Laparoscopic Witzel gastrostomy--a reappraised technique.

BACKGROUND: Laparoscopic gastrostomy is the best alternative for long-term enteral feeding when percutaneous endoscopic gastrostomy is not possible. The aim of the present study was to determine the feasibility, complications, adequacy of feeding support, and tolerability of laparoscopic Witzel gastrostomy (LWG) in head and neck cancer patients. The initial results and the results of extended follow-up were evaluated. METHODS: A consecutive series of 48 patients with stenotic head and neck or esophageal cancer were referred for laparoscopic gastrostomy. The patients consisted of 42 men and 6 women aged 36 to 82 years (mean, 54 years). After laparoscopic placement of a Foley catheter of 16 F into the stomach, a seromuscular tunnel 4 cm in length is created, embedding the catheter by interrupted sutures. Three stay sutures for gastropexy are fixed and tied on the abdominal skin at the end of the procedure. The mean duration of the procedure was 62.4 +/- 11 min (52-124 min). RESULTS: Laparoscopic Witzel gastrostomy could be performed successfully in all patients with aerodigestive cancer. None of the laparoscopic gastrostomy tube placement procedures was converted to an open surgery, and none of the 48 patients in this series died as a result of the laparoscopic procedure. All LWG complications (11%) were minor, consisting of superficial wound infections, balloon rupture, and chronic granulation. No major complications were encountered. The mean usage time of gastrostomy was 6.3 +/- 5.3 months. CONCLUSIONS: Current techniques of LWG could be an alternative to percutaneous endoscopic gastrostomy (PEG) for long-term enteral access, because it has proved to be safe and reproducible with relatively few complications.

Prognostic significance of pre- and postoperative serum carcinoembryonic antigen levels in patients with colorectal cancer.

BACKGROUND: To evaluate the prognostic significance of pre- and postoperative serum carcinoembryonic antigen(CEA) levels in colorectal cancer (CRC) patients. METHODS: 425 CRC patients underwent curative resection at our institution. Their pre- and postoperative serum CEA level was classified into two groups according to concentration: normal CEA (<5.0 ng/ml) and abnormal CEA (> or =5.0 ng/ml). RESULTS: Of all patients, abnormal pre- and postoperative serum CEA levels were observed in 181 (42.6%) and 48 (11.3%) patients, respectively. Abnormal preoperative serum CEA level was significantly correlated with the tumor located in the colon, the depth of tumor invasion, the status of lymph node metastasis, UICC stage, and the presence of postoperative relapse (p < 0.05). Concurrently, an abnormal postoperative serum CEA level was also prominently related to the above corresponding parameters (p < 0.05), except for the tumor location. Patients with a failed conversion of abnormal preoperative value to normal postoperative concentration were found to have the worst overall survival rate. Abnormal pre- and postoperative serum CEA levels were single independent predictors for survival and postoperative relapse, respectively. CONCLUSIONS: The identification of abnormal pre- and postoperative serum CEA levels may be useful in the auxiliary cancer prognosis or postoperative surveillance of CRC patients.

Molecular detection of disseminated tumor cells in the peripheral blood of patients with gastric cancer: evaluation of their prognostic significance.

