RESUMO
A 66-year-old man with cStage III B (cT4aN2H0P0M0) advanced gastric cancer in the cardia with esophageal invasion was treated with S-1/CDDP as neoadjuvant chemotherapy. After 3 courses of chemotherapy, a significant reduction in tumor burden was observed. Total gastrectomy and splenectomy with lymph node dissection (D2) were performed. Pathological specimens showed no cancer cells in the stomach and lymph nodes, indicating a pathological complete response.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Idoso , Cisplatino/administração & dosagem , Combinação de Medicamentos , Humanos , Metástase Linfática , Masculino , Terapia Neoadjuvante , Estadiamento de Neoplasias , Ácido Oxônico/administração & dosagem , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tegafur/administração & dosagemRESUMO
We report a patient who underwent 2-term surgery to treat focal progression of a huge liver metastasis and peritoneal dissemination from a gastric gastrointestinal stromal tumor(GIST)during imatinib mesylate treatment. A 59-year-old man underwent an emergency surgery for perforative peritonitis caused by gastric GIST in June 2006 and a partial resection of the stomach in September 2006. Four years later, abdominal computed tomography(CT)detected a huge liver tumor that occupied the entire right lobe. We initiated imatinib mesylate treatment(400mg/day), and the patient maintained stable disease for several months. However, focal progression of the huge liver tumor and a peritoneal tumor at the splenic hilum were revealed by CT; therefore, an extended right hepatic resection was performed in August 2011 and a distal pancreatectomy, splenectomy, and partial resection of the stomach were performed in February 2012. The patient died of the primary disease at 16 months after the hepatic resection for focal progression.
Assuntos
Antineoplásicos/uso terapêutico , Benzamidas/uso terapêutico , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Hepáticas/cirurgia , Neoplasias Peritoneais/secundário , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico , Neoplasias Gástricas/cirurgia , Progressão da Doença , Evolução Fatal , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/secundário , Humanos , Mesilato de Imatinib , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologiaRESUMO
The authors report their experience in a patient with brain metastasis from rectal cancer who has survived without recurrence after multidisciplinary treatment. A 60-year-old man presented to the Department of Neurosurgery with the primary complaint of spasm of the left side of the face. Examination revealed a tumor 2 cm in diameter in the right frontal lobe. The tumor was suspected to be metastatic, and brain metastasis from rectal cancer was diagnosed. The brain tumor was removed by a neurosurgeon, and the patient was transferred to the Department of Surgery. Removal of the primary lesion in the rectum was attempted, but only colostomy could be performed due to extensive anterior invasion. Postoperatively, 5 courses of capecitabine and oxaliplatin (XELOX) + bevacizumab were administered. The rectal tumor shrank in size, while another mass, suspected to be a lung metastasis, remained unchanged. Therefore, a second surgery on the rectum was scheduled, and abdominoperineal resection of the rectum and lateral lymphadenectomy were performed. Postoperatively, 4 courses of XE LOX therapy were administered. The patient is currently alive without recurrence at 1 year after surgery. Treatment (including timing) for brain metastasis from rectal cancer has not been established and prognosis is poor. However, multidisciplinary treatment may provide the possibility of cure.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Anticorpos Monoclonais Humanizados/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bevacizumab , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Capecitabina , Terapia Combinada , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Fluoruracila/administração & dosagem , Fluoruracila/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade , Oxaloacetatos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Resultado do TratamentoRESUMO
The patient was a 66-year-old male. He underwent sigmoidectomy with D1 for an advanced sigmoid colon cancer with massive metastasis to the para-aortic lymph nodes. After the resection he underwent chemotherapy, and CT showed that the para-aortic lymph node metastasis had disappeared. However, CT showed other lymph node(No. 252, No. 273 lt)swelling. We therefore resected No. 252 and No. 273 lt lymph nodes. Two years after the resection the patient is alive and shows no sign of recurrence while being without chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Idoso , Aorta/cirurgia , Humanos , Metástase Linfática , Masculino , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia , Fatores de TempoRESUMO
The patient, a 58-year-old woman, underwent a partial excision of the right breast and an axillary lymph node dissection in October 2004. The histopathological findings were: solid tubular carcinoma with metastasis to 17 axillary lymph nodes; triple negative-type breast cancer. As adjuvant therapy, FEC60 was administered 6 times, followed by radiotherapy applied to the residual breast and the right supraclavicular fossa. In Novermber 2007, she noted a tumorous growth above the right clavicle. The pathological diagnosis via fine needle biopsy was adenocarcinoma. An oral antineoplastic agent was given for about 6 months, but did not alter the lymph nodes. No distant recurrence was noted during this time. In August 2008, the right supraclavicular lymph nodes were dissected. The patient has been under observation without treatment, but no signs of recurrence have been noted. It was thought that excision of the recurrent supra-clavicular lymph nodes should be considered after careful examination in some individual cases.
