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Biomedical subjects

A Nashimoto

Publications and source records attributed to A Nashimoto.

At least 19 recordsLinked to original sources
PubMed2006

Stage migration caused by D2 dissection with para-aortic lymphadenectomy for gastric cancer from the results of a prospective randomized controlled trial.

BACKGROUND: Extended lymphadenectomy (D2) provides accurate nodal staging of gastric cancer. The aim of this study was to clarify the degree of stage migration seen with D2 combined with para-aortic lymph node dissection for gastric cancer invading the subserosa, the serosa and adjacent structures (T2ss-4) in patients considered not to have distant metastases (M0). METHODS: Between July 1995 and April 2001, 523 patients were recruited and randomized in a prospective phase III trial comparing D2 with D2 and para-aortic nodal dissection for T2ss-4 gastric cancer without macroscopic para-aortic nodal metastases. Stage migration was evaluated by Japanese Gastric Cancer Association staging in 260 patients who underwent D2 with para-aortic dissection by analysing pathological information from the dissected lymph nodes. RESULTS: Node (N)-stage migration was observed in 1 per cent (1 of 82) of patients with N1 disease, 20 per cent (12 of 59) with N2, 43 per cent (10 of 23) with N3 and 8.8 per cent (23 of 260) of all patients. Final stage migration occurred in 9 per cent (5 of 58) of patients with stage IIIa, 19 per cent (8 of 42) with stage IIIb, 56 per cent (9 of 16) with stage IVa and 8.5 per cent (22 of 260) of all patients. Metastasis to N4 nodes was found in 4 per cent (four of 95) of tumours invading the subserosa and 17.4 per cent (19 of 109) of tumours penetrating the serosa. The overall incidence of N4 involvement was 8.8 per cent (23 of 260). CONCLUSION: Extended para-aortic lymphadenectomy for gastric cancer provides accurate nodal staging and results in stage migration, which may improve stage-specific survival regardless of overall survival benefit.

Humans↗
PubMed2005

Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer.

BACKGROUND: Extended lymphadenectomy for gastric carcinoma has been associated with high mortality and morbidity rates in several multicentre randomized trials. METHODS: Using data from 523 patients registered for a prospective randomized trial comparing extended (D2) and superextended (D3) lymphadenectomies, risk factors for overall complications and major surgical complications (anastomotic leakage, intra-abdominal abscess and pancreatic fistula) were identified by multivariate logistic regression analysis. RESULTS: Mortality and morbidity rates were 0.8 per cent (four of 523) and 24.5 per cent (128 of 523) respectively. Pancreatectomy (relative risk 5.62 (95 per cent confidence interval (c.i.) 1.94 to 16.27)) and prolonged operating time (relative risk 2.65 (95 per cent confidence interval 1.34 to 5.23)) were the most important risk factors for overall complications. A body mass index of 25 kg/m2 or above, pancreatectomy and age greater than 65 years were significant predictors of major surgical complications. CONCLUSION: Pancreatectomy should be reserved for patients with stage T4 disease. Age and obesity should be considered when planning surgery.

Adult↗
PubMed2002

Fatty acid synthase is highly expressed in carcinoma, adenoma and in regenerative epithelium and intestinal metaplasia of the stomach.

AIMS: To investigate the relation of fatty acid synthase (FAS) expression to the clinicopathological characteristics of gastric cancers and gastric tumorigenesis. METHODS AND RESULTS: FAS expression was examined immunohistochemically in 626 gastric cancers, 51 gastric adenomas, and non-neoplastic epithelium contiguous with cancer tissue including normal foveolae, intestinal metaplasia, regenerative epithelium, and gastric glands. FAS expression was found in more than 70% of gastric cancers. Interestingly, it occurred preferentially in differentiated carcinomas, male cases, and in patients over 51 years old. Although previous reports showed that FAS expression is closely related to cancer progression, in gastric cancers FAS expression had no relationship with prognosis, cancer progression as indicated by depth of invasion, venous and lymphatic permeation, and distant metastasis. Gastric tubular adenoma and intestinal metaplasia, which are thought to be associated with well-differentiated gastric carcinomas, showed a frequency of FAS expression similar to that of differentiated carcinomas; however, normal foveolae and gastric glands showed no or less FAS expression. CONCLUSIONS: FAS expression occurs at the early stage of tumorigenesis and plays important roles in the formation of precancerous foci rather than in the progression of carcinoma of the stomach.

Adenoma↗
PubMed2001

Expression of glucose transporter-1 in human gastric carcinoma: association with tumor aggressiveness, metastasis, and patient survival.

