Two-field lymph-node dissection may be enough to treat patients with submucosal squamous cell carcinoma of the thoracic esophagus.

Significance of extended radical surgical treatment including three-field lymph node dissection for squamous cell carcinoma (SCC) of the esophagus remains debatable. The aim of the current study was to reconsider the merits and demerits obtained by three-field lymph node dissection for esophageal carcinoma and also to attempt to elucidate an appropriate surgical strategy for submucosal SCC of the thoracic esophagus. Thirty-one patients with SCC of the thoracic esophagus who had been treated with esophagectomy and two-field (thoracic and abdominal) lymph node dissection without preoperative therapies were enrolled. Five-year survival rate was 75.0% and the incidence proportion of postoperative complication was 9.7%. These data regarding postoperative outcome of patients were by no means inferior to those in the previous reports referring the prognosis of patients with esophageal carcinoma who had been treated with three-field lymph node dissection. Authors would like to mention that two-field lymph node dissection associated with reduced incidence of postoperative complications might be enough to treat the submucosal SCC of the thoracic esophagus.

Relationship between intracellular localization of p34cdc2 protein and differentiation of esophageal squamous cell carcinoma.

PURPOSE: G2/M cyclins including cyclins A and B can exert their biologic functions of mitosis and proliferation of the tumor cells by being combined by protein kinase p34cdc2. The aim of the current study was to elucidate the clinicopathologic significance of immunohistochemical expression of p34(cdc2) in esophageal squamous cell carcinoma (ESCC), which has not been resolved. METHODS: Immunohistochemical expression of p34(cdc2) was examined for 91 cases of ESCC, and the relationship between the type of p34(cdc2) expression and the clinicopathologic features of the patients and tumors was analyzed. RESULTS: Forty-one ESCCs demonstrated cytoplasm dominant expression of p34(cdc2) and the other 50 ESCCs showed nuclei dominant p34(cdc2) expression. This differential expression pattern of p34(cdc2) did not reflect a prognostic aspect; however, the proportion of keratinizing tumors ESCCs with cytoplasm dominant expression of p34(cdc2) was significantly higher than that among ESCCs presenting nuclei-dominant p34(cdc2) expression (P=0.006). CONCLUSION: Cellular differentiation in squamous cell carcinoma of the esophagus may be mediated by an intracellular localization of p34(cdc2).

Correlation of ABO blood group with clinicopathologic characteristics of patients with esophageal squamous cell carcinoma.

The aim of the current study was to determine the nvolvement of ABO blood group in clinicopathologic features in squamous cell carcinoma (SCC) of the esophagus, that has not previously been studied fully. Two hundred and eighty four consecutive patients with esophageal SCC were enrolled for the study. The relationship between patients' ABO blood group and the clinicopathologic features was analyzed. The proportion of poorly differentiated SCC among patients with blood group O was significantly lower than in those patients with other blood types (P = 0.001). The mean size of the tumors in patients with blood group AB was significantly larger than those in patients with other blood groups. The proportion of tumors associated with venous invasion was significantly higher in patients with blood type A than those of tumors in other blood types (P = 0.007). The TNM stages of tumors in blood group AB were found to be significantly more advanced (P = 0.036) than other groups. The functional significance of ABO blood group distribution might be associated with biological behavior of SCCs. However, it was found not to be a clinical predictor for the prognosis of the patients with esophageal SCC.

Clinicopathologic significance of cyclin A expression in colorectal carcinoma.

The clinical significance of cyclin A expression, which has been known to act in the mitotic phase of the cell cycle, as an indicator of malignant potential in human tumors, has been suggested. The aim of this study was to elucidate the significance of immunohistochemical expression of cyclin A in colorectal carcinomas based on a larger study population. Immunohistochemical staining for cyclin A was performed for 167 colorectal carcinomas and the correlation between cyclin A expression and the clinicopathological characteristics was analyzed. One hundred and two carcinomas (61.1%) had cyclin A expression and the other 65 (38.9%) did not. The mean size of the tumors with cyclin A expression was significantly larger than that of tumors without cyclin A expression (p = 0.012). Survival in patients with cyclin A-expressing carcinomas was significantly worse than that in patients with carcinomas without cyclin A expression (p = 0.004). Cyclin A expression (p = 0.030), as well as lymph node metastasis (p = 0.007) and Dukes' stage of the tumors (p < 0.0001) were found to be factors independently associated with unfavorable prognosis in patients with colorectal carcinoma. Our results demonstrated that immunohistochemical expression of cyclin A is an independent prognostic indicator in patients with colorectal carcinoma.

