Background
There is controversy regarding strategies for treating very elderly patients with gastric carcinoma. We aimed to assess survival after surgery in very elderly patients according to their ...clinical characteristics.
Methods
Gastric cancer patients aged ≥85 years were retrospectively reviewed. There were no significant differences in clinical characteristics between 58 patients with curative resection (OP group) and 32 patients with best supportive care alone (BSC group) in cancer stage IA–IIIC and with a performance status of 0–3.
Results
Overall survival (OS) was significantly better in the OP group than in the BSC group in females hazard ratio (HR) 0.27, 95 % confidence interval (CI) 0.12–0.57,
P
< 0.001 but not in males (HR 0.71, 95 % CI 0.35–1.49,
P
= 0.35). OS was significantly better in the OP group in patients aged 85–89 years (HR 0.44, 95 % CI 0.25–0.78,
P
= 0.006) but not in patients aged ≥90 years (HR 0.47, 95 % CI 0.12–1.66,
P
= 0.24). OS was significantly better in the OP group in patients with stage IB–IIIC cancer (HR 0.29, 95 % CI 0.14–0.58,
P
< 0.001) but not in patients with stage IA cancer (HR 0.52, 95 % CI 0.21–1.27,
P
= 0.15).
Conclusions
Females, patients aged 85–89 years, and patients with stage IB–IIIC cancer had significantly better OS with surgery than without. For males, patients aged ≥90 years, or stage IA patients, the decision to perform surgery should be carefully made, and BSC might be an optimal strategy.
Pancreatic cancer is one of the most common causes of death from cancer. Despite the availability of various treatment modalities, such as surgery, chemotherapy and radiotherapy, the 5‐year survival ...remains poor. Although gemcitabine‐based chemotherapy is typically offered as the standard care, most patients do not survive longer than 6 months. Therefore, new therapeutic approaches are needed. The α‐gal epitope (Galα1‐3Galβ1‐4GlcNAc‐R) is abundantly synthesized from glycoproteins and glycolipids in non‐primate mammals and New World monkeys, but is absent in humans, apes and Old World monkeys. Instead, they produce anti‐Gal antibody (Ab) (forming approximately 1% of circulating immunoglobulins), which specifically interacts with α‐gal epitopes. Anti‐Gal Ab can be exploited in cancer immunotherapy as vaccines that target antigen‐presenting cells (APC) to increase their immunogenicity. Tumor cells or tumor cell membranes from pancreatic cancer are processed to express α‐gal epitopes. Subsequent vaccination with such processed cell membranes results in in vivo opsonization by anti‐Gal IgG in cancer patients. The interaction of the Fc portion of the vaccine‐bound anti‐Gal with Fcγ receptors of APC induces effective uptake of the vaccinating tumor cell membranes by the APC, followed by effective transport of the vaccinating tumor membranes to the regional lymph nodes, and processing and presentation of the tumor‐associated antigens. Activation of tumor‐specific B and T cells could elicit an immune response that in some patients is potent enough to eradicate the residual cancer cells that remain after completion of standard therapy. This review addresses these topics and new avenues of clinical importance related to this unique antigen/antibody system (α‐gal epitope/anti‐Gal Ab) and advances in immunotherapy in pancreatic cancer.
The proto-oncogene bcl-2, isolated from the t(14;18) chromosomal breakpoint in follicular B-lymphoma, and a bcl-2-related gene bcl-x (ref. 4) prevent apoptotic cell death induced by various ...treatments. Although a mechanism has been proposed that involves Bcl-2 activity on reactive oxygen species (ROS), expression of Bcl-2 or Bcl-xL prevents cell death induced by withdrawal of oxygen (hypoxia), which drastically decreases the net formation of oxygen free radicals and does not increase oxidized lipid, protein or DNA. Furthermore, neither ROS scavenger nor inhibitor of ROS scavenger affects cell death, regardless of the expression of Bcl-2 or Bcl-xL. Thus our data suggest that Bcl-2 and Bcl-xL exert an anti-cell death function by a mechanism other than regulation of ROS activity.
