Purpose: We investigated whether small-cell lung cancer (SCLC) patients with The Eastern Cooperative Oncology Group Performance Status (PS) 4 could benefit from chemotherapy.
Methods: PS 4 patients were extracted from medical records, and their characteristics including administered drugs and relevant dosages were obtained. Response, toxicities, survival and changes in PS were retrospectively evaluated.
Results: Of the 314 patients, 25 patients exhibited PS 4. Excepted for 4 patients without chemotherapy, 21 patients were treated with reduced doses in the first cycle, and, with recovery of PS (42.9% improved PS), the doses were increased in subsequent cycles (median of 3 cycles). Response rate was 66.7%, and progression free survival of patients with chemotherapy was 94 days (95% confidence interval [CI], 81 to 107 days). Median survival time was 195 days (95% CI, 81 to 269 days). While, the range of survival times for 4 patients without chemotherapy was 10 to 32 days. Grade 4 neutropenia occurred in 10 patients, and one patient experienced treatment-related death. A significant difference in survival was observed between improved and non-improved PS groups (263 and 83.5 days, respectively; p = 0.029).
Conclusion: There could be a chance for chemotherapy in SCLC patients with PS 4.
Cholecystohepatic duct (CHD) is a very rare anomaly of the extrahepatic biliary tract. Herein we report on a case of bile leakage after cholecystectomy due to injury to the CHD, the presence of which had not been recognized before surgery. Follow-up computed tomography (CT) of an asymptomatic 63-year-old man 1 year after Roux-en Y reconstruction for advanced gastric cancer revealed a gallbladder mass, and so cholecystectomy was planned. Preoperatively, there was no indication of biliary anomaly by magnetic resonance cholangiopancreatography (MRCP). During surgery, a “string” was visualized between the cystic duct and the bed of the gallbladder. This “string” was ligated without intraoperative cholangiography and the gallbladder was removed. On postoperative day (POD) 5, bile peritonitis developed and percutaneous drainage was performed. Abdominal contrast examinations from the drainage tube enabled visualization of the intrahepatic duct of the posterior segment of the liver. Careful re-examination of preoperative MRCP images showed a confluence between the bile duct and the neck of the gallbladder (i.e. a CHD), which drained the posterior segment of the liver. Although the end of the CHD was blind, the bile leakage improved following percutaneous abdominal drainage alone, without percutaneous transhepatic cholangiodrainage or reoperation. In conclusion, CHD is a very rare biliary anomaly. However, it should be kept in mind during cholecystectomy to avoid serious complications.
Background: Ultrasound guidance in bronchofiberscope has been used in endobronchial approach and body-surface ultrasound in transcutaneous approach. We attempted to combine the two methods, creating the body-surface ultrasound-guided bronchofiberscope (BSUS-BF) method, and evaluated its utility in diagnosing peripheral lung lesions.
Methods: The patients with lesions visible in body-surface ultrasound and ≤5 cm in longer axis in CT scan were selected for the study. The forceps were controlled under the fluoroscopy and checked by the ultrasound for real-time visualization of the forceps in the lesions. Statistical analyses used Pearson’s chi-squared test.
Results: The forceps were visualized in 68.7% cases (79/115). The diagnostic rate was 59.1% overall and 67.1% when the forceps were visualized. For malignant lesions; the diagnostic rate was 72.6% overall and 78.6% when the forceps were visualized. For lesions ≤3 cm in malignant lesions; the diagnostic rate was 62.7% (18/29) overall and 73.7% (14/19) when the forceps were visualized. The diagnostic rate was 74.0% (37/50) when the forceps were located within the lesions and 48.3% (14/29) when the forceps were located adjacent to them.
Conclusions: BSUS-BF offers real-time confirmation of the positioning of forceps in lesions, giving a higher diagnostic rate when the forceps are visualized. This study is registered in the University Hospital Medical Information Network (UMIN) clinical trials registry with registration number UMIN000013227.
