担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Initial chemotherapy (Initial-C) followed by surgery is a promising treatment strategy for peritoneal lavage cytology-positive gastric cancer (CY1 GC) with no other noncurative factors. The aim of this study was to investigate the survival advantage of Initial-C compared to initial surgery (Initial-S) for this disease according to the macroscopic type, which was associated with prognosis and the efficacy of chemotherapy in GC. METHODS: One hundred eighty-nine patients who were diagnosed with CY1 GC with no other noncurative factors at four institutions from January 2007 to December 2018 were enrolled. The patients were divided into a macroscopic type 4 group (N = 48) and a non-type 4 group (N = 141). The influence of initial treatment on overall survival (OS) in each group was evaluated. RESULTS: In the type 4 group, the 5-year OS rates of Initial-C (N = 35) and Initial-S (N = 13) were 11.6% and 0%, respectively (P = 0.801). The multivariate analysis could not show the survival advantage of Initial-C. In the non-type 4 group, the 5-year OS rates of Initial-C (N = 41) and Initial-S (N = 100) were 48.4% and 29.0%, respectively (P = 0.020). The multivariate analysis revealed that Initial-C was independently associated with prolonged OS (hazard ratio, 0.591; 95% confidence interval, 0.375-0.933: P = 0.023). CONCLUSIONS: Initial-C improves the prognosis of non-type 4 CY1 GC with no other noncurative factors. On the other hand, further development of effective chemotherapeutic regimens and innovative treatment strategies are required for type 4 CY1 GC.

DOI： 10.1007/s10147-024-02496-1

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: NAD(P)H dehydrogenase [quinone] 1 (NQO1), an antioxidant enzyme, confers resistance to anticancer agents. NQO1 C609T is a single-nucleotide polymorphism associated with reduced protein expression in the non-neoplastic esophageal squamous epithelium (ESE). This study aimed to investigate immunohistochemical NQO1 expression in non-neoplastic ESE and to elucidate its prognostic significance in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant therapy followed by esophagectomy. MATERIALS AND METHODS: NQO1 expression in non-neoplastic ESE was determined in surgical specimens from 83 patients with ESCC using immunohistochemistry. The association between NQO1 expression and clinicopathological factors, and the prognostic significance of NQO1 expression for relapse-free survival (RFS) were statistically evaluated. RESULTS: Patients with complete loss or weak NQO1 expression and patients with moderate or strong NQO1 expression were classified into the NQO1-negative (n=29) and NQO1-positive (n=54) groups, respectively. The downstaging of T classification status after neoadjuvant therapy was significantly more frequent in the NQO1-negative group than in the NQO1-positive group (59% vs. 33%; p=0.036). The NQO1-negative group had significantly more favorable RFS than the NQO1-positive group (p=0.035). Multivariate survival analysis demonstrated that NQO1 negative expression had a favorable prognostic impact on RFS (HR=0.332; 95%CI=0.136-0.812; p=0.016). CONCLUSION: Immunohistochemical evaluation of NQO1 expression in non-neoplastic ESE has clinical utility for predicting patient prognosis after neoadjuvant therapy followed by esophagectomy and might be helpful for selecting candidates for adjuvant therapy to treat ESCC.

DOI： 10.21873/anticanres.16993

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: De novo malignancy (DNM) is a major cause of death in long-term recipients of liver transplantation (LT). We herein report our experience with DNM after living-donor LT (LDLT). PATIENTS AND METHODS: A total of 111 LDLT procedures were performed in our institute from 1999 to 2022. Among them, 70 adult (>13 years old) LDLT recipients who survived for more than 1 year were included in this study. RESULTS: During a median follow-up of 146 (range, 12-285) months, 7 out of 70 recipients developed 8 DNMs, including lung cancer in 4, post-transplant lymphoproliferative disease in 3, and skin cancer in 1. One patient developed metachronal skin cancer and post-transplant lymphoproliferative disease. The pre-LT smoking history rate in patients with DNM was higher than in patients without DNM (P = .004). The survival time after DNM was 6 (1-166) months. Only 2 patients underwent R0 resection. DNM did not recur during follow-up. Other patients who underwent R1 resection and/or chemotherapy and/or radiotherapy all died due to DNMs during the follow-up. The cumulative DNM incidence was 3.5% at 10 years and 18.4% at 20 years after LDLT. The cumulative survival rate in patients with DNM was significantly worse than that in patients without DNM after LDLT (P = .049). CONCLUSION: The survival rate of patients with DNM was lower than that of those without DNM. A pre-LT smoking history is a risk factor for DNM. R0 resection is effective for improving the prognosis of patients with DNM. Regular cancer screening is important for detecting DNM early after LDLT.

DOI： 10.1016/j.transproceed.2024.02.015

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.humpath.2024.02.009

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent advances in treatment are expected to bring a cure to more patients with gastric cancer (GC). Focusing on the risk of death from other diseases (DOD) has become a crucial issue in patients cured of GC. The aim of this study was to elucidate the risk factors for DOD in patients who underwent curative gastrectomy with lymph node dissection for GC. METHODS: We enrolled 810 patients who underwent curative gastrectomy with lymph node dissection for GC from January 1990 to December 2014 and had no recurrence or death of GC until December 2019. We investigated the risk factors for DOD defined as death excluding death from a malignant neoplasm, accident, or suicide after gastrectomy, focusing on the perioperative characteristics at gastrectomy. RESULTS: Among 315 deaths from any cause, 210 died from diseases other than malignancy, accidents and suicide. The leading cause of DOD was pneumonia in 54 patients (25.7%). The actual survival period in 167 patients (79.5%) with DOD was shorter than their estimated life expectancy at gastrectomy. Multivariate analysis revealed that a high Charlson Comorbidity Index score (score 1-2: hazard ratio [HR] 2.192, 95% confidence interval [CI] 1.713-2.804, P < 0.001 and score ≥ 3: HR 4.813, 95% CI 3.022-7.668, P < 0.001), total gastrectomy (HR 1.620, 95% CI 1.195-2.197, P = 0.002) and the presence of postoperative complications (HR 1.402, 95% CI 1.024-1.919, P = 0.035) were significant independent risk factors for DOD after gastrectomy for GC, in addition to age of 70 years or higher, performance status of one or higher and body mass index less than 22.0 at gastrectomy. CONCLUSIONS: Pneumonia is a leading cause of DOD after curative gastrectomy and lymph node dissection for GC. Paying attention to comorbidities, minimizing the choice of total gastrectomy and avoiding postoperative complications are essential to maintain the long-term prognosis after gastrectomy.

DOI： 10.1186/s12893-024-02313-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study aimed to evaluate the adequate extent of regional lymphadenectomy according to tumor location and the impact of number-based nodal classification on survival in patients with non-ampullary duodenal adenocarcinoma (NADAC). METHODS: A total of 85 patients with NADAC who underwent surgery were enrolled. The frequency of metastasis was calculated for each node group in the respective tumor locations for 63 patients who underwent lymphadenectomy for pT2-pT4 tumor. RESULTS: The frequency of metastasis in the pancreaticoduodenal (nos. 13 and 17) and superior mesenteric artery (no. 14) nodes was high (16.7 %-52.3 %) regardless of tumor location. Metastasis in the perigastric (nos. 3 and 4d) and right celiac artery (no. 9) nodes was not uncommon (14.3 %-22.2 %) for tumors in the first portion. The frequency of metastasis in the pyloric (nos. 5 and 6) and the other peripancreaticoduodenal (nos. 8 and 12) nodes varied depending on tumor location but could not be ignored for staging. When these nodes were classified as regional nodes, the 5-year survival in patients with pN0, pN1 (1-2 positive nodes), and pN2 (≥3 positive nodes) were 82.9 %, 51.7 %, and 19.2 %, respectively (p < 0.001). pN classification independently predicted survival (pN1, p = 0.022; pN2, p < 0.001). CONCLUSIONS: Nos. 5, 6, 8, 12, 13, 14, and 17 nodes in all advanced NADAC and nos. 3, 4d, and 9 nodes in advanced NADAC in the first portion should be considered as regional nodes for accurate staging. The number-based nodal classification allows good patients' prognostic stratification.

DOI： 10.1016/j.ejso.2023.107122

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Ceramide and sphingosine-1-phosphate (S1P) play opposing roles in cell death and survival, and maintain a dynamic balance called the sphingolipid rheostat. Glucosylceramide is a substrate to generate ceramide but its effect on breast cancer by oral administration was never tested. The purpose of this study was to reveal the anticancer activity of glucosylceramide and its potential as a new therapeutic agent in breast cancer. METHODS: E0771 cells were inoculated into the breast tissue of female C57BL/6NJcl mice. Glucosylceramide was administered orally to the mice for nine consecutive days. The concentrations of sphingolipid mediators including ceramide, glucosylceramide, and S1P in tumor tissues and serum were determined by mass spectrometry. RESULTS: Oral administration of glucosylceramide significantly suppressed E0771 tumor growth compared with the control group (P = 0.006). There were no significant differences in the serum concentrations of sphingolipid mediators including ceramide and S1P between the mice treated with glucosylceramide and control-treated mice. The ceramide concentration was significantly lower in tumor tissues (P = 0.026), and the S1P concentration was significantly higher than that in paired non-tumor tissues (P = 0.009). The S1P concentration in tumor tissues was significantly lower in mice treated with glucosylceramide than in control-treated mice (P = 0.001). The ceramide-to-S1P concentration ratio in tumor tissues was significantly higher in mice treated with glucosylceramide than in control-treated mice (P = 0.034). CONCLUSIONS: Breast tumors could enhance their survival by increasing S1P conversion from ceramide. Oral administration of glucosylceramide suppressed tumor growth by affecting the ceramide/S1P balance. Oral administration of glucosylceramide is a promising basis for a new therapeutic approach.

DOI： 10.14740/wjon1656

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: Sphingosine-1-phosphate (S1P) is a pleiotropic, bioactive, lipid mediator, produced by sphingosine kinase 1 (SphK1). In this study, we evaluated the expression of phosphorylated SphK1 (pSphK1) in patients with pancreatic ductal adenocarcinoma (PDAC) and investigated its clinical significance. MATERIALS AND METHODS: A total of 111 patients who underwent curative-intent resection for PDAC were enrolled. We investigated pSphK1 (Ser-225) expression in surgically resected specimens of PDAC using immunohistochemistry. The patients were divided into two groups according to pSphK1 immunoreactive expression: a pSphK1-high group (n=63) and a pSphK1-low group (n=48). RESULTS: Logistic regression analyses revealed that lymphatic invasion (p=0.007) was a significantly independent factor associated with high pSphK1 immunoreactive expression. The pSphK1-high group showed significantly worse disease-specific survival (DSS) than the pSphK1-low group (5-year DSS rate, 19.6% vs. 58.7%; p=0.001). High pSphK1 immunoreactive expression (hazard ratio=2.547; 95% confidence interval= 1.434-4.527; p=0.001) was an independent prognostic factor for DSS. CONCLUSION: High pSphK1 expression is independently associated with lymphatic invasion and unfavorable prognosis in PDAC patients. Thus, the SphK1-S1P axis may be important in mechanisms of tumor progression, such as lymphatic invasion, in PDAC patients.

DOI： 10.21873/anticanres.16584

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although previous studies have demonstrated that tumor deposits (TDs) are associated with worse prognosis in colon cancer, their clinical significance in rectal cancer has not been fully elucidated, especially in the lateral pelvic lymph node (LPLN) area. This study aimed to clarify the clinical significance of TDs, focusing on the number of metastatic foci, including lymph node metastases (LNMs) and TDs, in the LPLN area. METHODS: This retrospective study involved 226 consecutive patients with cStage II/III low rectal cancer who underwent LPLN dissection. Metastatic foci, including LNM and TD, in the LPLN area were defined as lateral pelvic metastases (LP-M) and were evaluated according to LP-M status: presence (absence vs. presence), histopathological classification (LNM vs. TD), and number (one to three vs. four or more). We evaluated the relapse-free survival of each model and compared them using the Akaike information criterion (AIC) and Harrell's concordance index (c-index). RESULTS: Forty-nine of 226 patients (22%) had LP-M, and 15 patients (7%) had TDs. The median number of LP-M per patient was one (range, 1-9). The best risk stratification power was observed for number (AIC, 758; c-index, 0.668) compared with presence (AIC, 759; c-index, 0.665) and histopathological classification (AIC, 761; c-index, 0.664). The number of LP-M was an independent prognostic factor for both relapse-free and overall survival, and was significantly associated with cumulative local recurrence. CONCLUSION: The number of metastatic foci, including LNMs and TDs, in the LPLN area is useful for risk stratification of patients with low rectal cancer.

DOI： 10.1007/s10147-023-02391-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-023-13418-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The definition and classification of regional nodes are not standardized for perihilar cholangiocarcinoma. This study aimed to clarify the rational extent of regional lymphadenectomy and to elucidate the impact of number-based regional nodal classification on survival of patients with this disease. METHODS: Data of 136 patients with perihilar cholangiocarcinoma who underwent surgery were reviewed. The incidence of metastasis and the survival of patients with metastasis were calculated for each node group. RESULTS: The incidence of metastasis for the node groups in the hepatoduodenal ligament (denoted as no. 12) ranged from 3.7% to 25.4%, with 5-year disease-specific survival of 12.9% to 33.3% for patients with metastasis. The incidences of metastasis in the common hepatic artery (no. 8) and posterior superior pancreaticoduodenal (no. 13a) node groups were 14.4% and 11.2%, respectively, with 5-year disease-specific survival rates of 16.7% and 20.0% for the patients with metastasis. When these node groups were defined as regional nodes, the 5-year disease-specific survival rates for the patients with pN0 (n = 80), pN1 (1-3 positive nodes, n = 38), and pN2 (≥ 4 positive nodes, n = 18) were 61.4%, 22.9%, and 17.6%, respectively (p < 0.001). The pN classification was independently associated with disease-specific survival (p < 0.001). When only the no. 12 node groups were regarded as regional nodes, pN classification failed to stratify the patients prognostically. CONCLUSIONS: No. 8 and no. 13a node groups should be considered regional nodes in addition to no. 12 node groups and should be dissected. The number-based regional nodal classification allows patients with this disease to be stratified prognostically.

DOI： 10.1245/s10434-023-13361-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study aimed to clarify potential candidates for anatomic resection (AR) among patients with pathological T1-T2 (pT1-T2) hepatocellular carcinoma (HCC) and to determine whether AR is effective for HCC with microscopic vascular invasion (MVI). METHODS: We retrospectively analyzed 288 patients with pT1a (n = 50), pT1b (n = 134) or pT2 (n = 104) HCC who underwent curative-intent resection between 1990 and 2010. Surgical outcomes were compared between patients who underwent AR (n = 189) and those who underwent nonanatomic resection (NAR; n = 99) according to pT category and MVI status. RESULTS: Patients who underwent AR were more likely to have good hepatic functional reserve and an aggressive primary tumor than those who underwent NAR. When patients were stratified according to pT category, AR had a more favorable impact on survival than NAR only in patients with pT2 HCC in univariate (5-year survival, 51.5% vs. 34.6%; p = 0.010) and multivariate analysis (hazard ratio 0.505; p = 0.014). However, AR had no impact on survival in patients with pT1a or pT1b HCC. In patients with MVI (n = 57), AR achieved better survival than NAR (5-year survival, 52.0% vs. 16.7%; p = 0.019) and was an independent prognostic factor (hazard ratio 0.335; p = 0.020). In patients without MVI (n = 231), there was no significant difference in survival between the two groups (p = 0.221). CONCLUSION: AR was identified as an independent factor in improved survival in patients with pT2 HCC or HCC with MVI.

DOI： 10.1016/j.suronc.2023.101951

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Next-generation sequencing (NGS) has enabled comprehensive genomic profiling to identify gene alterations that play important roles in cancer biology. However, the clinical significance of these genomic alterations in triple-negative breast cancer (TNBC) patients has not yet been fully elucidated. The aim of this study was to clarify the clinical significance of genomic profiling data, including copy number alterations (CNA) and tumor mutation burden (TMB), in TNBC patients. METHODS: A total of 47 patients with Stage I-III TNBC with genomic profiling of 435 known cancer genes by NGS were enrolled in this study. Disease-free survival (DFS) and overall survival (OS) were evaluated for their association to gene profiling data. RESULTS: CNA-high patients showed significantly worse DFS and OS than CNA-low patients (p = 0.0009, p = 0.0041, respectively). TMB was not associated with DFS or OS in TNBC patients. Patients with TP53 alterations showed a tendency of worse DFS (p = 0.0953) and significantly worse OS (p = 0.0338) compared with patients without TP53 alterations. Multivariable analysis including CNA and other clinicopathological parameters revealed that CNA was an independent prognostic factor for DFS (p = 0.0104) and OS (p = 0.0306). Finally, multivariable analysis also revealed the combination of CNA-high and TP53 alterations is an independent prognostic factor for DFS (p = 0.0005) and OS (p = 0.0023). CONCLUSIONS: We revealed that CNA, but not TMB, is significantly associated with DFS and OS in TNBC patients. The combination of CNA-high and TP53 alterations may be a promising biomarker that can inform beyond standard clinicopathologic factors to identify a subgroup of TNBC patients with significantly worse prognosis.

DOI： 10.1007/s12282-023-01449-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: This study aimed to evaluate the association between the preoperative Controlling Nutritional Status (CONUT) score, survival outcomes, and recurrence pattern in patients with resectable biliary tract cancer (BTC). METHODS: A total of 224 BTC patients (gallbladder, n = 69; intrahepatic bile ducts, n = 26; perihilar bile ducts, n = 72; distal bile duct, n = 57) who underwent surgery with curative intent were enrolled. The best cutoff point of the preoperative CONUT score in discriminating survival was determined using χ2 scores. The sites of recurrence were subclassified as locoregional or distant. RESULTS: Patients were subdivided into the CONUT-low (score ≤ 3, n = 156) and the CONUT-high (score > 3; n = 68) groups. In-hospital mortality occurred more frequently in the CONUT-high group than in the CONUT-low group (7.4% vs. 1.3%; p = 0.028). A high preoperative CONUT score was independently associated with worse overall survival (hazard ratio [HR] 1.906, p = 0.001), worse disease-specific survival (HR 1.840, p = 0.006), and worse recurrence-free survival (HR 1.680, p = 0.005). Recurrence developed in 110 (49.1%) patients. A high preoperative CONUT score was independently associated with a higher risk of distant recurrence (HR 2.245, p = 0.001), but not locoregional recurrence. The incidences of distant recurrence at 5 years were 55.4% and 34.2% in the CONUT-high and CONUT-low groups, respectively (p = 0.001). CONCLUSIONS: The preoperative CONUT score independently predicts survival outcomes and may serve as a surrogate marker of aggressive systemic disease recurrence in patients with resectable BTC.

DOI： 10.1016/j.ejso.2022.11.003

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Anastomotic leakage (AL) is a serious complication after esophagectomy for esophageal cancer. The objective of this study was to identify the risk factors for AL. METHODS: Patients with esophageal cancer who underwent curative esophagectomy and cervical esophagogastric anastomosis between 2009 and 2019 (N = 346) and those between 2020 and 2022 (N = 17) were enrolled in the study to identify the risk factors for AL and the study to assess the association between the risk factors and blood flow in the gastric conduit evaluated by indocyanine green (ICG) fluorescence imaging, respectively. RESULTS: AL occurred in 17 out of 346 patients (4.9%). Peptic or endoscopic submucosal dissection (ESD) ulcer scars were independently associated with AL (OR 6.872, 95% CI 2.112-22.365) in addition to diabetes mellitus. The ulcer scars in the anterior/posterior gastric wall were more frequently observed in patients with AL than in those without AL (75.0% vs. 17.4%, P = 0.042). The median flow velocity of ICG fluorescence in the gastric conduits with the scars was significantly lower than in those without the scars (1.17 cm/s vs. 2.23 cm/s, P = 0.004). CONCLUSIONS: Peptic or ESD ulcer scarring is a risk factor for AL after esophagectomy in addition to diabetes mellitus. The scars in the anterior/posterior gastric wall are significantly associated with AL, impairing blood flow of the gastric conduit. Preventive interventions and careful postoperative management should be provided to minimize the risk and severity of AL in patients with these risk factors.

DOI： 10.1007/s11605-022-05545-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent improvements in systemic chemotherapy have provided an opportunity for patients with stage IV gastric cancer (GC) to undergo conversion surgery (CS). The aim of this study was to evaluate the long-term outcomes of patients who underwent CS and to elucidate the prognostic factors for CS in stage IV GC. METHODS: A total of 79 patients who underwent CS with the aim of R0 resection for stage IV GC at six institutions from January 2008 to July 2019 were enrolled. We retrospectively reviewed the clinicopathological data and prognosis. RESULTS: Of the 79 patients, 23 (31.1%) had initially resectable disease (IR) before chemotherapy, defined as positive for cancer on peritoneal cytology (CY1), resectable hepatic metastasis, or para-aortic lymph node No. 16a2/b1 metastasis. Of the 56 remaining patients with primary unresectable disease, 39 had peritoneal dissemination. R0 resection was accomplished in 63 patients (79.7%). The 3-year OS rates for patients with IR and unresectable disease were 78.3% and 44.5%, respectively. Multivariate analysis showed that IR (P = 0.014) and R0 (P = 0.014) were statistically significant independent prognostic factors for favorable OS. Among patients with peritoneal dissemination alone, OS was significantly better for patients with R0 resection than for patients with R1/2 resection, with the 3-year OS rates of 65.5% and 23.1%, respectively (P = 0.011). CONCLUSIONS: CS is a treatment option for selected patients with stage IV GC. Patients with IR and patients who achieve R0 resection may obtain a survival benefit from CS.

DOI： 10.1186/s12893-022-01874-8

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

With the discovery of bacterial symbiosis in the tissues of various cancers, the study of the tumor microbiome is attracting a great deal of attention. Anatomically, since the gastrointestinal tract, liver, and pancreas form a continuous ductal structure, the microbiomes in the digestive juices of these organs may influence each other. Here, we report a series of microbiome data in tumor-associated tissues such as tumor, non-tumor, and lymph nodes, and body fluids such as saliva, gastric juice, pancreatic juice, bile, and feces of patients with pancreatic or biliary tract cancers. The results show that the microbiome of tumor-associated tissues has a very similar bacterial composition, but that in body fluids has different bacterial composition which varies by location, where some bacteria localize to specific body fluids. Surprisingly, Akkermansia was only detected in the bile of patients with biliary tract cancer and its presence was significantly associated with the performance of external biliary drainage (P = 0.041). Furthermore, we found that tumor-associated tissues and body fluids in deep inner body are mostly inhabited by unidentified and uncharacterized bacteria, suggesting that such bacteria may be potential targets for precision therapy in the future.

DOI： 10.1038/s41598-022-12658-8

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その他リンク： https://www.nature.com/articles/s41598-022-12658-8

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Ulcerative colitis-associated neoplasia (UCAN) harbors unique genetic alterations and mutational tendencies. The clinical application of gene panel testing enables precision medicine by tailoring treatment to individual gene alterations. We hypothesized that gene panel testing may detect clinically important genetic alterations in UCAN, with potential usefulness for the diagnosis and treatment of UCAN. In the present study, gene panel testing was used to identify genetic alterations in UCAN, and the possibility of clinical utility of gene panel testing in UCAN was investigated. The present study included 15 patients with UCAN, and gene panel testing was performed to identify genetic alterations associated with diagnosis and treatment. Genetic alterations of UCAN were compared with those of 203 patients with sporadic colorectal cancer (CRC). APC and PTEN mutations were less frequent, while RNF43 frameshift or nonsense mutations were more frequent in UCAN compared with sporadic CRC. TP53 mutations were identified in 13/15 patients (87%) with UCAN. Notably, 4/15 patients (27%) with UCAN had no genetic alterations other than TP53 mutation, while this occurred in 1/203 patients (0.5%) with sporadic CRC (P<0.001). Microsatellite instability-high was identified in 2/15 patients (13%) with UCAN. Mutational signature 3, which is associated with homologous recombination deficiency, was detected in 14/15 patients (93%) with UCAN, and enriched in UCAN compared with sporadic CRC (P=0.030). In conclusion, gene panel testing can detect important genetic alterations that can be useful for diagnosis and treatment in UCAN, and may provide clinicians with important information for tailored treatment strategies.

