記述言語：英語   出版者・発行元：BioMed Central  

出版者・発行元：金原出版  

DOI： 10.18888/op.0000003555

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: Despite investigations of intraperitoneal paclitaxel as a personalized treatment for peritoneal metastasis of gastric cancer, few studies have evaluated its prognostic impact on conversion surgery for unresectable gastric cancer with peritoneal metastasis. Our study aimed to close this gap in knowledge. Methods: We retrospectively enrolled 128 patients who underwent chemotherapy for peritoneal metastasis from gastric cancer and assigned them into intraperitoneal (IP) (n = 36) and non-IP (n = 92) groups, based on the use of intraperitoneal paclitaxel plus systemic chemotherapy. Results: Disease control rates were 94% and 69% in the IP and non-IP groups, respectively, with the former having a significantly higher tumor response rate than the latter (p < 0.01). The median survival times in the IP and non-IP groups were 665 and 359 days, respectively, with the former having significantly better prognosis than the latter (p = 0.02). Fifteen (42%) and sixteen (17%) patients underwent conversion surgery after chemotherapy in the IP and non-IP groups, respectively, with the former having a significantly higher conversion surgery induction rate than the latter (p < 0.01). Although the prognosis of the conversion surgery group was significantly better than that of the non-conversion surgery group (p < 0.01), there was no significant difference in prognosis between patients in the IP and non-IP groups who underwent conversion surgery (p = 0.22). Multivariate analysis identified performance status and conversion surgery as independent prognostic factors (all p < 0.01). Conclusion: Our study demonstrated that the IP chemotherapy was one of important factors for conversion surgery induction, while it was not a risk factor for prognosis.

DOI： 10.1007/s10147-023-02384-0

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PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

パクリタキセル(PTX)腹腔内投与(IP)を受けた患者と受けなかった患者の腫瘍反応性、コンバージョン手術(CS)の施行、予後を比較し、腹膜播種胃癌に対するIP PTXと全身化学療法の併用の臨床的意義について検討した。胃癌の腹膜転移に対して化学療法を受けた患者128例(年齢30～91歳)を後ろ向きに登録し、IP PTXを行ったIP群36例と非IP群92例に割り付けた。その結果、病勢コントロール率はIP群で94%、非IP群で69%であり、前者は後者より有意に高かった(p<0.01)。IP群と非IP群の生存期間中央値はそれぞれ665日と359日で、前者は後者より予後が有意に良好であった(p=0.02)。IP群と非IP群で化学療法後にCSを受けた患者はそれぞれ15例(42%)と16例(17%)であり、前者のCS導入率は後者よりも有意に高かった(p<0.01)。CS群の予後は非CS群の予後よりも有意に良好であったが(p<0.01)、CSを受けたIP群と非IP群の予後には有意差はなかった(p=0.22)。多変量解析の結果、パフォーマンスステータスとCSが独立した予後因子として同定された(いずれもp<0.01)。以上より、IP PTXがCS誘導の重要な因子の一つであることが示された。

記述言語：日本語   出版者・発行元：金原出版(株)  

71歳男性。胃体上部の早期胃癌に対して腹腔鏡下噴門側胃切除術が行われるも、食道残胃吻合時に自動吻合器の粘膜下誤挿入が生じた。対処として腹腔鏡下に修復を行うことで、術後1年経過現在、吻合部狭窄や逆流症状はなく、良好である。

