Biomedical subjects

Huann-Sheng Wang

Publications and source records attributed to Huann-Sheng Wang.

17 recordsLinked to original sources

PubMed2006

p53 protein accumulation as a prognostic marker in sporadic colorectal cancer.

BACKGROUND AND AIMS: p53 protein plays a crucial role in the pathogenesis of a large number of malignancies. In this study, our goal was to elucidate the prognostic role of p53 overexpression and its relationship to clinicopathological variables in colorectal cancer. MATERIALS AND METHODS: Between 1999 and 2004, surgical specimens of 258 patients who received surgical treatment for colorectal cancer at the Veterans General Hospital, Taipei were collected. p53 expression in tumor tissue was evaluated by immunohistochemical analysis using the human p53-specific mouse monoclonal antibody, PAb 1801. RESULTS: Of the 258 patients, 97 (37.6%) had overexpression of p53 in tumor tissues. The accumulation of p53 protein in tumor tissues did not correlate with age, gender, preoperative serum carcinoembryonic antigen (CEA) level, mucin content, nodal status, and tumor stage. A statistically significant correlation was found between p53 overexpression and location of the tumor in the rectum (p=0.038). Well to moderately differentiated tumors had significantly higher frequency of p53 overexpression than poorly differentiated tumors (40.0 vs 20.0%, p=0.050). Each patient was followed up for a minimum of 2 years (median 35 months). In univariate analysis, 3-year cancer-specific survival rate was significantly higher in patients with tumor p53 overexpression (88.2%) than in patients without overexpression (log rank test, p=0.037). However, in multivariate analysis, the tumour node metastasis stage remained the most significant independent prognostic factor. CONCLUSION: The accumulation of p53 protein might have a favorable prognostic value in colorectal cancer, but it is not an independent prognostic factor.

Adolescent↗

PubMed2006

Distinctive clinicopathological features of Ki-ras mutated colorectal cancers.

BACKGROUND AND OBJECTIVES: We explored the relationship between the mutation pattern of Ki-ras and the clinicopathological features of colorectal cancers (CRCs). METHODS: Relationships between clinicopathological parameters and Ki-ras mutation status were analyzed in 255 CRC patients using the chi-square and student t-tests. Kaplan-Meier survival curves were compared using the log-rank test. RESULTS: Ki-ras mutation occurred in 43.9% of tumors, and 83% affected codon 12. The most frequent mutations were GGT->GAT (Gly->Asp) (37.5%), followed by GGT->GTT (Gly->Val) (31.3%), both in codon 12. The frequency of Ki-ras mutation was similar for different tumor stages (38.2-47.8%). The mucin component of tumors was significantly associated with Ki-ras mutation. The 4-year overall and disease-free survival was 61% and 54%, respectively, for patients with Ki-ras mutated tumors, and 73% and 60% for patients with nonmutated tumors (not statistically significant). Patients with Ki-ras mutated tumors had lower plasma folate (24 ng/dl) than those bearing nonmutated tumors (37 ng/dl). Patients with G->T Ki-ras mutations had the lowest folate level (22 ng/dl), followed by those with G->A mutations (25 ng/dl). CONCLUSIONS: Ki-ras mutated colorectal tumors have a higher mucin production and higher differentiation, and are associated with lower plasma folate levels and a relatively poorer disease outcome.

Aged↗

PubMed2006

Role of MTHFR polymorphisms and folate levels in different phenotypes of sporadic colorectal cancers.