Early detection of disseminated tumor cells in the peripheral blood of patients with early stage gastric cancer could help to improve the outcome after tumor resection. The aim of this study is to evaluate the prognostic significance of tumor-related mRNA for the detection of circulating tumor cells in gastric cancer patients by a reverse-transcriptase polymerase chain reaction (RT-PCR) method. We simultaneously analyzed human telomerase reverse transcriptase (hTERT), cytokeratin-19 (CK-19), cytokeratin-20 (CK-20) and carcinoembryonic antigen (CEA) mRNA (messenger RNA) expression in the peripheral blood of 42 gastric cancer patients and 30 healthy individuals. Additionally, analyses were carried out for the correlation of these four molecular markers with patients' clinicopathologic features, as well as the occurrence of postoperative recurrence/metastasis. Among 42 gastric cancer patients, the prevalence of mRNA for hTERT, CK-19, CK-20, and CEA was 61.9% (26/42), 69% (29/42), 61.9% (26/42), and 78.6% (33/42), respectively. All 30 healthy individuals were negative for hTERT and CEA mRNA, while two were positive for either CK-19 mRNA or CK-20 mRNA. Positive CEA mRNA was significantly correlated with tumor size p=0.008), vessel invasion (p=0.001), depth of tumor invasion (p=0.007), lymph node metastasis (p< 0.001), and TNM stage (p<0.001). In addition, the multivariate logistic regression demonstrated that CEA mRNA expression was an independent and significant predictor for postoperative recurrence/metastasis (p=0.032). Our findings suggest that CEA mRNA may be a more reliable marker than hTERT, CK-19 and CK-20 for the detection of circulating cancer cells in gastric cancer patients' peripheral blood. Patients with positive CEA mRNA expression in peripheral blood have a significantly higher risk of postoperative recurrence/metastasis.

Determination of acidic and basic species by headspace gas chromatography.

This paper reported a novel headspace gas chromatographic (GC) technique on quantification of acidic and basic species. It is based on an acid-base reaction between the measured species and bicarbonate in an aqueous solution, which generates carbon dioxide in a closed headspace sample vial. By operating at 60 degrees C, carbon dioxide is completely released to the headspace and thus can be measured by GC with a thermal conductivity detector. Bicarbonate concentrations of 0.030 and 0.0025 mol/L are recommended for general applications and very small species content, respectively. This method is able to accurately measure small sample sizes (down to few milligrams or microliters). The present method is simple, accurate, and automatic.

A labile hyperphosphorylated c-Fos protein is induced in mouse fibroblast cells treated with a combination of phorbol ester and anti-tumor promoter curcumin.

Curcumin is a potent inhibitor of tumor promotion, and was shown previously to inhibit 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced AP-1 activity. The c-Fos protein is inducible by TPA and thus is associated with c-Jun to result in an increased AP-1 activity in mouse fibroblast cells. We therefore hypothesized that c-Fos may be one of the targets of curcumin action. In the present study, the effects of curcumin on TPA-induced c-fos mRNA and protein levels were determined by RNA hybridization and western blot analysis, respectively. Curcumin decreases the TPA-induced nuclear abundance of c-Fos protein in spite of the slight super-induction of c-fos mRNA. Upon TPA stimulation, the amount of c-Fos in the quiescent cells increases and reaches maximum at 30 min, and then progressively disappears over a period of 60 min. However, the c-Fos protein seems susceptible to rapid degradation by 45 min if NIH 3T3 cells were treated with TPA in the presence of curcumin. The curcumin-induced hyperphosphorylated forms of c-Fos proteins are significantly more unstable; they entirely disappeared within 40 min after incubation at 37 degrees C. These findings prompted us to suggest that the decrease of c-Fos protein could account for the repressed in vitro DNA binding probably by reducing the Jun/Fos complex formation.

Mutations of p53 gene in gastric carcinoma in Taiwan.

BACKGROUND: p53 gene mutation and p53 protein accumulation is the most common event in human cancers. The present study was conducted to investigate the occurrence of p53 mutations in patients with gastric carcinoma in Taiwan. MATERIALS AND METHODS: Tumor samples from 36 patients with primary gastric carcinoma undergoing radical gastrectomy were evaluated. The mutational status of the p53 (exons 5 to 8) was screened by polymerase chain reaction/single strand conformation polymorphism (PCR-SSCP) analysis followed by direct sequencing. These results were compared with p53 protein expression as assessed by immunohistochemical staining. RESULTS: Of all 36 gastric carcinomas, mutations of the p53 gene were found in 7 cases (19.4%). These results from direct sequencing indicated that mutations consisted of five missence mutations, one silent mutation and one mutation within the splice donor site of intron 5. Mutations were found at codon 145 in exon 5 (1 case), intron 5 (1 case), codon 248 in exon 7 (1 case), codon 251 in exon 7 (2 cases), codon 285 in exon 8 (1 case) and codon 287 in exon 8 (1 case). The mutation hot spot at codon 251 in gastric cancer has not been observed previously. Over-expression of p53 oncoprotein was observed in 10 patients (27.8%) immunohistochemically. CONCLUSIONS: p53 gene mutation might contribute to the pathogenesis of human gastric carcinoma. However, the suggestion awaits further investigation for confirmation.