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

Background: We performed pull-through hand-sewn coloanal anastomosis immediately after sphincter-preserving ultralow anterior resection (ULAR) [pull-through ultra (PTU)] to avoid permanent stoma and reduce postoperative complications of lower rectal tumors. This study aimed to compare the clinical outcomes of PTU versus non-PTU (stapled or hand-sewn coloanal anastomosis with diverting stoma) after sphincter-preserving ULAR for lower rectal tumors. Methods: This retrospective cohort study analyzed prospectively maintained data from 100 consecutive patients who underwent PTU (n = 29) or non-PTU (n = 71) after sphincter-preserving ULAR for rectal tumors between January 2011 and March 2023. In PTU, hand-sewn coloanal anastomosis was immediately performed using 16 stitches of 4–0 monofilament suture during primary surgery. The clinical outcomes were assessed. The primary outcomes were rates of permanent stomas and overall postoperative complications. Results: The PTU group was significantly less likely to require a permanent stoma than the non-PTU group (P < 0.01). None of the patients in the PTU group required permanent stoma and the rate of overall complications was significantly lower in the PTU group (P = 0.01). The median operative time was comparable between the two groups (P = 0.33) but the median operative time during the second stage was significantly shorter in the PTU group (P < 0.01). The rates of anastomotic leakage and complications of Clavien–Dindo grade III were comparable between the two groups. Diverting ileostomy was performed in two patients with an anastomotic leak in the PTU group. The PTU group was significantly less likely to require a diverting ileostomy than those in the non-PTU group (P < 0.01). The composite length of hospital stay was significantly shorter in the PTU group (P < 0.01). Conclusions: PTU via immediate coloanal anastomosis for lower rectal tumors is a safe alternative to the current sphincter-preserving ULAR with diverting ileostomy for patients who wish to avoid a stoma.

DOI： 10.1007/s00464-023-10184-w

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: To develop a recurrence risk score for determining the clinical indication for adjuvant chemotherapy in patients with initially unresectable advanced gastric cancer who underwent conversion surgery after chemotherapy. Patients and Methods: A total of 65 patients with stage IV gastric cancer who underwent conversion surgery after chemotherapy were retrospectively enrolled. We established a risk score based on clinicopathological factors related to recurrence after conversion surgery. Results: Out of 65 patients, 40 (62%) had recurrence after conversion surgery. The 5-year overall survival rates in patients with and without recurrence were 14.4% and 87.1%, respectively (p<0.01). Multivariate logistic regression analysis identified the depth of tumor invasion (pT2-4) and histological tumor response (grade 0-1a) as an independent risk factor for disease recurrence (p=0.033 and p=0.048, respectively). A scoring system determined by these two factors was created; total score ranged from 0 to 2 points, and patients were categorized into three groups (scores of 0 vs. 1 vs. 2 points). This scoring system showed that 12 (18%), 15 (23%), and 38 (58%) patients had recurrence risk scores of 0, 1, and 2 points, respectively. There was a close relationship between a high score and the presence of tumor recurrence (p<0.01). Moreover, our model system had a high sensitivity for the prediction of recurrence, compared with the pathological stage. Conclusion: Recurrence risk score is a promising tool for assessing the need for adjuvant chemotherapy in patients with initially unresectable advanced gastric cancer after conversion surgery.

DOI： 10.21873/anticanres.16506

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PubMed

記述言語：日本語   出版者・発行元：Oncology (Switzerland)  

Introduction: This study aimed to assess the clinical significance of eligibility criteria determined by phase 3 clinical trials in the clinical practice of patients with advanced gastric cancer who underwent chemotherapy. Methods: Patients with stage IV gastric cancer who received chemotherapy between February 2002 and December 2021 were retrospectively enrolled and divided into two groups (the eligible vs. ineligible group) based on eligibility criteria determined by the SPIRITS (S-1 vs. S-1 plus cisplatin) trial. Results: Among the 207 patients, 103 (49.8%) and 104 (50.2%) patients were classified into eligible and ineligible groups, respectively. Eligibility criteria were significantly correlated with age, the first-line regimen of chemotherapy, the presence or absence of conversion surgery, and tumor response to the first-line chemotherapy (all p < 0.01). The eligible group had a significantly higher induction of post-progression chemotherapy after first-and second-line chemotherapy than did the ineligible group (all p < 0.01). The ineligible group had significantly poorer prognoses than the eligible group (p < 0.0001). Multivariate analysis showed that peritoneal dissemination, tumor response, conversion surgery, and eligibility criteria were independent prognostic factors (all p < 0.05). Conclusion: Eligibility criteria determined by the SPIRITS trial may have clinical utility for predicting tumor response, the induction of conversion surgery, and prognosis in patients with advanced gastric cancer who underwent chemotherapy.