BACKGROUND AND AIMS: By altering both DNA methylation and nucleotide synthesis, folate metabolism is thought to contribute to colorectal carcinogenesis. We examined the role of folate metabolism in three different phenotypes of sporadic colorectal cancers (CRCs), phenotypes that were classified by the status of microsatellite instability (MSI) and chromosomal instability (CIN): MSI-H, microsatellite stability (MSS)/aneuploidy, and MSS/diploid. PATIENTS AND METHODS: A total of 195 sporadic colorectal tumors and another 195 age- and gender-matched healthy volunteers in Taipei-Veteran General Hospital and Taipei City Hospital were collected. We analyzed for MTHFR (methylenetetrahydrofolate reductase) polymorphisms (C677T, A1297C), folate, and vitamin B(12) levels. We determined MSI status and DNA ploidy with fluorescent polymerase chain reaction and flow cytometry. Relations between clinicopathological variables and molecular variables were analyzed by chi (2) tests (with Yates' correction) for categorical variables and Student's t test for numerical variables. RESULTS: Folate levels (5.02+/-4.43 ng/ml) were significantly lower in cancer patients than in controls (7.22+/-4.46 ng/ml). Vitamin B(12) level was similar between cancer patients and controls. The frequency of the TT genotype of MTHFR C627T (12.3%) was slightly higher than controls (8.2%), but it did not reach statistical significance (p=0.174). Within the low-folate group (<5 ng/ml), the frequency of the TT genotype in cancer patients (14.4%) was significantly higher than in controls (4.6%). Sixteen patients who had MSI-H CRC (8.2%) had a significantly higher frequency of TT MTHFR (37.5%) and lower folate levels (3.56+/-2.41 ng/ml) than patients with MSS tumors (10.1%, 5.14+/-3.72 ng/ml). Patients with MSS/aneuploid tumors had significantly lower folate levels (4.50+/-3.06 ng/ml) than those with MSS/diploid tumors (6.69+/-4.73 ng/ml). CONCLUSION: Folate deficiency and the MTHFR genetic polymorphism play an important role in colorectal carcinogenesis, including MSI and CI. SYNOPSIS: Folate metabolism plays an important role in colorectal carcinogenesis. We demonstrate that patients with MSI-H tumors had higher frequency of TT MTHFR C627T (37.5%), and patients with MSS/aneuploid tumor had lower folate level (4.50+/-3.06 ng/ml).

Adult↗

PubMed2006

Relationship between genetic alterations and prognosis in sporadic colorectal cancer.

Because chromosomal chromosomal instability (CIN) and microsatellite instability (MSI) are important genetic alterations in colorectal cancers, we classified the sporadic colorectal cancers (CRC) on the status of the CIN and MSI and explored their molecular profiles. A total of 213 colorectal tumors were collected for analysis of DNA ploidy, MSI, loss of heterozygosity (LOH), mutation of p53 (exons 5 to 9), Ki-ras (exons 1 and 2) and BRAF (V599E). Relationships between clinicopathological variables and molecular analyses were analyzed with the chi(2) test (Yates' correction). Kaplan-Meier survival curves were compared using log-rank test. Variables with p < 0.1 were entered into the Cox regression hazard model for multivariate analysis. High microsatellite instability (MSI-H) existed in 19 tumors (8.9%), which were more likely to be right-sided (31.6%) with poor differentiation (26.3%). Seventy-one (33.3%) tumors were diploid and 142 (66.7%) were aneuploid. Mutations in p53, Ki-ras and BRAF were found in 45.1%, 41.8% and 4.2% of tumors, respectively. Based on MSI, and CIN, 3 classes were defined: (i) High microsatellite instability MSI-H tumors: young age, high carcinoembryonic antigen (CEA) level, right colon, poorly differentiated, mucin production, high BRAF mutation, lower allelic loss and relatively good prognosis; (ii) Microsatellite stability (MSS) diploid tumors: right colon, poorly differentiated, less infiltrative tumor, mucin production, lower allelic loss and low p53, BRAF mutation; (iii) MSS aneuploid tumors: more infiltrative invasion, greater allelic loss and high p53 mutation. According to multivariate analysis, tumor stage and p53 mutation were significantly associated with disease progression. The MSS diploid and MSS aneuploid CRCs could be subtyped with p53 mutation and had different prognostic outcome and molecular profiles. The 4-year disease-free survival (DFS) of patients with MSS-diploid, wild-type p53 tumors was 67% and significantly higher than those of patients with MSS-diploid, mutant p53 CRC (30%, p = 0.003). The same trend was found in patients with MSS-aneuploid CRC(wild p53 vs. mutant p53, 64% vs. 41%, p = 0.009). We concluded that CIN, MSI and p53 mutation status might be used as a multiple parameter profile for the prognosis of sporadic colorectal cancer.