DOI： 10.3892/ol.2022.13562

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elmer Press, Inc.  

DOI： 10.14740/wjon1530

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The incidence of gastric tube carcinoma (GTC) after esophagectomy for esophageal carcinoma has increased in recent years. Surgical removal of the reconstructed gastric tube is associated with high mortality, and endoscopic submucosal dissection (ESD) is a promising alternative. There are limited reports of ESD for GTC. This study investigated the efficacy and safety of ESD in GTC. This single-center retrospective study examined patients who underwent ESD for GTC after esophagectomy at our institution between 2003 and 2018. The curability of GTC with ESD was evaluated histologically according to the Japanese Gastric Cancer Treatment Guidelines. Patient characteristics and procedural and long-term outcomes were analyzed. Overall, 31 patients (29 men and 2 women; median age, 73 years) with 45 GTC lesions underwent ESD. The mean period between primary esophagectomy and the diagnosis of GTC was 10.6 years. Bleeding during ESD was noted in two patients (6.5%). No other adverse or fatal events such as perforation were noted. Complete resection and curative resection were documented in 80.6% and 48.4% of cases, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC, and fourteen patients died of other diseases, including primary carcinoma in five cases. ESD was safe and provided good long-term outcomes in patients with GTC. Regular long-term gastroscopy is required for the early detection of GTC. Patients with GTC after esophagectomy for esophageal carcinoma have a high risk of other primary carcinomas or comorbidities after ESD.

DOI： 10.1155/2022/1631415

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although numerous experiments revealed an essential role of a lipid mediator, sphingosine-1-phosphate (S1P), in breast cancer (BC) progression, the clinical significance of S1P remains unclear due to the difficulty of measuring lipids in patients. The aim of this study was to determine the plasma concentration of S1P in estrogen receptor (ER)-positive BC patients, as well as to investigate its clinical significance. We further explored the possibility of a treatment strategy targeting S1P in ER-positive BC patients by examining the effect of FTY720, a functional antagonist of S1P receptors, on hormone therapy-resistant cells. Plasma S1P levels were significantly higher in patients negative for progesterone receptor (PgR) expression than in those positive for expression (p = 0.003). Plasma S1P levels were also significantly higher in patients with larger tumor size (p = 0.012), lymph node metastasis (p = 0.014), and advanced cancer stage (p = 0.003), suggesting that higher levels of plasma S1P are associated with cancer progression. FTY720 suppressed the viability of not only wildtype MCF-7 cells, but also hormone therapy-resistant MCF-7 cells. Targeting S1P signaling in ER-positive BC appears to be a possible new treatment strategy, even for hormone therapy-resistant patients.

DOI： 10.3390/ijms222413367

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer  

Various surgical interventions are known to result in postoperative swallowing dysfunction. This preliminary study aimed to comprehensively assess the swallowing function before and after abdominal surgery including thoracoabdominal esophagectomy and to explore the factors associated with swallowing dysfunction. Forty-five participants underwent swallowing function tests including a repetitive saliva swallowing test and modified water swallowing test, and their maximum phonation time and tongue pressure were measured before and after the operation. The pre- and postoperative results of these tests were compared, and correlations between the changes in the results of each test and clinicopathological characteristics were assessed. The maximum phonation time and tongue pressure were significantly decreased after the operation (P &lt
0.01 and P &lt
0.05, respectively). Changes in the maximum phonation time and tongue pressure were negatively correlated with age. Changes in the maximum phonation time were positively correlated with the preoperative value and operative time, and changes in tongue pressure were also positively correlated with the preoperative value
however, these changes were not correlated with other variables. Maximum phonation time and tongue pressure were significantly decreased after abdominal surgery including thoracoabdominal esophagectomy
however, their clinical significance remains unknown.

DOI： 10.1007/s12262-020-02586-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Activin A receptor type 2A (ACVR2A) is one of the most frequently mutated genes in microsatellite instability-high (MSI-H) gastric cancer. However, the clinical relevance of the ACVR2A mutation in MSI-H gastric cancer patients remains unclear. The aims of this study were to explore the effect of ACVR2A mutation on the tumor behavior and to identify the clinicopathological characteristics of gastric cancer patients with ACVR2A mutations. METHODS: An in vitro study was performed to investigate the biological role of ACVR2A via CRISPR/Cas9-mediated ACVR2A knockout MKN74 human gastric cancer cells. One hundred twenty-four patients with gastric cancer were retrospectively analyzed, and relations between MSI status, ACVR2A mutations, and clinicopathological factors were evaluated. RESULTS: ACVR2A knockout cells showed less aggressive tumor biology than mock-transfected cells, displaying reduced proliferation, migration, and invasion (P < 0.05). MSI mutations were found in 10% (13/124) of gastric cancer patients, and ACVR2A mutations were found in 8.1% (10/124) of patients. All ACVR2A mutations were accompanied by MSI. The 5-year overall survival rates of ACVR2A wild-type patients and ACVR2A-mutated patients were 57% and 90%, respectively (P = 0.048). Multivariate analysis revealed that older age (P = 0.015), distant metastasis (P < 0.001), and ACVR2A wild-type status (P = 0.040) were independent prognostic factors for overall survival. CONCLUSIONS: Our study demonstrated that gastric cancer patients with ACVR2A mutation have a significantly better prognosis than those without. Dysfunction of ACVR2A in MKN74 human gastric cancer cells caused less aggressive tumor biology, indicating the importance of ACVR2A in the progression of MSI-H tumors.

DOI： 10.1007/s11605-020-04889-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC). METHODS: Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3). RESULTS: Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024). CONCLUSION: The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.

DOI： 10.1007/s00423-021-02165-1

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Esophageal involvement length (EIL) is a promising indicator of metastasis or recurrence in mediastinal lymph nodes (MLNs) in adenocarcinoma of the esophagogastric junction (EGJ). This study aimed to elucidate the accuracy of the preoperative endoscopic evaluations of EIL and its clinical significance in this disease. Materials and methods: In total, 75 patients with Siewert type II (N = 53) or III (N = 22) adenocarcinoma of the EGJ, who underwent surgical resection without preoperative therapy between 1995 and 2016 were enrolled. We retrospectively examined the accuracy of the preoperative endoscopic evaluations of EIL (preoperative EIL), compared to the pathologically evaluated EIL. Finally, we investigated the association between preoperative EIL and metastasis or recurrence in MLNs. Results: The accuracy of the preoperative EIL within a 1-cm interval was only 53.3%. Among patients with discordance between the pre- and postoperative evaluations, 68.6 % had the underestimation in the preoperative EIL. pN1-3 (OR = 5.85, 95% CI: 1.03-33.17) and undifferentiated histologic type (OR = 2.52, 95% CI: 0.89-7.14) were potential risk factors for the discordance. Regarding metastasis or recurrence in MLNs, preoperative EIL of 2-3 cm (OR = 10.41, 95% CI: 1.35-80.11) and >3 cm (OR = 8.33, 95% CI: 1.09-63.96) were independent predictors. Conclusion: Although the accuracy of the endoscopic evaluations of EIL is insufficient with many underestimations, EIL should be assessed in preoperative staging because of significant predictive power for metastasis or recurrence in MLNs.

DOI： 10.1016/j.amsu.2021.102590

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Outcomes following surgery for advanced gallbladder carcinoma remain unsatisfactory. This study aimed to determine the surgical outcome and effectiveness of adjuvant chemotherapy according to TNM stage in patients with gallbladder carcinoma. METHODS: A total of 200 patients undergoing surgery for gallbladder carcinoma were enrolled. Clinicopathological data were evaluated and surgical outcomes were compared between patients with and without adjuvant chemotherapy according to TNM stage. RESULTS: The 5-year overall survival (OS) after resection for patients with stage I (n = 27), IIA (n = 18), IIB (n = 28), IIIA (n = 25), IIIB (n = 43), IVA (n = 7), and IVB (n = 52) disease was 90.8%, 94.4%, 73.6%, 33.7%, 57.7%, 14.3%, and 11.8%, respectively (p < 0.001). R0 resection was performed in all patients with stage I or II disease, in 89.7% of those with stage III disease, and 69.5% of those with stage IV disease. For patients with stage III disease, adjuvant chemotherapy was associated with improved OS (5-year OS, 60.9% vs. 41.1%; p = 0.028) and was an independent prognostic factor (hazard ratio, 2.045; p = 0.039). For patients with stage IV disease, adjuvant chemotherapy appeared to affect OS (5-year OS, 25.1% vs. 5.3%; p = 0.041); R0 resection (hazard ratio, 1.882; p = 0.040) was the only independent prognostic factor. CONCLUSION: TNM stage clearly predicts survival after resection of gallbladder carcinoma. R0 resection with adjuvant chemotherapy is recommended for long-term survival in the multimodal management of patients with stage III or IV gallbladder carcinoma.

DOI： 10.1007/s00423-020-02068-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIM: This study aimed to evaluate how NAD(P)H: quinone oxidoreductase-1 (NQO1) affects survival after hepatectomy in patients with colorectal liver metastasis (CRLM). PATIENTS AND METHODS: A retrospective analysis was conducted of 88 consecutive patients who underwent hepatectomy for CRLM. Of the 88 patients, preoperative chemotherapy was administered to 30 patients. Immunohistochemistry of the resected specimens was conducted using monoclonal anti-NQO1 antibody. RESULTS: NQO1-positive expression in tumor cells of CRLM was associated with worse overall survival (p=0.026) and was an independent adverse prognostic factor in multivariate analysis (hazard ratio=5.296, p=0.007). Among 30 patients who received preoperative chemotherapy, patients with loss of NQO1 expression in non-neoplastic epithelial cells of the bile ducts (NQO1 polymorphism: n=19) showed significantly better response to preoperative chemotherapy for CRLM (p=0.004). CONCLUSION: NQO1-positive expression in tumor cells of CRLM may be an adverse prognostic factor after hepatectomy for CRLM.

DOI： 10.21873/anticanres.14916

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: The role of preoperative frailty assessment in patients with gastrointestinal (GI) disease remains unclear. This study aimed to clarify the relationship between frailty and postoperative outcomes in patients with GI disease. METHODS: This study investigated 42 patients (aged ≥65 years) with GI disease who underwent abdominal surgery. The frailty status was analyzed using the Japanese version of the Cardiovascular Health Study criteria. We also investigated postoperative outcomes. RESULTS: Of the 42 patients, seven (16.7%) were robust, 24 (57.1%) were prefrail and 11 (26.2%) were frail. Postoperative complications were observed in 45.5% and 63.6% of prefrail and frail patients, respectively, whereas no complications were found in robust patients (P = 0.026). The median hospital stay was 15, 19.5 and 27 days in robust, prefrail and frail patients, respectively (P < 0.01). CONCLUSION: Preoperative frailty status based on the Japanese version of the Cardiovascular Health Study criteria is associated with postoperative complication incidence and hospital stay extension in patients with GI disease. Geriatr Gerontol Int 2021; ••: ••-••.

DOI： 10.1111/ggi.14134

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-020-09184-0

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system provided a specific 'ypTNM' stage grouping for patients with esophageal cancer. OBJECTIVE: This study aimed to evaluate the clinical utility of the AJCC 8th edition ypTNM stage grouping for patients with esophageal squamous cell carcinoma (ESCC). METHODS: We enrolled 152 patients with ESCC who underwent surgery after neoadjuvant cisplatin plus 5-fluorouracil (CF) therapy between June 2005 and December 2011. ypStage was evaluated according to the AJCC 7th and 8th editions. Predictive performance for disease-specific survival (DSS) and overall survival (OS) was compared between both editions. The prognostic significance of ypTNM stage grouping was evaluated using univariate and multivariate analyses. RESULTS: Revision of the AJCC 7th edition to the 8th edition was associated with a change in ypStage in 96 patients (63.2%). The AJCC 8th edition revealed a better predictive performance than the 7th edition in terms of DSS (Akaike's information criterion [AIC] 499 vs. 513; Bayesian information criterion [BIC] 505 versus 519; concordance index [C-index] 0.725 versus 0.679) and OS (AIC 662 vs. 674; BIC 669 vs. 681; C-index 0.662 vs. 0.622). On univariate and multivariate analyses, ypStage in the 8th edition was an independent prognostic factor for both DSS and OS. CONCLUSIONS: ypTNM stage grouping in the AJCC 8th edition provided a better predictive performance for DSS and OS than that in the 7th edition. ypStage in the 8th edition was the most reliable prognostic factor for ESCC patients who underwent surgery after neoadjuvant CF therapy.

DOI： 10.1245/s10434-020-09181-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This study aimed to investigate the impact of surgery on outcomes in patients with recurrent biliary tract cancer (BTC) and elucidate factors affecting survival after surgery for this disease. METHODS: A single-center study was undertaken in 178 patients with recurrent BTC, of whom 24 underwent surgery for recurrence, 85 received chemotherapy, and 69 received best supportive care. Then, we carried out a multicenter study in 52 patients undergoing surgery for recurrent BTC (gallbladder cancer, 39%; distal cholangiocarcinoma, 27%; perihilar cholangiocarcinoma, 21%; intrahepatic cholangiocarcinoma, 13%). RESULTS: In the single-center study, 3-year survival after recurrence was 53% in patients who underwent surgery, 4% in those who received chemotherapy, and 0% in those who received best supportive care (p < 0.001). Surgery was an independently prognostic factor (p < 0.001). In the multicenter series, the respective 3-year and 5-year survival after surgery for recurrence was 50% and 29% in the 52 patients. Initial site of recurrence was the only independent prognostic factor (p = 0.019). Five-year survival after surgery for recurrence in patients with single distant, multifocal distant, and locoregional recurrence was 51%, 0%, and 0%, respectively (p = 0.002). Sites of single distant recurrence included the liver (n = 13, 54%), distant lymph nodes (all from gallbladder cancer, n = 7, 29%), lung (n = 2, 9%), peritoneum (n = 1, 4%), and abdominal wall (n = 1, 4%). CONCLUSION: Surgery may be an effective option for patients with less aggressive tumor biology characterized by single distant recurrence in recurrent BTC.

DOI： 10.1016/j.hpb.2021.01.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Some bacteria are symbiotic in tumor tissues, and metabolites of several bacterial species have been found to cause DNA damage. However, to date, the association between bacteria and host genetic alterations in colorectal cancer (CRC) has not been fully investigated. We evaluated the association between the intra-tumor microbiome and host genetic alterations in 29 Japanese CRC patients. The tumor and non-tumor tissues were extracted from the patients, and 16S rRNA genes were sequenced for each sample. We identified enriched bacteria in tumor and non-tumor tissues. Some bacteria, such as Fusobacterium, which is already known to be enriched in CRC, were found to be enriched in tumor tissues. Interestingly, Bacteroides, which is also known to be enriched in CRC, was enriched in non-tumor tissues. Furthermore, it was shown that certain bacteria that often coexist within tumor tissue were enriched in the presence of a mutated gene or signal pathway with mutated genes in the host cells. Fusobacterium was associated with many mutated genes, as well as cell cycle-related pathways including mutated genes. In addition, the patients with a high abundance of Campylobacter were suggested to be associated with mutational signature 3 indicating failure of double-strand DNA break repairs. These results suggest that CRC development may be partly caused by DNA damage caused by substances released by bacterial infection. Taken together, the identification of distinct gut microbiome patterns and their host specific genetic alterations might facilitate targeted interventions, such as modulation of the microbiome in addition to anticancer agents or immunotherapy.

DOI： 10.1016/j.csbj.2021.05.049

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We investigated the rational extent of regional lymphadenectomy and evaluated the prognostic impact of number-based regional nodal classification in patients with distal cholangiocarcinoma. METHODS: This study included 191 patients with distal cholangiocarcinoma who underwent pancreaticoduodenectomy. The nos. 8, 12a-b-c-p, 13, 14, and 17 nodes were dissected routinely. The impact of the extent of lymphadenectomy on prognostic stratification performed using number-based nodal classification was evaluated. RESULTS: The incidence of metastasis in the routinely dissected nodes was 1.0-25.7%, with 5-year overall survival of 0-36.4% in patients with metastasis. The incidence of metastasis in the no. 12p nodes, which were not included in regional nodes in the American Joint Committee on Cancer or International Union Against Cancer staging systems, was 5.8% with a 5-year overall survival of 36.4% in patients with metastasis. When our dissected nodes were adopted (P < .001), number-based nodal classification predicted overall survival better than when regional nodes defined by the International Union Against Cancer or American Joint Committee on Cancer staging systems were used (nos. 8, 12a-b, 13, 14, and 17 nodes with or without no. 9 nodes; P = .004 each). The 5-year overall survival in patients with pN0, pN1 (1-3 positive nodes), and pN2 (≥4 positive nodes) disease was 57.4%, 37.3%, and 13.6%, respectively (P < .001). The pN classification was an independent prognostic factor (pN1, P = .009; pN2, P < .001). CONCLUSION: The nos. 8, 12a-b-c-p, 13, 14, and 17 nodes should be prioritized as the rational extent of regional lymphadenectomy for distal cholangiocarcinoma for accurate staging. Number-based regional nodal classification is suitable for prognostic stratification.

DOI： 10.1016/j.surg.2024.109099

PubMed

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掲載種別：研究論文（学術雑誌）  

症例は75 歳,男性.食事のつかえ感の精査の結果,胃および胸部中部食道の壁内転移と左鎖骨上リンパ節転移を伴う 進行食道扁平上皮癌,LtMtJzG,cT3rN2M1b,cStage ⅣB と診断された.術前docetaxel,cisplatin,5‒fluorouracil 併用 (DCF)療法を3 コ-ス施行された後,部分奏効判定を得て,胸腔鏡下食道亜全摘と3 領域リンパ節郭清(D3)を施行され た.病理診断の結果,病理学的完全奏効と判定された.術後5 年間経過し,無再発生存中である.術前化学療法の進歩に伴 い,これまで予後不良とされてきた胃壁内転移を伴う高度進行症例であっても,強力な術前化学療法と手術を組み合わせた 集学的治療により,根治が得られる可能性がある.

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症例は73 歳,男性.約40 年前から肛門周囲膿瘍および痔瘻を自覚していた.肛門痛を主訴に受診した.初診時に肛 門腫瘤を認め,同部位の生検で腺癌の診断であった.下部消化管内視鏡検査では肛門腫瘤の他に肛門縁から15 cm の直腸S 状部に全周性の腫瘍があり,生検で腺癌であった.痔瘻癌,T3N0M0,Stage ⅡB および直腸S 状部癌,cT3N0M0,cStage Ⅱa の診断となった.腹会陰式直腸切断術および腹直筋皮弁再建を施行した.病理組織学的診断では,肛門病変・直腸病変 ともに中分化管状腺癌が主体であり一部に粘液癌の組織型を有していた.また,遺伝子検査では肛門病変・直腸病変ともに KRAS G12V,BRAFV600E wild,microsatellite stable であった.長期間の痔瘻の既往,組織型の類似性,遺伝子変異の類似 性から直腸癌管腔内implantation による転移性痔瘻癌と診断した.

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症例は73 歳,男性.胸部中部食道扁平上皮癌(cT2N0M0)と診断され,cisplatin,5fluorouracil( CF)療法併用60 Gy の根治的化学放射線療法(definitive chemoradiotherapy: dCRT)を施行された.完全奏効(CR)が得られたが,1 年7 か月後に胸部気管リンパ節(No. 106recL,No. 106pre)に転移を認めた.CF 療法2 コ-ス後に,胸骨正中切開下左頸部食 道傍・胸部気管リンパ節郭清術を施行した.気管軟骨への浸潤が疑われ,気管軟骨の一部を合併切除しR0 切除が得られた. 病理診断ではNo. 106recL とNo. 106pre リンパ節に各々1 個の転移を認めた.術後2 年間のS1 療法を施行した.術後2 年 目に多発肺転移,左鎖骨上窩リンパ節転移再発を認めたが,局所再発はなくpembrolizumab 併用CF 療法が奏効し治療を継 続している.dCRT 後のリンパ節転移再発に対する救済リンパ節郭清術では,良好な視野で確実なR0 切除を達成すること が局所制御のために重要である.

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症例は80 歳,男性.精査にて胸部食道癌,Mt,cT3rN1M1a,cStage ⅢA と診断し,術前化学療法として5‒FU+シ スプラチン療法(FP 療法)を開始した.1 コ-ス終了後のCT 検査で大動脈弓部から下行大動脈にかけて壁在性血栓を認 め,リバ-ロキサバン内服による抗凝固療法を開始した.抗凝固療法を併用しながらFP 療法を継続した.術前CT 検査で は,血栓は著明な縮小を認めた.胸腔鏡下食道切除,2 領域リンパ節郭清術を施行し,術後合併症なく退院した.現在,血 栓の再燃なく経過観察中である.今回われわれは,食道癌に対して術前FP 療法中に大動脈血栓症を発症し,抗凝固療法併 用下にFP 療法を継続した後に食道癌根治切除術を施行した1 例を経験したので報告する.

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掲載種別：研究論文（学術雑誌）  

症例は76 歳,男性.膀胱癌に対する術前検査のMRI で膵囊胞性病変を指摘された.EUS ではNEN などの悪性腫瘍 が疑われたが,EUSFNA は施行されなかった.また,肝S5 に10 mm 大の単発腫瘤を認め,肝転移が疑われた.NEN の 肝転移であれば切除も有用と判断し,尾側膵切除,脾臓摘出,肝部分切除を施行した.病理組織学的検査で破骨型多核巨細 胞を伴う退形成性膵管癌,肝転移と診断された.化学療法としてmodified FOLFIRINOX を4 コ-ス,nalIRI+ 5FU/ LV を3 コ-ス施行したが,各々有害事象のため中止とした.その後S1 を7 か月施行し,術後1 年8 か月現在無再発生存中で ある.退形成性膵管癌は術後早期再発も多く,R0 手術を行っても長期生存を得ることは難しい.今回われわれは,同時性肝 転移を伴う退形成性膵管癌において切除および化学療法を施行し,無再発生存中の症例を経験したので若干の考察を加えて 報告する.

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The patient was a 61-year-old man with a diagnosis of carcinoma of the pancreatic head. Abdominal computed tomography( CT)showed no distant metastasis, and he underwent subtotal stomach-preserving pancreatoduodenectomy. Immediately after surgery, he received liver perfusion chemotherapy with 5-fluorouracil followed by systemic gemcitabine. Eighteen months after surgery, CT revealed liver metastasis in the S6 segment, and partial hepatectomy was performed. The pathological diagnosis was liver metastasis of pancreatic cancer. Postoperatively, the patient was treated with gemcitabine and S-1 therapy for 1 year and then switched to S-1 monotherapy for about 6 months. Four years after the initial surgery, CT showed 2 metastases in the right lung. After 2 months of S-1 monotherapy, wedge resection of the upper and lower lobes of the right lung was performed. Gemcitabine and nab-paclitaxel therapy were administered, after the metastasectomy, but pleural dissemination appeared on CT 5 years after the initial surgery. Modified FOLFIRINOX therapy was started and continued for 8 months, but CT revealed further disseminated lesions in the diaphragm. Palliative irradiation was provided, but the disease gradually progressed. After multidisciplinary treatment, the patient survived for 6 years and 3 months after the initial surgery.