Breast cancer (BC) is a commonly diagnosed cancer amongst women and the second leading cause of cancer deaths in the world. BC has created huge challenges to healthcare providers regarding the identification of main risk factors and how they contribute to the development of the disease. Several studies suggest that biological risk factors such as duration of breast feeding, age at menarche, menopausal status and the use of contraceptive pills have contributed to the increase of BC diagnoses. Moreover, psychological factors such as depression, stress and negative lifestyles are gaining more attention as a major contributor to this type of cancer. The role of psychological stress regarding BC has been widely demonstrated in the literature across several fields including but not exclusive to epidemiology, physiology, and molecular biology which all show a clear relationship between intracellular stress signaling and protumorigenic pathways within breast cells. Cortisol is primary stress hormone of the human body and a growing body of research both clinically and molecularly are revealing a positive correlation of high cortisol levels and the progression of BC. This review attempts to establish and highlight how cortisol levels impact breast cancer development and progression.
Annexin A1 (ANXA1) is a calcium-dependent phospholipid-linked protein that is associated with anti-inflammatory effects, regulation of cellular differentiation, proliferation, and apoptosis. In gastric cancer, ANXA1 is upregulated and has a significant role of gastric tumorigenesis. Although ANXA1 is known to be a p53 target gene, the association between ANXA1 expression and p53 expression is yet to be fully investigated in gastric cancer. We therefore investigated in this study the expressions of ANXA1 and p53 by immunohistochemical (IHC) staining in 231 gastric cancer tumors. ANXA1 expression was positive in 108 cases (46.8%), whereas negative in 123 cases (53.2%). p53 expression was positive in 109 cases (47.2%), but negative in 122 cases (52.8%). The percentage of positive ANXA1 was significantly higher in p53 positive tumors compared with p53 negative tumors (P < 0.001). We next performed IHC staining for ANXA1 and p53 in three human gastric cancer cell lines (MKN28, NUGU4, KATOIII). Positive staining for ANXA1 and p53 was detected in MKN28 cells with TP53 gene mutations. On the other hand, weak positive staining for ANXA1 and positive staining for p53 was found in NUGC4 and KATOIII cells with TP53 wild-type and truncating mutations, respectively. Our results demonstrated that ANXA1 is upregulated in p53-positive gastric cancer. ANXA1 expression may be induced by aberrant p53 protein, providing the possibility that ANXA1 works with the TP53 gene in gastric cancer.
We describe a case of difficult deflation of the upper right lobe caused by the existence of a tracheobronchial anomaly during the thoracoscopic esophagectomy. A 70-year-old man with a history of myocardial infarction and dysphagia was diagnosed with thoracic esophageal squamous cell carcinoma. Endoscopy revealed a type 2 tumor in the lower esophagus and a superficial lesion in the middle esophagus and computed tomography showed no evidence of metastasis. We performed 2 courses of neo-adjuvant chemotherapy followed by thoracoscopic esophagectomy. During surgery, one-lung ventilation using right bronchus balloon occlusion was performed. However, the upper lobe of the right lung did not deflate, and upper mediastinal dissection was difficult. Intraoperative bronchoscopy revealed a right tracheal bronchus arising from just under the bifurcation. We reviewed the preoperative 3-dimensional computed tomography, which showed the right tracheal bronchus causing intraoperative incomplete deflation of the upper lobe. We recommend investigating this anomaly with 3-dimensional computed tomography before thoracoscopic esophagectomy.
Concomitant gastrointestinal malignancy and abdominal aortic aneurysm (AAA) pose treatment difficulties. Herein we present the clinical features and treatment course of a 69-year-old male patient with AAA and sigmoid colon cancer. The maximum aneurysm diameter exceeded 50 mm, and it was evident from immediately after the bifurcation of the renal arteries. Due to the possibility of rupture, sigmoidectomy was preceded by endovascular aneurysm repair (EVAR). After confirming blood flow from the collateral arteries to the descending and sigmoid colon, a laparoscopic sigmoidectomy with lymph node dissection was safely performed one month after EVAR. The postoperative recovery was uneventful, and the patient was discharged 11 days after the second operation. Based on these findings and the literature, EVAR followed by the resection of colon cancer provides the safest order of treatments, especially when the patient has no cancer-related symptoms.