Aged↗

PubMed2006

Matrix metalloproteinase-7 increases resistance to Fas-mediated apoptosis and is a poor prognostic factor of patients with colorectal carcinoma.

The ability of tumor cells to resist apoptosis triggered by immune cells results in their escape from immune surveillance of the host. A critical effector of apoptosis is the Fas/Fas ligand (FasL) system that mediates the tumoricidal effects of cytotoxic T cells. Recently, in vitro cleavage of Fas expressed in various tumor cells by matrix metalloproteinase-7 (MMP-7) was demonstrated. In the present study, we first analyzed the influence of this metalloproteinase on Fas signaling in SW480, HCT-15 and HT-29 colorectal carcinoma (CRC) cells by assessing their responses to either an agonistic Fas antibody (CH11) or the FasL-bearing Jurkat cells after they were pretreated with MMP-7. Interestingly, both antibody- and Jurkat cell-induced apoptosis in three different CRC lines were significantly reduced by MMP-7 pretreatment. Additionally, immunohistochemical (IHC) staining was used to examine the expression levels of MMP-7 and Fas in tumor samples of 54 CRC patients. In agreement with our in vitro observation, the expression of MMP-7 in tumor tissues was inversely correlated with those of Fas (P < 0.001; chi2-test). Moreover, shortened survival was found in patients with a higher MMP-7 and a lower Fas expression, respectively, in their tumor tissues (P < 0.0001). Finally, by multivariate analysis, we discovered that MMP-7 (P = 0.001) and Fas levels (P = 0.036) were independent prognostic factors for CRC patients. These results suggest that Fas downregulation and a consequential increased resistance to FasL-triggered apoptosis resulting from upregulated MMP-7 in colorectal cancer cells could be a key mechanism for their escape from the immune surveillance, thereby predicting a poor survival in CRC patients.

Apoptosis↗

PubMed2005

Pre-operative chemoradiotherapy with oral tegafur-uracil and leucovorin for rectal cancer.

BACKGROUND: To evaluate the efficacy and toxicity of pre-operative radiotherapy (RT) combined with oral tegafur-uracil (UFUR) plus leucovorin (LV) in rectal cancer. PATIENTS: Sixty-five patients with rectal adenocarcinoma (clinical staged T2-4N0-2M0) received pelvic RT of 45 Gy in 20 fractions over 28 days. Concurrent chemotherapy consisted of UFUR (200 mg/m(2)/day) and LV (45 mg/day) on day 1-28. UFUR (250 mg/m(2)/day) and LV were continued on day 36-63. Surgery was performed on day 70. RESULTS: Sixty-three patients completed the concurrent chemoradiotherapy (CCRT) and 56 received curative or palliative surgery. Among the 52 patients receiving curative resection, downstaging (DS) occurred in 39 (75%), pathological complete response in 13 (25%), and sphincter preservation was achieved in 16 of 29 (55%) with lower-seated tumors. With a median follow-up time of 33 months, local failure developed in 4 (8%) and distant metastases occurred in 7 (14%). The 3-year overall survival was 92% and disease-free survival 76%. For all 65 patients, grade 3-4 diarrhea developed in 6 (9%) and grade 3-4 leucopenia observed in 2 (3%). CONCLUSIONS: Oral UFUR + LV administered with pre-operative RT are effective in tumor DS, pathological complete response, and sphincter preservation with tolerable toxicity in rectal cancer.