Modified devascularization surgery for isolated gastric varices assessed by endoscopic ultrasonography.

BACKGROUND: This study aimed to assess the role of endoscopic ultrasonography (EUS) in the surgical management of isolated gastric varices (IGV), and to report the authors' experience in the treatment of IGV with modified devascularization surgery. METHODS: In this study, 26 cirrhotic patients with IGV were treated with devascularization surgery for variceal hemorrhage. Preoperatively, percutaneous transhepatic portography (PTP) and EUS were used to determine the mode of therapy for IGV. Fundectomy was performed for 14 patients with fundic IGV, whereas 12 patients with cardiac IGV underwent proximal gastrectomy. RESULTS: A significantly higher proportion of patients with cardiac varices showed grade 3 IGV on preoperative EUS than those who had fundic varices (p < 0.05). No major complications were observed during or after the operation, and only one patient died of prolonged shock and massive transfusion. Postoperatively, gastric varices had been eradicated completely in 25 of 26 patients, as determined by EUS study. During a mean follow-up period of 50 months, two patients had recurrent varices without bleeding, as demonstrated by EUS. The overall 5-year survival rate for the fundic IGV group was 67.9%, whereas that for the cardiac IGV group was 64.3% (p > 0.05). CONCLUSIONS: This study showed that devascularization surgery is highly effective for the prevention of recurrent bleeding from IGV and provides an alternative treatment method. Preoperatively, EUS is very helpful in detailed devascularization of patients with specific IGV, and may be used also for postoperative follow-up evaluation.

Secure placement of continuous ambulatory peritoneal dialysis catheters under laparoscopic assistance.

Laparoscopic surgical procedures were performed in 18 patients with end-stage renal disease for the placement of a Tenckhoff peritoneal dialysis catheter. Among them, 6 patients had received previous lower abdominal surgical treatment and 3 patients underwent laparoscopic rescue of dysfunctional Tenckhoff catheters. The operating time was between 40 and 80 minutes (median, 50 minutes). After a median follow-up period of 11 months, the short-term results revealed that no significant morbidity was associated with this procedure, and all catheters except two functioned well postoperatively. One of the catheters was not functional because of the patient's death, and the other one was removed because of persistent peritonitis. Laparoscopic secure placement of continuous ambulatory peritoneal dialysis catheters appears to be a simple, safe, and viable procedure, even in patients with previous lower-abdominal operations. The same technique can be used to rescue dysfunctional catheters that are displaced or obstructed by adhesion and omental wrapping, thus increasing catheter longevity.

The role of epidermal growth factor in gastric epithelial proliferation in portal hypertensive rats exposed to stress.

BACKGROUND/AIMS: This study was designed to determine whether epidermal growth factor may have a role in the stomach of portal hypertensive rats after exposure to water immersion and restraint stress. METHODOLOGY: Rats with portal hypertension (portal vein partial ligation) were studied to determine the proliferative response of the gastric epithelium to epidermal growth factor (EGF) during stress. The portal hypertensive rats received EGF (0, 10, 25, 50, and 100 microg/kg/day) subcutaneously for 7 days before water immersion restraint stress. Each rat was subjected to water immersion restraint stress for 6 hours, at the end of which the stomachs were excised to evaluate gross and microscopic mucosal damage, and gastric epithelial proliferation using proliferating cell nuclear antigen (PCNA) immunoreactivity. RESULTS: The gross and microscopic mucosal damage were significantly greater in control or low dose EGF-pretreated (10 or 25 microg/kg/day) rats than in high dose EGF-pretreated (50 or 100 microg/kg/day) rats (p<0.01). These changes were accompanied by parallel alterations in the PCNA labeling index. The PCNA labeling index between high dose EGF-pretreated and control or low dose EGF-pretreated rats differed significantly (p<0.01). CONCLUSIONS: This study clearly indicates that the influence of EGF on the proliferative response of the portal hypertensive (PHT) gastric epithelium to stress in rats was dose-dependent, suggesting an important role for EGF in the protection of PHT gastric mucosa from stress injury.