Assuntos
Adenocarcinoma/tratamento farmacológico , Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Clavícula/patologia , Ácido Oxônico/uso terapêutico , Tegafur/uso terapêutico , Adenocarcinoma/cirurgia , Biópsia por Agulha , Neoplasias da Mama/patologia , Terapia Combinada , Combinação de Medicamentos , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Recidiva , Indução de RemissãoRESUMO
Eight patients with inoperable advanced gastric cancer were treated with combination chemotherapy of S-1, low-dose cisplatin(CDDP)and Lentinan. S-1 80 mg/ m² was orally administered for 2 weeks followed by 1-week rest, CDDP 15 mg/ m² and Lentinan 2 mg/body were given intravenously on day 1 and 8. One complete response and four partial responses were observed for an overall response rate of 63%(5 of 8 patients). Only one patient developed over grade 3 toxicity leukocytopenia. Many patients could be maintained by long-term continuous treatment. Since combination chemotherapy of S-1/low-dose CDDP/Lentinan for advanced gastric cancer was very tolerable, it could be used for a long time.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Lentinano/uso terapêutico , Ácido Oxônico/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Tegafur/uso terapêutico , Adulto , Idoso , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Combinação de Medicamentos , Feminino , Humanos , Lentinano/administração & dosagem , Lentinano/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Ácido Oxônico/administração & dosagem , Ácido Oxônico/efeitos adversos , Neoplasias Gástricas/patologia , Tegafur/administração & dosagem , Tegafur/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
A 61-year-old man with esophagus invasive advanced gastric cancer and peritoneum dissemination underwent three courses of S-1/CDDP/Lentinan (LNT) combination neoadjuvant chemotherapies (T3N1P1H0, Stage IV) (It is S-1 80 mg/m2,CDDP 15 mg/m2 and LNT 2 mg/body twice/week for two weeks) since down staging was obtained. We performed the surgery of total gastrectomy, splenectomy, D2 lymph node dissection, and Roux-en Y reconstruction in March 2008. With the surgical examination, there was no ascites and peritoneal dissemination. Although there was serious infiltration, we were able to remove it. In the histopathological effect judgment, it was Grade 1b. We changed the therapy to S-1 alone after the same chemotherapy for six months. One year after the operation, he is still alive one year after the surgery.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Terapia Neoadjuvante , Neoplasias Gástricas/terapia , Antimetabólitos Antineoplásicos/administração & dosagem , Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Combinação de Medicamentos , Gastrectomia , Humanos , Lentinano/administração & dosagem , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Ácido Oxônico/administração & dosagem , Esplenectomia , Tegafur/administração & dosagemAssuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias Pancreáticas/etiologia , Alcoolismo/complicações , Aldeído Desidrogenase/genética , Aldeído-Desidrogenase Mitocondrial , Doença Crônica , Genes ras/genética , Humanos , Mutação , Pancreatite Alcoólica/complicações , Fatores de RiscoRESUMO
There are various therapeutic options for hepatocellular carcinoma. Radiofrequency ablation (RFA) was introduced to Japan in 1998, and has become popular in percutaneous local treatment for HCC as a treatment with the advantage of both percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy. In this study, we investigated the efficacy and complication of RFA for HCC. Seventeen patients underwent percutaneous or open RFA with a Cool-tip needle (Radionics Co. Ltd) from April 2001 to May 2005. All tumors were solitary and the average diameter of 17 tumors was 2.24 cm. Fifteen tumors were completely ablated, but two weren't. Local recurrence occurred in only one patient and the rate of local recurrence was 6.7%. Mild complication occurred in some patients, but critical complication did not occur in any patients. In this study, it was considered that RFA could be performed safely and was a good treatment for HCC with high efficacy. After investigating the long-term results and indication of RFA, it was suggested that RFA might be reestablished as an effective treatment for HCC.