BACKGROUND: Malignant cells show increased glucose uptake in vitro and in vivo, which is believed to be facilitated by glucose transporters (Gluts). Expression of Glut1, one of the Gluts, has been described in malignancies of the esophagus, colon, pancreas, lung, and brain, but to the authors' knowledge the significance of Glut1 expression in human gastric carcinoma has not been elucidated. The objective of the current study was to examine the expression and distribution of Glut1 and its relation to clinicopathologic parameters in patients with gastric carcinoma. METHODS: Immunohistochemistry with anti-Glut1 antibody was performed on 617 gastric carcinomas and 50 tubular adenomas of the stomach. Glut1-positive and Glut1-negative carcinomas were analyzed for their clinicopathologic characteristics including histologic subtype, depth of invasion, vascular permeation, lymph node and hepatic metastasis, peritoneal dissemination, and prognosis. RESULTS: None of the adenomas expressed Glut1, whereas 182 of 617 carcinomas (29.5%) were positive for the protein. Signet ring cell carcinoma and mucinous adenocarcinoma rarely were positive (2.0% and 6.3%, respectively) and papillary adenocarcinoma (44%) showed slightly higher positivity for Glut1 than tubular (32%) or poorly differentiated adenocarcinoma (28%). Glut1-positive tumor cells were localized mainly in the central part of tumor nests with or without peripheral distribution (92%) but peripheral distribution alone was very limited (8%) (P = 0.0001). Glut1 positivity was associated with depth of invasion (P = 0.0001), lymphatic permeation (P = 0.0001), venous invasion (P = 0.0001), lymph node metastasis (P = 0.0001), hepatic metastasis (P = 0.0001), and carcinoma stage (P = 0.0001). However, peritoneal dissemination was not found to be associated with Glut1 positivity (P = 0.0833). The survival of patients who had tumors that expressed Glut1 was significantly shorter than that of patients with Glut1-negative tumors (P = 0.0001). CONCLUSIONS: In human gastric carcinoma, Glut1 is expressed late in carcinogesis and increases with disease progression. Glut1 expression is associated with tumor aggressiveness and patient survival.

Adult↗
PubMed2001

Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric cancer.

BACKGROUND: No reports have, to date, focused on the relationship between preoperative determination of the depth of invasion and lymph node metastasis. The present study, under the leadership of the Japanese Gastric Cancer Association, was designed to form a basis for decision making in limited treatment for early gastric cancer (EGC). METHODS: From eight major hospitals in Japan, 2672 gastric cancers whose preoperative depth of invasion was mucosal(M-cancer), and 6209 EGCs, consisting of 3584 mucosal(m-) and 2625 submucosal(sm-) cancers, were collected by questionnaire. All registered patients underwent gastrectomy with D1 or more extensive lymphadenectomy between 1985 and 1998. RESULTS: The accuracy of preoperative diagnosis of depth of invasion of M-cancers was 80.2% (2144/2672). However, of the total of 2432 M-cancers in which no nodal involvement was observed intraoperatively (N0), histological examination of the resected specimens confirmed that lymph node metastasis was absent in 2353 (96.8%). The frequencies of lymph node metastasis in early gastric, m-, and sm-cancers were 8.9%, 2.5%, and 17.6%, respectively. Node involvement was associated with a higher frequency of undifferentiated than differentiated histology, as well as with greater tumor size. The incidences of lymph node metastasis in m-cancers with a diameter of less than 4 cm, and in sm-cancers with a diameter below 1 cm were 1.3% (37/2837) and 4.9% (4/82), respectively. These metastases rarely extended beyond the first tier. CONCLUSION: N0 and M-cancers, m-cancers less than 4 cm in diameter, and sm-cancers no larger than 1 cm in diameter may be appropriate indications for limited surgery.

Chi-Square Distribution↗
PubMed2001

[A patient with obstructive jaundice due to recurrence after gastric cancer surgery responding remarkably to FLP combination therapy].

The patient was a 67-year-old man who had undergone distal gastrectomy because of early gastric cancer without lymph node metastasis two years earlier. The postoperative course was uneventful, but he was admitted again to our hospital because of abrupt jaundice. A CT scan of the abdomen showed obstructive jaundice due to the enlargement of the lymph nodes around the hepatoduodenal ligament, pancreas head, portal vein, and celiac axis. After percutaneous transhepatic cholangio-drainage (PTCD), 5 cycles of FLP combination therapy (5-fluorouracil, leucovorin, cisplatin) were performed. Consequently, the tumor marker level returned to the normal range and the shrinkage of the metastatic lymph nodes was remarkable. A reopening of the biliary tract was attained, so the PTCD tube could be removed. As an outpatient without recurrence he has received oral administration of uracil plus tegafur. The FLP combination therapy was effective for obstructive jaundice due to intraperitoneal lymph node recurrence of the gastric cancer.