The effect of portal hypertension on expression of gastric mucin mRNA in rats.

BACKGROUND/AIMS: Gastric mucin, a principal component of gastric mucus, is thought to play an important role in protecting gastric mucosa and maintaining the homeostasis of the gastric mucosa. Our previous studies have demonstrated that the contents of gastric mucin were decreased in rats with portal hypertension. Thus, the purpose of this present study was designed to confirm the effect of portal hypertension on the expression of gastric mucin mRNA and to localize gastric mucin mRNA production site in rats. METHODOLOGY: Portal hypertension was induced experimentally by partial ligation of the portal vein in Wistar rats. The severity of gastric mucosal lesions was evaluated macroscopically by a gross ulcer index. We simultaneously measured the levels of mRNA in the gastric tissues of control and portal hypertension rats by reverse transcription-polymerase chain reaction, Southern blot hybridization, and in situ hybridization. RESULTS: The damage to gastric mucosa was found to be prominently greater in the portal hypertension rats compared to the control (P < 0.01). The expression of mucin mRNA was significantly reduced in portal hypertension rats compared to the control using the reverse transcription-polymerase chain reaction and Southern blot hybridization (both P < 0.01). In situ hybridization showed that mucin mRNA was localized primarily in the gastric submucosa and mucosa, particularly in the surface mucous and the gland mucous cells. CONCLUSIONS: Our results reveal that portal hypertension would cause a decrease in mucin mRNA, and it would be helpful in understanding the mechanism of gastric mucosal mucin alteration in portal hypertension and the pathogenesis of portal hypertension gastropathy. Furthermore, it may provide the strategy in the prevention and therapy of portal hypertension gastropathy.

Endoscopic ultrasonography for preoperative locoregional staging and assessment of resectability in gastric cancer.

We performed a prospective study from November 1989 to December 1996 to assess the accuracy of endoscopic ultrasonography (EUS) in the locoregional staging and resectability of patients with gastric carcinoma. One hundred and nineteen patients with gastric cancer who received preoperative assessment by EUS underwent subsequent surgery. The endosonographic tumor-node-metastasis (TNM) classification was used for comparison with the histopathologic findings of the resected specimens. The ability of EUS to accurately predict the T stage (depth of tumor invasion) and N stage (involvement of lymph node) was 70% and 65%, respectively. EUS displayed a tendency to overestimate T stage and underestimate N state. The differentiation of early gastric cancer from advanced gastric cancer showed a concordance rate of 89% and underestimation rate of 8% and underestimation rate of 3%. The accuracy of EUS in predicting the stage T1 to T3, which correspond to D0 resectability (no macroscopic or microscopic tumor remains), was 91%. In conclusion, these results revealed EUS as a valuable tool for evaluating the local staging and resectability of gastric cancer. We suggest that EUS should be introduced in the preoperative assessment of patients with gastric cancer.

The effect of portal hypertension on transforming growth factor-alpha and epidermal growth factor receptor in the gastric mucosa of rats.