Assuntos
Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Neoplasias Hepáticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Complicações Pós-OperatóriasRESUMO
We have previously reported that decreased intercellular adhesion molecule-1 (ICAM-1) expression in cancer cells is associated with liver metastasis of colorectal cancer. In this study, we have investigated the effect of ICAM-1 gene transfection into the human colorectal cancer cell line LM-H3 on cell adhesiveness and cytotoxicity of peripheral blood mononuclear cells (PBMC) to cancer cells. Furthermore, we have investigated the effects of this gene transfer on subcutaneous tumour and liver metastases of LM-H3 in nude mice. More PBMC adhered to ICAM-1 transfected LM-H3 cells, LM-H3/ICAM-1, than to non-transfected LM-H3 cells and control LM-H3/Vector. Lysis of LM-H3/ICAM-1 cells by PBMC was significantly increased compared with LM-H3/Vector. Liver metastases with LM-H3/ICAM-1 cells were fewer in number and smaller than metastases with LM-H3/Vector. Intra-tumoural injection of ICAM-1 adenoviral vector significantly inhibited the growth of subcutaneous LM-H3 tumour. In conclusion ICAM-1 gene transfection using adenovirus vector might be an effective therapy for liver metastasis of colorectal carcinoma.
Assuntos
Neoplasias Colorretais/genética , Molécula 1 de Adesão Intercelular/genética , Neoplasias Hepáticas/secundário , Regulação para Cima/genética , Adenoviridae , Animais , Divisão Celular , Linhagem Celular Tumoral , Neoplasias Colorretais/patologia , Feminino , Citometria de Fluxo , Humanos , Leucócitos Mononucleares/metabolismo , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Transplante de Neoplasias , TransfecçãoRESUMO
We studied on possible association between the tumor marker (CEA, CA 19-9, and SPan-1) change and the clinical outcome after treatment with gemcitabine (GEM) in 23 patients with unresectable or recurrent pancreatic cancer. GEM was administered intravenously at a standard dose of 1000 mg/m2 weekly. One course consisted of weekly administration for 3 weeks followed by 1 week's rest. When the adverse effect did not allow the weekly administration, GEM was given bi-weekly without dose modification. Objective responses were evaluated by computed tomography and tumor marker change. Two or more courses were given for only 6 (26.1%) patients. The number of patients, administered GEM 6 or more times including by the weekly and bi-weekly method, was 12 (52.2%). Antitumor effects were evaluable in 16 patients. The clinical efficacies were 1 partial response (PR), 6 stable disease (SD), and 9 progressive disease (PD). Decreases in tumor marker levels were recognized in 9 of the 16 patients. The median survival time (MST) of the PR+NC group was significantly longer than that of the PD group (9 vs 3.5 months; p=0.0151). MST of those in the decreasing tumor marker group was significantly longer than the group with no decreases in the tumor markers (7.0 vs 5.5 months; p = 0.0478). The adverse effects at grade 3 or more were 4 (17.3%) leukopenia, 2 (8.7%) thrombocytopenia, and 1 (4.3%) skin toxicity. In conclusion, the tumor marker change after GEM treatment may be a predictor of preferable prognosis in patients with pancreatic cancer.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/sangue , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Adulto , Idoso , Antígenos de Neoplasias/sangue , Antimetabólitos Antineoplásicos/efeitos adversos , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Desoxicitidina/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Leucopenia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Pancreáticas/sangue , Análise de Sobrevida , Trombocitopenia/induzido quimicamente , Resultado do Tratamento , GencitabinaRESUMO
OBJECTIVES: Accurate preoperative prediction of the prognosis of patients with invasive ductal carcinoma of pancreatic head (pancreatic head cancer) is important for selecting treatment methods. We retrospectively examined the prognostic predictive values of endoscopic ultrasound (EUS) findings for patients with this disease. METHODS: The subjects were 66 patients with pancreatic head cancer who had undergone EUS. We examined each EUS finding as a possible prognostic predictor, including heterogeneity of internal echo, irregularity of peripheral echo, clarity of boundary echo, dilatation of the main pancreatic duct (MPD), dilatation of the common bile duct, lymph node swelling, vessel invasion, and the presence of ascites, by univariate and multivariate analysis for survival. RESULTS: Irregular peripheral echo, portal vein invasion, superior mesenteric artery/celiac artery invasion, and the presence of ascites were significant predictors of a poorer prognosis by univariate analysis for survival. In resectable cases, EUS findings of MPD dilatation and portal invasion were significant prognostic predictors by univariate analysis, and MPD dilatation was an independent prognostic predictor by multivariate analysis. CONCLUSION: EUS may be useful for predicting the prognosis of patients with pancreatic head cancer, based on the accuracy it provides in evaluating locoregional spreading.