DOI： 10.1159/000527114

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PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: Minimally invasive esophagectomy (MIE) has been widely accepted as a treatment for esophageal cancer. This retrospective study compared the short-term outcomes and surgical invasiveness between thoracoscopic esophagectomy (TE) and mediastinoscopic esophagectomy with pneumomediastinum (pneumatic mediastinoscopic esophagectomy [PME]). Methods: A total of 72 patients who underwent TE or PME were included and assessed for their surgical findings, postoperative complications, and inflammatory responses on postoperative day (POD) 1, 3, 5, and 7. Results: The PME group exhibited a significantly shorter operative time and fewer lymph nodes retrieved than the TE group. Furthermore, the PME group tended to have greater incidences of recurrent laryngeal nerve palsy and lower incidences of atelectasis than the TE group. The PME group had significantly lower white blood cell counts on POD 5, serum C-reactive protein (CRP) levels on POD 3 than the TE group. Conclusion: PME seems to be less invasive than TE and can be considered the preferred option for patients with lower-stage esophageal cancer expected to have severe pleural adhesion or who cannot tolerate TE.

DOI： 10.1007/s00595-022-02509-4

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PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

食道癌に対する胸腔鏡下食道切除(TE)と空気圧縦隔鏡下食道切除(PME)の手術侵襲と短期アウトカムを比較した。TEまたはPMEを行った食道癌患者72例を対象に、手術所見、術後合併症、術後1、3、5、7日目における炎症性反応を評価した。PME群(男性30名、女性4名、年齢中央値67歳)はTE群(男性31名、女性7名、年齢中央値66.5歳)に比べて手術時間が有意に短く、リンパ節切除数も有意に少なかった。反回神経麻痺の発現率はPME群がTE群に比べて高い傾向を示し、無気肺の発現率はPME群の方が有意に低かった。術後5日目の白血球数、術後3日目の血清CRP値はPME群の方が有意に低かった。PMEはTEに比べて手術侵襲が少ないことから、胸膜癒着を複数認める可能性のある患者や、TEに不耐の食道癌患者に対する治療選択肢として有望であると考えられた。

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

化学療法を施行した進行胃癌(AGC)患者(男性94名、女性52名、平均年齢65.9歳)を対象に後向き研究を行った。ヒト上皮成長因子受容体2(HER2)陽性AGC患者におけるtrastuzumabベース化学療法後の外科的介入の臨床的適応と予後への影響について検討した。免疫組織化学(IHC)スコア3+、またはIHCスコア2+かつFISH法で陽性を、HER2陽性とした。33例がHER2陽性でtrastuzumabベース化学療法を行っていた。多変量解析では、高齢、腹膜播種、組織学的に未分化な腫瘍、腫瘍縮小効果が進行であることが独立した予後不良因子であった。HER2陽性AGC患者のうち、コンバージョン手術施行群は化学療法単独群よりも予後が良好であった。年齢、腹膜播種、腫瘍の組織型に基づく新たに作成した予後スコアリングシステムは、コンバージョン手術の有無やHER2陽性AGC患者の予後と有意に関連した。