The aim of this study was to evaluate the expression of transforming growth factor-alpha (TGF-alpha) and epidermal growth factor receptor (EGFR) immunohistochemically in gastric mucosa of portal hypertensive (PHT) and sham-operated rats. PHT was induced experimentally by partial ligation of the portal vein (PVL) in 12 male Wistar rats; another group of 12 rats (control) received sham operations. The severity of macroscopic gastric mucosal lesions and immunoreactivity of TGF-alpha and EGFR were evaluated 14 days following the above procedure. The damage to gross gastric mucosa was found to be significantly greater in the PVL group than the control group (p<0.01). Additionally, the TGF-alpha and EGFR immunoreactivities were significantly more intense in the PVL groups compared to the control (P<0.05). The TGF-alpha and EGFR immunoreactive cells were more prominent around injured mucosa. From these findings, we suggest that locally produced TGF-alpha and EGFR may play an important role in the gastric mucosal repair following PHT to rats.

Hypothalamic dysfunction in acute head-injured patients with stress ulcer.

In patients with severe head injury, hypothalamohypophyseal impairment with subsequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: 1) Glasgow coma scale 4 to 10; 2) within 24 hours after head injury; 3) not in shock or sepsis; and 4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gonadotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p < 0.001). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p < 0.001). In the patients with stress ulcer, significant increases (p < 0.001) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely head-injured patients. In patients with stress ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage.

Expression of P53 protein and it's prognostic significance in breast cancer patients.

Nuclear accumulation of p53 protein is associated with a poor clinical outcome in breast cancer patients. This study was designed to determine the frequency of p53 protein immunoreactivity in primary breast cancer to correlate the presence of p53 protein with established risk factors including the estrogen receptor and progesterone receptor status, and to evaluate the prognostic significance of p53 protein immunoreactivity regarding patient survival in Taiwan. To assess the p53 protein immunoreactivity, 104 patients with breast cancer were examined using immunohistochemical methods. P53 protein was detected in 40 (38.5%) of these primary breast cancer specimens. Highly significant associations were found between p53 protein expression and negative steroid receptors, histologic grade III. There were no statistically significant references in p53 protein expression with respect to age, tumor size, lymph node status, or clinical stage. Patients with p53 positive tumor showed poorer survival but this did not achieve significance. However, there were more patients with poor survival in the axillary node-positive group (p < 0.05) than in node-negative group. This suggests that the p53 protein expression is marginal as a prognostic indicator in breast cancer with axillary-node metastasis.

Serum vitamin A level in breast cancer patients.

Vitamin A or its synthetic analogues are potent in controlling cell differentiation and in preventing epithelial cancer in experimental animals. Although some community-based studies have found that high serum retinol levels in prediagnostic sera were associated with reduced risk for cancer, other reports in humans have not confirmed this finding. This study is to evaluate the preoperative serum vitamin A level in breast cancer patients in Taiwan. The serum specimens were collected from 106 female cases of breast cancer (aged 30 to 70 years), 32 female cases of benign breast disease (aged 29 to 57 years), and 40 healthy females (aged 22 to 52 years). The serum vitamin A levels were measured by colorimetic analysis. The results showed the mean value of the vitamin A level was 140.4 +/- 65.7 micrograms/dl in the breast cancer group comparing to 145.2 +/- 44.2 micrograms/dl in the benign breast disease group, 144.0 +/- 30.0 micrograms/dl in the control group (P > 0.05). The characteristics of the breast cancer group were analyzed and they revealed that serum vitamin A levels did not bear statistically significant differences in age, duration, steroid receptor, tumor size and menopausal state. (P > 0.05) In conclusion, the serum vitamin A levels were not decreased in early breast cancer patients. The serum vitamin A levels were significantly decreased in the metastatic breast cancer group, especially in liver metastatic women. (P < 0.05). Postoperative vitamin A supplement may have potential benefit to metastatic breast cancer patients.

Primary abscess of the omentum: report of a case and review of the literature.