Adenocarcinoma↗

PubMed2005

Curative resection of T1 colorectal carcinoma: risk of lymph node metastasis and long-term prognosis.

PURPOSE: The features of T1 colorectal adenocarcinoma and the risk determination of lymph node metastasis were reviewed. Prognostic factors were assessed to verify whether the risk of lymph node metastasis would influence the long-term prognosis. METHODS: Patients undergoing curative resection of T1 colorectal adenocarcinoma at the Taipei Veterans General Hospital from December 1969 to August 2002 were retrospectively studied. Patients with synchronous colorectal cancer, distant metastasis, familiar adenomatous polyposis, or inflammatory bowel disease were excluded. The associations between lymph node metastasis and clinicopathologic variables were evaluated univariately using chi-squared test, Fisher's exact test, or Student's t -test, and multivariately using logistic regression. Univariate analysis by the log-rank test and multivariate analysis by Cox regression hazards model determined the factors influencing the overall survival. RESULTS: A total of 159 patients were included. Sixteen patients (10.1 percent) had lymph node metastasis. The risk of lymph node metastasis included histologic grade (P = 0.005), lymphatic vessel invasion (P = 0.023), inflammation around cancer (P = 0.049), and budding at the invasive front of tumor (P = 0.022). Age (P = 0.001) and number of total sampling lymph nodes (P < 0.0001) were found to be the factors influencing the overall survival. CONCLUSIONS: Variables that predict lymph node metastasis in surgically resected T1 colorectal carcinoma may not impact the long-term prognosis.

Adenocarcinoma↗

PubMed2005

Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer?

BACKGROUND: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common tumor markers for colorectal cancer. The aim of this study was to evaluate the possibility of adding them into the current staging system by analyzing their prognostic significance. MATERIALS AND METHODS: The study population was patients (n = 574, 67.1 +/- 11.3 years old, 397 males) who received potentially curative resection of colorectal adenocarcinoma (stage I-III) between January 1994 and August 2002, including preoperative measurements of CEA and CA19-9. Clinicopathological characteristics and associated follow-up data were retrospectively collected by reviewing available medical charts. CEA higher or equal to 5 ng/ml was defined as abnormal (CEA+). The CA19-9 level was set at 37 U/ml (CA19-9+). Patients were further divided into four groups (1, 2, 3, 4) according to the results of these two markers (CEA/CA19-9: -/-, -/+, +/-, and +/+). Survival was analyzed for AJCC staging, CEA (+) versus (-), CA19-9 (+) versus (-), and four groups. RESULTS: CEA and CA19-9 survival curves were not significantly different. However, the combined use of the two markers revealed a significant survival benefit (P = 0.035) of group 1 ("-" for both markers) over 4 ("+" for both) in stage II. CONCLUSIONS: Patients with an elevated level of both CEA and CA19-9 in stage II of colorectal cancer have a significantly poorer prognosis than those with normal levels of these markers. We recommend adding both CEA and CA19-9 to the current staging system.

Adenocarcinoma↗

PubMed2004

Metachronous colorectal cancer: necessity of post-operative colonoscopic surveillance.

BACKGROUND AND AIMS: The aim of this study was to identify the occurrence and analyze the characteristics of metachronous colorectal cancers, and to compare the characteristics of these cases (index tumor) with the control group to find any predicting factor that may influence the occurrence of metachronous cancer. PATIENTS AND METHODS: The database of colorectal cancer in the Veterans General Hospital-Taipei, from January 1981 to September 2001 was reviewed. In total, 3,846 cases of adenocarcinoma of the colon and rectum, which received curative resection during this period, were found. The criteria of metachronous cancer were: occurrence more than 12 months after curative surgery; with pre-operative complete colonoscopy or one negative post-operative colonoscopic follow-up to rule out synchronous tumor; tumor arising from mucosa at a site other than anastomosis. The age, gender of the patients, the location, pathological characteristics of the metachronous tumors, occurrence of associated adenomas, the number of lesions, and the tumor stage were analyzed and compared with the control group. RESULTS: In total, 43 cases of metachronous cancer were identified, giving an annual incidence of 0.18%. The distribution of the location of the index tumor of metachronous cases was predominantly left-sided, which was not different from that of the control group. The mean duration of occurrence of metachronous cancer after the primary operation was 71+/-46.6 months. The association of adenomas had no relationship with the occurrence of the metachronous cancer. No significant predicting factors for the development of metachronous tumors were found. CONCLUSION: Lifelong regular post-operative colonoscopic surveillance is essential for colorectal cancer patients.