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: To investigate the clinical indications and prognostic significance of surgical interventions after chemotherapy using trastuzumab-containing regimens for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (AGC). Methods: A total of 146 patients with AGC who underwent chemotherapy were enrolled in this retrospective study. Tumors with an immunohistochemistry (IHC) score of 3 + or an IHC score of 2 + plus fluorescence in situ hybridization positivity were defined as HER2-positive AGC. We devised a scoring system for predicting prognosis associated with conversion surgery. Results: Thirty-three patients received trastuzumab-based chemotherapy for HER2-positive tumors. Multivariate analyses identified advanced age, peritoneal dissemination, histologically undifferentiated tumors, and tumor response of progressive disease as independent prognostic factors for a worse prognosis. Twelve patients with HER2-positive AGC underwent conversion surgery. The conversion surgery group of patients with HER2-positive AGC had a better prognosis than the chemotherapy-alone group. A prognostic scoring system based on age, peritoneal dissemination, and histological type was significantly correlated with the presence or absence of conversion surgery and the prognosis of patients with HER2-positive AGC. Conclusions: Our scoring system has the clinical potential to predict prognosis associated with conversion surgery after trastuzumab-containing chemotherapy for patients with HER2-positive AGC.

DOI： 10.1007/s00595-022-02515-6

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PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_geka84_1168

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: To further improve the prognosis of locally advanced esophageal cancer patients, investigating new perioperative treatment strategies is necessary. The current study aimed to retrospectively investigate neoadjuvant radiotherapy with cisplatin and 5-fluorouracil (CF-RT) and radiotherapy with docetaxel and CF (DCF-RT) and compare their treatment outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Patients and Methods: We retrospectively reviewed 95 patients with ESCC who received CF-RT or DCF-RT followed by esophagectomy. The CF-RT group received chemotherapy consisting of two courses of CF repeated every 4 weeks. The DCF-RT group received chemotherapy consisting of two courses of DCF repeated every 2 weeks. A radiotherapy dose of 1.8-2 Gy was administered per session, up to a total of 40-41.4 Gy. Adverse events of neoadjuvant chemoradiotherapy, surgical outcomes, pathological responses, prognosis, and recurrence patterns were evaluated. Results: Both the CF-RT and DCF-RT groups had equivalent pathological complete response rates of the primary tumor at 31.6% and 38.6%, respectively. However, the DCF-RT group had significantly better 5-year disease-free survival and 5-year overall survival than (HR=0.50, 95%CI=0.26-0.97, p=0.0392) than the CF-RT group. Conclusion: DCF-RT may be a candidate neoadjuvant therapy for locally advanced ESCC.

DOI： 10.21873/anticanres.15884

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: Given the increased incidence of esophageal cancer (EC) in individuals over 80 years old, the optimum therapeutic strategy for elderly patients is needed to be established with scientific evidence. Here, we studied the short-term and long-term outcomes after treatment of patients aged 80 years old or older with EC. Patients and Methods: Eighty patients with EC aged 80 years old or older, who underwent esophagectomy (n=23), definitive chemoradiotherapy (dCRT) (n=46) or best supportive care (n=11) between January 2010 and March 2019 were included in this study, and clinical data were compared among these groups. Results: Surgery had a great benefit on the 3-year overall survival (OS) compared to dCRT (68.4% vs. 29.3%, p<0.01). The cure rates of treatment were 86.9% in surgery and 34.8% in dCRT. dCRT led to a better 3-year OS compared to BSC (29.3% vs. 0%, p<0.01); however, dCRT did not improved OS in patients with T4. Patients with T4 had high frequency of adverse events and treatment-related death in dCRT; CTCAE Grade 3-5 was observed in 100% of all T4 patients and Grade 5 in 57.1%. Multivariate analysis revealed that T4 was an independent risk factor of treatment-related death after dCRT (p<0.01). Conclusion: Surgery is the first treatment option for resectable EC even in elderly patients, and dCRT can be considered as an alternative. However, dCRT may induce severe toxicity especially in T4 EC patients.