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は61歳,男性。閉塞性黄疸で発症し,切除可能膵頭部癌と診断し,亜全胃温存膵頭十二指腸切除術を施行した。術後5-FUの肝灌流化学療法を行い,引き続きgemcitabine(GEM)療法を6ヵ月間施行した。術後1年6ヵ月のCTで肝S6に肝転移が出現し,肝部分切除術を施行した。病理診断では膵癌肝転移であった。術後にGEM+S-1療法を1年間行い,S-1単独療法に切り替え約6ヵ月間施行した。初回手術後4年のCTで右肺に2ヶ所の肺転移を認めた。S-1療法を2ヵ月間施行後に右肺部分切除術を施行した。術後にGEM+nab-paclitaxel療法を開始したが,初回手術後5年のCTで胸膜播種が出現した。modified FOLFIRINOX療法へ変更し8ヵ月治療を継続したが,CTで横隔膜にも播種性病変が出現した。病変に緩和照射を行ったが,病状は徐々に進行した。初回手術から6年3ヵ月で死亡したが,再発後約5年の長期生存を得た。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00296&link_issn=&doc_id=20240124460012&doc_link_id=%2Fab8gtkrc%2F2024%2F005101%2F014%2F0072-0074%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2024%2F005101%2F014%2F0072-0074%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)篠原出版新社  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は75歳,女性。腹痛と下血の精査目的に施行した下部消化管内視鏡検査で虫垂開口部に2型病変を認め,生検結果は腺癌であった。胸腹部骨盤部造影CT検査で,虫垂を主座とした盲腸および終末回腸に進展する11.8×6.7cm大の腫瘤影を認めた。領域リンパ節や遠隔臓器への転移所見は認めなかった。領域リンパ節郭清を伴う回盲部切除術を施行した。病理組織学的検査では中分化管状腺癌・粘液癌・印環細胞癌などの多彩な組織型を示し,BRAF V600E変異と高頻度マイクロサテライト不安定性(MSI-H)を認めた。病理組織学的診断による進行度分類は,pT4bpN1bcM0,pStage IIICであった。術後補助化学療法としてCapeOX療法を8コース施行し,術後12ヵ月現在無再発で生存中である。虫垂腺癌におけるBRAF V600E変異およびMSI-Hの臨床的意義は不明であり,今後の検討が必要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320075&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F075%2F1584-1586%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F075%2F1584-1586%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 75-year-old woman presented to our hospital with abdominal pain and melena. Colonoscopy revealed an ulcer at the appendiceal orifice. Histopathological examination of biopsy specimens revealed adenocarcinoma. Computed tomography showed an appendiceal mass of 11.8×6.7 cm in size involving the cecum and terminal ileum without any distant metastatic findings. Ileocecal resection with regional lymph node dissection to the root of the ileocolonic artery was performed. Histopathological examination of the specimen revealed appendiceal adenocarcinoma. Molecular subtype of the tumor was BRAF V600E mutation and microsatellite instability-high(MSI-H). The pathological stage was pT4bpN1bcM0, pStage ⅢC. She received 8 courses of CapeOX as adjuvant chemotherapy and no recurrence was noted 12 months following the surgery. The establishment of standard treatment strategies including surgery, chemotherapy, and immunotherapy for carcinoma of the appendix with BRAF V600E mutation and/or MSI-H is needed.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 72-year-old woman presented with obstructive jaundice. Computed tomography revealed a 12-mm low-density mass in the head of the pancreas. She was diagnosed as having pancreatic cancer by endoscopic ultrasound-guided fine-needle aspiration. She received gemcitabine plus nab-paclitaxel as preoperative chemotherapy. After 2 courses, hepatoduodenal lymph node metastasis appeared and was accompanied by increased tumor marker levels. The regimen was changed to modified FOLFIRINOX. After 5 courses, the lymph node metastasis was reduced in size and the tumor marker levels were decreased, so subtotal stomach-preserving pancreaticoduodenectomy was performed. Adjuvant chemotherapy was administered postoperatively. The patient was alive and well without recurrence 2 years and 9 months after the surgery, but died of sepsis. Nevertheless, this case highlights that when preoperative chemotherapy for resectable pancreatic cancer appears to be ineffective, a change in regimen may be useful.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 57-year-old man was diagnosed as having resectable advanced esophageal carcinoma adjacent to the trachea(Ut, cT3N0M0)and received preoperative docetaxel, cisplatin, and 5-fluorouracil therapy. Due to tracheal tumor invasion and upstaging to cT4bN0M0 after 1 course of chemotherapy, the treatment was converted to definitive chemoradiotherapy (CRT). A remarkable response with no evidence of tracheal invasion was observed on computed tomography following definitive CRT. He underwent successful curative resection with salvage esophagectomy, and the resected tumor was staged as pT1bN0M0. No adjuvant therapy was administered, and the patient was alive with no evidence of disease at the 5-year postoperative follow-up. The response to preoperative treatment should be meticulously assessed and appropriate treatment modalities used to avoid overlooking the potential for cure, even if the response to preoperative treatment with docetaxel, cisplatin, and 5-fluorouracil is poor.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

An 87-year-old woman with a gradually enlarging mass in her left breast, diagnosed as having left-sided breast cancer with skin invasion by a local practitioner, was referred to our hospital. Computed tomography revealed ascending colon cancer with abdominal wall invasion and a thoracic aortic aneurysm(Stanford type B), in addition to breast cancer with skin invasion. A thoracic endovascular aortic repair and bypass surgery between the subclavian arteries were both performed for the thoracic aortic aneurysm. After 6 days, a right hemicolectomy and D2 lymphadenectomy were performed for the ascending colon cancer. A postoperative pathological diagnosis of pT3N0M0, pStage Ⅱa, was made. A total left mastectomy with a full-thickness skin graft for left breast cancer was performed after 2 months following the ascending colon cancer surgery. The postoperative pathological diagnosis was pT3N0M0, pStage ⅡB. No evidence of local recurrence or distant metastasis of the ascending colon cancer has been observed at 20 months postoperatively, or of the breast cancer after 18 months following surgery.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report a case of biliary cystadenocarcinoma in which long-term survival was achieved after 2 operations for intrahepatic recurrence. A 72-year-old man with biliary cystadenocarcinoma located mainly in segment 3 of the liver underwent left hepatectomy, extrahepatic bile duct resection, and lymph node dissection. Seven years and 9 months after the initial resection, he underwent partial liver resection(segment 5)for intrahepatic recurrence detected by computed tomography. Fifteen years and 7 months after the initial resection, he underwent repeat partial resection of the liver(segment 5)for intrahepatic recurrence. Histologically, these tumors were confirmed to be recurrence of biliary cystadenocarcinoma. He remains alive and well with no further recurrence 21 years and 6 months after the initial resection. This case and a literature review suggest that hepatic resection is a useful treatment option for intrahepatic recurrence of biliary cystadenocarcinoma.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 58-year-old woman presented with a complaint of weight loss. Abdominal computed tomography showed dilatation of the biliary and pancreatic ducts and a mural nodule in the pancreatic duct. The diagnosis was intraductal papillary mucinous neoplasm(IPMN). Endoscopic retrograde cholangiopancreatography(ERCP)and cholangioscopy revealed a fistula between the common bile duct and the IPMN. A sudden increase in hepatobiliary enzymes was noted preoperatively. ERCP showed that the common bile duct was obstructed by mucus. A nasobiliary drainage tube was inserted into the bile duct endoscopically and kept open by daily tube washing, and the liver dysfunction improved. Total pancreatectomy, splenectomy, and regional lymph node dissection were performed. Histological examination confirmed that the primary tumor was mixed invasive intraductal papillary mucinous adenocarcinoma. The patient remains alive and well with no evidence of recurrence 18 months after resection.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 66-year-old man was referred to our hospital with fever and abdominal pain. CT showed a mass in the intrapancreatic bile duct but no wall thickness in the perihilar bile ducts. Neither regional lymphadenopathy nor distant metastasis was observed. Biliary cytology showed adenocarcinoma. The diagnosis was distal cholangiocarcinoma, and pancreatoduodenectomy was performed. Intraoperative frozen section examination of the ductal resection margins at the right and left hepatic ducts was positive for carcinoma in situ, and the operation ultimately completed with R1 resection. Histological examination confirmed a diagnosis of cholangiocarcinoma with superficial spread and a single positive lymph node. Adjuvant chemotherapy with S-1 was administered for 1 year. Anastomotic recurrence at the hepaticojejunostomy was found 5 years after resection; biopsy specimens revealed adenocarcinoma. Thereafter, S-1 chemotherapy was resumed, and the patient remains alive and well 9 years and 1 month after resection.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は87歳,女性。左乳房腫瘤が徐々に増大したため近医を受診した。皮膚浸潤を伴う左乳癌と診断され,当科を受診した。精査の結果,左乳癌に加え,上行結腸癌と胸部大動脈瘤を認めた。上行結腸癌(cT4bN1bM0,cStage IIIc,大腸癌取扱い規約第9版),左乳癌(cT3N0M0,cStage IIB,乳癌取扱い規約第18版),胸部大動脈瘤(Stanford B型)と診断した。まず,胸部大動脈瘤に対して胸部大動脈ステント内挿術,両側鎖骨下動脈バイパス術を施行した。その6日後,上行結腸癌に対して結腸右半切除術,D2郭清を施行した。病理組織診断の結果,pT3N0M0,pStage IIaであった。上行結腸癌手術の2ヵ月後に左乳癌に対して左乳房全切除術,全層植皮術を施行した。病理組織診断の結果,pT3N0M0,pStage IIBであった。上行結腸癌術後20ヵ月,左乳癌術後18ヵ月無再発生存中である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320011&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F011%2F1393-1395%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F011%2F1393-1395%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

担当区分：責任著者   記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は57歳,男性。嚥下困難と嘔吐の精査で進行食道扁平上皮癌(Ut,cT3N0M0)と診断した。経鼻栄養チューブによる栄養管理を行いながら,術前docetaxel,cisplatin,5-fluorouracil併用(DCF)療法を実施した。1コース終了後に気管浸潤を認めた(cT4bN0M0)。根治的化学放射線療法(CF療法併用,照射60Gy)を実施し,気管浸潤の解除を認めた(cT3N0M0)。生検では癌の検出はなかったが,肉眼的に遺残が疑われ狭窄の悪化も認められた。安全に根治切除が可能と判断し,右開胸食道切除術(D0),胸骨後経路胃管再建を行った。病理診断ではpT1bN0M0であった。術後補助治療は実施せず,術後5年が経過して無再発生存中である。術前治療中の注意深い治療効果判定と適切な治療選択により,術前DCF療法不応例であっても根治の可能性を逃さないことが重要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320029&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F029%2F1447-1449%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F029%2F1447-1449%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は66歳,男性。発熱と腹痛の精査で肝機能障害を認めた。精査で膵内胆管の不整な壁肥厚と狭窄を認め,遠位胆管癌と診断された。根治切除の方針となり,亜全胃温存膵頭十二指腸切除術を施行された。肝側胆管切離断端は切離限界まで追加切除を行ったが,術中迅速組織診断で上皮内癌陽性であった。病理所見では膵内胆管に浸潤癌が存在し,そこより肝側の切除胆管全域に上皮内癌を認めた。また,No.13aリンパ節に転移を1個認めた。最終診断はpT3N1M0,pStage IIBであった。術後補助化学療法として1年間,S-1を内服した。術後5年目に胆管空腸吻合部に乳頭状隆起性病変を認め,生検で腺癌の診断であった。S-1内服を再開し,その後は腫瘍の増大を認めていない。術後9年1ヵ月現在,生存中である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320132&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F132%2F1753-1755%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F132%2F1753-1755%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は58歳,女性。体重減少を主訴に来院した。腹部CT検査で胆管および膵管の拡張と膵管内に造影される壁在結節が認められ,膵管内乳頭粘液性腫瘍(IPMN)と診断された。内視鏡的逆行性胆管造影(ERCP)および胆道鏡で総胆管とIPMNとの間の瘻孔が確認された。IPMNの総胆管穿破と診断し,手術適応と判断した。術前待機中に急激な肝胆道系酵素の増加が認められ,ERCPを施行したところ粘液により総胆管が閉塞していたため,内視鏡的経鼻胆道ドレナージ(ENBD)チューブを挿入した。連日の洗浄によりチューブ開存を維持することで,肝機能障害は改善した。膵全摘術,脾臓合併切除,領域リンパ節郭清を施行した。病理診断は混合型浸潤性膵管内乳頭粘液性腺癌であった。術後18ヵ月が経過した現在,無再発生存している。胆管穿破を伴うIPMNに対する胆道ドレナージは,排液量の観察と洗浄が可能なENBDが妥当である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320172&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F172%2F1872-1874%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F172%2F1872-1874%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

今回,2回の肝内再発巣切除を施行して長期生存が得られた肝嚢胞腺癌の1例を経験したので報告する。症例は72歳,男性。肝S3を主座とする肝嚢胞腺癌に対して,肝左葉切除+肝外胆管切除+リンパ節郭清を施行した。術後7年9ヵ月目のCTで単発の肝内再発を指摘され,肝S5部分切除を施行した。初回手術から15年7ヵ月目には再度S5に肝内再発を来し,肝部分切除術を施行した。これらの肝再発巣は,病理組織学的に肝嚢胞腺癌の転移であることが確認された。以降は再発を認めず,初回手術から21年6ヵ月を経過した現在,生存中である。本症例の経験および文献的考察から,肝嚢胞腺癌の肝内再発に対して,再発巣切除は有用な治療選択肢の一つとなる可能性があることが示された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320198&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F198%2F1953-1955%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F198%2F1953-1955%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は72歳,女性。黄疸精査のCTで膵頭部に12mm大の乏血性腫瘤を認め,超音波内視鏡下穿刺吸引法で膵癌と診断した。術前化学療法としてGEM+nab-PTX療法を施行し,2コース終了後に肝十二指腸間膜リンパ節転移,腫瘍マーカーの上昇を認めた。modified FOLFIRINOX療法へレジメン変更を行い,5コース終了後,リンパ節転移の縮小,腫瘍マーカーの低下を認めたため亜全胃温存膵頭十二指腸切除術を施行した。S-1による術後補助化学療法を施行し,膵癌切除後2年9ヵ月間,無再発で経過したが,敗血症で他病死した。切除可能膵癌に対する術前化学療法中,病勢進行時にはレジメン変更が有用な可能性がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20240115320070&doc_link_id=%2Fab8gtkrc%2F2023%2F005013%2F070%2F1569-1571%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005013%2F070%2F1569-1571%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

Colorectal cancer (CRC) metastasizes to various organs, while cutaneous metastases are rare. Although there have been several previous reports of axillary cutaneous metastases with other metastases of CRC, there has never been a report of axillary cutaneous metastasis of CRC that could be treated with curative-intent surgery.

Case presentation

A 68-year-old female was diagnosed with an axillary cutaneous tumor and ascending colon cancer with invasion to the duodenum. Histopathological and immunohistochemical analysis revealed that the axillary cutaneous tumor showed adenocarcinoma and the same expression pattern for cytokeratin 7, cytokeratin 20, and CDX2 as the ascending colon cancer, and that proved to be KRAS–NRAS wild type, MSI-H, and with a BRAF V600E mutation. The patient underwent a two-stage resection with curative intent after receiving neoadjuvant chemotherapy which consisted of one cycle of modified FOLFOX6 followed by two cycles of FOLFOXIRI. During and after the two operations, the patient received a total of nine cycles of modified FOLFOX6 as adjuvant chemotherapy. Two years after the initial surgery, and 1 year and 8 months after the second surgery, the patient is alive without recurrence.

Conclusions

To the best of our knowledge, this is the first report of axillary cutaneous metastasis of CRC with microsatellite instability-high and BRAF V600E mutation that could be treated with curative-intent surgery. It is important to recognize the presence of such cases for the accurate diagnosis and treatment of CRC with cutaneous metastasis.

DOI： 10.1186/s40792-023-01780-y

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その他リンク： https://link.springer.com/article/10.1186/s40792-023-01780-y/fulltext.html

記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00083&link_issn=&doc_id=20230919470544&doc_link_id=%2Fcl8isoke%2F2023%2Ft058s1%2F083%2F0341-0341%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2023%2Ft058s1%2F083%2F0341-0341%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00083&link_issn=&doc_id=20230919470476&doc_link_id=%2Fcl8isoke%2F2023%2Ft058s1%2F015%2F0318-0318%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2023%2Ft058s1%2F015%2F0318-0318%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00083&link_issn=&doc_id=20230919470531&doc_link_id=%2Fcl8isoke%2F2023%2Ft058s1%2F070%2F0337-0337%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2023%2Ft058s1%2F070%2F0337-0337%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00083&link_issn=&doc_id=20230919470477&doc_link_id=%2Fcl8isoke%2F2023%2Ft058s1%2F016%2F0319-0319%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcl8isoke%2F2023%2Ft058s1%2F016%2F0319-0319%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：新潟医学会  

重症胆道感染症から敗血症性ショックに至った症例に対してエンドトキシン吸着療法(polymyxin-direct hemoperfusion:PMX-DHP)を行い,急性期から脱却後に手術を施行し得た2例を経験したので報告する.症例1は79歳の男性で,発熱と呼吸困難を主訴に救急外来を受診した.呼吸数36回/分,経皮的動脈血酸素飽和度81%(room air),心拍数71回/分,血圧85/61mmHgとショック状態であった.腹部造影CT検査で胆嚢結石と総胆管の拡張を認め,総胆管結石による重症急性胆管炎と診断した.気管内挿管と急速輸液,ノルアドレナリンの持続静注を開始し,経皮経肝胆道ドレナージを行なったが,敗血症性ショックが遷延したためPMX-DHPを施行した.PMX-DHP開始後4時間程度で循環動態は安定し,ノルアドレナリンの投与を終了した.急性胆管炎発症から3病日目に人工呼吸器管理を終了し,15病日目に内視鏡下に総胆管結石を採石した.29病日目に自宅へ退院となった.発症から3ヵ月後に腹腔鏡下胆嚢摘出術を施行した.術後2年2ヵ月が経過した現在,胆道感染症の再発なく経過している.症例2は86歳の女性で,大動脈弁置換術後のため入院加療中であった.術後21病日目に発熱し,呼吸数34回/分,経皮的動脈血酸素飽和度96%(酸素8L/分投与下),心拍数125回/分,血圧85/41mmHgとショック状態となった.腹部造影CT検査で腫大した胆嚢と周囲の脂肪織濃度の上昇を認め,重症急性胆嚢炎と診断した.急速輸液,ノルアドレナリンの持続静注を開始し,経皮経肝胆嚢ドレナージを施行した.敗血症性ショックが遷延したためPMX-DHPを施行し,血圧は上昇傾向となった.急性胆嚢炎発症から3病日目にノルアドレナリンの投与を終了できた.46病日目にリハビリ目的に他院へ転院となった.発症から3ヵ月後に開腹下胆嚢摘出術を施行した.術後1年6ヵ月が経過した現在,胆道感染症の再発なく経過している.重症胆道感染症により循環動態が不安定な症例では,PMX-DHPは支持療法として治療選択肢の1つになり得る.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00990&link_issn=&doc_id=20240628120003&doc_link_id=%2Fdg3nigta%2F2023%2F013707%2F003%2F0243-0248%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2023%2F013707%2F003%2F0243-0248%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-023-13440-4

PubMed

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記述言語：日本語   出版者・発行元：新潟医学会  

重症胆道感染症から敗血症性ショックに至った症例に対してエンドトキシン吸着療法(polymyxin-direct hemoperfusion:PMX-DHP)を行い,急性期から脱却後に手術を施行し得た2例を経験したので報告する.症例1は79歳の男性で,発熱と呼吸困難を主訴に救急外来を受診した.呼吸数36回/分,経皮的動脈血酸素飽和度81%(room air),心拍数71回/分,血圧85/61mmHgとショック状態であった.腹部造影CT検査で胆嚢結石と総胆管の拡張を認め,総胆管結石による重症急性胆管炎と診断した.気管内挿管と急速輸液,ノルアドレナリンの持続静注を開始し,経皮経肝胆道ドレナージを行なったが,敗血症性ショックが遷延したためPMX-DHPを施行した.PMX-DHP開始後4時間程度で循環動態は安定し,ノルアドレナリンの投与を終了した.急性胆管炎発症から3病日目に人工呼吸器管理を終了し,15病日目に内視鏡下に総胆管結石を採石した.29病日目に自宅へ退院となった.発症から3ヵ月後に腹腔鏡下胆嚢摘出術を施行した.術後2年2ヵ月が経過した現在,胆道感染症の再発なく経過している.症例2は86歳の女性で,大動脈弁置換術後のため入院加療中であった.術後21病日目に発熱し,呼吸数34回/分,経皮的動脈血酸素飽和度96%(酸素8L/分投与下),心拍数125回/分,血圧85/41mmHgとショック状態となった.腹部造影CT検査で腫大した胆嚢と周囲の脂肪織濃度の上昇を認め,重症急性胆嚢炎と診断した.急速輸液,ノルアドレナリンの持続静注を開始し,経皮経肝胆嚢ドレナージを施行した.敗血症性ショックが遷延したためPMX-DHPを施行し,血圧は上昇傾向となった.急性胆嚢炎発症から3病日目にノルアドレナリンの投与を終了できた.46病日目にリハビリ目的に他院へ転院となった.発症から3ヵ月後に開腹下胆嚢摘出術を施行した.術後1年6ヵ月が経過した現在,胆道感染症の再発なく経過している.重症胆道感染症により循環動態が不安定な症例では,PMX-DHPは支持療法として治療選択肢の1つになり得る.(著者抄録)

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記述言語：日本語   出版者・発行元：新潟医学会  

【症例】60歳代女性.右乳癌に対して,右乳房切除術ならびに腋窩リンパ節郭清術を施行され,pT3N0M0,pStage IIB,ホルモン受容体陰性,human epidermal growth factor receptor type 2(HER2)陽性と診断された.術後補助療法(trastuzumab,pertuzumab併用療法)中の術後1年5ヵ月時に右胸壁再発(ホルモン受容体陰性,HER2陰性),多発肺転移再発をきたした.Paclitaxel,bevacizumab併用療法を開始したが,右胸壁再発巣が増大したため放射線治療を行い,縮小を得た.しかし,多発肺転移再発巣は増大したため,右胸壁再発巣の針生検検体でPD-L1(SP142)陽性であることを確認し,nab-paclitaxel,atezolizumab併用療法を施行した.3コース終了後,右胸壁再発巣と多発肺転移再発巣は縮小し,部分奏効と判断した.4コース目の治療中に下垂体機能低下症を発症したため治療を中止し,以後は無治療経過観察の方針とした.治療中止後1年8ヵ月経過時点で,全ての再発巣は縮小した状態を維持している.【結語】HER2陽性乳癌では再発巣がHER2陰性である可能性があり,再発巣のサブタイプに応じた適切な治療選択が重要である.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00990&link_issn=&doc_id=20240528040003&doc_link_id=%2Fdg3nigta%2F2023%2F013705%2F003%2F0179-0184%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2023%2F013705%2F003%2F0179-0184%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report a case of intrahepatic cholangiocarcinoma(ICC)with lymph node metastases in which long-term survival was achieved after surgery followed by chemotherapy. A 69-year-old man underwent left hepatectomy, extrahepatic bile duct resection, and lymph node dissection for ICC located mainly in segment 4 of the liver with enlarged lymph nodes in the hepatoduodenal ligament. The histopathologically confirmed diagnosis was ICC(T2N1M0, Stage ⅣA)with 3 positive lymph nodes(No. 12a1, No. 12p1, and No. 12p2). He received chemotherapy with gemcitabine(GEM)plus cisplatin(CDDP)for 9 months, followed by GEM monotherapy for 4 months, and then S-1 monotherapy was started. A right lung nodule was detected 12 months after the initiation of S-1 monotherapy. He received GEM plus S-1 therapy for 28 months, followed by S-1 monotherapy, leading to disappearance of the lung nodule. He remains alive and well without disease 78 months after surgery. Our experience in this case suggests that radical resection followed by chemotherapy may provide a survival benefit in selected patients who have ICC with nodal disease.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