Assuntos
Carcinoma Ductal Pancreático/diagnóstico por imagem , Endossonografia , Neoplasias Pancreáticas/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma Papilar/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Endossonografia/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos TestesRESUMO
A 34-year-old man was admitted to our hospital with the chief complaints of back pain and epigastralgia. The physical examinations on admission disclosed no abdominal tumor. The serum concentration of total bilirubin was 1.4 mg/dl. The serum elastase-1 level was elevated to 526 ng/dl. Computed tomography showed a cystic lesion, 1 cm in diameter, in the head of the pancreas, without dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography via the papilla of Vater and the accessory papilla revealed an enlarged ventral pancreatic duct and pancreas divisum. The preoperative diagnosis was mucin-producing pancreatic tumor in the ventral pancreas of a patient with pancreas divisum. A pylorus-preserving pancreatoduodenectomy was performed. The gross findings of the cut surface of the resected specimen disclosed mural nodules in the dilated duct of the ventral pancreas. A histological examination of the mural nodules in the ventral pancreas revealed mucin and intraductal papillary adenoma. Benign tumors associated with pancreas divisum are rare; to the best of our knowledge, only three cases have been reported. Although in these three patients the tumor developed in the dorsal pancreas, the tumor developed in the ventral pancreas in our patient.
Assuntos
Adenoma/complicações , Pâncreas/anormalidades , Neoplasias Pancreáticas/complicações , Adenoma/diagnóstico , Adenoma/metabolismo , Adenoma/patologia , Adulto , Dor nas Costas/etiologia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Dilatação Patológica , Humanos , Masculino , Mucinas/metabolismo , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patologia , PancreaticoduodenectomiaRESUMO
It has been reported that osteoclast-type giant cell tumor of the pancreas (OGTP) is rare, with a frequency of only 0.2% of the total reported pancreatic carcinomas. We report herein a rare case of OGTP in a 57-year-old Japanese man. Preoperative examinations showed a solid and cystic tumor, measuring 20 x 15 cm at the pancreas body. The resected specimen was a solid tumor with a giant cyst containing bloody contents. The tumor was composed of a proliferation of mononuclear cells admixed with osteoclast-type giant cells. The tumor cells were immunoreactive for vimentin, alpha1-antitrypsin, and EMA but not for CEA and cytokeratin. These findings indicated that this case was a malignant OGTP. The tumor cells showed microsatellite instability with high frequency (MSI-H). The present patient is alive 3 years after the operation, while OGTP has been reported to have a poor outcome. It has been reported that pancreatic carcinomas with MSI-H status have a favorable outcome. MSI-H might be one of the predictive markers for the long survival in OGTP.
Assuntos
Tumores de Células Gigantes/genética , Repetições de Microssatélites , Osteoclastos/patologia , Neoplasias Pancreáticas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Feminino , Instabilidade Genômica , Tumores de Células Gigantes/química , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mucina-1/análise , Proteínas de Neoplasias/análise , Osteoclastos/química , Neoplasias Pancreáticas/química , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Indução de Remissão , Células Estromais/química , Células Estromais/patologia , Vimentina/análise , alfa 1-Antitripsina/análiseRESUMO
Liver metastasis is a major contributor to mortality in patients with colorectal cancer. Hence, it is essential to establish preventive therapy to control liver metastasis. Recently, it has become widely accepted that cyclooxygenase (COX)-2 inhibitors possess anti-cancer activity for various types of tumor, especially colorectal. The clinical application of COX-2 inhibitors may therefore be beneficial. In this study, we have developed a combined treatment with a selective COX-2 inhibitor and fluorinated pyrimidines for liver metastasis of colorectal cancer, and examined the effect of these agents on proliferation and invasion of a highly metastatic human colon cancer cell line, LM-H3. The COX-2 inhibitor etodolac was found to inhibit cell invasion of LM-H3. 5-Fluorouracil (5-FU) inhibited proliferation of this line in vitro. Etodolac did not increase the inhibitory effect of 5-FU on cell proliferation. We also examined the inhibitory effect of etodolac and UFT, belonging to the fluorinated pyrimidines, on liver metastasis by using a liver metastatic model in the nude mouse. Combined treatment with etodolac and UFT markedly reduced liver metastasis. Serious side effects were not observed. In conclusion, combined treatment with etodolac and UFT might be a promising preventive therapy for liver metastasis of colon cancer.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Ensaios Antitumorais Modelo de Xenoenxerto/métodos , Animais , Divisão Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Neoplasias do Colo/patologia , Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase 2 , Inibidores de Ciclo-Oxigenase/administração & dosagem , Relação Dose-Resposta a Droga , Etodolac/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Humanos , Isoenzimas/antagonistas & inibidores , Neoplasias Hepáticas/secundário , Proteínas de Membrana , Camundongos , Camundongos Endogâmicos BALB C , Invasividade Neoplásica , Prostaglandina-Endoperóxido SintasesRESUMO