Adenocarcinoma↗

PubMed2004

Overexpression of the thymosin beta-4 gene is associated with increased invasion of SW480 colon carcinoma cells and the distant metastasis of human colorectal carcinoma.

Cell-matrix and cell-cell adhesive interactions play important roles in the normal organization and stabilization of the cell layer in epithelial tissue. Alterations in the expression and function of these adhesion systems that cause a switch to a migratory phenotype in tumor invasion and metastasis are critical for the malignant conversion of epithelial cells. Thymosin beta-4 (Tbeta-4) is the major actin-sequestering protein that has been shown to be upregulated in a wide variety of human carcinomas and has been implicated to be involved in altering the motility of certain tumors. We have recently demonstrated that the growth rate, colony formation in soft agar, and motility, all good indicators for malignant progression, of SW480 colon carcinoma cells are dramatically increased by enforced Tbeta-4 expression. To test the hypothesis that overexpression of this G-actin sequestering peptide also promotes tumor invasion, we examined not only the invasion capability of Tbeta-4-overexpressing SW480 cells, but also the expression levels of Tbeta-4 as well as several proteins that participate in different stages of tumor progression in matched samples of human primary colorectal adenocarcinoma and liver metastases from several patients. A marked increase on the invasiveness in Tbeta-4-overexpressing SW480 cells with increased levels and activity of matrix metalloproteinase-7 (MMP-7) was observed. Furthermore, the levels of Fas as well as the susceptibility to Fas ligand-mediated apoptosis in Tbeta-4-overexpressing cells were significantly decreased. Interestingly, the levels of Tbeta-4 mRNA, beta-catenin, c-Myc, and MMP-7 in metastatic liver lesions were relatively higher, whereas the levels of E-cadherin and Fas were significantly lower than those in the matched primary colorectal tumors. These results suggest that upregulation of Tbeta-4, by promoting the disruption of cell-cell adhesion and a consequential activation of the beta-catenin signaling, could be a key event in the acquisition of growth advantages as well as invasive phenotypes in human colorectal carcinomas.

Cell Line, Tumor↗

PubMed2004

Long-term prognosis of patients with obstructing carcinoma of the right colon.

BACKGROUND: The long-term prognosis of patients with colon cancer is dependent on many factors. The aim of this retrospective study was to assess the long-term prognosis of patients with obstructing carcinoma of the right colon. METHODS: From 1981 to 1988, 256 patients at the Veterans General Hospital-Taipei who were status postcurative resection of right colon adenocarcinoma were classified as obstruction group (n = 35) or nonobstruction group (n = 221) as appropriate. RESULTS: Analysis revealed no differences in age, sex, tumor location, or stage (P >0.05) between the two groups. However, the overall and distant recurrence rates were significant higher in obstructed patients than in nonobstructed patients. Further, long-term crude and cancer-specific survival rates were significantly lower in obstructed patients when examining either overall patient outcome or stage-matched outcomes. Multivariate analysis demonstrated that obstruction and tumor stage were both independent prognostic factors. CONCLUSIONS: Obstruction status was an independent prognostic factor for patients with right colon carcinoma. The long-term prognosis of patients with obstructing carcinoma of the right colon was poor.