術後化学療法を併施して,根治切除後に長期生存したリンパ節転移陽性肝内胆管癌の1例を経験したので報告する。症例は69歳,男性。肝十二指腸間膜内リンパ節の腫大を伴う肝S4が主座の肝内胆管癌に対して,肝左葉切除+肝外胆管切除+リンパ節郭清を実施した。進行度はT2N1M0,Stage IVAで,郭清リンパ節3個(No.12a1,No.12p1,No.12p2)に転移を認めた。術後補助化学療法としてgemcitabine(GEM)+cisplatin(CDDP)療法を9ヵ月,GEM療法を4ヵ月実施した後,S-1療法を継続した。S-1開始1年後に出現した右肺結節に対し,GEM+S-1療法を2年4ヵ月間実施した。その後S-1療法に変更し,肺結節は消失した。術後6年6ヵ月が経過した現在,無再発生存中である。本症例の経験から,予後不良なリンパ節転移陽性の肝内胆管癌において,根治切除と化学療法が長期生存に寄与する症例も存在することが示された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00296&link_issn=&doc_id=20230221480024&doc_link_id=%2Fab8gtkrc%2F2023%2F005002%2F026%2F0227-0229%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2023%2F005002%2F026%2F0227-0229%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 74-year-old man presented to our hospital with a mass in the left supraclavicular fossa. He was diagnosed with advanced gastric cancer with liver metastasis and left supraclavicular and para-aortic lymph node metastasis, cT3N2M1 (LYM, HEP), cStage Ⅳ(the Union for International Cancer Control, TNM 7th edition). He received a total of 3 courses of S- 1 plus cisplatin therapy. Since he developed adverse reactions such as anorexia, renal dysfunction, and thrombocytopenia and the tumor was HER2-positive, he received 25 courses of capecitabine, cisplatin, and trastuzumab chemotherapy. Three years and 2 months after the first chemotherapy, remarkable tumor reduction was observed. The patient then underwent radical distal gastrectomy with D2 lymphadenectomy, and R0 resection was achieved. The histopathological diagnosis was ypT1aN0M0, ypStage ⅠA. Chemotherapy with trastuzumab may improve the long-term prognosis of HER2-positive Stage Ⅳ gastric cancer if the disease is controlled and radical resection can be achieved.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A woman in her 60s had been aware of perianal erosions for 1 month. Skin biopsy showed Paget's cells in the stratified squamous epithelium, and immunohistochemistry showed negative staining for CK7 and positive staining for CK20. Colonoscopy revealed well-differentiated adenocarcinoma in the anal canal. Computed tomography showed neither regional lymph node metastasis nor distant metastasis. Hence, she was diagnosed with anal canal carcinoma with pagetoid spread. We determined the extent of resection of the skin lesion preoperatively by mapping biopsy, and performed laparoscopic abdominoperineal resection. The pathological findings revealed adenocarcinoma(tub1, tub2), and the skin resection margin was negative. Immunohistochemistry for Paget's cells in the stratified squamous epithelium showed negative staining for GCDFP-15 and CK7, and positive staining for CK20. Twenty-four months after surgery, we detected right inguinal lymph node metastasis and performed right inguinal lymphadenectomy. As of 4 months after the lymphadenectomy, no local recurrence or distant metastasis has been detected during follow-up examinations.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 71-year-old man with middle thoracic esophageal cancer was treated with neoadjuvant chemotherapy using docetaxel plus 5-FU plus cisplatin therapy and was also administered pegfilgrastim. Blood tests showed elevated white blood cell counts and C-reactive protein levels before the start of the third course. Contrast-enhanced computed tomography revealed wall thickening of the aortic arch. We diagnosed this as aortitis due to pegfilgrastim. Inflammation was improved with conservative treatment. We then performed video-assisted thoracoscopic esophagectomy. Drug-induced vasculitis should be included in the differential diagnosis of patients with elevated inflammation markers of unknown cause following the administration of granulocyte colony-stimulating factor preparations.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 53-year-old woman underwent subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)for resectable pancreatic cancer after neoadjuvant chemotherapy. Postoperatively, she received hepatic arterial infusion of 5-FU and S-1 chemotherapy. Two years after SSPPD, abdominal computed tomography showed a 2-cm mass in the remnant pancreas, which was diagnosed as recurrence of cancer by endoscopic ultrasound-guided fine-needle aspiration. Staging laparoscopy was performed and peritoneal washing cytology(CY)was positive. She then received gemcitabine plus nab-paclitaxel chemotherapy for 8 months. After that, staging laparoscopy was performed again and negative CY was confirmed. A total remnant pancreatectomy with splenectomy was performed. She received chemotherapy after pancreatectomy and is now alive and well without recurrence 2 years and 1 month after the second surgery. Although positive CY is a poor prognostic factor, surgery combined with perioperative chemotherapy may contribute to prolonged survival for some patients who have recurrence in the remnant pancreas with positive CY.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The patient was a 71-year-old man with a diagnosis of duodenal carcinoma. Abdominal computed tomography(CT) showed no distant metastasis, and he underwent subtotal stomach-preserving pancreaticoduodenectomy. Postoperative adjuvant chemotherapy was not administered. A left supraclavicular lymph node recurrence was detected on CT 15 months after surgery. Capecitabine and oxaliplatin(CAPOX)therapy was administered and the metastatic lesion shrank. Positron emission tomography(PET)-CT showed no lesions at other sites and left cervical lymph node dissection was performed 5 months after the recurrence. Postoperative adjuvant therapy with S-1 was administered for 6 months. However, 2 years and 10 months after the first recurrence, CT showed recurrence in the left supraclavicular lymph node. CAPOX therapy was resumed, but due to an allergic reaction to oxaliplatin, the patient was treated with capecitabine alone. The recurrent lesion was gradually increased in size, and FOLFIRI therapy was introduced. One year and 5 months after secondary recurrence, PET-CT showed that the second recurrent lesion had grown but was confined to the left supraclavicular lymph node, so radiation therapy(60 Gy)to the left neck was performed. The disease was stable for about 10 months and chemotherapy could be discontinued. The lesion increased in size thereafter, and the patient died 7 years after initial surgery.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は74歳,男性。左鎖骨上窩の腫瘤を主訴に当院を受診した。精査で領域リンパ節転移,肝転移,左鎖骨上窩リンパ節転移,傍大動脈リンパ節転移を伴う切除不能進行胃癌,cT3N2M1(LYM,HEP),cStage IVと診断した。一次化学療法としてS-1+cisplatin療法を計3コース施行後,食欲不振,腎機能障害,血小板減少の有害事象を認め,経過中にHER2陽性と判明したため,二次化学療法としてcapecitabine+cisplatin+trastuzumabに変更して計25コース施行した。原発巣の著明な縮小を認め,遠隔転移巣に対してcomplete response(CR)が得られ,初回化学療法開始から3年2ヵ月後に幽門側胃切除,D2郭清,Billroth I法再建術を施行し,R0切除を達成し得た。術後経過は良好であり,第14病日に退院した。病理組織診断結果はypT1aN0M0,ypStage IAであった。術後補助化学療法としてS-1単剤療法を1年間施行し,術後5年5ヵ月現在,無再発生存中である。HER2陽性Stage IV胃癌に対するtrastuzumab併用化学療法は,病勢コントロールし得て根治切除が可能となれば長期予後が得られる可能性がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20230119420042&doc_link_id=%2Fab8gtkrc%2F2022%2F004913%2F042%2F1515-1517%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004913%2F042%2F1515-1517%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は71歳,男性。腹痛,体重減少を主訴に原発性十二指腸癌と診断され,亜全胃温存膵頭十二指腸切除術が施行された。術後15ヵ月後のCTで左鎖骨上リンパ節再発を認めた。カペシタビン+オキサリプラチン(CAPOX)療法を行い,転移巣は縮小した。他部位に病変を認めず,再発から5ヵ月後に左頸部リンパ節郭清術を施行し,S-1による術後補助化学療法を6ヵ月間施行した。しかし初回再発から2年10ヵ月後のCTで左鎖骨上リンパ節の再々発を認めた。CAPOX療法を再開したが薬剤アレルギーを認め,カペシタビン単独療法を行い,その後はFOLFIRI療法とした。再々発から1年5ヵ月後のPET-CTでは病変は限局しており,左頸部に60Gyの体外照射を行った。10ヵ月程度は病状が安定し化学療法を休薬できたが,徐々に病変が増大し術後7年で原病死した。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20230119420086&doc_link_id=%2Fab8gtkrc%2F2022%2F004913%2F086%2F1648-1650%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004913%2F086%2F1648-1650%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は53歳,女性。切除可能膵癌に対して術前化学療法後に亜全胃温存膵頭十二指腸切除術を施行した。術後補助化学療法として,5-FU肝動注療法およびS-1療法を施行した。術後2年目のCTで残存膵に2cm大の腫瘤が出現し,超音波内視鏡下穿刺吸引法で残膵再発癌と診断した。審査腹腔鏡検査でCY陽性を確認後,GEM+nab-PTX療法を8ヵ月行い,再度の審査腹腔鏡検査でCY陰転化したため,残膵全摘術,脾臓摘出術を施行した。術後化学療法を施行し,残膵再発癌切除後2年1ヵ月現在,無再発生存中である。CY陽性は予後不良因子であるが,術前・術後化学療法を組み合わせることで,CY陽性残膵再発癌も切除適応となる可能性がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20230119420097&doc_link_id=%2Fab8gtkrc%2F2022%2F004913%2F097%2F1681-1683%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004913%2F097%2F1681-1683%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は71歳,男性。進行食道癌に対して術前化学療法としてドセタキセル+5-FU+シスプラチン療法を開始した。2コース目の抗癌剤投与終了後にペグフィルグラスチムを投与した。3コース目開始時に白血球増多とCRP上昇を認めた。精査目的の造影CT検査で大動脈弓部の壁肥厚を認め,ペグフィルグラスチムによる大動脈炎と診断した。保存的治療で炎症所見は改善し,造影CT検査で大動脈弓部の壁肥厚の改善を認めた。手術は胸腔鏡下食道切除,3領域リンパ節郭清,胸骨後経路胃管再建を施行した。大動脈弓部付近の炎症による影響はなく,剥離は容易に可能であった。ペグフィルグラスチム投与後に原因不明の炎症反応の上昇を認めた場合には,薬剤誘発性血管炎も鑑別にあげるべきである。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20230119420141&doc_link_id=%2Fab8gtkrc%2F2022%2F004913%2F141%2F1817-1819%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004913%2F141%2F1817-1819%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は60歳代,女性。1ヵ月前より肛門周囲のびらんを自覚していた。生検で重層扁平上皮内にPaget細胞が散見され,免疫組織化学検査の結果,CK7陰性,CK20陽性であった。また,肛門管内に腺癌(tub1)を認めた。CT検査で遠隔転移や有意なリンパ節腫大を認めなかった。免疫組織化学検査の結果より,重層扁平上皮内のPaget細胞は肛門管癌から皮膚へ進展したpagetoid spread(PS)であると診断した。肛門管癌はcT2N0M0,cStage I(大腸癌取扱い規約第9版)と診断した。会陰部皮膚病変に対しmapping biopsyを行い,病変辺縁から2cmの部位でPS陰性であることを確認した上で,腹腔鏡補助下直腸切断術を施行した。病理組織学的検査では腺癌(tub1,tub2)を認め,皮膚切除断端は陰性であった。術後24ヵ月目に右鼠径リンパ節転移を認め,右鼠径リンパ節切除術を施行した。リンパ節切除術後4ヵ月無再発生存中である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20230119420022&doc_link_id=%2Fab8gtkrc%2F2022%2F004913%2F022%2F1455-1457%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004913%2F022%2F1455-1457%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

【目的】消化器外科術後に発症した播種性血管内凝固(disseminated intravascular coagulation;以下,DICと略記)に対する遺伝子組み換えトロンボモジュリン(recombinant human soluble thrombomodulin;以下,rTMと略記)の効果を検証し,治療成績改善に向けた方策を考察する.【方法】2016年1月から2021年5月に当科で消化器外科術後DICの改善を目的にrTMが投与された48例を対象とした.対象症例におけるDICの改善効果,および在院死亡の危険因子を検証した.DICの診断には,日本救急医学会の急性期DIC診断基準を使用した.患者背景および検査項目に関する2群間のカテゴリー変数の比較にはPearsonのχ2検定,Fisherの直接法を用いた.多変量解析はstepwise法によるロジスティック回帰分析を用いて行った.生存曲線はKaplan-Meier法で算出し,log rank検定で有意差検定を行った.有意水準5%(P<0.05)をもって有意差ありと判断した.【結果】年齢の中央値は76歳(59-91),男女比は21:27であった.原疾患は下部消化管穿孔が22例(45.8%),悪性腫瘍が11例(22.9%),消化管虚血が10例(20.8%),上部消化管穿孔が5例(10.4%)であった.DICを発症した原因は,急性汎発性腹膜炎が38例(79.2%),術後感染症が5例(10.4%),術後肝不全が4例(8.3%),術後出血が1例(2.1%)であった.rTM投与開始後7日目に28例(58.3%)で血小板数増加を認め,31例(64.6%)でDICスコアの改善を認めた.投与開始後28日の生存率は72.9%で,在院死亡率は41.7%であった.在院死亡群と生存群における比較では,在院死亡群において「悪性疾患あり」(P=0.034),「DICの原因が術後肝不全」(P=0.025),rTM投与開始時の「血小板数5万/μl未満」(P=0.009),「総ビリルビン2.0mg/dl以上」(P=0.002),rTM投与開始後7日目の「血小板数増加なし」(P=0.001),「DICスコア改善なし」(P=0.003)の占める割合が高かった.多変量解析ではrTM投与開始後7日目の「血小板数増加なし」(HR 5.076:95%CI 1.145-22.222:P=0.032)が独立した在院死亡の危険因子であった.【結語】消化器外科術後に発症するDICは極めて予後不良な病態であるが,rTM投与開始後早期に血小板数の増加を認めた場合,予後の改善を期待できる可能性がある.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00990&link_issn=&doc_id=20230518110002&doc_link_id=%2Fdg3nigta%2F2022%2F013605%2F002%2F0151-0158%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg3nigta%2F2022%2F013605%2F002%2F0151-0158%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は72歳、男性。肛門痛と排便困難を主訴に来院した。肛門管内に腫瘤を認め、生検で腺癌と診断された。胸腹骨盤部CT検査の結果、遠隔転移を認めず、肛門管癌、cT3N0M0、cStage IIaと診断された。術前化学放射線療法(chemoradiotherapy:CRT)(capecitabine併用、1.8Gy28回、50.4Gy)を施行した。術前CRT8週間後、骨盤部CT検査にて縮小率34%とPR判定であった。術前CRTから15週間後に腹腔鏡下腹会陰式直腸切断術を施行した。病理組織学的診断では、組織型はadenocarcinoma(muc、tub1)であり、肛門周囲皮膚と肛門管重層扁平上皮の境界相当部から直腸粘膜に連続する痔瘻様上皮嵌入部に癌の上皮内病変を認めた。周囲に粘液癌を主体とする浸潤癌を認め、痔瘻癌と診断された。術後12ヵ月となる現在まで無再発生存中である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20211216370020&doc_link_id=%2Fab8gtkrc%2F2021%2F004812%2F021%2F1515-1517%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004812%2F021%2F1515-1517%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 70-year-old female with liver metastases from gastrointestinal stromal tumor(GIST)that were found 3 months after partial gastrectomy for the primary GIST underwent Auchincloss operation for left breast cancer with ipsilateral axillary lymph node metastases. The diagnosis was microinvasive ductal cancer that was pT1miN1M0, pStage ⅡA, hormone receptor negative, and HER2 positive. Given the impact of this cancer on the prognosis of liver metastases of GIST, imatinib therapy, but not adjuvant chemotherapy, was started promptly for breast cancer after surgery. Four months after the surgery, left subclavian lymph node recurrence of breast cancer was found. Since the liver metastases of GIST had been stable, imatinib was discontinued, and paclitaxel and anti-HER2 therapy were administered. After confirming tolerability, imatinib was carefully added in combination. Because the lymph nodes shrank and liver metastases of GIST were stable, both anti-HER2 therapy and imatinib were continued. There are few reports of combined chemotherapy for synchronous double cancer, and we report our experience in which careful treatment was required.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は70歳、女性。胃GIST術後3ヵ月目に左乳癌、腋窩リンパ節転移、GIST肝転移を認め、左乳癌に対し手術を施行した。病理組織学的結果はHER2陽性乳癌、pT1miN1M0、pStage IIAであった。予後規定因子はGIST肝転移と考え、イマチニブを開始した。乳癌術後4ヵ月目に乳癌左鎖骨下リンパ節再発を認めた。GIST肝転移の病勢は安定していたためイマチニブをいったん休薬し、パクリタキセル、抗HER2療法を開始した。忍容性を確認した後、慎重にイマチニブを併用した。リンパ節は著明に縮小し肝転移も増大を認めず、パクリタキセルを7コースで終了した。現在は抗HER2療法、イマチニブを継続中である。転移性の重複癌において両者に対する薬物療法を同時併用した報告は少なく、若干の考察を加えて報告する。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20220117600064&doc_link_id=%2Fab8gtkrc%2F2021%2F004813%2F064%2F1725b1727%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004813%2F064%2F1725b1727%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は64歳、男性。慢性腎臓病で当院通院中に腹部CTで膵頭部癌と診断された。腹部CTおよびMRIでは遠隔転移や大動脈周囲リンパ節(PALN)転移は認めなかった。手術の方針とし術中にPALNサンプリングを行ったところ、迅速病理診断にてリンパ節4個中2個に転移を認めた。非切除とした場合、腎機能障害のため標準的な化学療法を施行できないと考え、PALN郭清を伴う亜全胃温存膵頭十二指腸切除術を施行した。病理診断は浸潤性膵管癌であり、S-1による術後補助化学療法を減量して行った。術後1年10ヵ月で腸間膜内リンパ節再発および肺転移再発を認めた。さらに、術後2年で腹腔内再発による上腸間膜動静脈狭窄を認めた。腹腔内再発に対し放射線療法を行い、引き続きgemcitabine単独療法を行った。肝外門脈狭窄による腹水貯留や消化管出血は治療により軽快した。結果、術後5年7ヵ月の長期生存を得た。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20220117600154&doc_link_id=%2Fab8gtkrc%2F2021%2F004813%2F154%2F2002b2004%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004813%2F154%2F2002b2004%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 72-year-old man had a chief complaint of anal pain and difficulty in defecation. He was diagnosed with adenocarcinoma by biopsy from a tumor of the anal canal. A computed tomography scan revealed neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa anal canal cancer. Preoperative capecitabine- based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. Digital rectal examination and imaging evaluation 8 weeks after preoperative CRT revealed that the tumor had shrunk. Fifteen weeks after preoperative CRT, laparoscopic abdominoperineal resection was performed. The pathological findings showed mucinous adenocarcinoma associated with anal fistula. At present, 12 months after the operation, no local recurrence and distant metastasis has been detected under follow-up evaluations.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The patient was a 64-year-old man with diagnosis of pancreatic head cancer. Initially, abdominal CT showed pancreatic head tumor with bile duct invasion and no distant metastases including para-aortic lymph nodes(PALN). Although, subtotal stomach-preserving pancreatoduodenectomy(SSPPD)and PALN sampling was performed, intraoperative frozen section examination revealed PALN metastasis. He had chronic kidney disease and was unsuitable for standard chemotherapy, SSPPD and PALN dissection was performed instead of standard chemotherapy. Histopathological examination of the resected specimens revealed invasive ductal carcinoma in the pancreatic head region and 11 nodes out of the 17 dissected PALN. Adjuvant chemotherapy with S-1 was performed. 22 months after surgery, intraabdominal lymph nodes metastasis and lung metastasis was found. 24 months after surgery, palliative radiation therapy at a dose of 40 Gy was performed. Systemic chemotherapy with gemcitabine alone was performed, but he was dead 67 months after the initial therapy.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 62-year-old man was incidentally found to have a pancreatic tumor by CT. He was diagnosed with pancreatic cancer by EUS-FNAB. Gemcitabine(GEM)plus nab-paclitaxel(PTX)was started as neoadjuvant chemotherapy(NAC)for resectable pancreatic cancer. However, after the end of the second course, the tumor grew rapidly and invaded the stomach, so NAC was discontinued, and surgery was performed. The pathological diagnosis was anaplastic ductal carcinoma of the pleomorphic cell type, and the histological response was Grade 1a. Multiple liver metastases appeared during adjuvant chemotherapy with S-1, so GEM plus nab-PTX and modified FOLFIRINOX were administered, but the therapeutic response was poor, the patient died 9 months after surgery. Anaplastic carcinoma has a poor response to chemotherapy and may be included with cancers showing treatment resistance to NAC, as seen in our case. It is necessary to pay attention to anaplastic carcinoma during the course of NAC for pancreatic cancer.

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は62歳、男性。他疾患の経過観察目的の胸腹部CTで膵腫瘍を指摘され、超音波内視鏡下吸引生検で膵癌と診断された。切除可能膵癌に対する術前化学療法としてgemcitabine(GEM)+nab-paclitaxel(PTX)を開始したが、腫瘍増大および胃浸潤が出現したため、術前化学療法を中止し手術を施行した。術中所見で胃体上部と横行結腸への腫瘍浸潤を認め、膵体尾部切除、脾臓摘出、胃全摘、横行結腸部分切除、領域リンパ節郭清術を施行した。病理組織学的診断は多形細胞型退形成性膵管癌で、進行度はpT3N1aM0、Stage IIB、術前治療の組織学的効果判定はGrade 1aであった。S-1による術後補助化学療法中に多発肝転移が出現し、GEM+nab-PTX、modified FOLFIRINOXを施行したが治療効果に乏しく、術後9ヵ月目に原病死した。退形成性膵管癌は化学療法が無効であることが多く、自験例のように術前化学療法に対して治療抵抗性を示すもののなかに退形成性膵管癌が含まれている可能性に留意し治療を行う必要がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20220117600023&doc_link_id=%2Fab8gtkrc%2F2021%2F004813%2F023%2F1601-1603%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004813%2F023%2F1601-1603%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   出版者・発行元：金原出版(株)  

食道癌に対する根治的な食道切除術では気管分岐部・主気管支下リンパ節郭清が標準的に行われており、リンパ節郭清を施行する際、右肺静脈破格の存在は大出血の原因となる可能性がある。今回、術前のCTで右上肺静脈V2の破格の存在を把握し、リンパ節郭清を安全に施行することができた症例を2例経験したので、郭清操作を中心に報告した。両例とも右上肺静脈V2が右中間気管支管の背側を通る破格を認めたため、N0.109R・LからNo.107への郭清操作では、郭清組織を心外膜から剥離し浮かせる操作を先行した。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00620&link_issn=&doc_id=20211008100016&doc_link_id=10.18888%2Fop.0000002465&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002465&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tumor mutational burden-high (TMB-H), which is detected with gene panel testing, is a promising biomarker for immune checkpoint inhibitors (ICIs) in colorectal cancer (CRC). However, in clinical practice, not every patient is tested for TMB-H using gene panel testing. We aimed to identify the histopathological characteristics of TMB-H CRC for efficient selection of patients who should undergo gene panel testing. Moreover, we attempted to develop a convolutional neural network (CNN)-based algorithm to predict TMB-H CRC directly from hematoxylin and eosin (H&E) slides. METHODS: We used two CRC cohorts tested for TMB-H, and whole-slide H&E digital images were obtained from the cohorts. The Japanese CRC (JP-CRC) cohort (N = 201) was evaluated to detect the histopathological characteristics of TMB-H using H&E slides. The JP-CRC cohort and The Cancer Genome Atlas (TCGA) CRC cohort (N = 77) were used to develop a CNN-based TMB-H prediction model from the H&E digital images. RESULTS: Tumor-infiltrating lymphocytes (TILs) were significantly associated with TMB-H CRC (P < 0.001). The area under the curve (AUC) for predicting TMB-H CRC was 0.910. We developed a CNN-based TMB-H prediction model. Validation tests were conducted 10 times using randomly selected slides, and the average AUC for predicting TMB-H slides was 0.934. CONCLUSIONS: TILs, a histopathological characteristic detected with H&E slides, are associated with TMB-H CRC. Our CNN-based model has the potential to predict TMB-H CRC directly from H&E slides, thereby reducing the burden on pathologists. These approaches will provide clinicians with important information about the applications of ICIs at low cost.