Primary abscess of the omentum is an infrequent disease entity. We report a case of 60-year-old male patient who suffered from left lower quadrant abdominal pain with localized abdominal wall tenderness, nausea and high-grade fever for the previous few days. Computerized tomography scan revealed a heterogeneous lesion that adhered to the abdominal wall. A pre-operative diagnosis of colonic diverticulitis complicated with intra-abdominal abscess was made and a laparotomy was done. At surgical exploration, an indurate mass consisting of abscess within the omentum was identified. The surgical procedure consisted of resection of the omental abscess with abdominal wall debridement, and subsequent antimicrobial therapy was administered. Postoperatively, the patient recovered uneventfully. Clinicians who treated such patients should be aware of this problem because of the difficulty of preoperative diagnosis.

Gastric duplication cyst: report of a case.

Gastric duplication cyst is a rare disease entity, especially in the adult population. We report a case of 33-year-old female patient who presented with epigastric pain, postprandial fullness and nausea for the past several months. Gastroendoscopy showed a submucosal mass with normal overlying gastric mucosa. Upper gastrointestinal series confirmed a extrinsic compression of mass in the fundus of the stomach. Endoscopic ultrasonography and computerized tomography demonstrated the lesion to be a cyst in nature. The surgical procedure consisted of total excision without violation of the gastric lumen. Gastric mucosa was found by the histologic study of the excised cyst.

Mondor's disease in the breast.

Mondor's disease, superficial thrombophebitis of the breast, is an uncommon self-limiting condition. Surgical procedures and trauma were the common known causes. The objective of this study was to evaluate the incidence of Mondor's disease in different breast operations in lower risk of breast cancer area over a 6-year period and to identify its causes, clinical features, related surgical factors and associated breast cancer. Eighty-four cases of Mondor's disease were obtained from 9657 new patients in the breast clinic of Kaohsiung Medical University Hospital between January 1991 and December 1996. The incidence per year was close (0.84%-0.96%) although the number has been increasing each year. In 23 cases, no definite cause was diagnosed, whereas in 61 cases, the disorder was secondary because the pathogenesis could be discerned. The identified causes included forty-three cases caused by breast surgery, two cases associated with breast cancer and sixteen cases with other benign causes. Although the incidence did not differ significantly between breast surgery (0.95%) and non-surgical causes (0.79%), the highest incidence, 1.52%, occurred when excision through circumareolar incision and tunnel procedure for cosmesis (25 cases in 1634 excisions) were used, and the lowest 0.69% when excisions through direct incision (14 cases in 2004 excisions) were performed. (P < 0.05) The other incidence rates were 1.56% in breast conserving surgery which is higher than 0.37% following mastectomy. The incidence of the disease was higher (4.28%) when the distance of the breast lesion was more than 3 cm from the areolar edge, compared to 1.20% for the 2 cm group and 0.32% for the 1 cm group (P < 0.05) in tunnel procedures. The incidence of Mondor's disease during breast surgery was not significantly different in different breast quardrants. Although Mondor's disease is a benign, self-limiting condition, a high incidence developed in the excision biopsy through circumareolar incision with tunnel procedure when the distance from the breast lesion to the areolar edge was more than 3 cm. To prevent this complication, the tunnel procedure in breast biopsy should be avoided. The incidence of Mondor's disease associated with breast cancer was low (2.4%) in the lower-incidence breast cancer area from this series, but awareness of the condition is recommended.

Biochemical markers for assessment of bone metastases in patients with breast cancer.