Adenocarcinoma↗

PubMed2003

A randomized prospective trial of bowel preparation for colonoscopy with Fortrans compared with bisacodyl.

BACKGROUND: An empty and adequate clean colon is a prerequisite of diagnostic or therapeutic colonoscopy. Our aim is to assess the efficacy and tolerance of bowel preparation for colonoscopy with Fortrans (polyethylene glycols) versus oral bisacodyl. METHODS: One hundred and four consecutive patients scheduled for colonoscopy were prospectively enrolled and allocated to Fortrans group or bisacodyl group by block randomization. RESULTS: Ninety-four patients were included for final analysis. Forty-five patients underwent preparation with Fortrans. The efficacy and tolerance of colon preparation were similar with both methods (p = 0.102, p = 0.202). The latency before the first bowel movement and total preparation time were shorter with Fortrans than with bisacodyl (p = 0.0001 and 0.001, respectively). Statistically significant differences were noted in changes of body weight, serum levels of sodium and calcium in patients taking bisacodyl (p = 0.049, 0.015, and 0.038, respectively). The taste of Fortrans was rated significantly better than that of bisacodyl (p = 0.002). Patients experienced more abdominal discomfort completing preparation with bisacodyl (p = 0.002). CONCLUSIONS: Fortrans and bisacodyl are equally effective and well tolerated in preparation for colonoscopy. However, Fortrans preparation takes less time and provides a better taste with less abdominal discomfort and less change in body weight as well as serum levels of sodium and calcium than bisacodyl preparation.

Bisacodyl↗

PubMed2003

Retained rectal foreign bodies.

BACKGROUND: Retained rectal foreign bodies have been encountered more frequently and present a dilemma for management. Most of the reports on these cases were documented in the form of case report and from Western countries. The present study was a review on the authors' experiences in such cases. METHODS: Data from January 1979 to January 2000 were extracted from a computerized database of Taipei Veterans General Hospital. The clinical features, treatment strategies and outcomes were analyzed. RESULTS: Ten male patients (mean age: 57.0 years) with 12 presentations of retained rectal foreign bodies were collected. Glass bottles and vibrators were the most common objects encountered, while anal eroticism was reported as the reason for insertion in 50% of the cases. The majority of the objects were extracted by non-surgical methods through either anoscope (n = 4), rigid sigmoidoscope (n = 2) or colonoscope (n = 1). Obstetric forceps was utilized to remove an incarcerated bowling bottle. Emergent laparotomies were performed in cases with overt peritonitis (n = 2), pelvic sepsis (n = 1) and an impacted high-lying glass bottle. Minor complications, such as mucosal abrasion or superficial tear, were found in 62.5% of the non-surgically treated cases. Delayed bleeding was found in 2 of them. There was no mortality in our series. CONCLUSIONS: Despite its rarity, the retained rectal foreign body had varying clinical features. Most of the uncomplicated rectal foreign bodies could be simply extracted transanally under adequate anesthesia. Fiberoptic colonoscopic extraction provided an alternative choice. Open surgery should be reserved only for those patients with overt peritonitis or pelvic sepsis.

Adult↗

PubMedDate not supplied

CA19-9 as the most significant prognostic indicator of metastatic colorectal cancer.