Trypsinogen/trypsin is one of the major serine proteases and is produced by pancreatic acinar cells. Tumor-associated trypsinogen (TAT) has been reported to be produced by several cancer cell lines. The biological roles and activation mechanisms of both TAT and pancreatic acinar trypsinogen (PAT) have not been elucidated in the context of cancer extension, in particular at the stage of invasion and metastasis. In this study, we investigate the roles played by PAT and TAT in pancreatic cancer invasion. In addition, we determined their mechanisms of activation and identified a trypsinogen activity-stimulating factor (TASF) produced by pancreatic cancer cells. TAT expression and high TAT activity were associated with high invasive and liver metastatic potential in SW1990 and CAPAN-2 cells. Moreover, a trypsinogen activating effect and activity prolonging effect was observed in a mixture of these supernatants with trypsinogen. These cells revealed significantly enhanced invasiveness upon invasion assay and in the presence of PAT. TAT and PAT were activated by TASF, active u-PA, produced by pancreatic cancer cells. Activated TAT and PAT can degrade not only ECM proteins but they can also activate other latent proteases. This ECM-protease-network may form a vicious cycle, thereby promoting tumor cell invasion.
Assuntos
Ativadores de Enzimas/metabolismo , Neoplasias Pancreáticas/metabolismo , Tripsinogênio/metabolismo , Humanos , Immunoblotting , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/secundário , Invasividade Neoplásica , Metástase Neoplásica , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Ativador de Plasminogênio Tipo UroquinaseRESUMO
The significance of hepatic arterial infusion chemotherapy for unresectable liver metastases from colorectal cancer was evaluated in 50 patients, who received either of the following regimens: 1 shot 5-FU + epirubicin + MMC (FAM group); hepatic arterial infusion of 5-FU for 2 hours + MMC (MF group); hepatic arterial infusion of 5-FU for 2 hours (5-FU group). There were no differences in the clinicopathological backgrounds of the patients among the groups. The mean survival time was 10.3 months, 16.0 months and 16.2 months in the FAM, MF and 5-FU groups. The effective percentages were 0%, 40% and 31% in the FAM, MF and 5-FU groups and the survival time of the effective cases was 18.1 months and 21.8 months in the MF and 5-FU groups. The MF group and 5-FU group showed significant improvement in prognosis. Concerning side effects, myelo-suppression and gastrointestinal toxicity appeared frequently in the MF group. In conclusion, 2-hour continuous hepatic arterial infusion with low-dose 5-FU for unresectable liver metastases from colorectal cancer may be helpful for improvement of prognosis.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Colorretais/patologia , Fluoruracila/administração & dosagem , Infusões Intra-Arteriais/métodos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Esquema de Medicação , Epirubicina/administração & dosagem , Artéria Hepática , Humanos , Neoplasias Hepáticas/mortalidade , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Prognóstico , Reprodutibilidade dos Testes , Taxa de SobrevidaRESUMO
The prognostic values of immunohistochemical staining for hMSH2 and hMLH1 in patients with pancreatic carcinomas were investigated. Fifty-five patients with histologically proven pancreatic carcinomas were studied. Immunohistochemical staining for hMSH2 and hMLH1 was performed by avidin-biotin-peroxidase complex method with a catalyzed signal amplification system. Tumor cells that exhibited an absence of nuclear staining in the presence of non-neoplastic cells with nuclear staining were considered to have an abnormal pattern. Four tumors (7.3%) demonstrated abnormal hMS2-negative staining. One tumor (1.8%) had abnormal hMLH1-negative staining and this tumor showed negative hMSH2 staining. No particular clinicopathologic factor such as tumor location, histology, T-factor, N-factor and TNM-stage were observed in patients with negative hMSH2 staining tumors. Median survival time (MST) of patients with hMSH2-negative tumors was comparatively longer than that of patients with hMSH2-positive tumors, however, there was no significant difference between MSTs of the two groups (56 months vs. 14 months; p=0.16). We concluded that negative hMSH2 immunohistochemical staining in the pancreatic carcinomas may demonstrate certain patients, but not all, who had microsatellite instability-positive tumors. The patients with hMSH2-negative tumors may have better prognoses than those with hMSH2-positive tumors. To clarify these findings, further large number of pancreatic carcinomas must be investigated.