Significance of immunohistochemical over-expression of CD44v6 as an indicator of malignant potential in esophageal squamous cell carcinoma.

PURPOSE: The aim of the current study was to find out a clinicopathologic significance of CD44v6 over-expression in esophageal squamous cell carcinoma (ESCC), which has not been elucidated fully. METHODS: Immunohistochemical expression of CD44v6 was examined for 81 ESCCs. Correlation of CD44 over-expression with the clinicopathologic features were investigated. RESULTS: Thirty-eight ESCCs (46.9%) had over-expression of CD44v6. The proportions of the incidence of lymph node metastasis (P=0.039), lymphatic permeation (P=0.003), and blood vessel invasion (P=0.037) in ESCCs with over-expression of CD44v6 were significantly higher than those in ESCCs without over-expression of CD44v6. The stage of the tumor in ESCCs with over-expression of CD44v6 was significantly more advanced (P=0.045). Survival rates of patients with ESCC with over-expression of CD44v6 were significantly worse (P=0.0005). Moreover, CD44v6 over-expression (P=0.048) as well as blood vessel invasion (P=0.014) and stage of the tumor ( P=0.010) were factors independently associated with the unfavorable prognosis of the patients with ESCC. CONCLUSIONS: Over-expression of CD44v6 can be an indicator of the malignant potential of ESCC.

p34cdc2 expression is an independent indicator for lymph node metastasis in colorectal carcinoma.

PURPOSE: The significance of p34(cdc2) expression in human tumors has not been fully explained. The aim of the current study was to elucidate the clinicopathologic significance of immunohistochemical p34(cdc2) expression in carcinoma of the colon and rectum. METHODS: The immunohistochemical expression of p34(cdc2) was examined in 90 consecutive colorectal tumor cases, and p34(cdc2) expression and the clinicopathologic features of the patients and their tumors were compared. RESULTS: Lymph node metastasis was significantly more frequent in tumors expressing p34(cdc2) (47.8%, 11 of 23 tumors) than in tumors not expressing p34(cdc2) (22.4%, 15 of 67 tumors; P=0.020). Multivariate analysis demonstrated that tumor depth ( P=0.008) and p34(cdc2) expression ( P=0.022) were independently associated with lymph node metastases of colorectal carcinomas. CONCLUSIONS: The immunohistochemical expression of p34(cdc2) is independently associated with lymph node metastasis in colorectal carcinoma.

Assessment of the intestinal permeability following postoperative chemotherapy for human malignant disease.

PURPOSE: Administration of anticancer drugs may damage gastrointestinal epithelium, thereby increasing the permeability of the gastrointestinal mucosa. We estimated the usefulness of oral lactulose and mannitol (L/M) test for assessment the extent of mucosal damage following postoperative chemotherapy for human malignant disease. METHODS: The permeability index (PI): the urinary recovery ratio of excreted L to M was measured before and after chemotherapy in 31 patients with gastrointestinal cancers who underwent surgical resection. These findings were compared with data on 12 patients with breast cancer. The effect of chemotherapy was evaluated by the ratio of increase in PI, which was designed as post-chemotherapy value on day 7 divided by pre-chemotherapy value. RESULTS: The mean PIs before chemotherapy in patients who underwent gastrectomy or colectomy were significantly higher than the value in those treated with mastectomy (p < 0.05). In the gastrointestinal cancer patients, the mean PIs significantly increased after chemotherapy compared with the pre-chemotherapeutic value (p < 0.01), however no significant difference was seen in breast cancer patients. When the ratios of increase in PI were calculated among gastric cancer patients, the total gastrectomy group showed a significantly higher increase in PI compared with the partial gastrectomy group (p < 0.05). CONCLUSIONS: Since the oral L/M absorption test is useful for assessing the degree of mucosal damage and measurement of intestinal permeability, this analysis should be recommended to determine the optimum timing and the adequate dosage of the anticancer drug administration.

Clinicopathological significance of pRb2/p130 expression in squamous cell carcinoma of the esophagus.

PURPOSE: The aim of the current study was to find out the significance of the immunohistochemical expression of pRb2/p130, which is a member of the retinoblastoma gene family, in squamous cell carcinoma of the esophagus. METHODS: We analyzed immunohistochemically the expression of pRb2/p130 of 107 squamous cell carcinomas (SCCs) of the esophagus and the correlation of pRb2/p130 expression with clinicopathological features was investigated. RESULTS: Expression of pRb2/p130 was observed in 42 SCCs (39.3%). There was a significant correlation of pRb2/p130 expression with the histological type of well-differentiated SCC (P< 0.0001). The survival rate of patients with esophageal SCCs expressing pRb2/p130 was significantly better than that of patients with tumors without pRb2/p130 expression (P= 0.016). A multivariate analysis demonstrated that pRb2/p130 expression (P= 0.026), venous invasion (P= 0.028), and TNM stage (P= 0.044) were independent prognostic indicators in patients with esophageal SCCs. CONCLUSIONS: Differentiation of esophageal SCC might be partially mediated by the pRb2/p130 gene, and pRb2/p130 expression can additionally be an indicator of the better prognosis of patients with esophageal SCCs.