BACKGROUND/AIMS: Colorectal cancer is the third leading cause of cancer-related mortality in Taiwan. We became interested in searching for the factors predictive of survival. Serum CA19-9 (carbohydrate antigen 19-9) level has been reported as a factor predictive of survival in patients with colorectal cancer. A few articles have reported that patients with metastatic colorectal cancer who have normal (< or = 37 U/mL) serum CA19-9 levels survived significantly longer than those with higher serum CA19-9 levels. However, these reports are contradictory and lack definite conclusions. This study was carried out in an effort to evaluate the prognostic significance of serum CA19-9 levels in patients with metastatic colorectal cancer in Taiwan. METHODOLOGY: Between 1991 and 1994, a total of 128 patients with histologically confirmed metastatic colorectal cancers were evaluated retrospectively at Veterans General Hospital-Taipei. All patients had measurable metastatic lesions and life expectancies of more than 3 months. 5-Fluorouracil-based chemotherapy, either in a weekly bolus regimen or a monthly 5-day bolus schedule, were administered to all of them. Data on age, sex, performance status, location of primary tumor, extent of metastases, site of metastases, histological differentiation, serum CEA (carcinoembryonic antigen) and CA19-9 levels were analyzed before chemotherapy to determine their association with survival. Blood samples for CEA and CA19-9 measurement were analyzed using the radioimmunoassay method. Multivariate analysis by the Cox's proportional hazards regression model was performed to determine independent prognostic factors among all of the possible variables. RESULTS: By univariate analysis, serum CA19-9 levels (P < 0.001) and performance status of the patients (P = 0.022) were identified as prognostic factors, while age, sex, location of primary tumor, site of metastasis, histological differentiation, and pre-treatment serum CEA levels were not considered significant. By multivariate analysis, serum CA19-9 levels (P < 0.001) and performance status of the patients (P = 0.014) were still found as independent prognostic factors of these patients. CONCLUSIONS: The data from our study indicate that serum CA19-9 level is the most significant prognostic indicator of patients with metastatic colorectal cancer. It is recommended that stratification for further clinical trials for patients with metastatic colorectal cancer should be carried out according to serum CA19-9 levels.

Adenocarcinoma↗

PubMedDate not supplied

Tumor marker CEA in monitoring of response to tegafur-uracil and folinic acid in patients with metastatic colorectal cancer.

BACKGROUND/AIMS: The assessment of response to chemotherapy of solid tumors is generally made by measurement of tumors visualized by imaging, commonly computed tomography scanning. However, response assessment based on imaging is not always feasible because patients often have disease not measurable by imaging study, such as diffuse peritoneal dissemination. Furthermore, response assessment by imaging is expensive and time consuming. This study was carried out in an effort to evaluate the correlation between serial change on imaging and on CEA (carcinoembryonic antigen) levels for assessing chemotherapeutic response of patients with metastatic colorectal cancer. METHODOLOGY: Between May 1998 and August 1999, a total of 40 patients with metastatic colorectal carcinoma were enrolled in this study. All the patients had to have measurable lesions. Oral tegafur-uracil 300 mg/m2/day and folinic acid 60 mg/day were administered concurrently for four weeks, repeated every five weeks, as the first-line treatment. Tumor marker CEA was examined before and during the whole course of treatment. Response based on CEA assessment was defined as a more-than 50% drop in serum CEA level for more than four weeks. The correlation between serial change on CEA and on imaging for assessing chemotherapeutic response was evaluated. RESULTS: Forty patients received a total of 318 courses of treatment and a response rate of 32.5% (95% confidence interval, 18.0% to 47.0%), including five complete responses and eight partial responses, was achieved by imaging studies. The pretreatment CEA levels were elevated beyond the normal cut-off value in 34 (85%) patients. The response rate evaluated by CEA assessment was 42.5% (17/40). Nine responders (22.5%) based on CEA had no remission on imaging. Agreement in assessment by imaging study and by CEA was observed in 20 patients (50%), including eight responders, five stable diseases, and seven progressive diseases. The sensitivity of falling CEA levels in the prediction of true responders on imaging was 62%. The sensitivity of elevated CEA levels for the prediction of progressive disease was 70%. Concerning the diagnostic accuracy, change in CEA levels in the prediction of true responders and progressive disease on imaging were 65% and 85%, respectively. On a follow-up of 24 months, patients with remarkable falling CEA levels survived significantly longer than non-responders (P = 0.0184, log-rank test). CONCLUSIONS: The measurement of CEA levels might be useful in monitoring chemotherapeutic response and in predicting the prognosis of patients with metastatic colorectal cancer. Serum CEA level may be used as a means of monitoring chemotherapeutic response when imaging study is unsuitable for assessing the response in clinical practice.