Aged↗
PubMed2001

[A case of remnant gastric cancer responding to neoadjuvant TS-1 therapy].

We report the case a 77-year-old male with remnant gastric cancer successfully treated with TS-1 as neoadjuvant chemotherapy. His treatment was daily oral administration of 100 mg TS-1 for 28 days. This therapy was safely carried out on an outpatient basis. The histological diagnosis of the resected stomach revealed complete disappearance of cancer cells in the stomach and the regional lymph nodes. This case suggests that TS-1 may have a potent therapeutic effect in neoadjuvant chemotherapy for recurrent gastric cancer.

Administration, Oral↗
PubMed2000

[A patient with advanced gastric cancer who obtained downstaging and underwent radical surgery by neoadjuvant chemotherapy].

The patient was a 74-year-old man with extremely advanced gastric cancer. A CT scan of the abdomen showed enlargement of many huge abdominal para-aortic lymph nodes. Neoadjuvant chemotherapy (NAC) was planned in order to reduce or eliminate the tumor. Two cycles of FLP combination therapy (5-fluorouracil, leucovorin, cisplatin) were given. After NAC, a CT scan revealed marked shrinkage of the No. 16 lymph nodes, and a distal gastrectomy with extended radical lymph node dissection including the No. 16 nodes was performed. The histological effect was judged to be grade 2. There were no viable cancer cells in the No. 16 lymph nodes. The FLP combination therapy as NAC was so effective that it induced downstaging from stage IVb to IIIb.

Adenocarcinoma↗
PubMed2000

[A case of AFP-producing gastric cancer after curative operation effectively treated with chemotherapies including hepatic arterial infusion therapy].

A 63-year-old woman was admitted complaining of epigastralgia. An endoscopic examination revealed a Borrmann type 2 lesion at the greater curvature of the middle third in the stomach. Abdominal computed tomography detected no liver metastasis. The preoperative serum alpha-phetoprotein (AFP) level was elevated to 242.9 ng/ml. 5-fluorouracil (5-FU) was given 200 mg/day for 26 days orally. Distal gastrectomy with D3+ No. 16b1 lymph node dissection, cholecystectomy and hepatic arterial canulation were performed, and mitomycin C 20 mg was injected intravenously during the operation. Immunohistochemical staining of the specimen for AFP by the SAB method was positive in the cancer lesion. After the operation, FP (cisplatin 100 mg on day 1, 5-FU 750 mg on days 1-3) therapy of one course and intrahepatic arterial infusion therapy using adriamycin 10-20 mg every 2 weeks for 7 months were conducted. Moreover, the patient took UFT 400 mg/day for 26 months orally on an outpatient basis as an adjuvant chemotherapy. The only toxicity was neutropenia (grade 3), but it abated without an interruption in the chemotherapy. The AFP level declined gradually, and returned to the normal range 1 month after surgery. The patient is still alive with no sign of hepatic metastasis or recurrence 7 years and 7 months after the gastrectomy.

Adenocarcinoma↗
PubMed1999

Adjuvant mitomycin and fluorouracil followed by oral uracil plus tegafur in serosa-negative gastric cancer: a randomised trial. Gastric Cancer Surgical Study Group.

BACKGROUND: To study the survival benefit of adjuvant chemotherapy in gastric cancer, seven cancer centres in Japan carried out a phase III clinical trial of adjuvant chemotherapy after curative gastrectomy for macroscopically serosa-negative gastric cancer. METHODS: 579 patients were enrolled in the study, stratified by disease stage (T1, n=188; T2, n=323), and allocated randomly adjuvant chemotherapy or no further treatment. 285 of 288 cases in the treatment group and 288 of 291 in the control group were eligible. Six cases were excluded because they did not fulfill the entry criteria. The treatment group had intravenous mitomycin (1.4 mg/m2) and fluorouracil (166.7 mg/m2) twice weekly for 3 weeks after surgery, and oral UFT (uracil plus tegafur, 300 mg daily) for 18 months. Analyses were by intention to treat. FINDINGS: No serious toxic effects were observed in the treatment group. At median follow-up of 72 months, 59 patients in the control group and 47 in the treatment group had died. There was no significant difference in survival between the groups (5-year survival 82.9% control vs 85.8% treated; hazard ratio 0.738 [95% CI 0.498-1.093]). 5-year survival of patients with T1 (mucosal or submucosal) cancer in the control and treatment groups was 94.9% versus 92.0%, and that of patients with T2 (muscularis propria or subserosa) cancer was 76.9% versus 83.0%. However, a test for heterogeneity and interaction over T1 and T2 subgroups revealed no significant difference in terms of drug response. INTERPRETATION: There was no survival benefit with this adjuvant therapy regimen for patients with macroscopically serosa-negative gastric cancer (T1 and T2) after curative gastrectomy. Patients with T1 cancer can be excluded from future trials, because curative surgery alone yielded a very good survival rate and there seemed no need for adjuvant therapy.