Increased intestinal permeability correlates with gastrointestinal toxicity among formulations of the fluorouracil analogue tegafur in rats.

BACKGROUND: S-1 is a new antitumor agent which was developed based on biochemical modulation of fluorouracil. S-1 consists of tegafur (FT), 5-chloro-2,4-dihydroxypyridine (CDHP), and potassium oxonate (Oxo) in a molar ratio of 1:0.4:1. S-1 has been reported to enhance therapeutic effects and to reduce the gastrointestinal toxicity as compared with 5-fluorouracil. In this study performed in rats, S-1 was used to assess the relationship between gastrointestinal mucosal toxicity and changes in intestinal barrier function. METHODS: Fifteen rats were equally divided into three groups: group A (untreated controls), group B (FT and CDHP mixture), and group C (FT and CDHP in combination with Oxo). The animals in groups B and C received equitoxic doses of the drugs in their food for 14 consecutive days. The intestinal permeability was determined on the basis of the urinary recovery of orally administered lactulose and mannitol (L/M). Injury to the small intestines was evaluated by light microscopy. The cell surface expression of CD44 was evaluated immunohistochemically. RESULTS: Recovery of L/M in urine (expressed as a fraction of the dose administered) was 0.15 +/- (SE) 0.08, 0.23 +/- 0.13, and 0.09 +/- 0.04 in groups A, B, and C, respectively. The intestinal permeability in group B was significantly higher than that in group C (p < 0.05). Treatment with FT and CDHP (groups B and C) induced injury to the small intestine and decreased expression of CD44 within the intestinal mucosa, but the extent of damage was reduced by coadministration of Oxo (group C). CONCLUSION: This experimental study suggested that the gastrointestinal toxicity resulting from administration of anticancer drugs is accompanied by an impaired gut barrier function measurable as an increase in intestinal permeability to L/M.

Clinicopathological features of early esophageal squamous cell carcinoma with subsequent recurrence.

It has been well known that there is occasionally a postoperative recurrence in early esophageal carcinoma. However, the clinicopathologic characteristics of early squamous cell carcinoma of the esophagus with a postoperative recurrence have not been elucidated. The subjects were 103 patients with early carcinoma of the esophagus including 10 patients with subsequent recurrence, who had been surgically treated. Clinicopathologic features were compared between patients with the presence and absence of recurrence of carcinoma. No special clinicopathologic feature was observed in early esophageal carcinomas with subsequent recurrence, when compared with early carcinomas without recurrence. Physicians should realize that there is always a possibility of recurrence in early carcinomas of the esophagus, and that a leading clinical strategy for superficial carcinoma of the esophagus is the surgical treatment.

Correlation of pre-operative nutritional condition with post-operative complications in surgical treatment for oesophageal carcinoma.

AIMS: The relationship between the pre-operative nutritional condition and the outcome of the surgical treatment in patients with oesophageal carcinoma has been discussed diversely. The aim of the current study was to demonstrate the relationship between pre-operative nutritional condition and post-operative complications and prognosis following surgical treatment for oesophageal carcinoma. METHODS: Two hundred and fifty-eight patients with oesophageal carcinoma treated with oesophageal resection and reconstruction were selected. The correlation of pre-operative values of prognostic nutritional index (PNI) with the incidence of post-operative complications and prognosis of the patients was investigated. RESULTS: The mean pre-operative value of PNI in patients with post-operative complications (41.8+/-5.4) was significantly lower than that in patients without post-operative complications (46.5+/-5.3; P<0.0001). The survival in patients with higher PNI value was significantly more favourable than that in patients with lower PNI value (P=0.0001). CONCLUSIONS: Pre-operative assessment of the nutritional condition could provide predictive information for post-operative complications in patients with oesophageal carcinoma.

Significance of allogenic blood transfusion on decreased survival in patients with esophageal carcinoma.