Adult↗

PubMedDate not supplied

Prospective study of the functional results of transanal endoscopic microsurgery.

BACKGROUND/AIMS: Most clinical research addresses the technological advances and oncological outcomes of transanal endoscopic microsurgery. Our aim was to examine the functional results. METHODOLOGY: From August 1999 to November 2000, 22 Taiwanese patients (14 men, 8 women; median age, 68 years) undergoing transanal endoscopic microsurgery were prospectively examined. Functional questionnaires and anorectal manometry were assessed before surgery and at 2 weeks, 6 weeks, 3 months, and 1 year. RESULTS: The median distance from the anal verge to the tumor was 10 cm. The median tumor diameter was 2.0 cm. The median duration of surgery was 120 minutes. No surgical mortality or morbidity and no local recurrence occurred during a median follow-up of 23 months. The mean stool frequency and consistency were significantly better at 3 months after surgery than before surgery. The maximal resting pressure significantly decreased after surgery. The maximal contraction pressure and maximal tolerated volume were significantly lower at 2 and 6 weeks than before surgery; these values recovered at 1 year. CONCLUSIONS: Transanal endoscopic microsurgery is safe for the cure of benign tumors and the palliative excision of malignant tumors in middle and upper rectum. Anorectal function was preserved and improved, though some anorectal manometric parameters changed over time.

Adenocarcinoma↗

PubMedDate not supplied

EIA versus RIA in detecting carcinoembryonic antigen level of patients with metastatic colorectal cancer.

BACKGROUND/AIMS: Little literature exists comparing the differences between enzyme immunoassay (EIA) and radioimmunoassay (RIA) in the detection of serum carcinoembryonic antigen (CEA) levels of patients with metastatic colorectal cancer. Because EIA has the advantage of avoiding the use of radioisotopes, the potential of using EIA instead of RIA in detecting CEA of patients with colorectal cancer is of interest to us. METHODOLOGY: Between March and August 2001, a total of 120 blood specimens, including 60 specimens from patients with metastatic colorectal cancer and another 60 from patients with non-malignant diseases, were examined in this study. Serum CEA levels were examined by EIA and RIA methods in parallel. The CEA-EIA tests were done using EIA kits manufactured by Abbott Laboratories at Illinois in the United States. Comparison was done with the conventional CEA-RIA tests using RIA kits manufactured by CIS laboratory at France. The blood samples were sent to Veterans General Hospital-Taipei for EIA and RIA determination. The cut-off value for CEA was set at 5.0 ng/mL. RESULTS: The correlation between the Abbott-EIA and the CIS-RIA methods in detecting serum CEA levels was high. The results give a correlation coefficient of 0.992 with a linear regression line y=0.975 x + 0.215 (p<0.0001). Agreement in the Abbott-EIA and CIS-RIA tests in diagnosis was observed in 113 patients (94%), including 53 positive (>5 ng/mL) and 60 negative (<5 ng/mL) in both tests. The sensitivity was similar in both assays (83% vs. 80%) at a cut-off level of 5 ng/mL. The ability to discriminate between colorectal cancer and non-malignant diseases was good in both assays (p<0.001). The specificity and positive predictive value were slightly higher with the Abbott-EIA method compared with CIS-RIA assay (92% vs. 83% and 91% vs. 83%, respectively). The Abbott-EIA method achieved a similar diagnostic accuracy to CIS-RIA method (88% vs. 82%). CONCLUSIONS: These data suggest that the Abbott-EIA has similar diagnostic power to CIS-RIA in the measurement of CEA levels of patients with metastatic colorectal cancer, with an additional advantage of avoiding the use of radioisotopes. We believe that ELA has the potential to replace RIA in the measurement of CEA in clinical practice.

Adult↗