A 63-year-old male was diagnosed as ascending colon cancer with severe liver dysfunction caused by multiple liver metastases. Initially, hepatic arterial infusion (HAI) chemotherapy was started to reduce the size of metastatic tumors and to prevent a liver failure. After 7 courses of HAI chemotherapy, he recovered from liver dysfunction, and underwent right hemicolectomy. Pathological examination of the resected specimen revealed the tumor was neuroendocrine carcinoma. After surgery, a systemic infusion of mFOLFOX6/bevacizumab regimen was started. A partial response (PR) of metastatic lesions was observed. Irinotecan/cetuximab was administered as the second-line. He survived for 10 months after HAI. HAI for colonic neuroendocrine carcinoma with severe liver dysfunction by multiple liver metastases might be benefitial to prevent a liver failure.
Increasing negative lymph node count has been reported to be associated with better outcomes in patients with colon cancer. The present study aimed to clarify the clinical significance of the lymph node ratio (LNR) and location of lymph node metastasis (LNM) in patients with stage III right colon cancer.We enrolled 820 patients who had undergone curative resection due to colon cancer at a single institution between 1991 and 2005. Among them, 197 underwent curative resection for T2-T4 right colon cancer. We evaluated the oncological outcomes according to LNR (quartiles) and distribution of LNM (n1 = LNM adjacent to the colon or along the vascular arcades of the marginal arteries; n2 = LNM along the major vessels; n3 = LNM near the roots of the major vessels).The rates of LNM in T2, T3 and T4 right colon cancer were 11.1, 38.6 and 58.0%, respectively (p < 0.0001). Recurrence rates were 27.3, 37.5 and 57.1% in patients with n1, n2 and n3 LNM, respectively (p < 0.0001). LNR (p < 0.0001) and distribution of LNM (p = 0.046) were independent risk factors for recurrence in patients with stage III right colon cancer.Some patients with extensive LNM benefited from lymph node dissection with high ligation. Those with T3-T4 right colon cancer are suitable candidates for lymph node dissection with high ligation. Adding the concept of LNR and location of LNM to conventional TNM staging could improve the accuracy of evaluating nodal status.
418 The signal transducers and activators of transcription (STATs) are latent cytoplasmic proteins that are activated to participate in gene control by phosphorylation on a single tyrosine which results from activation of the Janus kinase (JAK) when cells encounter various extracellular cytokine, growth factor and hormones. Tyrosine phosphorylation of STAT proteins induces dimmer formation, followed by translocation to the nucleus, where they bind to specific DNA response elements in target gene promoters and thereby regulate gene expression. Seven types of STAT proteins have been identified so far; STATs 1, 2, 3, 4, 5A, 5B and 6. A growing number of tumor-derived cell lines and samples from human cancers are reported to contain constitutively activated STAT proteins, very frequently STAT3. Some target genes of STAT3 include those encoding the antiapoptotic proteins, the proliferation-associated proteins, and the proangiogenic factor. STAT3 was proposed to be an oncogene, based on evidence that a constitutively dimerized/active form of STAT3 transformed immortalized mouse and rat fibroblasts and bestowed upon these cells the ability to grow into tumors in nude mice. In addition, it has been recently reported that the expression of tyrosine-phosporylated STAT3 (p-STAT3) is associated with poor prognosis in head and neck cancer and lymphoma. In our study, we investigated expression of the p-STAT3 in primary breast cancer by immunohistochemistry and analyzed the relation between p-STAT3 expression and clinicopathological and molecular features of breast cancer. It was reported that the suppressor of cytokine signaling-1 (SOCS-1), which was identified as a protein involved in a negative feedback loop for STAT pathway, is silenced by CpG island methylation. Therefore, we also investigated methylation status of SOCS-1 and analyzed the relation between p-STAT3 and SOCS-1 methylation status. P-STAT3 was overexpressed in 39 of 74 breast cancers. There was no significant correlation the p-STAT3 expression and clinicopathological features including age, tumor size, histology, lymph node metastasis. However, the p-STAT3 expression showed a significant correlation with VEGF-C (p=0.0015), although there was no significant correlation between p-STAT3 and the other molecular findings such as hormone receptors and HER2. Next, we investigated methylatin status of SOCS-1 in 57 breast cancers available for DNA. SOCS-1 methylation was detected in 25 of 57 cases. There was a significant correlation between SOCS-1 methylation and p-STAT3 expression. Our results suggest that STAT3 signalings may be one of the major pathways that contribute to tumorigenesis in breast cancer.
Platelet-derived growth factors (PDGFs) are known to be associated with tumor growth and angiogenesis through their activation of the receptor tyrosine kinases, PDGF receptors alpha and beta. Several studies revealed the participation of the PDGF family in colorectal cancer (CRC). However, the role of platelet derived growth factor-C (PDGFC) in CRC is less well studied. This study aimed to determine the correlation between PDGFC expression and the prognosis of patients with CRCs. Tumor samples were obtained from patients with CRC who underwent surgical resection between 2002 and 2006. The mRNA expression of PDGFC was investigated by quantitative reverse transcription-polymerase chain reaction in 85 patients with stage I-IV CRC. PDGFC protein expression was analyzed by immunohistochemistry, and the relationship between PDGFC protein expression and clinicopathologic features was investigated in 245 patients with stage I-III CRC. PDGFC mRNA expression in cancer tissues was significantly higher in patients with distant metastases than in those without metastases (P = 0.016). PDGFC protein overexpression was associated with significantly worse overall and relapse-free survival (P P - 6.081, P
We report a case of rectal cancer with unresectable multiple liver metastases, which was worried about the transition from liver dysfunction to liver failure. The male patient in his 70s was diagnosed as advanced rectal cancer with severe liver dysfunction because of multiple liver metastases. Hepatic arterial infusion (HAI) chemotherapy, which was effective to reduce the size of metastatic liver tumors, was initially started. During HAI chemotherapy, sigmoid colostomy was performed. He recovered from liver dysfunction after he had been treated with 13th cycle HAI chemotherapy. He was treated with the modified FOLFOX6 regimen following a resection of rectal cancer. Although the standard therapy for colorectal cancer with unresectable liver metastases is firstly systemic chemotherapy such as FOLFOX or FOLFIRI, it might be better to control the liver metastases by HAI chemotherapy when a liver function is severely damaged by extensive liver tumors.
A new method for assessing the selected hearing aids was developed and applied 53 patients with hearing impairment. Our previous paper showed that the average confusion distance which was introduced in this method was useful for estimating the hearing aids.We carried out a follow-up survey in order to measure the usefulness of this method after 3 or 4 years practical hearing aid use. There were 34 patients out of 53 from whom we could obtain adequate information about their hearing aids. They were asked to rate their satisfaction with the recommended instrument in five degrees. Fifteen of the 34 patients who had purchased the recommended hearing aid rated it very satisfactory; four rated the aid satisfactory; eight rated the aid helpful; six rated the aid sometimes helpful; and one rated the aid unsatisfactory.The Spearman's rank correlation coefficient between the change in the speech discrimination score with and without a hearing aid and the user's evaluation was 0.34. The Spearman's rank correlation coefficient between the change in the average confussion distance and user's evaluation was 0.41. The value 0.34 is not significant, but the value 0.41 is significant at the 1% level of significance. Therefore, we think that the average confusion distance should be taken into consideration as well as the speech discrimination score at least for predicting successful hearing aid use.Finally we feel that there is need for the inclusive system which is able to estimate both the speech mediated communication ability and user's satisfaction.