BACKGROUND: To the authors' knowledge, the significance of allogenic blood transfusion in the prognosis of patients with esophageal carcinoma remains controversial. The objective of the current study was to elucidate the correlation, if any, between intraoperative allogenic blood transfusion and prognosis in patients with esophageal carcinoma. METHODS: Two hundred fifty-nine patients with esophageal carcinoma who had undergone esophagectomy and reconstruction were studied. The clinicopathologic data and survival were compared between the 87 patients (33.6%) who received an intraoperative allogenic blood transfusion and the 172 patients (66.4%) who did not. RESULTS: Multivariate analysis demonstrated that the factors that appeared to independently determine prognosis in patients with esophageal carcinoma were the depth of the tumor (P = 0.0001), lymph node metastasis (P < 0.0001), lymphatic invasion (P = 0.0002), venous invasion (P = 0.0008), and the occurrence of postoperative complications (P = 0.034). Intraoperative allogenic blood transfusion was not found to be an independent prognostic indicator. CONCLUSIONS: In the current study, an advanced stage of disease at the time of surgery, which resulted in the need for blood transfusion and the occurrence of postoperative complications, appeared to worsen the prognosis in patients with esophageal carcinoma.

Adenosquamous carcinoma of the sigmoid colon: report of a case.

A case of adenosquamous carcinoma of the sigmoid colon is presented herein. An 85-year-old woman without any symptoms was admitted to our hospital to undergo detailed examinations of the colon and rectum. Colonoscopy showed a huge type 2 tumor in the sigmoid colon. A typical sigmoid colectomy and lymph node dissection were performed. A histopathological investigation demonstrated adenosquamous carcinoma invading the subserosa. Although an absolute curative resection was performed, she died of metastatic lung carcinoma 14 months after the operation.

Obstructing carcinomas of the colon and rectum have a smaller size compared with those of non-obstructing carcinomas.

The aim of the current study was to elucidate the histopathological characteristics of obstructing carcinoma of the colon and rectum. We studied 72 patients with colorectal carcinoma, including 13 with obstructing carcinoma. The obstruction carcinomas occurred in sigmoid colon significantly more frequently than did non-obstructing carcinomas (p=0.007). The mean size of the obstructing carcinomas was 3.7+/-0.9 cm, which was significantly smaller than that of non-obstructing carcinomas (5.4+/-1.9 cm, p=0.003). The proportion of lymph node metastasis in obstructing carcinomas was 66.9%, which was significantly higher than that in non-obstructing carcinomas (42.4%, p=0.021). The proportion of carcinomas classified into Dukes' C or D in obstructing carcinomas was 84.6% and was significantly higher than that in non-obstructing carcinomas (52.5%, p=0.026). The pathogenesis of obstruction in colorectal carcinoma can be also derived from the contraction of the intestinal lumen caused by the condensation of cancer cells.

Significance of preoperative elevation of serum C-reactive protein as an indicator of prognosis in esophageal carcinoma.

BACKGROUND: Preoperative elevation of serum C-reactive protein (CRP) has been reported to be a prognostic indicator in gastric carcinoma and colorectal carcinoma. The aim of this study was to establish the significance of preoperative elevation of serum CRP as an indicator of prognosis in patients with esophageal carcinoma. METHODS: Two hundred sixty-two patients with esophageal carcinoma who had been treated by esophageal resection and reconstruction of digestive tracts were evaluated, excluding patients with neoplasms in other organs. Preoperative serum CRP was measured, and the relation between the elevation of serum CRP and the clinicopathological factors and prognosis of the patients was investigated. RESULTS: The mean size of the tumors and the proportions of lymph node metastasis and lymphatic invasion were significantly larger in patients with preoperative elevation of serum CRP than in patients without preoperative elevation of serum CRP (5.8 +/- 2.5 cm versus 4.8 +/- 2.5 cm, P <0.01, 59.5% versus 35.4%, P <0.001, and 35.7% versus 23.6%, P <0.05, respectively). 1-, 3-, and 5-year survival rates in patients with preoperative elevation of serum CRP (60.6%, 18.4%, and 11.5%, respectively) were significantly lower than those in patients without preoperative elevation of serum CRP (88.7%, 70.9%, and 68.4%, respectively; P <0.0001). Multivariate analysis demonstrated that the preoperative elevation of serum CRP was an independent prognostic factor in esophageal carcinoma (P <0.0001). CONCLUSIONS: The preoperative serum elevation of CRP can be a marker of the malignant potential of the tumor and an independent prognostic indicator in esophageal carcinoma.

Preoperative therapy with insufficient effectiveness is related to unfavorable prognosis of patients with esophageal squamous cell carcinoma.