DOI： 10.21873/anticanres.15890

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PubMed

記述言語：日本語   出版者・発行元：日本リンパ学会  

胃癌細胞株および胃癌切除症例におけるB7-H3発現について解析を行い、B7-H3抗体による腹水中腫瘍細胞検出の有無を含めた精度の高い胃癌腹膜播種診断法の臨床応用の可能性について検討した。当院で胃癌と診断され、リンパ節郭清を伴う胃切除術を行った10例と審査腹腔鏡でP1が確認された4型の切除不能進行胃癌の1例を対象とした。B7-H3 mRNA発現はすべての胃癌細胞株に認められ、B7-H3発現は細胞膜および細胞質に認められた。臨床検体である癌性腹水を用いて磁気ビーズとB7-H3抗体を用いて腹水中からの腫瘍細胞検出を試みた。その結果、in vitro assayと同様に腫瘍細胞の表面に多数の磁気ビーズが付着しているのが確認された。新規免疫チェックポイント分子であるB7-H3を用いたcell search systemは精度の高い胃癌腹膜播種診断法となる可能性が示唆された。

記述言語：日本語   出版者・発行元：Pathology Research and Practice  

Plexiform fibromyxoma (PFM) is a rare gastrointestinal tract tumor that develops in the stomach in most cases. Here, we report an extremely rare case of esophageal PFM. A female in her mid-30 s presented with difficulty in swallowing and breathing. Endoscopic examination revealed a submucosal tumor measuring approximately 45 × 50 mm in the upper thoracic esophagus. The biopsied specimen did not show definite histological evidence of gastrointestinal stromal tumors (GISTs). Since imatinib administration based on a clinical diagnosis of GIST did not show a therapeutic effect for tumor reduction, tumor resection was performed. The resected tumor exhibited proliferation of spindle tumor cells with abundant myxoid and vascular stroma separated by a muscular layer, indicating a plexiform arrangement. Immunohistochemical analysis demonstrated that the tumor cells diffusely expressed vimentin and alpha-smooth muscle actin, but not desmin, c-kit, DOG1, and CD34. MALAT1-GLI1 fusion was detected in formalin-fixed paraffin-embedded tissue using RT-PCR and Sanger sequencing. The results suggested that a fibromyxoid tumor can develop in the esophagus, showing an identical histology and MALAT1-GLI1 fusion to gastric PFM.

DOI： 10.1016/j.prp.2022.153878

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PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_geka84_358

記述言語：日本語   出版者・発行元：BMC Cancer  

Background: Postoperative complications have been linked to the morbidity and mortality of several cancers. However, predicting whether complications will occur in the early period after surgery or not is challenging. Hence, this study aimed to examine the diagnostic accuracy of serum creatine phosphokinase (CPK) and c-reactive protein (CRP) in predicting the development of postgastrectomy complications. Methods: We retrospectively analyzed 188 patients with gastric cancer (GC) who underwent gastrectomy. The diagnostic accuracy of serum CPK and CRP was investigated using the areas under the curves (AUC). The CPK ratio was defined as the CPK on postoperative day (POD) 1 to the CPK on a preoperative day. Results: Out of 188 patients, 48 (25.5%) developed postoperative complications. The complications group had a greater operative time (p = 0.037), higher CPK ratio on POD1 (p < 0.0001), and a higher serum CRP level on POD3 (p = 0.001). The AUC for the CPK ratio was 0.772, with an optimal cutoff value of 7.05, whereas that for CRP was 0.659, with an optimal cutoff value of 11.4 mg/L. The CPK ratio on POD1 (p < 0.0001) and the CRP on POD3 (p = 0.007) were independent factors for predicting the development of postgastrectomy complications. The CPK ratio on POD1 and the CRP on POD3 predicted postgastrectomy complications in 41 patients (85.4%). According to combined value of both CPK ratio and CRP level, the positive predictive value and the negative predictive value was 0.70 and 0.829. And sensitivity and specificity were 0.438 and 0.936. Conclusion: The CPK ratio on POD1 and the CRP on POD3 after gastrectomy for GC were predictive factors for complication development and may be employed to prevent the development of such complications and improve the prognosis of patients with GC.

DOI： 10.1186/s12885-021-07801-z

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PubMed

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