Serum IAP and IS levels were studied in patients with stomach cancer. We found that the serum levels of IAP and IS increased as the disease progressed; their true positive rates as tumor markers were 49.3% and 39.8%, respectively. There was some delicate difference between these glycoproteins and T-cell subpopulation. IAP and IS correlated well with a correlation coefficient of 0.847, their value in clinical oncology are thought to be equivalent. Some difference was found between their substances and ASP, this might indicate the heterogeneous nature of the circulating glycoproteins in varying cancer-bearing status.
The TNM system for classification and staging approved by Union Internationale contro le Cancer (UICC)/TNM Committee is designed primarily for patient care and, in this context, is equally applicable to patients in clinical research, community hospitals, and developing countries. It is clearly evident to all who have been involved that international agreement on the classification of cancer at all anatomical sites is exhilarating, since data from around the world can finally be compared with validity. The UICC believes that the TNM system can fulfil the following five objectives: (1) aid in the planning of treatment; (2) give an indication of prognosis; (3) assist in evaluation of the results of treatment; (4) facilitate the exchange of information between centres; and (5) contribute to the continuing investigation of human cancer. The important questions for planning of treatment (1), however, can not be answered by the information of the clinical TNM stage as the concept in the Japanese Joint Committee. The knowledge of the TNM stage does not yield information of prognostic importance (2). More accurate indices of prognosis can be calculated from multivariate analysis to examine many clinicopathological variables, and biological markers along with patient age and nodal status. The analysis makes the difficulties for the results of treatment due to the large number of combinations with T and N subgroups (3) (4). According to the fifth objective (5) of TNM classification, we would like to propose a more simple and pragmatic classification by classifying patients into those requiring surgical approach and adjuvant therapy.
In our institution, 152 cases have been treated, which are 24.3% of total 626 cases with esophageal carcinomas. Analysis of these 152 cases revealed that neither intraepithelial cancer (ep), nor mm2 cancer, in which the lesion is limited within the upper two-thirds of the proper mucosal layer, had any vessels invasion and lymph node metastases. In addition, only 25% of the cases with mm3 cancer, limited within the deeper one-third of the proper mucosal layer, had vessels invasion without lymph node metastases. The 5-year survival of the cases less than sm1 was as good as 100%. However, those of sm2 and sm3 patients were 58.9% and 54.2%, respectively. Thus, we made the treatment strategy for superficial esophageal cancer as follows: 1. For ep to mm2 cases, endoscopic mucosal resection could be applied. 2. For the cases whose lesions widely spread in the esophagus, blunt resection would be indicated. 3. For the cases with mm3 to sm3 cancer, thoracotomy and laparotomy with wide lymph node dissection from neck to abdomen should be employed. Since a radical operation for esophageal cancer has high operative risk and poor postoperative quality of life, we should properly pick up and apply more cases with mucosal carcinoma for endoscopic mucosal resection.
It has been well recognized that results of treatment in hepatocellular carcinoma with main portal vein tumor thrombus (Vp 3 HCC) are very poor. But we tried aggressive transcatheter treatment (one shot or continuous hepatic arterial infusion, TAE) and hepatectomy with postoperative TAE in 52 cases by Vp3 HCC in recent 10 years. Analysis of the results disclosed that PR or CR cases were observed only in the series of continuous hepatic arterial infusion therapy. And cumulative survival rate was the best in the series of hepatectomy (50% survival interval is 18 months). We concluded that hepatectomy and resection of the tumor thrombus with postoperative TAE is the best treatment in Vp3 HCC.
The serum levels of total triacylglycerol, cholesterol and phospholipids in 121 patients with breast carcinoma, 61 patients with benign breast diseases and 145 healthy females were studied especially in relation to their alteration by aging. At all age levels the patients with breast carcinoma had significantly higher concentrations of serum triacylglycerol than those with benign breast diseases. In carcinoma patients a gradual increase in the levels of serum cholesterol was observed with age, showing the same tendency as healthy females. Increases in serum phospholipids were observed with age in patients with carcinoma and benign diseases of the breast but were not statistically significant in comparison with those of healthy controls.
In a 55-year-old man, a tumor about 3 cm in diameter was detected in the upper abdomen by abdominal ultrasound screening during follow-up of chronic hepatitis C discovered in 1990. There were no symptoms and no abnormalities on physical examination. Tests for tumor markers were negative. By barium meal and gastroscopy, submucosal tumor was found on the lesser curvature of the stomach, with bridging fold in the absence of central ulceration. Biopsy revealed no tumor tissue. Under the diagnosis of submucosal tumor of the stomach, either a leiomyoma or leiomyosarcoma, partial resection of stomach was performed. Direct invasion of the surrounding organs, lymph node metastasis or distant metastasis was not observed grossly in the operation. Histologic examination of the resected specimen revealed proliferation of spindle cells and oval cells in an interlacing pattern. Immunohistochemistry for CD34, vimentin and c-kit protein was strongly positive, while smooth muscle actin, S-100 protein, desmin and p53 protein were negative. The proliferating cell nuclear antigen index was about 50%, while the MIB-1 index was < or = 1%. From these findings, this tumor was diagnosed as a gastrointestinal stromal tumor of the uncommitted type.
A 59-year-old-male with advanced gastric cancer and multiple liver metastasis was treated by intravenous administration of MMC (30 mg/body) and oral administration of HCFU (400mg/body/day) initially after palliative gastrectomy. CT scan revealed that liver metastatic lesions were undetectable at three months after operation. Seven months later, administration of HCFU was discontinued because liver metastatic lesions were observed again. Intravenous administration of MMC (10mg/body)+ACR (20mg/body) was performed four times weekly, but liver metastatic lesions were increasing in size. From 15 months after operation intravenous administration of CDDP (25mg/body/week) was started on an outpatient basis. After administration of CDDP 6 times, liver metastatic lesions were diminished in size. By CT scan the maximum percent reduction of liver metastatic lesions was 97% and duration of partial response was seven months. Eight months later, liver metastatic lesions regrew. At 28 months after operation, the patient died of liver metastatic lesions. This low dose regimen of CDDP on an outpatient basis is potentially useful in the treatment of advanced gastric cancer with multiple liver metastasis.
A 61-year-old male was admitted after detecting gastric lesion by gastrography in a medical health examination. The patient was diagnosed as Borrmann 2 advanced gastric cancer with remarkable intraperitoneal lymph node metastasis and liver tumor of lateral segment. Relative non-curative gastrectomy was performed with combined partial hepatectomy. The liver tumor measured 1.5 x 1.5 cm and was intraoperatively diagnosed as metastasis of gastric cancer. Mitomycin C 26 mg was given intravenously on the day of operation and 5-fluorouracil (5-FU) 150 mg/day orally since postoperative 14th day as adjuvant chemotherapy. The administration of 5-FU was continued for 5 years. As a result of such combination therapy, the patient still has had no recurrence 8 years following operation.
