Prognostic significance of the serum thymidine phosphorylase levels in venous blood drainage specimens in patients with colorectal cancer.

BACKGROUND/AIMS: We investigated whether the serum Thymidine phosphorylase (TP) levels in venous blood drainage specimens were associated with the prognosis and risk of liver metastasis in patients with resectable colorectal cancer. METHODOLOGY: From 88 patients with colorectal cancer, specimens of venous blood drainage were obtained during operation. The serum TP levels were measured by a highly sensitive Enzyme-Linked Immunosorbent Assay (ELISA) method. RESULTS: Subsequently, 88 patients were divided into two groups based on the levels of TP. The dividing line was determined to be 55ng/mL. The TP-high group (> 55ng/mL) had a significantly shorter overall survival than the TP-low group (< 55ng/mL). A multivariate analysis indicated that the serum TP level in venous blood drainage specimens to be a better prognostic factor independent of the traditional pathologic parameters. The serum TP levels of 3 patients with metachronous liver metastasis were high (> 55ng/mL). CONCLUSIONS: These findings suggest that the serum TP levels in venous blood drainage specimens reflect the prognosis of patients with colorectal cancer undergoing curative resection, particularly the risk of liver metastasis.

Colostomy with vancomycin administration as an effective treatment for toxic megacolon associated with fulminant pseudomembranous colitis: a case report.

We report a case of toxic megacolon associated with fulminant pseudomembranous colitis. A 72-year-old woman was admitted with severe dehydration and shock. Computed tomography showed evidence of diffuse thickening of the colonic wall, colonic dilatation and ascites. She underwent transverse colostomy and received postoperative vancomycin, both orally and by administration from the stoma. Her clinical situation improved dramatically following surgery. When a patient is unable to tolerate subtotal colectomy and ileostomy because of a severe overall condition, temporary colostomy followed by administration of vancomycin through the stoma is recommended.

Toward therapeutic guidelines for patients with acute right colonic diverticulitis.

BACKGROUND: At present, little information is available on the outcome of medical therapy for patients with acute right colonic diverticulitis, and this has meant a gap in constructing guidelines for its treatment. METHODS: The records of patients with acute right colonic diverticulitis at Nagasaki University Graduate School and affiliated hospitals were reviewed and analyzed with the goal of establishing therapeutic guidelines. The time frame of the data analyzed was from 1984 to 2002. RESULTS: Of the 81 patients included in the data, 80 patients who were suffering a first attack were successfully treated with bowel rest and antibiotics. Two of these 80 patients underwent an elective operation at the surgeon's discretion during the original hospitalization and 1 (1.2%) needed an urgent operation. Of the 78 patients who responded to medical therapy, 16 (20.5%) developed recurrent right colonic diverticulitis. All 16 patients who had a second attack were successfully treated with medical therapy. Three of the 16 patients underwent an elective operation during this rehospitalization period. Of the 13 patients who had had a second attack and had responded to medical therapy, there was a third attack in 2 patients (15.4%). Both of these patients were again successfully treated with medical therapy. There has been no morbidity and no mortality related to recurrence to date. The average time from the first attack to us contacting the patient was 35.2 months. CONCLUSIONS: Unlike acute uncomplicated left colonic diverticulitis, our findings indicate that after two documented episodes, medical treatment alone rather than elective surgery may be considered as an effective guideline for the treatment of acute uncomplicated right colonic diverticulitis.

Carcinoembryonic antigen mRNA in the mesenteric vein is not a predictor of hepatic metastasis in patients with resectable colorectal cancer: a long-term study.

PURPOSE: The clinical value of carcinoembryonic antigen messenger ribonucleic acid in the draining venous blood has been controversial because of short observation period. The authors prospectively investigated the clinical significance of detection of carcinoembryonic antigen messenger ribonucleic acid in the draining venous blood to predict hepatic metastases in patients with resectable colorectal cancer. METHODS: Drainage venous blood from 80 patients who underwent curative resections for colorectal cancer were obtained immediately before surgery to determine the presence of cancer cells by means of reverse transcription polymerase chain reaction. RESULTS: After an average follow-up period of 52.1 months, 7 of the 35 patients (20 percent) with positive carcinoembryonic antigen messenger ribonucleic acid had hepatic metastases, whereas 2 of the 45 patients (4.5 percent) with negative carcinoembryonic antigen messenger ribonucleic acid had hepatic metastases. The cumulative probability of hepatic metastatic recurrence rate differed significantly between two patient groups with positive or negative carcinoembryonic antigen messenger ribonucleic acid expression in the drainage vein (log-rank, 4.900; P = 0.0269). However, 28 of the 35 patients (80 percent) with positive carcinoembryonic antigen messenger ribonucleic acid did not have hepatic metastases. Additionally, Cox proportional hazards models identified the presence of lymph node metastases as the only independent predictor of hepatic metastatic recurrence. CONCLUSIONS: This study failed to demonstrate the high predictive value of carcinoembryonic antigen messenger ribonucleic acid detection in the draining venous blood for the development of hepatic metastases. However, the authors demonstrated that the presence of cancer cells in the draining venous blood was the essential and initial step to the development of hepatic metastasis.