Adenocarcinoma↗
PubMed1999

[A case of advanced gastric cancer with abdominal para-aortic lymph node metastasis successfully treated with FLP therapy].

A 73-year-old woman was admitted to our hospital in June 1998, suffering from upper abdominal pain. The upper G-I series and endoscopic examination revealed stenosis of the pylorus and antrum by a type 2 cancer, and a poorly differentiated adenocarcinoma and a signet-ring cell carcinoma were confirmed on endoscopic biopsy. A CT scan showed the enlargement of many regional and abdominal para-aortic lymph nodes. FLP therapy combined with cisplatin (50 mg/m2 drip i.v., day 1-8), 5-fluorouracil (333 mg/m2 drip i.v.) and leucovorin (30 mg/body i.v., day 1-8) was planned for neoadjuvant chemotherapy (NAC) in order to reduce or eliminate the tumor and increase curability. After two cycles of the FLP therapy, the tumor size shrunk remarkably and the enlargement of the para-aortic lymph nodes disappeared. Distal gastrectomy with extended lymphadenectomy and cholecystectomy was performed. The histological findings of the primary tumor and metastatic lymph nodes demonstrated massive cancer cell degeneration such as pycnosis and vacuolation, xanthogranulomatous inflammation and dense fibrosis. The effect of NAC was judged to be grade 2 histologically. FLP therapy is an effective and safe regimen for NAC.

Adenocarcinoma↗
PubMed1998

[Evaluation of hepatic arterial infusion chemotherapy using reservoir for liver metastases from gastric cancer].

UNLABELLED: We evaluated the results of hepatic arterial infusion chemotherapy (HAIC) using implantable reservoir for gastric cancer patients with unresectable liver metastases. Twenty-eight patients (19 with synchronous liver metastases, 6 patients with recurrent hepatic tumors, and 3 patients with high risk factors of liver recurrence after curative surgery) were treated with HAIC. The canula was inserted into the hepatic artery during primary surgery for 19 patients and during angiography for 7. The combination of anti-cancer drugs, such as, MMC + 5-FU (6 cases), ADM + 5-FU (14 cases), 5-FU + ADM + MMC (5 cases), and CDDP (3 cases) was administered by the intra-arterial route to out-patients every one or two weeks. RESULTS: The response rate of the metastatic liver foci in evaluable patients was 32.0% (1 CR + 7 PR/25). The median survival time (MST) of all patients was 294 days, and there were only two 5-year survivors treated to prevent recurrence. The 2-year survival after HAIC was 10.5% for the synchronous liver metastatic group and 53.3% for the metachronous group. The MST of responders was 94 days longer than that of non-responders, but there was no significant difference statistically. The remote survival of the patients whose palliative factors were liver metastases alone was significantly better than that of the patients with hepatic and extrahepatic palliative factors: the MST and 1-year survival was 329 days and 140 days, and 17.9% and 13.3%, respectively (p < 0.05). In conclusion, the clinical effect of HAIC was not sufficient. But the improvement of survival among patients without extrahepatic lesions as a palliative factor, and preventive HAIC was recommended.

Adult↗
PubMed1997

Disease-free survival for 6 years and 4 months after dissection of recurrent abdominal paraaortic nodes (no. 16) in gastric cancer: report of a case.

We herein report the case of a 63-year-old woman who underwent curative surgery consisting of a subtotal gastrectomy with D2 lymph node dissection for advanced stomach cancer in June 1984, and later underwent systemic dissection of recurrent abdominal paraaortic lymph nodes by a retromesenteric approach in June 1989. Metastatic nodes were found in nos. 16b1 (interaorticocaval), 16b2 (interaorticocaval), and 280 (aortic carinal). One of the resected nodes, which was histologically diagnosed as being poorly differentiated adenocarcinoma, measured approximately 10 x 7 cm and infiltrated the inferior caval vein. There was no distant metastasis except for nodal metastases. Since the reoperation, the patient has been disease-free for 6 years and 4 months, and she continues to visit our hospital as an outpatient. The findings of this case therefore suggest the significance of paraaortic lymph node dissection. To our knowledge, this is the first report in the world of a gastric cancer patient who has remained disease-free for more than 5 years after the systemic dissection of recurrent paraaortic lymph nodes.