DOI： 10.1007/s00535-021-01789-w

PubMed

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(株)篠原出版新社  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は64歳、男性。肝機能障害の精査で肝門部領域胆管癌と診断された。腫瘍は右側優位のBismuth分類IV型で、門脈右枝〜左右分枝への浸潤が認められた。肝予備能、残肝容積は十分であり、拡大肝右葉切除術+肝外胆管切除術+門脈合併切除術が実施された。術中迅速組織診断で十二指腸側・肝側胆管切離断端がともに浸潤癌陽性となったが、進行度や侵襲度を勘案し、膵頭十二指腸切除術の追加や左肝管断端の追加切除は行わなかった。最終的な進行度はpT4b、pN0、cM0、Stage IV A、pDMI(w)、pHM1(w)、pPV1(a)、R1であった。術後化学療法としてgemcitabine(GEM)+cisplatin療法を1年、GEM療法を1年実施した後、S-1療法を継続している。術後5年3ヵ月経過した現在、無再発生存中である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600053&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F053%2F1899b1901%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F053%2F1899b1901%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 73-year-old man presented with anemia, and gastroscopy showed a nonpigmented tumor in the esophagogastric junction. The result of the tumor biopsy initially suspected poorly differentiated adenocarcinoma. However, additional immunohistochemical examination revealed malignant melanoma. The final diagnosis was amelanotic malignant melanoma of the esophagogastric junction with adrenal and spinal metastasis. Although immunotherapy was performed, the patient died 132 days after diagnosis.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 64-year-old man with liver dysfunction was given a diagnosis of perihilar cholangiocarcinoma(Bismuth type Ⅳ). The tumor was predominantly right-sided and invaded to the bifurcation of the right and left portal veins. After confirming sufficient liver functional reserve and future liver remnant, the patient underwent extended right hepatectomy, extrahepatic bile duct resection, and portal vein resection and reconstruction. Intraoperative examination of frozen sections revealed the presence of residual invasive carcinoma on both the hepatic and duodenal sides of the ductal resection margins. However, we did not perform pancreaticoduodenectomy or additional resection of the margin-positive proximal bile duct considering the curability and invasiveness of these procedures. He received postoperative chemotherapy with biweekly gemcitabine plus cisplatin for 1 year, followed by gemcitabine monotherapy for 1 year, and S-1 monotherapy has been performed since then. He remains alive and well with no evidence of disease 63 months after surgery.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The patient was a 63-year-old woman with diagnosis of pancreatic cancer. Abdominal CT showed pancreatic head tumor and paraaortic lymph node metastasis. We performed chemotherapy with nab-paclitaxel plus gemcitabine. After 5 courses of chemotherapy, the tumor reduced in size. Pancreaticoduodenectomy followed by adjuvant chemotherapy with S-1 was performed. Fourteen months after surgery, umbilical metastasis(Sister Mary Joseph's nodule: SMJN)was found in the umbilicus near the abdominal incisional hernia. There was no evidence of metastasis except in the umbilicus, we performed the umbilical tumor resection and abdominal incisional hernia repair. Pathological diagnosis was pancreatic cancer metastasis. Although following chemotherapy, multiple skin metastases was found in the lower abdomen 3 months after umbilical resection. We performed skin metastases resection to relieve pain and symptoms of bleeding. But she died 29 months after the initial therapy(7 months after umbilical resection).

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 72-year-old man was referred to our hospital for treatment for rectal cancer. Digital rectal examination and colonoscopy revealed a 4 cm tumor located at the anterior rectal wall 5 cm away from the anal verge, and pathological examination confirmed that the tumor was adenocarcinoma. A computed tomography scan detected neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa rectal cancer. The preoperative general examination revealed bradyarrhythmia and severe emphysema, and he was considered to be high risk for general anesthesia. After placement of a pacemaker, preoperative capecitabine-based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. The digital rectal examination and imaging evaluation 4 weeks after preoperative CRT revealed that the tumor disappeared, and pathological examination showed no malignant findings. Considering the risks of general anesthesia, the"watch and wait therapy"approach was adopted with sufficient informed consent. At present, 15 months after preoperative CRT, no evidence of regrowth or distant metastasis has been detected under rigorous follow- up evaluations.

PubMed

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は63歳、女性。黄疸を契機に発見された膵頭部癌で、CTで上腸間膜動脈起始部の大動脈前面にリンパ節転移を認めた。nab-PTX+GEM併用療法を開始し、5コース後の治療効果判定は部分奏効PRで、初診から6ヵ月後に亜全胃温存膵頭十二指腸切除術を施行した。病理組織学的診断は浸潤性膵管癌で、ypT2N1bM0、Stage IIBであった。術後補助化学療法としてS-1療法を行った。術後14ヵ月で腹壁瘢痕ヘルニア近傍の臍部に臍転移(Sister Mary Joseph's nodule:SMJN)を認めた。他の遠隔転移は認めず、腫瘤切除および腹壁瘢痕ヘルニア修復術を施行した。病理組織学的診断では膵癌の転移であった。引き続きGEMOX療法を行ったが、臍切除3ヵ月後に多発の皮膚転移が出現した。mFOLFIRINOX療法に変更したが皮膚転移は増悪し、出血と疼痛の症状緩和のため皮膚切除した。化学療法を継続したが徐々に全身状態が悪化し、初診から2年5ヵ月(臍切除後7ヵ月)で死亡した。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600224&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F224%2F2409b2411%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F224%2F2409b2411%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は72歳、男性。下血を主訴に来院し、大腸内視鏡検査で肛門縁から5cmの直腸前壁に下縁を有する2型腫瘍を指摘された。生検で高分化管状腺癌であった。術前胸腹骨盤部CT検査の結果遠隔転移は認めず、下部直腸癌、cT3N0M0、cStage IIaと診断された。術前の全身検査で徐脈性心房細動および重症肺気腫を認め、全身麻酔のリスクが高い症例と判断された。ペースメーカー留置後、術前化学放射線療法(CRT)(capecitabine併用、1.8Gy28回、計50.4Gy)を開始した。術前CRT後4週間目の直腸診および画像評価では腫瘍は消失し、生検で悪性所見を認めなかった。十分なインフォームド・コンセントの下、全身麻酔のリスクを勘案し、"watch and wait治療"の方針とした。現在、術前CRT後15ヵ月経過し局所の再増大および遠隔転移を認めず、経過観察を行っている。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600073&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F073%2F1960b1962%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F073%2F1960b1962%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は73歳、男性。貧血精査目的の上部消化管内視鏡検査で、食道胃接合部に白色から発赤調で易出血性の不整な隆起性腫瘤を認めた。生検では充実型低分化腺癌が疑われたが確定診断が得られず、追加で施行した免疫組織化学染色で悪性黒色腫と診断した。食道胃接合部原発の悪性黒色腫、cT3N1M1(副腎、骨)、cStage IVb(食道癌取扱い規約第15版)に対して、ペムブロリズマブの投与を行ったが肺転移が出現し原病死した。本例は腫瘍の主局在が胃側にあり、メラニン欠乏性悪性黒色腫であったため典型的な肉眼的・組織学的所見が得られず診断に難渋した。食道胃接合部の腫瘍においても、メラニン欠乏性悪性黒色腫の可能性を念頭に置いて診断を行う必要がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600115&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F115%2F2083b2085%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F115%2F2083b2085%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege-Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege-Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection. CASE PRESENTATION: A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported. CONCLUSIONS: Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege-Potter syndrome.

DOI： 10.1186/s40792-020-01076-5

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

胆嚢癌根治手術の際の至適リンパ節郭清範囲に関して、文献をレビューすることで考察した。本邦、AJCC、UICCのすべての規約において、肝十二指腸間膜内および総肝動脈幹リンパ節は領域リンパ節に含まれている。しかし、本邦の規約のみ上膵頭後部リンパ節が、UICCの規約のみ腹腔動脈周囲および上腸間膜動脈リンパ節が領域リンパ節に含まれていることが規約間の相違点である。転移頻度と切除成績の両者の観点から、上膵頭後部リンパ節は領域リンパ節として取り扱うのが妥当である。一方、腹腔動脈周囲および上腸間膜動脈リンパ節は、少数の転移陽性症例の検討が存在するにすぎず、現時点では、領域リンパ節とすることは推奨できない。進行胆嚢癌において、腫瘍学的に根治をめざして郭清するべきリンパ節の至適範囲は、本邦の胆道癌取扱い規約第6版の定める領域リンパ節とすることが妥当である。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An asymptomatic epiphrenic diverticulum (ED) was diagnosed in a man undergoing annual esophagogastroduodenoscopy (EGD) at another hospital 40 years before he presented to our hospital at age 63 years for his annual EGD. However, because substantial food retention was found in the ED, we could not confirm a lesion. After the retained food was removed endoscopically, a second EGD showed a reddish, flat lesion with an elevated mass within the ED. Endoscopic ultrasonography indicated that the elevated mass was deep in the submucosal layer. An esophagram showed that the ED was approximately 80 mm in diameter, which is considered large. An endoscopic biopsy of the lesion confirmed squamous cell carcinoma. Total esophagectomy was performed. Microscopic examination revealed well-differentiated to moderately differentiated squamous cell carcinoma invading the adventitia at the elevated lesion. The final pathological stage was pT3N0M0. There was no evidence of recurrence for 3 years during the quarterly follow-up examinations. To our knowledge, this case involved the longest asymptomatic term (40 years) since the ED was detected. A review of 18 reported cases of carcinoma in an ED indicated that advanced cancer has a poor prognosis. Periodic follow-up of ED patients is essential for early diagnosis.

DOI： 10.1007/s12328-020-01098-4

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Here, we report about a woman in her 30s who had peritoneal dissemination and multiple colon cancer with high-frequency microsatellite instability(MSI-H). Her father, paternal grandfather, and maternal grandmother had a history of colorectal cancer treatment. Thus, Lynch syndrome was suspected. We performed R0 resection for peritoneal dissemination and subsequent peritoneal dissemination. A 435-gene panel testing using a next-generation sequencer identified MSH2 and other mutations in the tumor. Hence, we speculated that she could have a germline mutation of MSH2, which causes Lynch syndrome. In the future, if she wishes to receive genetic counseling and undergo germline testing for variants to confirm the diagnosis of Lynch syndrome, we will perform them after receiving informed consent.

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は30歳代、女性。家族歴は父、父方祖父、母方祖母が大腸癌である。高頻度マイクロサテライト不安定性(high-frequency microsatellite instability:MSI-H)Stage II大腸癌の術後経過観察中に、腹膜播種再発および多発大腸癌を指摘された。現病歴および家族歴からリンチ症候群が疑われたため、当院を紹介された。当院では腹膜播種再発と、その後の腹膜播種再々発に対して2回のR0切除術を施行した。腹膜播種再発の癌組織を用いて、次世代シークエンサーを用いた遺伝子パネル検査を施行したところ、MSH2変異(c.A2211-2G)を認めた。本症例では、生殖細胞系列におけるMSH2変異がリンチ症候群の原因遺伝子変異となり、MSI-H大腸癌の発生に関与している可能性がある。今後は、必要に応じて遺伝カウンセリングや生殖細胞系列の遺伝子変異検査を実施する予定である。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Right-sided colorectal cancer (RCRC) demonstrates worse survival outcome compared with left-sided CRC (LCRC). Recently, the importance of RNF43 mutation and BRAF V600E mutation has been reported in the serrated neoplasia pathway, which is one of the precancerous lesions in RCRC. It was hypothesized that the clinical significance of RNF43 mutation differs according to primary tumor sidedness. To test this hypothesis, the clinicopathological characteristics and survival outcome of patients with RNF43 mutation in RCRC and LCRC were investigated. Stage I-IV CRC patients (n=201) were analyzed. Genetic alterations including RNF43 using a 415-gene panel were investigated. Clinicopathological characteristics between RNF43 wild-type and RNF43 mutant-type were analyzed. Moreover, RNF43 mutant-type was classified according to primary tumor sidedness, i.e., right-sided RNF43 mutant-type or left-sided RNF43 mutant-type, and the clinicopathological characteristics between the two groups were compared. RNF43 mutational prevalence, spectrum and frequency between our cohort and TCGA samples were compared. RNF43 mutation was observed in 27 out of 201 patients (13%). Multivariate analysis revealed that age (≥65), absence of venous invasion, and BRAF V600E mutation were independently associated with RNF43 mutation. Among the 27 patients with RNF43 mutation, 12 patients were right-sided RNF43 mutant-type and 15 left-sided RNF43 mutant-type. Right-sided RNF43 mutant-type was significantly associated with histopathological grade 3, presence of lymphatic invasion, APC wild, BRAF V600E mutation, microsatellite instability-high (MSI-H), and RNF43 nonsense/frameshift mutation compared with left-sided RNF43 mutant-type. Similarly, RNF43 nonsense/frameshift mutations were more frequently observed in RCRC compared with LCRC in the TCGA cohort (P=0.042). Right-sided RNF43 mutant-type exhibited significantly worse overall survival than RNF43 wild-type and left-sided RNF43 mutant-type (P=0.001 and P=0.023, respectively) in stage IV disease. RNF43 mutation may be a distinct molecular subtype which is associated with aggressive tumor biology along with BRAF V600E mutation in RCRC.

DOI： 10.3892/or.2020.7561

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Nearly 50% of primary lung carcinoma patients present with distant metastasis at their first visit. However, gastrointestinal tract (GIT) metastasis is an infrequent impediment. Herein, we report a case of progressive dysphagia and epigastralgia as an initial manifestation of recurrence as gastric metastasis of primary lung squamous cell carcinoma (SCC) after curative surgery. A 64-year-old man was diagnosed with primary lung SCC of the right lower lobe, and underwent thoracoscopic lower lobectomy. One year after lobectomy, computed tomography (CT) scan showed a gastric fundal mass located in the gastric cardia which measured 5 cm. Endoscopic biopsies and histopathology subsequently confirmed that tumor was SCC. The patient then underwent proximal gastrectomy with resection of the diaphragmatic crus. Following surgery, histopathological examination revealed gastric metastasis from primary lung SCC. KEY POINTS: Gastric metastasis of primary lung carcinoma is one of the rarest phenomena. Gastrointestinal symptoms should raise suspicion of the presence of advanced metastatic disease with poor prognosis.

DOI： 10.1111/1759-7714.13410

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Molecular characteristics of carcinoma arising from mature cystic teratoma of the ovary (MCT) remain unclear due to its rarity. We analyzed RNA-sequencing data of 2322 pan-cancer [1378 squamous cell carcinomas (SCC), 6 adenosquamous carcinomas (ASC), and 938 adenocarcinomas (AC)] including six carcinomas arising from MCT (four SCCs, one ASC, and one AC). Hierarchical clustering and principal component analysis showed that gene expression profiles of carcinomas arising from MCT were different between each histological type and that gene expression profiles of SCCs arising MCT (MCT-SCCs) was apparently similar to those of lung SCCs. By epidermis-associated pathways activity based on gene set enrichment analysis, 1030 SCCs were divided into two groups: epidermis-signature high (head and neck, esophagus, and skin) and low (cervix, lung, and MCT). In addition to pan-SCC transcriptome analysis, cytokeratin profiling based on immunohistochemistry in the independent samples of 21 MCT-SCCs clarified that MCT-SCC dominantly expressed CK18, suggesting the origin of MCT-SCC was columnar epithelium. Subsequently, we investigated differentially expressed genes in MCT-SCCs compared with different SCCs and identified XCL1 was specifically overexpressed in MCT-SCCs. Through immunohistochemistry analysis, we identified XCL1 expression on tumor cells in 13/24 (54%) of MCT-SCCs but not in MCTs. XCL1 expression was also significantly associated with the number of tumor-infiltrating CD8-positive T cells and PD-L1 expression on tumor cells. XCL1 produced by tumor cells may induce PD1/PD-L1 interaction and dysfunction of CD8-positive T cells in tumor microenvironment. XCL1 expression may be a novel biomarker for malignant transformation of MCT into SCC and a biomarker candidate for therapeutic response to an anti-PD1/PD-L1 therapy.

DOI： 10.1038/s41388-020-1237-0

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jss.2019.07.040

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gastric cancer is one of the most common and clinically important diseases worldwide. The traditional Laeuren classification divides gastric cancer into two histopathological subtypes: diffuse and intestinal. Recent cancer genomics research has led to the development of a new classification based on molecular characteristics. The newly defined genomically stable (GS) subtype shares many cases with the histopathologically diffuse type. In this study, we performed genetic profiling of recurrently and significantly mutated genes in diffuse type and GS subtype tumors. We observed significantly different genetic characteristics, although the two subtypes overlapped in many cases. In addition, based on the profiles of the significantly mutated genes, we identified molecular functions and mutational signatures characteristic of each subtype. These results will advance the clinical application of the diffuse type and GS subtype gastric cancer in precision medicine for treating gastric cancer.

DOI： 10.1016/j.csbj.2020.10.021

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 62-year-old man was admitted with complaints of bloody stool. Colonoscopy revealed a 5 cm diameter type 2 tumor in the lower rectum close to the anal canal. Tumor biopsy indicated a well-differentiated tubular adenocarcinoma. Computed tomography revealed locally advanced rectal cancer with mesorectal lymph node metastases(cT3N1P0M0, Stage Ⅲa, JSCCR 8th). The patient was treated with neoadjuvant chemotherapy(NAC)after transverse colostomy as an anus-preserving procedure. For the NAC, 12 courses of capecitabine plus oxaliplatin(CapeOX)and bevacizumab(BV)were administered. Colonoscopy after NAC revealed that the main tumor had considerably shrunk. No malignant tissues were found on biopsy. However, rectal wall thickness remained unchanged. Therefore, response evaluation for chemotherapy indicated partial response. Intersphincteric resection(ISR)with diverting loop ileostomy was performed as an anus-preserving surgical procedure. No remnant tumor in the rectum or lymph node metastases were found upon the pathological examination of resected specimens. Ileostomy closure was performed at 6 months post-ISR. At 12 months post-ISR, the patient was well and showed no signs of recurrence. This case demonstrated that NAC with CapeOX and BV can be a promising option for treating locally advanced lower rectal cancer and preserving the anus.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 66-year-old man with middle thoracic esophageal squamous cell carcinoma with supraclavicular lymph node metastasis visited our hospital. He underwent 3 courses of preoperative chemotherapy with docetaxel, cisplatin, and 5-FU(DCF)with a clinically-determined partial response. Minimally-invasive esophagectomy with 3-fieldlymphad enectomy was subsequently performed. Histopathologic examination revealedno viable tumor cells in the resectedesophagus andsupraclavicular lymph node. DCF is a promising preoperative chemotherapy regimen for locally advanced esophageal cancer because of its higher complete response rate comparedto that for cisplatin plus 5-FU.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

AIM: This study aimed to determine surgical outcomes in patients with gynecological cancers for whom surgery was performed by gynecologists and digestive surgeons. METHODS: Seventy-three patients who underwent surgery for a gynecological malignant tumor from January 2010 to December 2014 were included in this retrospective study. Data on the definitive diagnosis, operative procedures, postoperative complications, stoma settings, length of hospital stay, and prognosis was collected for each patient. RESULTS: The median age of this female-only cohort was 60 years. Emergency surgery was performed in 8(11.0%)patients. Ovarian cancer was diagnosed in 56(76.7%)patients, and among these patients, the clinical disease Stage was Ⅰ, Ⅱ, Ⅲ, and Ⅳ in 4, 4, 20, and 11 patients, respectively. Moreover, 17 patients had recurrent ovarian cancer. Intestinal resection with anastomosis was performed in 25(34.2%)patients. Stoma formation was performed in 22 (30.1%)patients, however no patient underwent stoma closure surgery in the current study. The median operative time was 252 minutes, and the median blood loss was 1,190 mL. Regarding postoperative complications, ileus, pelvic abscess, and anastomotic leakage developed in 6(8.2%), 4(5.5%), and 2(2.7%)patients, respectively. The postoperative median survival time in patients with ovarian cancer was 1,399 days. CONCLUSION: These results suggest that tumor debulking, including intestinal tract resection, may contribute to the prolonged prognosis of gynecological tumors, although stoma closure is difficult to perform.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 65-year-old woman was referred for further examination following positive results on a fecal occult blood test. Colonoscopy revealed type 0-Ⅱa cancer, with a lesion measuring 2 cm in diameter in the rectosigmoid colon, and type 5 cancer, with a lesion measuring 6 cm in diameter in the upper rectum. Computed tomography(CT)and positron emission tomography (PET)-CT revealed mesorectal lymph node metastases. Therefore, she was diagnosed with rectosigmoid colon cancer(Stage Ⅰ)and upper rectal cancer(Stage Ⅲa). However, PET-CT also revealed slight fluorodeoxyglucose uptake in the paraaortic and lateral lymph node lesions; hence, the possibility ofmetastasis could not be ruled out. Given that chemotherapy was restricted due to renal dysfunction, low anterior resection was performed as the first choice. Analysis of intraoperative frozen sections showed paraaortic and lateral lymph node metastases; thus, we performed lymph node dissection of these lesions. Pathological examination ofthe resected lymph nodes revealed that 21 of 37 lesions were cancer metastases. S-1 was administered as adjuvant chemotherapy for 5 months. Mediastinal lymph node metastases was suspected on chest CT 5 months and 3 years post-surgery; thus, panitumumab was administrated. These lymph nodes decreased in size immediately. Six years after the first surgery, the patient was well without any signs of recurrence.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 77-year-old woman presented with peritoneal metastases from a pancreatic neuroendocrine tumor(p-NET). At the age of 56 years, she underwent distal pancreatectomy for p-NET, which was pathologically diagnosed as G2. She underwent right hemihepatectomy for liver metastasis(S6)from the p-NET 10 years post-pancreatectomy. Eight years post-hepatectomy, radiofrequency ablation(RFA)was attempted for liver metastasis(S4)from the p-NET. However, RFA was not completed because of hematoma development along the needle tract of RFA. She underwent partial hepatectomy for this lesion 6 months post-RFA. Two years post-RFA, localized peritoneal metastases on the right diaphragm were detected. She underwent en bloc tumor resection with partial resection of the diaphragm. She remains alive and well with no evidence of disease 2 years post-resection of the peritoneal metastases from the p-NET.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 78-year-old woman was endoscopically followed up for benign melanocytosis in the middle thoracic esophagus that was detected 3 years prior. She presented with chest tightness, and an endoscopic examination revealed a protruding tumor at the melanotic lesion. She was histologically diagnosedwith an esophageal primary malignant melanoma. Computedtomography showedno metastatic lesions. She underwent minimally invasive esophagectomy with 2-fieldlymphad enectomy. Immunotherapy with nivolumab is ongoing for liver metastasis, which developed1 year and6 months after esophagectomy. Careful follow-up for esophageal melanocytosis is important for early diagnosis of esophageal primary malignant melanoma.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 37-year-old man was admitted to our hospital for the treatment of familial adenomatous polyposis and rectal carcinoma. He underwent total colectomy with ileoanal anastomosis(pT3N1M0, pStage Ⅲa)followed by adjuvant therapy with S-1. Three months after primary surgery, CT and MRIrevealed liver metastases(S5, S6). Laparoscopic partial hepatectomy was performed. Two years after primary surgery, new liver metastases(S2, S8)were found and we performed open partial hepatectomy and administered mFOLFOX6. Three years and 5 months after primary surgery, right lung metastases(S6, S9) were detected and the patient underwent a thoracoscopic-assisted right lung wedge resection. Repeated resection of metastases might have contributed to the long-survival in our case.