We and others have recently shown that loss of the mitochondrial membrane potential (Δ ψ ) precedes apoptosis and chemical-hypoxia-induced necrosis and is prevented by Bcl-2. In this report, we ...examine the biochemical mechanism used by Bcl-2 to prevent Δ ψ loss, as determined with mitochondria isolated from a cell line overexpressing human Bcl-2 or from livers of Bcl-2 transgenic mice. Although Bcl-2 had no effect on the respiration rate of isolated mitochondria, it prevented both Δ ψ loss and the permeability transition (PT) induced by various reagents, including Ca2+, H2O2, and tert-butyl hydroperoxide. Even under conditions that did not allow PT, Bcl-2 maintained Δ ψ , suggesting that the functional target of Bcl-2 is regulation of Δ ψ but not PT. Bcl-2 also maintained Δ ψ in the presence of the protonophore SF6847, which induces proton influx, suggesting that Bcl-2 regulates ion transport to maintain Δ ψ . Although treatment with SF6847 in the absence of Ca2+caused massive H+influx in control mitochondria, the presence of Bcl-2 induced H+efflux after transient H+influx. In this case, Bcl-2 did not enhance K+efflux. Furthermore, Bcl-2 enhanced H+efflux but not K+flux after treatment of mitochondria with Ca2+or tert-butyl hydroperoxide. These results suggest that Bcl-2 maintains Δ ψ by enhancing H+efflux in the presence of Δ ψ -loss-inducing stimuli.
Treatment for gastric carcinoma in the oldest old patients Endo, Shunji; Yoshikawa, Yukinobu; Hatanaka, Nobutaka ...
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association,
06/2011, Letnik:
14, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Background
The strategy for treating extremely aged patients with gastric carcinoma is controversial. This study reviews the prognoses of patients aged 85 years and older who were diagnosed with ...gastric carcinoma.
Methods
One hundred seventeen patients aged 85 years and older were diagnosed as having gastric carcinoma after 1969 in our institution. After excluding those at stage IV, 36 cases underwent curative resection and 30 cases received best supportive care (BSC), which we reviewed retrospectively.
Results
Surgical methods included distal gastrectomy for 28 cases, total gastrectomy for five cases, and other procedures for three cases. Postoperatively, pneumonia developed in four cases, anastomotic leakage in two cases, and pancreatic fistula in one case. Two patients died of pneumonia within 1 month of surgery. Univariate analysis demonstrated that age, surgery, performance status, and sodium level were statistically significant prognostic factors. Multivariate analysis demonstrated that surgery was the only independent prognostic factor. When patients with a performance status of 4 were excluded, the clinical characteristics of the surgery group (
n
= 36) and BSC group (
n
= 20) were statistically identical, and the overall survival was significantly better in the surgery group (
p
= 0.0078).
Conclusions
Postoperative outcomes were relatively acceptable. Surgery may be feasible and beneficial even for extremely aged patients 85 years and older, except for those with a performance status of 4.
Advances in Modern Medicine introduces recent advanced medical practices performed at the Kure Medical Center and Chugoku Cancer Center (KMCCCC) - one of the leading hospitals in Japan - to those ...working in the field of medicine throughout the world, including physicians, surgeons, pharmacists, psychologists, medical engineers, medical technologists, nurses, and students. Readers will be updated on the general trends in modern medicine relevant to a variety of medical specialties performed at KMCCCC. The volume covers topics such as cancer management, acute phase reaction against a national-level disaster, depression management, emergency medicine, hepatobiliary and gastrointestinal diseases, orthopedics, organ transportation, infection control, blood disease, chronic kidney disease, palliative care, dermatology, ophthalmology, pathology, and nursing for cancer patients. Aspiring medical students can learn more about the latest developments in their field of interest, while patients can learn about treatment options available for different diseases.