Adenocarcinoma↗
PubMed1996

[Quality control of surgery in multicenter study--interinstitutional and individual differences].

UNLABELLED: In a prospective randomized controlled trial (PRCT) of adjuvant chemotherapy for gastric cancer patients participated by 6 cancer center hospitals, inter-institutional and inter-individual differences about several factors related to the surgery and remote survivals were analyzed. From 1988 to 1992, 1,049 evaluable patients were enrolled and stratified to 6 groups according to the grade of the serosal invasion and curability, and analyzed statistically. RESULTS: 1) There were no inter-institutional differences about postoperative survival rate, but there were slight differences about patient's background factors and entry policy of each institution. 2) There were no inter-institutional differences about several factors related to the surgery such as operative time, bleeding volume during operation, and the length of the administration periods. 3) There were no inter-individual differences about the length of the administration periods, but there were a little differences about operative time and the volume of hemorrhage. When the PRCT of adjuvant chemotherapy of which the end point is survival would be designed, no inter-institutional differences about remote survival and surgical operation in each institution should be confirmed before starting the trial.

Chemotherapy, Adjuvant↗
PubMed1994

Helicobacter pylori infection in gastric carcinoma.

PURPOSE: This study was undertaken to compare the pathoclinical findings in gastric adenocarcinoma with serum IgG antibody to Helicobacter pylori. MATERIALS AND METHODS: We examined 185 patients with histologically established gastric cancer. The presence of immunoglobulin (Ig)G antibody in the high molecular cell-associated antigen of H. pylori was determined by enzyme-linked immunosorbent assay. Pepsinogens I and II were measured by radioimmunoassay. The distribution of H. pylori on the gastric mucosa was assessed by the Campylobacter-like organism test and phenol red dye spraying. RESULTS: H. pylori IgG antibody was detected in 93.1% of patients with gastric cancer (mean age 61.7 years), 94.3% of patients with early gastric cancer and 91.2% with advanced gastric cancer. No statistical difference in serology was observed between type of gastric cancer, depth of cancer invasion, tumor size or histology. Only in patients with diffuse-type cancer of the cardia was there a lower percentage of positive results (80.0%). The ratio of pepsinogen I to pepsinogen II was higher in the patients who exhibited no H. pylori antibodies. CONCLUSIONS: H. pylori antibodies were common in patients with gastric cancer, and were not correlated with histological type nor stage of cancer. In the Niigata district, a higher percentage of patients with gastric carcinoma displayed H. pylori antibodies compared with other districts in Japan.

Adenocarcinoma↗
PubMed1993

A giant tumor of the mesocolon found to be metastasis from an alpha-fetoprotein-producing gastric carcinoma: report of a case.

We present herein an extremely rare case of metastasis from a gastric carcinoma to the mesocolon. A 71-year-old woman underwent a laparotomy for gastric cancer with an intra-abdominal mass. Her serum alpha-fetoprotein level was very high at 3,560 ng/ml. The abdominal mass was subsequently revealed to be a metastatic tumor of the transverse mesocolon derived from an alpha-fetoprotein-producing gastric carcinoma, but no other metastatic focus was found. An immunohistochemical study revealed alpha-fetoprotein-positive cells in both lesions. The serum alpha-fetoprotein level became normal after the operation which was followed by a course of chemotherapy, and no recurrence has been observed thus far in 6 months of follow up.

Adenocarcinoma↗
PubMed1992

[Borrmann 4 gastric cancer treated with l-LV and 5-FU combination--a case report].

The patient was a 44-year-old female who had Borrmann type 4 gastric cancer with enlarged intra-abdominal lymph node metastasis. L-leucovorin (l-LV, 100 mg/m2/day by intravenous bolus for a period of one minute) and fluorouracil (5-FU, 370 mg/m2/day by intravenous bolus) was administered for 5 consecutive days, with a 28-day interval. Dysphagia was subsided 4 weeks after the initial treatment. After 11 weeks, abdominal lymph node metastasis had been reduced in its size (reduced rate 89%). After 16 weeks, gastric structure were remarkably improved (62.2% enlarged in its focus space) in upper GI X-ray. Therefore, total gastrectomy was performed 20 weeks after the initial combination therapy. She has been alive for the past year after the initial treatment. We concluded a combination therapy of l-LV and 5-FU was effective in this patient.

Adenocarcinoma↗