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は78歳、女性。健診目的の上部消化管内視鏡検査で胸部中部食道に食道メラノーシスを認め、経過観察されていた。3年後に胸部圧迫感を自覚し上部消化管内視鏡検査を施行したところ、食道メラノーシスの部位に一致して1型腫瘍を認めた。生検にて食道原発悪性黒色腫と診断された。cT2N0M0、Stage II(食道癌取扱い規約第11版)であったため、根治的な食道切除術を施行した。術後1年6ヵ月のCT検査で肝転移を認め、一次治療としてnivolumabによる免疫療法を施行中である。食道メラノーシスに対しては食道原発悪性黒色腫の発症を念頭に置いた注意深い経過観察が必要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は66歳、男性。右頸部に腫瘤を自覚し、精査にて48×34mm大の右鎖骨上リンパ節転移を伴う胸部中部食道扁平上皮癌、cT2N2M0、cStage IIIと診断された。術前docetaxel/cisplatin/5-FU(DCF)療法を3コース施行され、部分奏効と判定された。手術は胸腔鏡下食道切除術、3領域リンパ節郭清、胸骨後経路胃管再建を施行された。術後病理組織学的診断にて原発巣および右鎖骨上リンパ節転移巣ともに腫瘍細胞の遺残を認めず、組織学的完全奏効と判定された。進行食道癌に対する術前DCF療法は高い組織学的完全奏効割合から新規術前化学療法として有望である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は77歳、女性。56歳時に膵腫瘍に対し尾側膵切除を施行され、病理組織学的検査で膵神経内分泌腫瘍(p-NET)G2と診断された。膵切除10年後に肝S6転移に対し肝右葉切除を施行された。初回肝切除8年後に肝S4転移を認め、ラジオ波焼灼療法(RFA)を施行されたが、肝内に血腫を形成して中止された。RFA施行6ヵ月後に肝S4部分切除を施行された。RFA施行2年後に右横隔膜下に限局性腹膜播種再発を認め、開胸を伴う右横隔膜合併切除を行い、病変を一括切除した。播種切除後2年が経過し、無再発生存中である。p-NETの限局性腹膜播種再発では他部位に再発巣がなく、根治切除が可能であれば外科切除が生存期間の延長に寄与する可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は37歳、男性。家族性大腸腺腫症および直腸癌、cT3N0M0、cStage IIの診断で、大腸全摘、回腸嚢肛門吻合、D3リンパ節郭清術を施行した。病理組織学的診断の結果は直腸癌、pT3N1M0、pStage IIIaであったため、術後補助化学療法としてS-1の内服を開始した。術後3ヵ月目に肝転移(S5、S6)を認め、腹腔鏡下肝部分切除術を施行した。術後24ヵ月後、肝転移再発(S2、S8)を認め、開腹肝部分切除術を施行した。術後41ヵ月後、右肺S6、S9に転移を認め、胸腔鏡補助下肺部分切除術(S6、S9)を行った。転移巣に対し外科的切除を行い、長期生存を得られている家族性大腸腺腫症に伴う直腸癌の1例を経験した。複数回の肝転移切除術、肺転移切除術の意義を示す症例として報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は62歳、男性。主訴は血便。下部消化管内視鏡検査で、下部直腸に5cm大の直腸癌が指摘された。組織型は高分化管状腺癌であり、腫瘍下縁は肛門管近傍まで達していた。腹部骨盤部造影CT検査で直腸間膜リンパ節転移が指摘され、進行直腸癌(cT3N1P0M0、Stage IIIa、大腸癌取扱い規約第8版)と診断された。本人が肛門温存を希望したため、前医で術前化学療法の方針となった。化学療法としてcapecitabine、oxaliplatin(CapeOX)+bevacizumab(BV)療法が12コース施行された。化学療法後の下部消化管内視鏡検査で腫瘍は著明に縮小し、肉眼的には厚みのある瘢痕のみとなっていた。瘢痕からの生検では悪性所見を認めなかった。しかし画像検査で直腸壁の肥厚は残存していたため、化学療法の効果判定はpartial response(縮小率40%)、ycT3N0M0、ycStage IIと診断した。肛門温存手術が可能と判断して、括約筋間直腸切除術、一時的回腸人工肛門造設術を施行した。切除標本の組織診断では主病巣に悪性細胞を認めず、リンパ節転移も陰性であった。原発巣切除後6ヵ月目に小腸人工肛門閉鎖術を施行した。術後追加治療を行わずに外来で経過観察中であるが、再発の所見は認めていない。CapeOX+BV療法によって組織学的完全奏効が得られた進行下部直腸癌の1例を経験したので報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

背景:婦人科悪性腫瘍に対して、婦人科医と消化器外科医による合同手術がしばしば行われているが、その術後成績については明らかでない。目的:婦人科悪性疾患手術時に消化器外科医が介入した症例について、術式、合併症、予後などの術後成績を明らかにすることを目的とした。対象と方法:2010年1月〜2014年12月までの5年間の73例を対象とした。疾患、術式、術後合併症、ストーマの有無、入院期間、予後などを検討した。結果:年齢中央値(範囲)は60(15〜78)歳、73例全例が女性であった。緊急手術が8例(11.0%)含まれていた。疾患は、卵巣癌が56例(76.7%)と最も多く、Stageの内訳はStage I/II/III/IV/再発:4/4/20/11/17例であった。25例(34.2%)で腸管切除吻合が行われていた。また、22例(30.1%)でストーマが造設されていたが、本検討ではストーマ閉鎖を行えた症例はなかった。手術時間(婦人科原発巣手術時間も含む)中央値(範囲)は252(37〜690)分であり、出血量は1,190(0〜11,210)mLであった。術後の合併症(Clavien-Dindo II以上)として、イレウス6例(8.2%)、腹骨盤内膿瘍4例(5.5%)、縫合不全2例(2.7%)などがみられた。Grade III以上の合併症としてはイレウス、縫合不全、腹水、膵液瘻がそれぞれ1例ずつ認められた。卵巣癌全症例の術後生存期間中央値は1,399日であった。結論:婦人科との合同手術のなかで、消化器外科医は進行卵巣癌の手術に携わることが多い。ストーマを造設した症例のストーマ閉鎖は困難であるが、消化管切除を含む腫瘍切除によって予後の延長に寄与することが期待される。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は65歳、女性。便潜血陽性のため下部消化管内視鏡検査が施行され、直腸S状部に2cm大のtype 0-IIa病変(組織型はtub2、por)、上部直腸に6cm大の5型病変(組織型はmuc、sig、tub2)が指摘された。胸腹骨盤部CT検査、PET-CT検査で腸管傍リンパ節転移陽性と診断された。直腸間膜リンパ節、大動脈周囲リンパ節、側方リンパ節領域にも淡いfluorodeoxyglucose集積を認めた。転移の可能性も否定できなかったが、直腸S状部癌cT1bN0M0、Stage I、上部直腸癌cT3N1M0、Stage IIIa(大腸癌取扱い規約第8版)と診断した。腎機能障害により化学療法の選択に制限があったため手術先行の方針とし、低位前方切除術を施行した。術中、大動脈周囲リンパ節、左総腸骨動脈リンパ節を迅速診断に提出し、リンパ節転移陽性と診断された。リンパ節以外に遠隔転移を認めなかったことからR0切除が可能と判断し、転移陽性であった領域のリンパ節は可及的に切除した。切除標本の組織診断では、直腸S状部の病変は深達度T1b、上部直腸病変は深達度T3であった。切除リンパ節37個中21個で転移陽性であった。RAS遺伝子検査では野生型であった。補助化学療法としてS-1単剤療法を施行した。術後5ヵ月目と3年目に縦隔リンパ節転移が疑われたためpanitumumab単剤療法を行ったところ、リンパ節腫大は縮小した。現在、初回手術から6年が経過したが直腸癌再発は認めていない。長期生存が得られている大動脈周囲リンパ節、側方リンパ節への転移を伴った進行直腸癌の1例を経験したので報告する。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10388-019-00665-0

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/his.13805

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.amsu.2019.02.004

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/s41598-019-39328-6

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jss.2018.09.012

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Numerous technical and functional advances in next-generation sequencing (NGS) have led to the adoption of this technique in conventional clinical practice. Recently, large-scale genomic research and NGS technological innovation have revealed many more details of somatic and germline mutations in solid tumors. This development is allowing for the classification of tumor type sub-categories based on genetic alterations in solid tumors, and based on this information, new drugs and targeted therapies are being administered to patients. This has largely been facilitated by gene panel testing, which allows for a better understanding of the genetic basis for an individual's response to therapy. NGS-based comprehensive gene panel testing is a clinically useful approach to investigate genomic mechanisms, including therapy-related signaling pathways, microsatellite instability, hypermutated phenotypes, and tumor mutation burden. In this review, we describe the concept of precision medicine in solid tumors using NGS-based comprehensive gene panel testing, as well as the importance of quality control of tissue sample handling in routine NGS-based genomic testing, and we discuss issues for the future adoption of this technique in Japan.

DOI： 10.1007/s10147-018-1375-3

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は78歳、女性。黄疸を主訴に来院した。ウイルス性肝炎は陰性で、AFP 925ng/mL、PIVKA-II 6,820mAU/mLはともに上昇していた。CT検査で肝S1に径3cm大の腫瘍と、これより連続して右肝管内に至る胆管内腫瘍栓を認めた。胆管内腫瘍を伴う肝細胞癌と診断し、減黄を図りつつ肝動脈化学塞栓療法を実施後に肝左葉切除、尾状葉切除、肝外胆管切除を実施した。胆道鏡検査で胆管内腫瘍栓の右肝管への浸潤が疑われ、右前・後区域胆管合流部直下で胆管を切離した。病理組織学的には中分化型肝細胞癌で胆管内腫瘍栓を認めたが、血管侵襲陰性、切離断端陰性であった。術後5年4ヵ月が経過し、無再発生存中である。自験例の経験および文献的考察から、根治切除が可能な胆管内腫瘍栓を伴う肝細胞癌では長期生存が得られる症例が存在するので、肝切除を考慮するべきである。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40792-019-0570-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nature Publishing Group  

Next-generation sequencing (NGS) has enabled comprehensive detection of genomic alterations in lung cancer. Ethnic differences may play a critical role in the efficacy of targeted therapies. The aim of this study was to identify and compare genomic alterations of lung adenocarcinoma between Japanese patients and the Cancer Genome Atlas (TCGA), which majority of patients are from the US. We also aimed to examine prognostic impact of additional genomic alterations in patients harboring EGFR mutations. Genomic alterations were determined in Japanese patients with lung adenocarcinoma (N = 100) using NGS-based sequencing of 415 known cancer genes, and correlated with clinical outcome. EGFR active mutations, i.e., those involving exon 19 deletion or an L858R point mutation, were seen in 43% of patients. Some differences in driver gene mutation prevalence were observed between the Japanese cohort described in the present study and the TCGA. Japanese cohort had significantly more genomic alterations in cell cycle pathway, i.e., CDKN2B and RB1 than TCGA. Concurrent mutations, in genes such as CDKN2B or RB1, were associated with worse clinical outcome in patients with EGFR active mutations. Our data support the utility of comprehensive sequencing to detect concurrent genomic variations that may affect clinical outcomes in this disease.

DOI： 10.1038/s41598-017-18560-y

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jss.2018.06.020

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は74歳、女性。心窩部痛の精査目的に当院を紹介され、多発リンパ節転移を伴う進行胃癌、cT4aN2M0、cStage IIIBと診断した。術前補助化学療法としてSP療法(S-1 100mg day 1〜21、cisplatin 80mg day 8)を2コース施行した。効果判定はnon-CR/non-PD(RECIST ver1.1)と診断した。切除を試みたが、腹腔内に多数の腹膜播種転移を認め、根治切除不能と判断した。化学療法をXP療法(capecitabine 3,000mg day 1〜14、cisplatin 112mg day 1)に変更したが、1コース施行後に原発巣の増大による腫瘍出血と狭窄症状を認めた。化学療法を中止して姑息的な幽門側胃切除術を行ったが、全身状態の改善に乏しく、胃切除後17病日に死亡した。癌遺伝子パネルによる解析を施行したところ、高度マイクロサテライト不安定性(MSI-H)胃癌と判定した。近年の遺伝子解析の結果から、大腸癌と同様に胃癌においてもMSI-H症例に対する周術期化学療法は効果に乏しい可能性がある。本症例は、胃癌における分子生物学的背景に基づいた治療戦略を検討する上で示唆に富む症例であると考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は57歳、女性。腹部膨満感と食欲低下を主訴に来院した。腹部CT検査で腹腔内臓器を圧排する巨大な後腹膜腫瘍を認め、後腹膜脂肪肉腫と診断し、手術を施行した。腫瘍は下行結腸、左腎臓、左卵巣を巻き込んでおり、腫瘍とともにこれらの臓器をen blocに摘出した。病理組織学的検査で脱分化型脂肪肉腫と診断された。術後1年目のCT検査で膵頭部背側に低濃度腫瘤の新規出現を認め、脂肪肉腫の再発と診断した。遠隔転移を認めず、完全切除が可能と判断し、再発巣に対して亜全胃温存膵頭十二指腸切除術を施行した。術後は特記すべき合併症を認めなかった。再発巣切除から1年が経過した現在、無再発生存中である。後腹膜脂肪肉腫に対し有効な化学療法が存在しない現況を考慮すると、本疾患の予後改善のためには可能な限り外科的切除を追求する必要があるものと考える。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は78歳、男性。下痢を主訴に受診し、肝転移を伴う直腸癌と診断された。術中所見で肝転移は切除不能と診断され、局所制御のため超低位前方切除術を施行した。術後にmFOLFOX6+bevacizumab療法を5コース、FOLFIRI+bevacizumab療法を2コース施行したが、どちらも奏効しなかった。後方視的に施行した次世代シークエンサーによる遺伝子変異解析パネル検査(415遺伝子)では、原発巣に高頻度の体細胞変異を有するhypermutationであったことが判明した。大腸癌におけるhypermutationの多くはミスマッチ修復遺伝子の異常を有し、5-fluorouracil系抗癌剤が無効である可能性がある。一方で、免疫チェックポイント阻害薬が有効である可能性がある。薬物療法前に遺伝子変異解析パネル検査を行うことで、個々の患者に最適な治療法を提案できる可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は65歳、女性。同時性肝転移を伴う上行結腸癌[T3N1M1(H2)、Stage IV]と診断し、結腸右半切除術を施行した。11個の肝転移に対して、5-FU肝動注療法を施行した。縮小率28.9%と奏効していたが、10ヵ月施行時に肝S2の病変が増大した。全身化学療法としてIRIS療法を施行したが奏効せず、拡大肝外側区域切除を施行した。さらに4ヵ月後、肝S6の再発病変に対して肝後区域切除を施行した。その9ヵ月後に肝S1の肝転移巣を指摘され、CapeOX、mFOLFOX6療法を施行したが、標的病変が増大し、肝S1部分切除を施行した。さらに4ヵ月後、肝S8に再発を来し、肝S8部分切除を行った(原発巣切除術後7年)。以後5年5ヵ月、再発を認めていない。本症例は分子標的薬導入以前の症例であり、肝動注療法、全身化学療法、4回の肝切除を行うことで12年5ヵ月の長期生存を得た。大腸癌肝転移に対する肝動注療法、複数回肝切除の意義を示す症例として報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は59歳、女性。心窩部痛を主訴に発症し、精査にて切除可能膵頭部癌と診断された。幽門輪温存膵頭十二指腸切除術を施行した。病理所見は高分化型管状腺癌で、細胞質に粘液成分を多く含む核異型の軽度な腫瘍細胞を主体としていた。最終診断は膵頭部癌、pT3N0M0、Stage IIAであった。術後、肝灌流療法として5-FUの肝動注・門脈注を行い、引き続きgemcitabineでの術後補助化学療法を1年間施行した。術後7年目のCT、PET-CTで左頸部リンパ節転移が疑われた。全身検索では他臓器癌を認めなかった。診断を兼ねて再切除の方針となり、左頸部リンパ節摘出術を行った。病理組織は初回切除時の原発巣と同様な組織像を呈する豊富な粘液産生を伴う高分化型腺癌であり、膵癌の再発として矛盾しなかった。術後はS-1単独療法を約1年間行った。現在は再切除から3年10ヵ月無再発生存中であり、初回手術から11年の長期生存を得ている。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20190107600174&doc_link_id=%2Fab8gtkrc%2F2018%2F004513%2F174%2F2312-2314%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004513%2F174%2F2312-2314%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

肝細胞癌(HCC)の腹膜播種はまれであり、これに対する外科切除の治療効果に関しては一定の見解が得られていない。症例1:48歳、男性。肝S6のHCCに対し二度の肝切除、一度のラジオ波焼灼療法(RFA)が施行された。初回手術から8年後に骨盤底に腹膜播種を来し外科切除が施行された。腹膜播種切除後17ヵ月が経過し再発生存中である。症例2:71歳、男性。肝S6のHCCに対して三度の穿刺局所療法が施行され、残肝局所再発に対し手術が施行された。腫瘍近傍に腹膜播種を認め同時切除が行われたが、骨盤内再発を認めて腹膜播種切除後20ヵ月目に原病死した。症例3:58歳、男性。肝S6のHCCに対する肝S6亜区域切除後8年目に十二指腸狭窄を伴う腹膜播種が認められた。外科切除を施行したが、その2ヵ月後に原病死した。文献的考察や自験例の経験から、HCC腹膜播種(少数個)に対して外科切除は有効な治療選択肢の一つになり得る。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J00296&link_issn=&doc_id=20190107600053&doc_link_id=%2Fab8gtkrc%2F2018%2F004513%2F053%2F1949-1951%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2018%2F004513%2F053%2F1949-1951%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞次世代シークエンサーを用いた癌遺伝子パネル検査によって,RAS/RAF遺伝子をはじめとする薬剤耐性関連の遺伝子変異や,HER2遺伝子増幅などの治療標的の候補となる遺伝子変異の網羅的検索が大腸癌において可能となる.今後の遺伝子解析に備え,手術や生検組織検体の適切な保存について熟知しておくことが重要である.Lynch症候群の大腸癌はマイクロサテライト不安定性を呈し,免疫チェックポイント阻害薬が有効である可能性が示唆され注目を集めている.癌遺伝子パネル検査の普及によって,Lynch症候群などの遺伝性腫瘍と診断される症例が今後増加することが予想され,遺伝カウンセリングやサーベイランスなどの患者,家族の支援体制の整備が急務である.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J00393&link_issn=&doc_id=20181106040006&doc_link_id=issn%3D0016-593X%26volume%3D80%26issue%3D12%26spage%3D1218&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D80%26issue%3D12%26spage%3D1218&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/cas.13837

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jss.2018.07.007

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記述言語：日本語   出版者・発行元：(株)メディカルドゥ  

次世代シークエンサーによるがんゲノム解析に使用するホルマリン固定パラフィン包埋サンプルの作製にあたっては、10%中性緩衝ホルマリン固定液を使用すること、固定は48時間以内とすることが肝要である。がんゲノム解析では、マイクロサテライト不安定性を有するグループを同定することが可能であり、大腸がんや胃がんにおける周術期化学療法の適応決定に有用である。また切除不能進行再発大腸がんでは、ゲノム情報に基づいて治療効果の高い薬剤を選択することにより、効率よくconversion surgeryを行えるようになることが期待される。(著者抄録)

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記述言語：英語  

DOI： 10.1093/jscr/rjy214

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/s41598-018-29144-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1200/PO.17.00211

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1200/PO.18.00097

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12957-018-1428-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer New York LLC  

Background: Lung squamous cell carcinoma (LSCC) is a major histological subtype of lung cancer. In this study, we investigated genomic alterations in LSCC and evaluated the clinical implications of mutation burden (MB) in LSCC. Methods: Genomic alterations were determined in Japanese patients with LSCC (N = 67) using next-generation sequencing of 415 known cancer genes. MB was defined as the number of non-synonymous mutations per 1 Mbp. Programmed death-ligand 1 (PD-L1) protein expression in cancer cells was evaluated by immunohistochemical analysis. Results: TP53 gene mutations were the most common alteration (n = 51/67, 76.1%), followed by gene alterations in cyclin-dependent kinase inhibitor 2B (CDKN2B
35.8%), CDKN2A (31.3%), phosphatase and tensin homolog (30.0%), and sex-determining region Y-box 2 (SOX2, 28.3%). Histological differentiation was significantly poorer in tumors with high MB (greater than or equal to the median MB) compared with that in tumors with low MB (less than the median MB
p = 0.0446). The high MB group had more tumors located in the upper or middle lobe than tumors located in the lower lobe (p = 0.0019). Moreover, cancers in the upper or middle lobes had significantly higher MB than cancers in the lower lobes (p = 0.0005), and tended to show higher PD-L1 protein expression (p = 0.0573). SOX2 and tyrosine kinase non-receptor 2 amplifications were associated with high MB (p = 0.0065 and p = 0.0010, respectively). Conclusions: The MB level differed according to the tumor location in LSCC, suggesting that the location of cancer development may influence the genomic background of the tumor.

DOI： 10.1245/s10434-018-6401-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Mosby Inc.  

Background: Sphingosine-1-phosphate, a pleiotropic bioactive lipid mediator, is an important player in cancer progression. Previous studies suggested that sphingosine-1-phosphate produced by sphingosine kinase 1, which is activated by phosphorylation, plays important roles in the progression of disease and metastasis. The association between phospho-sphingosine-1-phosphate produced by sphingosine kinase 1 and clinical parameters in human gastric cancer have not been fully investigated to date. Methods: We created phospho-sphingosine-1-phosphate produced by sphingosine kinase expression profiles by immunohistochemistry for 136 patients who underwent operative intervention for gastric cancer in 2007–2009. Phospho-sphingosine-1-phosphate produced by sphingosine kinase expression and compared clinicopathologic factors by univariate and multivariate analyses. Results: The univariate analysis revealed that phospho-sphingosine-1-phosphate produced by sphingosine kinase expression was correlated significantly with depth of tumor invasion, lymph node metastasis, distant metastasis, histologic type, and lymphatic invasion. The multivariate analysis revealed that the diffuse type (odds ratio 2.210
95% confidence interval, 1.045–4.671, P =.038) and the presence of lymphatic invasion (odds ratio 3.697
95% confidence interval, 1.161–8.483, P =.002) were associated independently with phospho-sphingosine-1-phosphate produced by sphingosine kinase expression in patients with gastric cancer. The 5-year rate of disease-specific survival was 79.3% in patients with phospho-sphingosine-1-phosphate produced by sphingosine kinasephospho-sphingosine-1-phosphate produced by sphingosine kinase-positive expression and 98.3% in those with phospho-sphingosine-1-phosphate produced by sphingosine kinase-negative expression (P =.002). In multivariate analysis, however, high phospho-sphingosine-1-phosphate produced by sphingosine kinase expression was not an independent prognostic factor for disease-specific survival (hazard ratio 5.540
95% confidence interval, 0.717–42.81, P =.100). Conclusion: We provide the first evidence that diffuse histologic type and lymphatic invasion were independently associated with high phospho-sphingosine-1-phosphate produced by sphingosine kinase expression in gastric cancer patients, indicating a role of sphingosine-1-phosphate in disease progression among patients with gastric cancer. (Surgery 2017
160:XXX-XXX.)

DOI： 10.1016/j.surg.2017.11.024

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer New York LLC  

Background: The number of patients with remnant gastric cancer following resection of gastric cancer may increase. The aims of this study were to investigate the development of remnant gastric cancer after distal gastrectomy for gastric cancer and to examine its cumulative incidence, clinicopathological characteristics, and risk factors. Methods: We examined 437 patients with relapse-free survival for 5 years or more after distal gastrectomy with Billroth I reconstruction for gastric cancer performed between 1985 and 2005. Results: A total of 17 patients suffered from remnant gastric cancer. The cumulative incidence was 3.7% at 10 years and 5.4% at 20 years. The median time until development of remnant gastric cancer was 79 months (range 30–209 months). The presence of synchronous multiple gastric cancers was a significant independent risk factor for remnant gastric cancer (hazard ratio 4.036
95% confidence interval 1.478–11.02
P = 0.006). Of the 17 patients, the 13 whose remnant gastric cancer was detected via regular endoscopy showed better prognoses than the patients detected by other means (P &lt
 0.001). Conclusion: The cumulative incidence of remnant gastric cancer was 5.4% at 20 years. In particular, patients who had multiple gastric cancers at initial gastrectomy were at higher risk for remnant gastric cancer. Therefore, long-term endoscopic surveillance is important.