Breast cancer commonly metastasizes to bones, producing both osteolytic and osteoblastic deposits. Different markers for quantitative determination of bone turnover have been developed to evaluate bone metastases of breast cancer. The urinary deoxypyridinoline (Dpd), a crosslink product of collagen molecules found in bone and excreted in urine during bone degradation, and bone specific alkaline phosphatase (B-ALP), an isoenzyme localized in the membrane of osteoblasts and released in circulation during bone formation, were recently described as a group of markers of bone turnover in metastatic cancer. The urinary Dpd/creatinine (Cre) ratios and the serum B-ALP activity were determined in the samples from 148 patients who suffered from breast cancer (BC patients) with or without bone metastases, and 42 healthy women. For comparison, other biochemical markers, e.g. carcinoembryonic antigen (CEA), CA15-3, tissue polypeptide antigen (TPA), tissue polypeptide specific antigen (TPSA), and total alkaline phosphatase (T-ALP) in these samples were also evaluated. The results showed that there was a significant difference in urinary Dpd/Cre ratio between the control group and the patients with breast cancer (BC group) (mean +/- S.D., 5.69 +/- 1.26 vs. 8.19 +/- 3.95 nM/mM, P < 0.05). However, there was no significant difference between their B-ALP activities in the two groups. In addition, the BC patients with bone metastases showed elevated urinary Dpd/Cre ratios and B-ALP activities and ratios of (Dpd/Cre)/B-ALP in compare with BC patients without bone metastases (P < 0.05). Meanwhile, the urinary Dpd/Cre ratios (10.50 +/- 5.04 nmol/mmol) in the advanced stage of BC patients were higher than those in an early stage (7.45 +/- 3.23 nmol/mmol) (P < 0.05), but their serum B-ALP activities increased only in stage IV (P < 0.05). The urinary Dpd/Cre ratios also increased progressively according to the degree of bone metastases (P < 0.05), but their serum B-ALP activities only increased in severe bone metastases (P < 0.05). The results showed that the increase of a bone osteolytic activity took place earlier than that of a bone osteoblastic activity in the metastatic BC patients. In compare with other conventional markers, the best diagnostic efficiency of biochemical markers, analyzed by step wise discriminate analysis, was provided by CEA followed by Dpd/Cre ratio, CA15-3, TPA, TPSA, B-ALP and T-ALP. We conclude that showed the urinary Dpd/Cre ratio was a useful tumor marker to evaluate breast cancer with bone metastases.

Evaluation of serum CA27.29, CA15-3 and CEA in patients with breast cancer.

The Truquant BR radioimmunoassay (RIA) using monoclonal antibody BR 27.29 to recognize a peptide sequence on the MUC-1 gene product for quantification of the CA 27.29 antigen in serum was used in this report to evaluate in 145 patients with breast cancer and compared the other conventional serum markers such as CA15-3 and CEA. The upper limit of normal (25 u/ml) was determined from CA27.29 values 12.4 +/- 4.1 u/ml (mean +/- 3 S.D.) for 112 female subjects apparently free of disease. The CA15-3 levels above 25 u/ml and CEA levels above 5 ng/ml were considered positive values. Thirty-seven cases of 145 patients studied had elevated CA 27.29 levels (sensitivity: 25.5%), 35 of 145 had positive CA15-3 levels (sensitivity 24.1%) and 27 of 145 patients had positive CEA levels (sensitivity: 18.6%) (p < 0.05). One hundred and ten cases of the breast cancer patients (75.8%) did not have metastatic disease. In this group CA 27.29 sensitivity was 6.4%, while CA15-3 sensitivity was 5.5% and CEA sensitivity was 4.5% (p > 0.05). Mean values were 10.2 +/- 9.2 u/ml for CA 27.29, 14.1 +/- 5.6 u/ml for CA 15-3 and 1.7 +/- 1.5 ng/ml for CEA. Thirty-five patients (24.2%) had metastatic disease. In this group CA 27.29 sensitivity was 85.7%, CA15-3 sensitivity was 82.8% and CEA sensitivity was 62.8% (p < 0.05). Mean values for CA27.29 was 152.6 +/- 131.6 u/ml, CA15-3 was 123.1 +/- 107.6 u/ml and 21.8 +/- 36.9 ng/ml of CEA. With regard to the correlation of three tumor markers with clinical stages, patients had significantly higher levels of CA27.29 than CEA, but they were similar to CA 15-3 in metastatic breast cancer. These results suggest CA27.29 to be more sensitive and specific than CEA, but that it is similar to CA15-3 for metastatic breast cancer detection and monitoring.