Assuntos
Biomarcadores Tumorais/metabolismo , Proteínas de Neoplasias/metabolismo , Neoplasias Pancreáticas/metabolismo , Proteínas Proto-Oncogênicas/metabolismo , Proteínas Adaptadoras de Transdução de Sinal , Adulto , Idoso , Proteínas de Transporte , Diferenciação Celular , Reparo do DNA , Proteínas de Ligação a DNA/metabolismo , Regulação para Baixo , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Proteína 2 Homóloga a MutS , Proteínas Nucleares , Neoplasias Pancreáticas/patologia , Prognóstico , Taxa de SobrevidaRESUMO
Intraductal papillary-mucinous carcinoma (IPMC) of the pancreas, a new entity of pancreatic cancer with a favorable prognosis, has shown a gradual increase in the number of reported cases. Patients with high-frequency microsatellite instability (MSI-H) tumors have been shown to survive longer than those with low-frequency MSI (MSI-L) or microsatellite stable (MSS) tumors in colorectal and gastric cancer. We investigated whether MSI-H in patients with IPMC can contribute to a good prognosis. The formalin-fixed paraffin-embedded tumors and surrounding normal pancreatic tissues from 10 patients with IPMCs and 16 with intraductal papillary-mucinous adenomas (IPMAs) were provided for DNA extraction after microdissection. Polymerase chain reaction (PCR) was carried out using 8 microsatellite primer marker sets. The mixed PCR samples were analyzed using a genetic analyzer. MSI-H was determined by assessment of microsatellite variations in 3 or more of the 8 tested markers. Immunohistochemical staining of the MSI-responsible proteins hMLH1 and hMSH2 was conducted for both the IPMC and IPMA samples. Ten percent of IPMC harbored MSI-H tumors, whereas no MSI-H tumors were detected in the IPMAs. Thirty percent of IPMC tumors and 25% of IPMA tumors showed MSI-L. All IPMCs and IPMAs showed normal expression of both hMLH1 and hMSH2. MSI-H and loss of hMLH1 and hMSH2 are very rare events in both IPMCs and IPMAs. We conclude that a good prognosis for patients with IPMC is not associated with MSI-H.
Assuntos
Adenocarcinoma Mucinoso/genética , Carcinoma Ductal Pancreático/genética , Carcinoma Papilar/genética , Repetições de Microssatélites , Neoplasias Pancreáticas/genética , Proteínas Adaptadoras de Transdução de Sinal , Idoso , Proteínas de Transporte , Proteínas de Ligação a DNA/genética , Feminino , Genes p16 , Genes p53 , Humanos , Imuno-Histoquímica , Incidência , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Proteína 2 Homóloga a MutS , Proteínas de Neoplasias/análise , Proteínas de Neoplasias/genética , Proteínas Nucleares , Proteínas Proto-Oncogênicas/análise , Proteínas Proto-Oncogênicas/genética , Proteína Smad4 , Transativadores/genéticaRESUMO
We investigated the adenoma-carcinoma sequence in intraductal papillary-mucinous neoplasm from the aspect of genetic changes. The formalin-fixed paraffin-embedded tumors and surrounding normal pancreatic tissues from patients with 16 intraductal papillary-mucinous adenoma of the pancreas (IPMA) and 10 intraductal papillary-mucinous carcinoma of the pancreas (IPMC) were provided for DNA extraction after microdissection. SSCP-DNA sequencing analysis demonstrated K-ras mutations at codon 12 in 75% of IPMA and 70% of IPMC, while those at codon 13 were observed neither in IPMA nor IPMC. There were no characteristic K-ras mutation types in IPMA and IPMC and no significant differences in incidence of K-ras mutations between the two categories. The frequencies of p53 mutations analyzed by SSCP-DNA sequencing were not high in IPMA (18.8%) and IPMC (30%), showing no significant difference between them. LOHs of APC in IPMA and IPMC were infrequent (6.3 and 20%, respectively) and showed no significant difference in incidence between the two categories. The LOH frequencies of DCC in IPMA and IPMC were 31.3 and 40%, respectively, and were not statistically different from each other. Taken together, genetic changes such as K-ras, p53, APC and DCC mutations may not be associated with adenoma-carcinoma sequence in intraductal papillary-mucinous neoplasm of pancreas.