DOI： 10.1007/s00268-017-4227-9

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記述言語：英語   出版者・発行元：AME Publishing Company  

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. However, rectal GIST is rare, the incident rate of it is approximately 5% of all GISTs. Rectal GIST symptoms generally include bleeding and/or pain and occasionally, urinary symptoms. Immunohistochemical evaluation finds that most rectal GIST tumors are CD117 (KIT) positive, and are sometimes CD34, platelet-derived growth factor receptor alpha (PDGFRA), smooth muscle actin, S-100, or vimentin positive. The National Institutes of Health (NIH) classifies rectal GIST as very-low risk, low risk, intermediate risk, or high risk, and the frequencies have been estimated as 0-23.8% for very-low risk, 0-45% for low risk, 0-34% for intermediate risk, and 21-100% for high risk tumors. The first-line treatment for localized GIST is curative resection, but is difficult in rectal GIST because of anatomical characteristics such as the deep, narrow pelvis and proximity to the sphincter muscle or other organs. Several studies noted the efficacy of the minimally invasive surgery, such as trans-anal, trans-sacral, trans-vaginal resection, or laparoscopic resection. The appropriate surgical procedure should be selected depending on the case. Imatinib mesylate (IM) is indicated as first-line treatment of metastatic or unresectable GIST, and clinical outcomes are correlated with KIT mutation genotype. However, the KIT mutation genotypes in rectal GIST are not well known. In this review, as in other GISTs, a large proportion (59-100%) of rectal GISTs carry exon 11 mutations. Although curative resection is indicated for localized rectal GIST, a high rate of local recurrence is a problem. Multimodal therapy including perioperative IM may improve postoperative outcomes, contributing to anus-preserving surgery. Moreover, KIT mutation analysis before IM treatment is important. This review summarizes current treatment strategies for rectal GIST.

DOI： 10.21037/tgh.2018.01.08

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ACADEMIC PRESS INC ELSEVIER SCIENCE  

Introduction: Precision medicine is only possible in oncology practice if targetable genes in fragmented DNA, such as DNA from formalin-fixed paraffin-embedded (FFPE) samples, can be sequenced using next generation sequencing (NGS). The aim of this study was to examine the quality and quantity of DNA from FFPE cancerous tissue samples from surgically resected and biopsy specimens.
Methods: DNA was extracted from unstained FFPE tissue sections prepared from surgically resected specimens of breast, colorectal and gastric cancer, and biopsy specimens of breast cancer. A total quantity of DNA &gt;= 60 ng from a sample was considered adequate for NGS. The DNA quality was assessed by Q-ratios, with a Q-ratio &gt;0.1 considered sufficient for NGS.
Results: The Q-ratio for DNA from FFPE tissue processed with neutral-buffered formalin was significantly better than that processed with unbuffered formalin. All Q-ratios for DNA from breast, colorectal and gastric cancer samples indicated DNA levels sufficient for NGS. DNA extracted from gastric cancer FFPE samples prepared within the last 7 years is suitable for NGS analysis, whereas those older than 7 years may not be suitable. Our data suggested that adequate amounts of DNA can be extracted from FFPE samples, not only of surgically resected tissue but also of biopsy specimens.
Conclusions: The type of formalin used for fixation and the time since FFPE sample preparation affect DNA quality. Sufficient amounts of DNA can be extracted from FFPE samples of both surgically resected and biopsy tissue, thus expanding the potential diagnostic uses of NGS in a clinical setting. (C) 2017 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jss.2017.06.077

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は81歳、女性。C型肝硬変で通院中にCTで肝S7に径20mm大の腫瘤を指摘され、肝細胞癌(HCC)と診断された。高齢であり本人が肝切除を望まなかったので、病変に対して2回の肝動脈化学塞栓療法(TACE)を施行した。1年後のCTで局所再発と大動脈周囲リンパ節転移を認めた。局所再発に対してはTACEを施行し、大動脈周囲リンパ節転移に対しては外科切除を施行した。外科切除から6ヵ月後、CTで縦隔リンパ節転移を認め、放射線局所照射療法を施行した。原病の診断から7年が経過した現在、無再発で外来経過観察中である。HCCの肝外転移再発は肺、骨、リンパ節への転移が多く、有効な治療法は確立されていない。孤立性のリンパ節転移を伴うHCCに対して、TACE、外科切除、放射線局所照射療法を組み合わせた集学的治療は予後延長に寄与する可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

SRC発現の亢進した癌は遠隔転移や薬剤耐性と関連があり、治療抵抗性とされている。今回、次世代シークエンサーによる415の癌関連遺伝子パネルを使用した後方視的な解析により、SRC増幅を認めた2例を報告する。症例1は62歳、男性。両葉多発肝転移を伴うRAS野生型cStage IVのS状結腸癌に対して、S状結腸切除を施行した。切除不能多発肝転移に対して、化学療法を行った。症例2は73歳、男性。肝外側区域に転移を伴うRAS野生型cStage IVの下行結腸癌に対して、左半結腸切除および外側区域切除を施行した。その後、肝再発に対して開腹ラジオ波焼灼術および化学療法を行った。SRC発現の亢進した大腸癌に対して、チロシンキナーゼ阻害薬による分子標的治療が有効であるという報告がある。包括的癌ゲノム検査により、新たな治療提案ができる可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は71歳、男性。急激な腹痛を主訴に当科を受診した。心房細動、脳梗塞、心弁置換術後の既往を有し、ワーファリンを内服中であった。腹部造影CTで血性腹水と十二指腸水平脚に接する巨大な腫瘤を認めた。腫瘤は石灰化を伴う充実性部分と新旧の血腫とが混在して被包化されていた。十二指腸原発の消化管間質腫瘍の穿破による腹腔内出血が疑われ、開腹手術が施行された。術中所見で右側結腸間膜原発の脂肪肉腫が疑われ、結腸右半切除術を伴う腫瘤摘出術が施行された。病理組織学的にて腫瘍内出血を伴う混合型脂肪肉腫と診断された。術後は合併症なく経過し、術後第8病日目に退院した。術後52ヵ月が経過した現在、無再発生存中である。非常にまれではあるが、特に抗凝固療法中においては脂肪肉腫が腹腔内出血の一因となることもある。(著者抄録)

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記述言語：日本語  

J-GLOBAL

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：IMPACT JOURNALS LLC  

Objectives: Anti-epidermal growth factor receptor (EGFR) therapy has been found to be more effective against left-sided colorectal cancer (LCRC) than right-sided colorectal cancer (RCRC). We hypothesized that RCRC is more likely to harbor genetic alterations associated with resistance to anti-EGFR therapy and tested this using comprehensive genomic sequencing.
Materials and methods: A total of 201 patients with either primary RCRC or LCRC were analyzed. We investigated tumors for genetic alterations using a 415-gene panel, which included alterations associated with resistance to anti-EGFR therapy: TK receptors (ERBB2, MET, EGFR, FGFR1, and PDGFRA), RAS pathway (KRAS, NRAS, HRAS, BRAF, and MAPK2K1), and PI3K pathway (PTEN and PIK3CA). Patients whose tumors had no alterations in these 12 genes, theoretically considered to respond to anti-EGFR therapy, were defined as "all wild-type", while remaining patients were defined as "mutant-type".
Results: Fifty-six patients (28%) and 145 patients (72%) had RCRC and LCRC, respectively. Regarding genetic alterations associated with anti-EGFR therapy, only 6 of 56 patients (11%) with RCRC were "all wild-type" compared with 41 of 145 patients (28%) with LCRC (P = 0.009). Among the 49 patients who received anti-EGFR therapy, RCRC showed significantly worse progression-free survival (PFS) than LCRC (P = 0.022), and "mutant-type" RCRC showed significantly worse PFS compared with "all wild-type" LCRC (P = 0.004).
Conclusions: RCRC is more likely to harbor genetic alterations associated with resistance to anti-EGFR therapy compared with LCRC. Furthermore, our data shows primary tumor sidedness is a surrogate for the non-random distribution of genetic alterations in CRC.

DOI： 10.18632/oncotarget.20510

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

An 81-year-oldwoman with advancedgastric cancer was referredto our hospital. Preoperative contrast-enhancedCT revealeda roundcalcification of the splenic hilum with 15mm in diameter as a splenic artery aneurysm. She underwent transcatheter arterial embolization(TAE)for the splenic artery aneurysm. Celiac artery angiography showedcollateral arterial network of the spleen from left gastric artery. Surgery for the gastric cancer was performed1 4 days after TAE. We cut the right gastric andbilateral epigastric arteries. After the left gastric artery clamping, we performedintraoperative indocyanine green(ICG)fluorography. ICG fluorography confirmedthat the bloodflow of the upper thirdof the stomach andspleen were maintained. We safely performed distal gastrectomy, and the postoperative course was uneventful.

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1186/s13073-017-0484-3

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その他リンク： http://link.springer.com/article/10.1186/s13073-017-0484-3/fulltext.html

記述言語：英語  

DOI： 10.1093/jscr/rjx216

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/jocmr3113w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Benign esophageal tumors are uncommon, comprising approximately 2% of esophageal tumors. Esophageal schwannomas constitute an even rarer entity, with few cases reported in the literature. CASE PRESENTATION: We present a 66-year-old male who was referred for dysphagia. A computed tomography scan showed a well-demarcated, enhancing, and homogenous esophageal tumor measuring 50 mm. The tumor was hypermetabolic on positron emission tomography, and an endoscopic ultrasound-guided fine needle aspiration demonstrated the presence of benign spindle cells. We performed an uncomplicated, simple, tumor enucleation through a cervical approach. Histology revealed spindle-shaped cells in a fasciculated, disarrayed pattern. Immunohistochemistry demonstrated positive staining for S-100 protein and negative staining for KIT, CD34, desmin, and α-smooth muscle actin. These findings were consistent with a benign esophageal schwannoma. CONCLUSIONS: We report our experience with esophageal schwannoma, a rare but benign diagnosis of the esophagus.

DOI： 10.1186/s40792-017-0369-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

HER2-targeted therapy is considered effective for KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (CRC). In general, HER2 status is determined by the use of immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Comprehensive genomic sequencing (CGS) enables the detection of gene mutations and copy number alterations including KRAS mutation and HER2 amplification; however, little is known about the utility of CGS for detecting HER2-positive CRC. To assess its utility, we retrospectively investigated 201 patients with stage I-IV CRC. The HER2 status of the primary site was assessed using IHC and FISH, and HER2 amplification of the primary site was also assessed using CGS, and the findings of these approaches were compared in each patient. CGS successfully detected alterations in 415 genes including KRAS codon 12/13 mutation and HER2 amplification. Fifty-nine (29%) patients had a KRAS codon 12/13 mutation. Ten (5%) patients were diagnosed as HER2 positive because of HER2 MC 3+, and the same 10 (5%) patients had HER2 amplification evaluated using CGS. The results of HER2 status and HER2 amplification were completely identical in all 201 patients (P &lt; .001). Nine of the 10 HER2-positive patients were KRAS 12/13 wild-type and were considered possible candidates for HER2-targeted therapy. CGS has the same utility as IHC and FISH for detecting HER2-positive patients who are candidates for HER2-targeted therapy, and facilitates precision medicine and tailor-made treatment. (C) 2017 The Authors. Published by Elsevier Inc.

DOI： 10.1016/j.humpath.2017.02.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Aim: To investigate the appropriate extent of lymphadenectomy for squamous cell carcinoma (SCC) of the esophagogastric junction (ECJ).
Methods: We retrospectively reviewed the cases of 52 patients with SCC of the ECJ who underwent extended mediastinal lymphadenectomy. We assessed potential risk factors for lymph node metastasis (LNM) in the upper/middle mediastinum by conducting univariate and multivariate analyses, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value. Survival rates were calculated using the Kaplan-Meier method, and the therapeutic value index of each nodal basin dissection was calculated by multiplying the frequency of metastasis at the basin and the 5-year overall survival rate of patients with metastasis at that basin.
Results: Twenty patients (38%) had mediastinal LNM; 13 (25%) had metastasis in the upper/middle mediastinum, and 13 (25%) had metastasis in the lower mediastinum. Tumor length (P = 0.03) and pathological nodal status (P = 0.01) were independent risk factors for upper/middle mediastinal LNM. The optimal ROC cutoff value of tumor length was 54 mm. The 5-year overall survival rate of the patients with LNM in the upper/middle mediastinum was 46%. The therapeutic value index of upper/middle mediastinal lymphadenectomy was 11.6, which was inferior to that of perigastric lymphadenectomy at 17.3, but superior to that of lower mediastinal lymphadenectomy at 5.8.
Conclusion: An upper/middle mediastinal lymphadenectomy may be required for patients with tumors that are &gt;= 54 mm long, and in those with suspected LNM. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ijsu.2017.07.041

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：E-CENTURY PUBLISHING CORP  

NAD(P)H: quinone oxidoreductase-1 (NQO1) protects cells against redox cycling and oxidative stress; however, in cancer cells, NQO1 confers resistance against anticancer agents. The aim of this study was to evaluate the association between NQO1 expression and prognosis in patients with advanced (locally advanced or metastatic/recurrent) colorectal cancer (CRC). A retrospective analysis of 47 patients [28 male and 19 female; median age: 62 years (range, 17-78)] with advanced CRC was conducted. Immunohistochemical examination of tumor tissue specimens was performed using monoclonal anti-NQO1 antibody. The association of NQO1 expression with patient characteristics, chemotherapeutic response, and clinical prognosis was assessed. Therapeutic efficacy (complete response, partial response, stable disease, and progressive disease) was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. We compared the therapeutic efficacy in KRAS wild and mutant CRC because epidermal growth factor receptor (EGFR)-signaling pathway plays a pivotal role in CRC. Of the 47 patients, 31 (66.0%) had KRAS wild CRC and 16 (34.0%) had KRAS mutant CRC. Moreover, 37 (78.7%) had NQO1-positive tumors and 10 (21.3%) had NQO1-negative tumors. Among the patients with KRAS wild CRC, NQO1-negative patients showed significantly better disease control rate (complete response + partial response + stable disease) than NQO1-positive patients (P = 0.028). Moreover, NQO1-negative patients had longer progression-free survival and overall survival than NQO1-positive patients (P = 0.041 and P = 0.043, respectively). NQO1 expression in the tumor may be a predictor of therapeutic efficacy and prognosis in patients with KRAS wild advanced CRC.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: Comprehensive genomic sequencing (CGS) has the potential to revolutionize precision medicine for cancer patients across the globe. However, to date large-scale genomic sequencing of cancer patients has been limited to Western populations. In order to understand possible ethnic and geographic differences and to explore the broader application of CGS to other populations, we sequenced a panel of 415 important cancer genes to characterize clinically actionable genomic driver events in 201 Japanese patients with colorectal cancer (CRC).
Methods: Using next-generation sequencing methods, we examined all exons of 415 known cancer genes in Japanese CRC patients (n = 201) and evaluated for concordance among independent data obtained from US patients with CRC (n = 108) and from The Cancer Genome Atlas-CRC whole exome sequencing (WES) database (n = 224). Mutation data from non-hypermutated Japanese CRC patients were extracted and clustered by gene mutation patterns. Two different sets of genes from the 415-gene panel were used for clustering: 61 genes with frequent alteration in CRC and 26 genes that are clinically actionable in CRC.
Results: The 415-gene panel is able to identify all of the critical mutations in tumor samples as well as WES, including identifying hypermutated tumors. Although the overall mutation spectrum of the Japanese patients is similar to that of the Western population, we found significant differences in the frequencies of mutations in ERBB2 and BRAF. We show that the 415-gene panel identifies a number of clinically actionable mutations in KRAS, NRAS, and BRAF that are not detected by hot-spot testing. We also discovered that 26% of cases have mutations in genes involved in DNA double strand break repair pathway. Unsupervised clustering revealed that a panel of 26 genes can be used to classify the patients into eight different categories, each of which can optimally be treated with a particular combination therapy.
Conclusions: Use of a panel of 415 genes can reliably identify all of the critical mutations in CRC patients and this information of CGS can be used to determine the most optimal treatment for patients of all ethnicities.

DOI： 10.1186/s13073-016-0387-8

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ovid Technologies (Wolters Kluwer Health)  

DOI： 10.1016/j.ijsu.2016.10.041

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE  

Background and aims: Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery.
Methods: A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak.
Results: Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P &lt; 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P &lt; 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F.
Conclusions: Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak. (C) 2016 The Authors. Published by Elsevier Ltd.

DOI： 10.1016/j.clnu.2016.03.018

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Nilotinib inhibits the tyrosine kinase activities of ABL1/BCR-ABL1, KIT, and platelet-derived growth factor receptors (PDGFRs). The results of a phase III clinical trial indicated that nilotinib could not be recommended for broad use as first-line therapy for gastrointestinal stromal tumor (GIST). However, some clinical studies have reported the effectiveness of nilotinib. We report here the cases of two patients who underwent surgical resections of nilotinib-resistant lesions after long-term nilotinib administration. CASE PRESENTATION: Two Japanese female patients, aged 66 and 70 years, experienced peritoneal recurrence of intestinal GIST several years after surgery. Both were registered in the ENESTg1 trial and received nilotinib therapy. Although they continued nilotinib administration with a partial response according to the protocol, nilotinib-resistant lesions, which were diagnosed as focally progressive disease, developed and complete surgical resection was performed. Pathological examination revealed that the tumors were composed of viable KIT-positive spindle cells, and the recurrent tumors were diagnosed as nilotinib-resistant GIST. In gene mutation analysis, a secondary KIT gene mutation was detected in one case. Both patients have survived more than 5 years after the first surgery. CONCLUSIONS: Of patients who were registered in this trial, we have encountered two patients with long-term effects after nilotinib administration. Moreover, secondary mutations in the KIT gene, similar to those involved in resistance to imatinib, might be involved in resistance to nilotinib.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Prognoses vary substantially among patients with advanced gastric cancer following curative surgery. The aim of the current study was to develop and verify the validity of a novel nomogram that predicts the probability of 5-year relapse-free survival (RFS) in patients who underwent curative resection for stage II/III gastric cancer.
Materials and methods: A nomogram to predict 5-year RFS following surgical resection of gastric cancer was constructed based on the data of patients who underwent surgery for primary gastric carcinoma at three institutions in Japan in January 2001-December 2006. Multivariate analysis using a Cox proportional hazards regression model was performed, and the nomogram's predictive accuracy (discrimination) and the agreement between observed outcomes and predictions (calibration) were evaluated by internal validation.
Results: Multivariate analyses revealed that age at operation, depth of tumor, tumor location, lymph node classification, and presence of combined resection were significant prognostic factors for RFS. In the internal validation, discrimination of the developed nomogram for 5-year RFS was superior to that of the American Joint Committee on Cancer TNM classification (concordance indices of 0.80 versus 0.67; P &lt; 0.001). Moreover, calibration appeared to be accurate. Based on these results, we have created free software to more easily predict 5-year RFS.
Conclusion: We developed and validated a nomogram to predict 5-year RFS after curative surgery for stage II/III gastric cancer. This tool will be useful for the assessing a patient's individual recurrence risk when considering additional therapy in clinical practice. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ijsu.2016.09.080

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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DOI： 10.1200/JCO.2016.34.15_suppl.e15103

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The objectives of this study were to assess the incidence of recurrent laryngeal nerve paralysis (RLNP) using laryngoscopy after esophagectomy for thoracic esophageal carcinoma and to clarify the risk factors influencing postoperative RLNP.
A total of 299 patients who underwent laryngoscopic examination after esophagectomy were retrospectively reviewed. Patients who were found to have postoperative RLNP were followed up every 1-3 months, with a median follow-up period of 3 months. Recovery from paralysis was also evaluated on the basis of each affected nerve. Multivariate analyses using logistic regression were used to identify independent risk factors for RLNP. Cumulative recovery rate was calculated using Kaplan-Meier method.
A total of 178 (59.5 %) patients were diagnosed with RLNP by first laryngoscopy [bilateral in 59 (33.1 %) patients, right in 15 (8.4 %), and left in 104 (58.4 %)]. In 206 patients who underwent transthoracic and thoracoscopic esophagectomy, independent risk factors for RLNP were lymph node dissection along the right RLN (odds ratio [OR] 3.01, 95 % confidence interval [CI] 1.06-8.54, P = 0.04) and cervical anastomosis (OR 5.94, 95 % CI 1.78-19.80, P &lt; 0.01). Cumulative recovery rate from RLNP was 61.7 % at 12 months after esophagectomy with 91 nerves eventually recovering from paralysis. Median recovery time was 6 months.
RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62 % of affected nerves recovered within 12 months, great attention should be given when performing these procedures.

DOI： 10.1007/s00268-015-3261-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

This study aimed to compare the utility of the number of positive lymph nodes with the lymph node ratio (LNR) in predicting survival after resection of extrahepatic cholangiocarcinoma.
A retrospective analysis of 142 consecutive patients who underwent radical resection of extrahepatic cholangiocarcinoma was performed. A total of 3066 regional lymph nodes were resected. The median number of nodes per patient was 21. The optimal cutoff values for the number of positive nodes and the LNR were determined using the Chi square scores calculated by the Cox proportional hazards regression model.
Nodal disease was found in 59 patients (42 %). In the subsequent analysis of the impact that nodal status has on survival, 18 patients with R1/2 resection and 6 patients with paraaortic nodal disease who did not survive for more than 5 years after resection were excluded. The optimal cutoff value for the number of positive nodes was 1, and the optimal cutoff value for the LNR was 5 %. Univariate analysis identified both the number of positive nodes (0, 1, or a parts per thousand yen2; P = 0.005) and the LNR (0, 0-5, or &gt; 5 %; P = 0.007) as significant prognostic factors. Multivariate analysis identified the number of positive nodes but not the LNR as an independent prognostic factor (P = 0.012). The 5-year survival rates were 64 % for the patients with no positive nodes, 46 % for the patients with one positive node, and 28 % for the patients with two or more positive nodes.
The number of positive lymph nodes predicts survival better than the LNR after resection of extrahepatic cholangiocarcinoma, provided that nodal evaluation is sufficient.

DOI： 10.1245/s10434-015-4609-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：E-CENTURY PUBLISHING CORP  

This study aimed to histologically characterize microscopic tumor invasion of the vasculo-biliary sheaths in perihilar cholangiocarcinoma so as to determine the primary tumor site and to clarify clinicopathologic differences according to the primary site. A retrospective analysis was conducted of 52 patients who underwent resection for perihilar cholangiocarcinoma involving both the hepatic hilus and the liver, verified histologically. Histologic features of the vasculo-biliary sheath invasion were evaluated by double staining with hematoxylin-eosin to assess general morphology and Victoria Blue to detect the elastic fibers of the vasculo-biliary sheaths. The perihilar cholangiocarcinomas were classified into extrahepatic-type (34 patients), featuring an extrahepatic component involving the liver, and intrahepatic-type (18 patients), featuring an intrahepatic component involving the hepatic hilus. Hemihepatectomy with extrahepatic bile duct resection was the most common surgical procedure. Tumor size (p = 0.002), pN classification (p = 0.005), and pM classification (p = 0.023) were significant independent prognostic factors. The primary site was not significantly associated with survival after resection (p = 0.214), as patients with extrahepatictype tumors had a cumulative 5-year survival rate of 32%, compared with 28% for patients with intrahepatic-type tumors. Double staining with hematoxylin-eosin and Victoria Blue permits histologic discrimination between tumors of extrahepatic and intrahepatic origin, and thereby determination of the primary tumor site in clinical cases of perihilar cholangiocarcinoma. Combining extrahepatic-type and intrahepatic-type tumors under the term perihilar cholangiocarcinoma is valid clinically, as these tumors show comparable surgical outcomes with similar clinical management.