In 2010, World Health Organization classified gastric neuroendocrine tumor (NET) as follows: NET grade (G) 1, NET G2, neuroendocrine carcinoma (NEC). We reviewed 22 gastric NETs that were encountered ...in our institutions. Nine, 6, and 4 were NET G1, G2, and NEC, respectively. We also encountered 3 NET G3. NET G1 was treated with observation in 2 patients, endoscopic mucosal resection (EMR) in 3, and gastrectomy in 4 patients. No recurrence was experienced during a median of 53 months of follow-up. All NET G2 was treated with gastrectomy. No patient experienced recurrence during a median of 25 months of follow-up. NET G3 was treated with gastrectomy. One patient died of liver metastasis 52 months after gastrectomy. For NEC, gastrectomy was performed in 3 cases and no patients died of tumor-related death. We conclude that the prognoses of NET G1 and G2 were good. We also experienced long-term survivors of NEC. An accumulation of more patients is needed for further investigation.
Fas (Apo-1/CD95) belongs to the tumor necrosis factor/nerve growth factor receptor family and transmits apoptotic signals by binding to its ligand. Interleukin-1beta-converting enzyme (ICE), which ...shows substantial homology to the product of the cell death gene, ced-3, of Caenorhabditis elegans, is reported to be involved in Fas-mediated apoptosis. Using two human carcinoma-derived cell lines with undetectable levels of ICE, we found that an agonistic antihuman Fas antibody induces the activation of CPP32/Yama(-like) proteases that are ICE(-like) protease family members, and that a tetrapeptide inhibitor of CPP32/Yama protease, DEVD-CHO, inhibits the Fas-mediated activation of the proteases, Fas-mediated apoptosis, and CPP32/Yama(-like) proteolytic activities in vitro. Fas-mediated apoptosis is inhibited by the CPP32/Yama inhibitor DEVD-CHO, but not by the ICE inhibitor YVAD-CHO, suggesting a dominant role for the CPP32/Yama(-like) proteases and not ICE itself in Fas-mediated apoptosis of the human carcinoma cell lines.
This study was undertaken to determine whether the recurrent laryngeal nerve involved in differentiated thyroid carcinoma could be preserved.
Few investigations have provided definitive results ...concerning preservation of the recurrent laryngeal nerve involved in thyroid cancer. Complete excision with resection of the recurrent laryngeal nerve reportedly did not improve survival over incomplete excision in differentiated thyroid carcinoma.
A retrospective study was performed with the medical records of 50 patients with differentiated carcinoma and preoperative normal vocal cord function to investigate outcomes of recurrent laryngeal nerve preservation including local recurrence, prognosis, and postoperative vocal cord function. The recurrent laryngeal nerves on 1 or both sides were preserved in 23 patients (the preserved group), whereas the involved recurrent laryngeal nerve of the other 27 patients was resected (the resected group).
Backgrounds of patients were similar between the resected and preserved groups. The number of patients with recurrences in each group was similar, and incidence of local, regional, and distant metastatic recurrences were not different between the groups. Postoperative overall survival of the preserved group was similar to that of the resected group (p = 0.1208). More than 60% of patients or of nerve at risk in the preserved group restored normal vocal cord function within 6 months. Some functional vocal cord movement was recognized in 80% of patients or of nerve at risk. All patients in the resected group including patients with nerve anastomosis showed permanent paralysis of the ipsilateral vocal cord.
These results suggested that the recurrent laryngeal nerve, even if infiltrated by differentiated thyroid cancer, is worthwhile to preserve for maintenance of postoperative vocal cord function without affecting the incidence of local recurrence or prognosis.
Esophageal cancer rarely metastasizes to the brain. The authors experienced a case of esophageal carcinoma which metastasized to the cerebellum as the first presentation. A 61-year-old man was ...identified as having esophageal carcinoma by esophagogastroduodenoscopy during a medical checkup. Subtotal esophagectomy with dissection of 3 regional lymph nodes was performed. The tumor was 30 × 20 mm
2
in size, and was revealed to be a moderately differentiated squamous cell carcinoma. The pathological finding was T1b(SM)N0M0 stage I. Fourteen months after the surgery, the patient complained of nausea. Brain magnetic resonance imaging (MRI) showed a cystic tumor of 42 × 28 × 28 mm
3
in size in the central cerebellum. No other metastasis was pointed out. A craniotomy for brain tumor resection was performed, and the histopathological examination revealed that it was a metastatic carcinoma from the esophagus. Gamma knife therapy was added. The patient died of cerebellar metastasis recurrence 24 months after the first surgery.
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