The disadvantage brought by the preoperative therapy with insufficient effectiveness for the patients with esophageal carcinoma has not been previously investigated. The aim of the current study was to show that the prognosis of patients with advanced esophageal carcinoma treated with preoperative therapy with insufficient effectiveness may be rather more unfavorable than that of patients without preoperative therapy. The subjects were 406 patients with esophageal squamous cell carcinomas of depth reaching to muscularis propria or adventitia but not to neighboring structures, who had been treated with esophagectomy and reconstruction. Although the proportions of lymphatic invasion and venous invasion in patients treated with preoperative therapy of insufficient effect were lower than those of patients without preoperative therapy, the 1-, 3- and 5-year survival rates in the former (62.2%, 32.0% and 23.1%, respectively) was significantly lower than in the latter (78.5%, 57.3% and 39.7%, respectively, p=0.01). A preoperative therapy with insufficient effectiveness may bring a more unfavorable prognosis of patients with esophageal squamous cell carcinoma.

Amelanotic malignant melanoma of the rectum: report of a case.

We describe herein a case of amelanotic melanoma of the rectum. Macroscopically, the tumor was lacking in pigmentation and microscopically, it was found to be deficient in melanin. Moreover, the tumor cells showed positive staining for HMB-45, the antimelanoma antibody, which led to a diagnosis of amelanotic melanoma. The patient died of metastatic tumors in the liver and bone 17 months after undergoing abdominoperineal resection of the rectum and dissection of the bilateral inguinal lymph nodes.

Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition.

BACKGROUND: Roux-en-Y reconstruction with a jejunal pouch is a modified standard procedure in total gastrectomy for gastric cancer. The aim of the current study was to evaluate the usefulness of the reconstruction using a jejunal pouch in subsequent improvement of the nutritional condition of patients with gastric cancer after total gastrectomy. METHODS: Sixteen patients with gastric cancer treated by total gastrectomy and reconstruction with simple Roux-en-Y from January 1993 to December 1996 and 14 patients treated by total gastrectomy and reconstruction with Roux-en-Y and jejunal pouch from January 1997 to December 1998 were investigated in regard to postoperative heartburn, changes in the body weight, and prognostic nutritional index. RESULTS: Postoperative heartburn occurred in 1 patient (7.1%) among patients treated with Roux-en-Y and jejunal pouch and 3 (18.8%) among patients treated with simple Roux-en-Y. The body weight ratio at 1 year after operation in patients treated with Roux-en-Y and jejunal pouch (88.2% +/- 4.2%) was significantly higher than that in patients treated with simple Roux-en-Y (80.0% +/- 4.6%; P <0.01). The prognostic nutritional index ratios for patients treated with Roux-en-Y and jejunal pouch at 1 and 3 months after operation were 93.9% +/- 9.1% and 101.7% +/- 11.0%, respectively, and were significantly higher than that in patients treated with simple Roux-en-Y (86.2% +/- 8.8% and 88.1% +/- 8.2%, P <0.05 and P <0.01, respectively). CONCLUSIONS: Reconstruction using a jejunal pouch in total gastrectomy is useful for an early improvement of the nutritional condition of patients with gastric cancer.

Partial resection for leiomyoblastoma of stomach.

We herein report the case of a 51-year-old male with a submucosal tumor of the stomach which was histopathologically demonstrated to have features compatible with leiomyoblastoma. As the submucosal tumor of the posterior wall of the antrum, which was initially found in the upper gastrointestinal series done during a health examination, had grown 3.8 cm in diameter, the partial resection of the full thickness of the gastric wall containing the tumor with a sufficient tumor margin was performed.

Clinicopathologic characteristics of esophageal squamous cell carcinoma in younger patients.

BACKGROUND: The aim of the current study was to find out the clinicopathologic characteristics of younger patients with squamous cell carcinoma of the esophagus. METHODS: A total of 259 patients with esophageal squamous cell carcinoma who had been treated by esophagectomy and reconstruction within 10 years between January 1990 and December 1999 were studied. Clinicopathologic characteristics were compared between 27 patients younger than 50 years and 232 patients 50 years and older. RESULTS: A significant difference was observed with regard to the size of the tumor (6.3 +/- 3.8 cm in younger patients versus 5.0 +/- 2.4 cm in older patients; p = 0.017). The proportion of patients with TNM stage III or IV in younger patients (59.3%, 16 of 27) was significantly higher than that in older patients (38.3%, 89 of 232; p = 0.020). Nevertheless, no significant difference in the 1-, 3-, and 5-year survival rates was observed between younger patients (77.2%, 54.7%, and 54.7%, respectively) and older patients (81.9%, 54.2%, and 48.8%, respectively). CONCLUSIONS: Although the prognosis of younger patients with esophageal squamous cell carcinoma did not differ from that of older patients, esophageal squamous cell carcinoma in younger patients has more malignant potential and aggressive activity.