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：E-CENTURY PUBLISHING CORP  

NAD(P) H:quinone oxidoreductase-1 (NQO1) confers resistance to anticancer agents, particularly to oxidative stress inducers such as cisplatin or 5-fluorouracil in malignant tumors. Here we evaluated the association between NQO1 expression in esophageal squamous cell carcinoma (ESCC) cells and the patients' responses to preoperative chemotherapy with cisplatin and 5-fluorouracil (CF), and we elucidated the prognostic significance of NQO1 expression in ESCC patients. We retrospectively analyzed the cases of 40 patients who underwent preoperative CF therapy followed by curative esophagectomy with lymphadenectomy. Immunohistochemistry of the surgically resected specimens was conducted using the primary monoclonal antibody against NQO1. Eighteen of the 40 patients (45%) had tumors that showed high NQO1 expression (NQO1-high group). The poorer histological response to preoperative CF therapy was dominant in the NQO1-high group compared to the NQO1-low group (72% and 45%, respectively) but the difference was not significant (P=0.09). The 3-year recurrence-free survival rate after esophagectomy in the NQO1-high group was significantly lower compared to the NQO1-low group (39% vs. 76%; P&lt;0.01). A Cox proportional hazards model revealed that high NQO1 expression was an independent unfavorable prognostic factor (HR=3.53; P=0.02) as was pN3 (HR=14.7; P&lt;0.01). The immunohistochemical evaluation of NQO1 expression has potential to predict the treatment response and prognosis in patients who undergo preoperative CF therapy followed by esophagectomy for ESCC.

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記述言語：日本語   出版者・発行元：新潟医学会  

症例は60歳、女性。人間ドックを契機に胃穹窿部大彎に7cm大の0-IIa+IIb型病変を指摘され、当院消化器内科にてESDが施行された。病理組織学的検討で、腫瘍は一部に低分化成分を伴った高分化型管状腺癌であり、免疫染色で胃型の粘液形質を有する腫瘍であった。粘膜下層浸潤があり、垂直断端陽性であったことから外科的追加切除の適応と判断され当科を受診した。高度なリンパ管侵襲を認めたこと、胃型の腫瘍であったことから、腹部CT所見では明らかなリンパ節の腫大を認めなかったものの、リンパ節転移の可能性は低くないと考えた。また、病変部位は胃上部の大彎側病変であり、脾門リンパ節郭清も省略できないと判断した。手術はESD2ヵ月後に胃全摘術、脾合併切除術、D2リンパ節郭清、Roux-en Y再建を施行した。病理組織学的検討では、ESD瘢痕部に癌の遺残を認めたが深達度は粘膜下層までであった。脾門リンパ節に4個、大彎左群リンパ節に1個、計5個のリンパ節転移を認め、いずれも原発巣と同様の胃型形質を示す腫瘍であった。胃型形質を示す高分化型腺癌は、比較的リンパ節転移をきたしやすいことが報告されている。早期胃癌で脾摘を伴うD2郭清が検討されることは稀であるが、本症例のように局在、組織型、リンパ管侵襲の程度によっては、脾門リンパ節郭清を考慮してもよいと思われた。消化器内科医、病理医と緊密な連携を図り、過不足のない術式を検討しなければならない。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: The aim of this study was to investigate the incidence and risk factors for anastomotic stricture after esophagectomy with gastric tube reconstruction. METHODOLOGY: A total of 150 consecutive patients with esophageal cancer who underwent esophagectomy with gastric tube reconstruction were analyzed in this study. Anastomotic stricture was de fined as disturbance of the passage of a standard endo scope, with no evidence of locoregional cancer recurrence. Cumulative incidence was calculated using the Kaplan-Meier method. A total of 38 clinicopathological variables were assessed to elucidate the risk factors by univariate and multivariate analyses. RESULTS: Anastomotic stricture developed in 61 of 150 patients 41%). The cumulative incidences were 34.2% at 6 months, and 37.9% at 12 months. Fifty-seven patients (93%) developed anastomotic stricture within 12 months after esophagectomy. A low preoperative partial pressure of arterial oxygen (odds ratio, 2.23; 95% confidence interval, 1.10-4.55; p = 0.027) and the presence of postoperative complications of Grade 3 or higher (3.05; 1.04-9.00; p = 0.043) were identified as the independent risk factors. CONCLUSIONS: The incidence of anastomotic stricture after esophagectomy was high. A modification of anastomotic procedure may be necessary for patients with a low preoperative partial pressure of arterial oxygen to prevent the development of stricture.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/ases.12159

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

We report three cases of esophageal carcinoma all of which achieved a pathological complete response after neoadjuvant chemotherapy (NAC) with cisplatin and 5-fluorouracil (CF). All three patients were men with clinical stage II squamous cell carcinoma of the middle thoracic esophagus. We administered 2 courses of CF treatment as NAC and then performed radical esophagectomy. Pathologic examination revealed no viable tumor cells in the resected esophagus. The patients are currently alive with no evidence of disease.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background. The aims of this study were to identify prognostic factors of patients with submucosa-invasive (T1b) gastric cancer and to verify the validity of adjuvant chemotherapy for this disease.
Methods. We retrospectively examined the cases of 1,236 consecutive patients in our prospectively maintained database with T1b gastric cancer who underwent gastrectomy in 1995-2012. We used 11 clinicopathologic characteristics to identify prognostic factors by univariate and multivariate analyses. We compared the survival of the 160 node-positive T1b gastric cancer patients with that of 133 patients in the same database who had node-positive muscularis propria-invasive (T2) gastric cancer and had undergone gastrectomy without adjuvant chemotherapy during the same period, as a reference cohort.
Results. The 5-year overall survival rate was 91.4% for all 1,236 patients. Advanced age (hazard ratio [HR] 4.51; 95% confidence interval [CI] 3.26-6.24; P &lt; .01), male sex (HR 2.26; 95% CI 1.5- 3.26; P &lt; .01), and the presence of lymph node metastasis (HR 1.89; 95% CI 1.33-2.70; P &lt; .01) were independent prognostic factors. The 5-year overall survival rates were 92.5 % in node-negative patients, 84.5% in patients with 1 or 2 metastatic nodes, and 80.1% in patients with 3 or more metastatic nodes (P &lt;.01). The 5-year overall survival rates of the node-positive T1b and T2 gastric cancer patients were 83.6% and 81.2%, respectively (P = .73).
Conclusion. The prognosis of node-positive T1b gastric cancer patients after curative gastrectomy was unsatisfactory. Adjuvant chemotherapy should be considered for these patients, especially those with 3 or more metastatic nodes.

DOI： 10.1016/j.surg.2014.10.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40792-015-0051-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40792-015-0073-x

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担当区分：筆頭著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Prognostic markers are urgently needed to optimize the postoperative treatment strategies for gastrointestinal stromal tumors (GIST). GIST of the small intestine (I‐GIST) show more aggressive behavior than those of the stomach (S‐GIST), and the molecular background of the malignancy in I‐GIST may include potential prognostic biomarkers. We conducted integrated proteomic and transcriptomic analysis to identify genes showing differential expressions according to the tumor site. We generated protein expression profiles for four cases each of surgically resected I‐GIST and S‐GIST using label‐free proteomic analysis. For proteins showing differential expressions, globalmRNAexpression was compared between 9 I‐GIST and 23 S‐GIST. Among the 2555 genes analyzed, we found that promyelocytic leukemia (PML), a tumor suppressor gene, was significantly downregulated in I‐GIST at both the protein andmRNAlevels (P &lt; 0.01; fold difference ≥2.0). Immunohistochemistry of 254 additional cases from multiple clinical facilities showed that PML‐negative cases were significantly frequent in the I‐GIST group (P &lt; 0.001). The 5‐year recurrence‐free survival rate was significantly lower in the PML‐negative than in the PML‐positive cases (60.1%vs91.7%;P &lt; 0.001). Multivariate analysis revealed that downregulation of PML was an independent unfavorable prognostic factor (hazard ratio = 2.739;P = 0.001). Our study indicated that prognostication based on PML expression may have potential for optimizing the treatment strategy for GIST patients. Further validation studies of PML for clinical application, and investigation for the mechanistic significance of PML to clarify the molecular backgrounds of malignancy in GIST are warranted.

DOI： 10.1111/cas.12565

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/cas.12565

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4240/wjgs.v6.i12.235

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 70-year-old man was referred to our hospital with ascending colon cancer (cT3N1M0, Stage IIIa), which was found during examinations following a positive fecal occult blood test. The patient was also diagnosed with early gastric cancer (cT1a, NO, MO, Stage IA) during a preoperative gastroscopy examination. A laparoscopically assisted right colectomy and D3 lymphadenectomy was performed for the ascending colon cancer. The postoperative pathological diagnosis was Stage IIIb (pT3N2), he was administered in combination with capecitabine plus oxaliplatin (CapeOX) as adjuvant chemotherapy before the treatment for the colon cancer. After 6 months of adjuvant chemotherapy, we were unable to detect any gastric lesions at the same location using gastroscopy, and so diagnosed a clinical complete response. A follow-up gastroscopy 6 months later showed the same findings. The patient has had no recurrence of gastric cancer for 18 months after the initial operation. He will continue to be followed up closely using gastroscopy. In this case, CapeOX as adjuvant chemotherapy for advanced colon cancer was also effective for early gastric cancer.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

An 81-year-old man presented with chief complaints of abdominal pain and vomiting. Intestinal obstruction was found at the time of admission to a local hospital in October 2011. Conservative treatment provided symptomatic relief
however, he was readmitted with similar symptoms in December 2011. Small-intestinal wall thickening was detected by abdominal and pelvic computed tomography, and he was referred to our hospital. Small-bowel endoscopy revealed an elevated subcircumferential tumor in the jejunum. Biopsy revealed well to moderately differentiated adenocarcinoma diagnosed as jejunal cancer, which caused narrowing of the jejunum. Single-incision laparoscopy-assisted small-bowel resection was performed. The intraoperative findings were a tumor with inflammatory changes in the jejunum and enlarged surrounding lymph nodes. We performed regional lymph node dissection. Histopathological analysis showed moderately differentiated small-intestinal tubular adenocarcinoma and 2 of 5 lymph nodes positive for metastatic cancer cells. After an uneventful postoperative course, he was discharged on day 7. He preferred not to undergo postoperative adjuvant chemotherapy and quickly recovered his activities of daily living postoperatively. He stayed home until he developed abdominal distention resulting from peritoneal recurrence 1 year and 6 months postoperatively and died 1 month later.

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Hematogenous recurrences of esophageal squamous cell carcinoma (ESCC) have dismal prognoses, but prognostic heterogeneity exists in this disease. The objectives of this study were to clarify the prognosis in this disease with regard to the initial recurrence site and to define the prognostic factors. Methodology: We retrospectively reviewed the cases of 67 consecutive patients with hematogenous recurrence in major organs after esophagectomy for ESCC of the thoracic esophagus and the esophagogastric junction. We analyzed clinicopathological characteristics, survival probability and potential prognostic factors. Results: Lung, liver, bone, and multiple-organ metastases occurred in 24, 19, 14, and 10 patients, respectively. Twenty-seven patients simultaneously had locoregional recurrence (combined recurrence). Among all 67 patients, the median disease-free interval (DFI) was 9.7 months, and the median survival time after the initial recurrence was 4.9 months. The patients with initial lung metastasis had most favorable prognosis with the median survival time of 9.8 months. A multivariate analysis identified that initial recurrence site, DFI, combined recurrence, and anticancer therapy were independent prognostic factors. Conclusions: The initial recurrence site contributes to the prognostic heterogeneity of patients with hematogenous recurrence of ESCC. The prognostic factors identified in this study are useful to optimize the management of these patients.

DOI： 10.5754/hge13171

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は81歳、男性。主訴は腹痛、嘔吐で腸閉塞を生じ、近医で入院加療が行われた。保存的治療で症状は改善したが、2ヵ月後に同じ症状で再入院となった。腹部骨盤部CT検査で小腸壁の肥厚が指摘されたため、当院紹介となった。小腸内視鏡検査で空腸に亜全周性の隆起性腫瘍を認め、生検で高分化〜中分化腺癌と診断された。狭窄所見を伴う空腸癌と診断し、単孔式腹腔鏡補助下空腸部分切除術を行った。術中所見として、空腸に炎症性変化を伴う腫瘍が確認された。リンパ節の腫大を認めたため腸管周囲リンパ節の郭清を行った。病理組織結果は小腸中分化管状腺癌、リンパ節は2/5個で転移陽性であった。術後経過は良好で、7病日に退院となった。術後補助化学療法は希望されなかった。術後すぐに日常生活動作は回復し、自宅で生活されていた。術後1年6ヵ月ごろより腹膜再発による腹部膨満を生じ、1年7ヵ月で永眠された。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00296&link_issn=&doc_id=20141217480335&doc_link_id=%2Fab8gtkrc%2F2014%2F004112%2F335%2F2442-2443%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2014%2F004112%2F335%2F2442-2443%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

The results of the Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer (ACTS-GC) demonstrated that postoperative chemotherapy using S-1 is a standard treatment in Japan for patients with p-Stage n and p-Stage in gastric cancer. We retrospectively reviewed the effect of adjuvant chemotherapy received by 47 patients with p-Stage II and p-Stage M gastric cancer between January 2007 and June 2012. Our hospital is a local university hospital with a high intensive care unit. S-1 monotherapy was administered to 32 patients (adjuvant S-1 group, 68.1%)
22 patients (68.8%) among them completed one year of therapy without any modification to the administration schedule. A total of 8 patients (25.0%) experienced grade 3 adverse events, and 9 patients required a dose reduction, a modification of the administration schedule, or termination of the therapy. S-1 was not administrated to 15 patients (no adjuvant S-1 group, 31.9%)
among these patients, 12 (80.0%) were not administered S-1 because of their advanced age and comorbidity. The 3-year overall survival rate was 89.3% in the adjuvant S-1 group and 77.1% in the no adjuvant S-1 group. The completion rate of S-1 and survival rate were high for patients in the adjuvant S-1 group, which was similar to the results of the ACTS-GC. However, 25 of 47 patients (53.2%) with p-Stage n and p-Stage IE gastric cancer did not improve after sufficient adjuvant therapy
therefore, it is important to develop new treatment strategies for these patients.

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4021/jocmr1665w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14740/wjon764w

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier  

To examine the proteomic background of lymph node metastasis (LNM) in gastric cancer, we performed protein expression profiling of paired non-tumor, primary tumor, and LNM tissues. Using a label-free proteomic approach, we generated protein expression profiles of 3894 unique proteins and identified 109 differentially expressed proteins. Functional pathway analysis of the differentially expressed proteins showed that members of the beta-3 integrin (ITGB3) pathway were significantly enriched. Aberrations of ITGB3 were reported in various malignancies
however, ITGB3 in LNM tissues has not been examined to date. Different level of ITGB3 expression was confirmed in 20 gastric cancer cases by Western blotting. We analyzed the mRNA levels of the differentially expressed proteins by using a public mRNA expression database
38.8% of the proteins examined, including those involved in oxidation and reduction, showed correlation between protein and mRNA levels. Proteins without such correlation included factors related to cell adhesion. Our study suggests a novel role for the integrin pathway in the development of LNM in gastric cancer and indicated possible benefits of observational transcriptomic analysis for proteomic studies. © 2014 The Authors.

DOI： 10.1016/j.euprot.2014.03.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer-Verlag Tokyo  

We report a case of esophageal perforation (Boerhaave syndrome) caused by vomiting related to a duodenal ulcer with pyloric stenosis. A 45-year-old male presented with left chest pain and dyspnea after forceful vomiting. Chest radiography and computed tomography (CT) revealed a massive left pleural effusion and left tension pneumothorax. Abdominal CT revealed pyloric stenosis with a remarkably dilated stomach. Tube thoracostomy and nasogastric suction were immediately performed and we selected conservative treatment based on the following factors-a stable general condition without sepsis, early diagnosis, and good drainage. Esophagogastroduodenoscopy on hospital day 9 demonstrated a healing ulcer in the lower esophagus and pyloric stenosis. We performed distal gastrectomy as elective surgery for pyloric stenosis due to a duodenal ulcer on hospital day 30. In summary, an esophageal perforation with contamination spreading to the thoracic cavity was successfully treated with conservative treatment. © 2014 Springer.

DOI： 10.1007/s12328-014-0493-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p &lt; 0.05. Group E showed fewer days for the first fecal passage (p &lt; 0.01), lesser dose of postoperative albumin infusion (p &lt; 0.01), less use of TPN (p &lt; 0.01), and shorter duration of SIRS (p &lt; 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.

DOI： 10.3390/nu5093461

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担当区分：筆頭著者   記述言語：英語   掲載種別：学位論文（博士）   出版者・発行元：AMER CHEMICAL SOC  

To reveal the proteomic background of lymph node metastasis (LNM) in gastric cancer, we performed a proteomic study of tumor and matched nontumor tissues obtained from surgically resected specimens of 22 patients with or without LNM. Using laser microdissection, we recovered specific populations of tumor and nontumor cells. We used two-dimensional difference gel electrophoresis with a large format electrophoresis apparatus to obtain protein expression profiles consisting of 3228 protein spots, and we classified them according to their expression pattern. We found that macrophage-capping protein (CapG) was up-regulated in the tumor tissues of patients with LNM, whereas it showed an equivalent expression level between nontumor and tumor tissues of patients without LNM. It was reported that CapG associated with invasion and metastasis in various malignancies. However, CapG was not investigated in gastric cancer until our study. Western blotting of the laser microdissected tissue samples confirmed up-regulation of CapG in the tumor tissues of patients with LNM. Functional assays demonstrated that CapG promoted tumor cell invasion, but not cell proliferation. The association between CapG expression and LNM is a novel finding in gastric cancer. Further investigation for a prognostic utility of CapG may lead to a risk stratification therapy for gastric cancer.

DOI： 10.1021/pr400439m

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined the proteins for intra-tumor heterogeneity in colorectal cancer. Tumor cells localized in the ulcer floor, the central area, and the invasive front, as well as normal colorectal epithelial cells were recovered from surgical specimens by laser microdissection. Proteome data were generated by 2D-DIGE and mass spectrometry. By distinguishing the tumor cells based on tissue localization, we observed 88 protein spots at a different intensity in tumor cell groups compared to normal epithelial cells. On the contrary, when the tissue localization of the tumor cells was not taken into account, only 1 protein spot was newly detected with a different intensity. The identified proteins corresponded functionally to the expected phenotypes in that particular region: proteins for stress response were identified in the ulcer floor, glucose metabolism proteins were found in the central area, and apoptosis proteins were associated with the invasive front. These results suggested the following: (1) proteome data may reflect the effects of the tissue microenvironment on tumor cells, (2) the tissue localization of tumor cells should be considered in the sampling process when comparing normal and tumor cells, and (3) we can expect novel findings on the backgrounds of intra-tumor heterogeneity by using the proteomic approach.

DOI： 10.1016/j.jprot.2012.11.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Sarcomas range from curable tumors to those causing death via metastasis and recurrence. Thus, there is an urgent need for biomarker identification in order to assess the degree of malignancy, predict prognosis, and evaluate possible therapies. Various proteomic approaches and different clinical materials have been used to this end, and candidate biomarkers have been reported for the different types of sarcomas. However, the sample size used in these biomarker studies was generally insufficient, and thus far, no biomarker has been proved useful in clinics. Given that sarcomas are rare, biomarker validation in this setting is more challenging than in other malignancies. In gastrointestinal stromal tumor, adjuvant therapy has proven to be effective. However, only 40% patients experience metastasis after curative surgery alone, and the rest of the patients may not need adjuvant therapy. Using a proteomic approach, we identified pfetin (potassium channel tetramerization domain containing 12, KCTD 12) as a novel prognostic biomarker for sarcoma, and immunohistochemically confirmed its clinical usefulness by a multiinstitutional validation study. Here, we describe our experience and discuss the critical points in the discovery of this biomarker.

DOI： 10.1002/prca.201200085

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2013/246515

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jprot.2012.06.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objectives: A treatment strategy for patients with esophageal carcinoma invading adjacent structures found during esophagectomy (surgical T4; sT4) has not been established and the role of esophagectomy remains controversial. The aims of this study were to assess the clinicopathological characteristics and to clarify the prognostic factors of patients who underwent esophagectomy for sT4 tumors.
Methods: A consecutive series of 76 patients who were found to have sT4 tumors was reviewed retrospectively. T4 tumors were divided into two groups according to the invaded structures. Cox's multivariate proportional hazard model was used to identify prognostic factors.
Results: Complete tumor clearance with combined resection was performed in 12 patients (16%). Overall 1-, 3-, and 5-year survival rates were 40.8%, 9.2%, and 7.9%, respectively. There was no significant relationship between survival and invaded structure type or residual tumor status. Postoperative therapy was selected as an independent prognostic factor.
Conclusions: The complete resection rate was low and the prognosis of patients with sT4 tumors was poor. Subclassification according to the invaded structures was not a prognostic factor in this study. Postoperative therapy may improve survival in sT4 patients and should be considered irrespective of residual tumor status after esophagectomy. J. Surg. Oncol. 2012;105:767-772. (C) 2012 Wiley Periodicals, Inc.

DOI： 10.1002/jso.22092

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background. The clinical significance of operative treatment for metachronous pulmonary metastasis from esophageal carcinoma is unclear.
Methods. We retrospectively reviewed 23 consecutive patients who underwent operative resection for metachronous pulmonary metastasis from esophageal carcinoma from 1991 to 2008. Patient baseline characteristics, survival probability, and prognostic factors were analyzed. The median follow-up period was 31 months for surviving patients.
Results. There were 19 men and 4 women, with a median age of 66 years at the time of pulmonary resection. The median disease-free interval was 15.5 months. Cervical or mediastinal lymph node metastases preceded pulmonary metastases in 4 patients. Seven patients (30.4%) had multiple metastases with a maximum number of 4. The median operative time and blood loss were 94.5 minutes and 18 mL, respectively. The median length of postoperative stay was 12.5 days. The predicted 1-, 3-, and 5-year survival rates using the Kaplan-Meier method were 73.9%, 43.5%, and 43.5%, respectively, with a median survival time of 28.7 months. Univariate analysis revealed that an extrapulmonary metastasis as the initial recurrence site was an unfavorable prognostic factor (P = .0411). Multivariate analyses, however, did not identify the initial recurrence site as an independent prognostic factor (P =. 0542).
Conclusion. Operative resection for metachronous pulmonary metastasis from esophageal carcinoma is an acceptable treatment. This study of a limited number of patients may have created a constitutional selection bias. An antecedent extrapulmonary metastasis was found to be an unfavorable prognostic factor. (Surgery 2011;149:164-70.)

DOI： 10.1016/j.surg.2010.07.047

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記述言語：日本語   出版者・発行元：Japan Surgical Association  

症例は62歳, 女性. 心房細動, 脳梗塞にてワーファリンカリウムの内服と, 抗凝固療法の補助を目的にブコロームの併用中であった. 1週間前より感冒症状があり, その後腹痛が出現し増悪したため当院を受診した. 精査にてイレウスと診断され, 腹膜刺激症状も認めたことから緊急開腹手術を行った. 終末回腸から盲腸にかけての虚血性変化を認め, 一部壊死を伴っていたため, 回盲部切除を行った. 切除した終末回腸には凝血塊が充満し, イレウスの原因と考えられた. 終末回腸の粘膜面には多発潰瘍を認め同部からの出血が疑われた. 原因としては, 基礎疾患や病理組織検査からは虚血性腸炎が疑われたが, 確定診断には至らなかった.<br>抗凝固療法中の消化管出血は周知された合併症である. しかし, 凝血塊を形成しイレウスの原因となった症例は極めて稀であるため, 文献的考察を含めて報告する.

DOI： 10.3919/jjsa.68.3040

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記述言語：日本語   出版者・発行元：日本小児医事出版社  

CiNii Article

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞次世代シークエンサーを用いた癌遺伝子パネル検査によって,RAS/RAF遺伝子をはじめとする薬剤耐性関連の遺伝子変異や,HER2遺伝子増幅などの治療標的の候補となる遺伝子変異の網羅的検索が大腸癌において可能となる.今後の遺伝子解析に備え,手術や生検組織検体の適切な保存について熟知しておくことが重要である.Lynch症候群の大腸癌はマイクロサテライト不安定性を呈し,免疫チェックポイント阻害薬が有効である可能性が示唆され注目を集めている.癌遺伝子パネル検査の普及によって,Lynch症候群などの遺伝性腫瘍と診断される症例が今後増加することが予想され,遺伝カウンセリングやサーベイランスなどの患者,家族の支援体制の整備が急務である.

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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Web of Science

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Web of Science

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本内分泌外科学会・日本甲状腺外科学会  

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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