resected gastric cancer successfully treated with postoperative continuous chemotherapy, resulting in long-term survival of 19 months. A 75-year-old woman underwent non-curative resection with total gastrectomy for advanced gastric cancer with peritoneal metastasis in June, 2005. Postoperatively, at first, she received oral administration of S-1. However, due to grade 2-3 nausea and anorexia, the dose of S-1 was reduced. After four courses, the value of the tumor markers increased. Next, we chose sequential methotrexate and 5-fluorouracil therapy, but no decrease tumor markers could be obtained. Then, 9 months after surgery, biweekly paclitaxel (PTX) chemotherapy was performed. The value of the tumor markers gradually decreased or stopped increasing, and PTX was administered 18 times. In this period, the quality of life of this patient was good. Eighteen months after surgery, the value of the tumor markers increased again, and S-1 and CPT-11 combination therapy was chosen. However, the patient died of brain infarction 19 months after surgery. Thus, continuous and persevering chemotherapy could be effective for advanced gastric cancer with peritoneal metastasis and may be promising for long-term survival.

Down-regulation of molecular chaperone 78-kd glucose-regulated protein/immunoglobulin-binding protein expression involved in enhancement of human RS cell mutability.

OBJECTIVES: Enhancement of cell mutability via extracellular materials of cancer cells is a crucial event leading to the development of cancers; however, the activation process of mutability is still not well understood. In this study, to identify the regulatory mechanism of cell mutability, we investigated mutability modulated in response to human pancreatic cancer cell-conditioned medium and identified the candidates for cellular molecules involved in the mutability modulation. METHODS: To test the mutation-modulating effects of the conditioned medium, human RS cells were cultured with medium derived by culturing human pancreatic cancer KP-4 cells, followed by irradiation with UV (mainly 254 nm in wavelength). Mutations were detected by phenotypic ouabain resistance and genetic base substitution of K-ras codon 12. Messenger RNA differential display was used to identify genes that were differentially expressed between conditioned medium-treated and mock-treated RSa cells. The influence of 78-kd glucose-regulated protein/immunoglobulin-binding protein (GRP78/BiP) expression on mutability was assessed by the down-regulation of GRP78/BiP using antisense oligonucleotides or antisense complementary DNA. RESULTS: The UV-induced mutagenicity in RS cells was strengthened by preculture with KP-4 cell-conditioned medium. Messenger RNA differential display revealed that GRP78/BiP expression was suppressed in RS cells after treatment of the conditioned medium. Furthermore, the level of UV-induced mutations was elevated significantly in GRP78/BiP down-regulated cells. CONCLUSIONS: Culture of human RS cells with pancreatic cancer KP-4 cell-conditioned medium resulted in increased UV mutagenicity, possibly via the down-regulation of GRP78/BiP.

The post-operative level of serum monocyte chemoattractant protein-1 and its correlation with the severity of surgical stress.

BACKGROUND: Several basic studies have demonstrated that monocyte chemoattractant protein-1 (MCP-1) influences type 2 cytokine production and cell-mediated immunity. However, there have been few reports on the changes in serum MCP-1 levels in patients undergoing major thoracoabdominal surgery. In this study, we examined the kinetics of serum MCP-1 post-operatively and clarified its significance regarding the extent of surgical stress. MATERIALS AND METHODS: Seventeen patients who underwent surgical operations were included in this study. All of them were fed by total parenteral nutrition to deliver the same amount of calories and nitrogen. Of the severely stressed group, nine patients underwent esophagectomy with thoracotomy. Of the group of moderately stressed group, eight patients underwent gastric or colorectal surgery. Serum MCP-1 and interleukin-6 (IL-6) were measured after operation. Cell-mediated immunity was measured by concanavalin A- or phytohemagglutinin-stimulated lymphocyte proliferation on the seventh post-operative day. RESULTS: Serum MCP-1 and IL-6 were increased immediately after surgery in both groups. The level of MCP-1 was significantly higher in the group of severely stressed patients than in the moderately stressed group. Concanavalin A or phytohemagglutinin-stimulated lymphocyte proliferation was significantly lower in the severely stressed group than in the moderately stressed group. CONCLUSIONS: These results indicate that serum MCP-1 levels are directly correlated, and cell-mediated immunity inversely correlated, with the severity of surgical stress.

[A case of metastatic submandibular lymphnode treated successfully with palliative oral (5-FU + PSK) chemotherapy in the elderly].

The patient was a 87-year-old woman diagnosed as type 2 advanced colon cancer in the ascending colon. The patient underwent right hemicolectomy. The pathological diagnosis showed poorly-differentiated adenocarcinoma, si, ly2, v1, n0 (0/41) and Stage IIIa. The postoperative course was uneventful, and she was discharged on POD 23. But a left submandibular lymph node enlarged rapidly within two months after the operation. Aspiration cytology of the lymph node indicated poorly-differentiated adenocarcinoma, and she was diagnosed as recurrent colon cancer. Combined chemotherapy of 5-FU (200 mg/day/po) and PSK (3.0 g/day/po) was started as palliative chemotherapy. The metastatic lymph nodes were reduced in size within two months after the treatment. Oral administration of 5-FU+PSK succeeded without serious adverse effects or worsening of quality of life. Ten months later, no recurrence was detected on physical examination or computed tomography. We conclude that palliative oral (5-FU+PSK) chemotherapy is useful for recurrent colon cancer in the elderly because of its excellent safety and effectiveness.

Influences of soybean oil emulsion on stress response and cell-mediated immune function in moderately or severely stressed patients.

OBJECTIVES: We previously reported that omega-6 fat emulsion increases cytokine production in burned rats. Effects of soybean oil emulsion on surgical stress responses and lymphocyte function according to the surgical severity have not been studied in detail. We investigated the effects of soybean oil emulsion, which contains 50% omega-6 fatty acid, on postoperative stress responses and cell-mediated immune function according to the severity of surgical stress. METHODS: Eight patients who underwent gastric or colorectal surgery and nine who underwent esophagectomy were fed fat-free total parenteral nutrition. Ten patients who underwent gastric or colorectal surgery and seven who underwent esophagectomy were fed total parenteral nutrition with soybean oil emulsion. Total parenteral nutrition provided 1.5 g of protein and 40 kcal per kilogram every day from 7 d before surgery to postoperative day 14. Soybean oil emulsion (Intralipid) accounted for 20% of the total calories. Serum interleukin-6, C-reactive protein, glucagon, and concanavalin A- or phytohemagglutinin-stimulated lymphocyte proliferation were determined. RESULTS: In the group of moderately stressed patients, soybean oil emulsion did not amplify the measured levels. In the group of severely stressed patients, soybean oil emulsion amplified the level of serum interleukin-6 and decreased concanavalin A- or phytohemagglutinin-stimulated lymphocyte proliferation. CONCLUSIONS: Soybean oil emulsion amplifies the stress responses and possibly suppresses cell-mediated immune function induced by surgical stress in severely stressed patients, but not in moderately stressed patients.