We aimed to identify prognostic and predictive markers among clinicopathological factors for efficacy of adjuvant chemotherapy in gastric cancer by pooled analysis from 3,521 patients on three large randomized trials: ACTS-GC, CLASSIC, and SAMIT. The primary endpoint was relapse-free survival, and the secondary endpoints were overall survival. The integrity of individual patient data was verified. Significant prognostic markers in surgery alone groups of ACTS-GC and CLASSIC were lower body mass index and advanced stage of disease.
Background: Gynaecological cancers account for more than 16% of all cancers in women. Evolving population demographics and patterns of incidence, mortality and survivorship make planning of cancer services challenging. There is a paucity of economic studies to inform this planning. To inform planning we sought to move beyond incidence estimates and take a utilisation approach by examining trends in hospital admission for gynaecological cancer
Methods: Data were obtained from the Australian Institute of Health and Welfare (AIHW) and Australian Cancer Database (ACD) for admission for primary gynaecological malignancy between 1998 to 2015 (inclusive). Population estimates for each year of the study were obtained from the Australian Bureau of Statistics (ABS). Regressions were performed to calculate R- and p-values.
Results: There were significant increases in admission for endometrial cancer in all groups apart from the 45-54 year group. There was a significant fall in hospital admission for ovarian cancer across all age groups. For cervical cancer there was no change in the rate of hospital admission in the 25-44 year age group, but significant falls in all other age groups. For all other primary gynaecological cancers there was no change in rates of hospital admission over the study period.
Conclusion: The most expensive single component of a cancer patients care remains inpatient care. This study provides national data for inpatient admission for Gynaecological cancer in Australia. With the burden of cancer increasing, this, in conjunction with demographic projections, may provide a useful adjunct method to assist planning of cancer care resources.
Cachexia is a syndrome characterized by continuous, involuntary weight loss and systemic inflammation. Several mediators that are either host- or tumor-derived, such as pro-inflammatory cytokines, have been implicated in the pathogenesis of cancer cachexia.
The compensatory humoral system that typically reduces the excessive production of pro-inflammatory cytokines in order to maintain homeostasis is also highly activated in patients with cancer cachexia. The above observations, along with cachexia, suggest that conditions similar to SIRS (systemic inflammatory response syndrome) and CARS (compensatory anti-inflammatory response syndrome), or to mixed anti-inflammatory response syndrome (MARS), may exist in cachexia. The typical immunological status of patients with cancer cachexia has been demonstrated to be suppressed cell-mediated immunity, and a Th2-dominant condition and myeloid-derived suppressor cells: MDSCs are major causes of this suppression.
Several therapies and strategies have been proposed with regard to anti-inflammatory treatments. However, no effective therapy against cancer cachexia is currently available. Further studies on the molecular mechanisms of inflammation, and the development of new anti-inflammatory agents, are required.
Background: The term “Dumping syndrome (DS)” is well-known among surgeons, however, its definition and diagnostic rule are still unclear. The aim of this study was to provide a general concept of DS and a relevant questionnaire to evaluate the symptoms from surgeon’s perspectives.
Methods: According to the established psychometrics methods of the scale development, we conducted this study; consensus meeting, item pool, qualitative survey, making draft scale, item selection and internal validation. In the validation, 359 patients who underwent surgery for gastric or esophageal cancer were enrolled. To assess the conceptual validity of DS, the exploratory factor analysis was conducted, and the subscale design and items were determined.
Results: A total of 359 patients were enrolled, and answers were obtained from 344 patients (95.8%), included 225 gastric cancer patients, 107 esophageal cancer patients and 12 other malignant disease in stomach patients. The symptoms of sleepiness, upper abdominal discomfort, gurgling noise and diarrhea after eating were common symptoms in patients. The timing of symptoms occurring were a normal distribution. After the factor analyses, 10 items and 2 domains were isolated: systemic symptoms and abdominal symptoms.
Conclusion: We have suggested a concept of DS after upper gastrointestinal surgery and provided an assessment scale.