Occurrence of hematogenous metastasis and serum levels of thymidine phosphorylase in colorectal cancer.

Thymidine phosphorylase (dThdPase) is known to promote the development of new blood vessels. Increased dThdPase expression in solid tumors has been shown to correlate with tumor growth, invasion and metastasis. In the present study, we measured dThdPase levels in the tumor tissue and in the serum from the tumor drainage and peripheral venous blood obtained from patients with resectable colorectal cancer. Serum dThdPase levels, measured by a modified ELISA method, were significantly higher in patients with hematogenous metastasis. In the tumor tissue specimens, no significant difference was observed between patients with or without hematogenous metastasis. These results suggest that the serum dThdPase levels are a novel marker to predict occurrence of hematogenous metastasis in patients with resectable colorectal cancer.

Expression of tumor-associated membrane antigen, RCAS1, in human colorectal carcinomas and possible role in apoptosis of tumor-infiltrating lymphocytes.

RCAS1, a novel tumor-associated antigen, is expressed in advanced human neoplasias including uterine and ovarian carcinomas. RCAS1 protein was indicated to induce cell cycle arrest and apoptosis of cultured human lymphoid and myeloid cell lines and normal lymphocytes. In the present study, we investigated the expression and prognostic value of RCAS1 in 58 patients with colorectal carcinomas. RCAS1 protein was detected by immunoperoxidase staining using a mouse monoclonal anti-RCAS1 antibody (22-1-1 antibody). Immunohistochemical examination showed expression of RCAS1 in 75% of colorectal carcinomas with lymph node metastases (n = 24), whereas it was present in only 41% of tumors without metastases (n = 34, P <.05). Patients with RCAS1-positive tumors showed a significantly poorer prognosis than those negative for RCAS1 (P <.05). Multivariate analysis using the Cox regression model indicated that RCAS1 positivity was an independent negative predictor for survival (P =.0300; risk ratio, 0.496). In addition, apoptotic cells of tumor-infiltrating lymphocytes were examined using nonradioactive in situ nick translation in paraffin-embedded sections. The proportion of apoptotic tumor-infiltrating lymphocytes was significantly higher in RCAS1-positive colorectal carcinomas (11.2 +/- 1.0) than in RCAS1-negative tumors (7.9 +/- 1.0, P <.05). Our results suggest that overexpression of RCAS1 may negatively affect the prognosis of human colorectal carcinomas and that RCAS1 may play a role in tumor immune privilege in vivo.

Elevated IL-8 levels in the drainage vein of resectable Dukes' C colorectal cancer indicate high risk for developing hepatic metastasis.

To investigate the relationship between tumor angiogenesis and hematogenous metastasis in colorectal cancer, an immunohistochemical analysis using antibody against factor VIII was carried out on archival specimens of 35 primary tumors. In addition, we also evaluated the levels of vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8), by an enzyme-linked immunosorbent assay (ELISA), in tumor specimens and the serum in the drainage venous blood. The levels of VEGF showed no correlation with the microvessel density and also did not increase significantly in patients with hepatic metastasis. On the other hand, the IL-8 levels in the tumor tissue (r=0.45) and the serum IL-8 levels (r=0.49) showed a significant correlation with the microvessel density. The serum IL-8 levels in patients with Dukes' C colorectal cancer and hepatic metastasis were significantly higher than in those without hepatic metastasis (p<0.05). In addition, the serum levels of IL-8 in patients with Dukes' C cancer without hepatic metastasis and those with Dukes' A and B cancer were also closely similar. These results suggest that IL-8 is associated with the microvessel density in primary tumors and thus play an important role in the occurrence of hepatic metastasis in patients with colorectal cancer. As a result, elevated levels of IL-8 in the drainage vein are considered to be a useful predictor for developing hepatic metastasis in patients with resectable colorectal cancer.