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A 72-year-old man was diagnosed with acute myeloid leukemia and advanced esophageal cancer(cT3N3M1, clinical Stage IV, high-moderately differentiated squamous cell carcinoma). He was started on remission induction chemotherapy and postremission therapy provided according to the Japan Adult Leukemia Study Group's AML201 protocols. His acute myeloid leukemia showed a complete response. After that, he was administered radiotherapy for esophageal cancer and showed a partial response. One year after treatment, he developed a local recurrence of esophageal cancer. A salvage operation was performed at another hospital, and his postoperative course was uneventful. A case of acute myeloid leukemia with advanced esophageal cancer is rare and has a poor prognosis, but we could improve the prognosis and quality of life.

To evaluate the sites and frequencies of overall and initial lymph node (LN) metastases (LNMs) of clinical T1N0 esophageal cancer.The sites and frequencies of initial LNMs and sentinel LNs (SLNs) of esophageal cancer remain unclear.The Japan Clinical Oncology Group JCOG0502 trial was a 4-arm prospective study that compared esophagectomy with chemoradiotherapy for clinical T1N0 esophageal cancer in both randomized and patient-preference arms. The preoperative diagnostic accuracy was evaluated for patients assigned to the surgery arm. Patients who withdrew consent and who were not treated were excluded. All patients underwent esophagectomy with D2 or greater LN dissection. From the pathologic findings, sites and frequencies of LNMs and SLNs were assessed and the frequency of skip LNMs was calculated.In total, 211 patients underwent LNM and SLN analysis. Regarding N-factor accuracy, 57 (27.0%) of 211 clinical N0 cases had pathologic LNMs. The upper mediastinal and mediastinal/abdominal regions were frequent sites of LNMs in upper and lower thoracic cases, respectively. However, in middle thoracic cases, LNMs were observed in the neck, mediastinal, and abdominal regions, and pathologic SLN spread to all 3 fields. The frequency of skip LNMs was 36.7%.A clinical diagnosis of T1N0 is not sufficiently accurate, and therefore, it is unacceptable to omit LN dissection or minimize the prophylactic radiation field. SLNs, which are not location restricted, should be surveyed in all 3 fields.

The optimal treatment for early stage carcinoma of the thoracic esophagus is undecided and remains debatable. This report documents the results of a series of patients with clinical stage IA carcinoma of the thoracic esophagus treated at our institute with esophagectomy and two-field lymphadenectomy (2FL). We analyzed 70 patients with clinical stage IA carcinoma who underwent radical esophagectomy with 2FL. The overall 5-year survival rate of the 70 patients was 81 %. Seventeen of the 70 patients (24 %) had lymph node metastasis. The overall 5-year survival rate of the 53 patients with no metastatic nodes (87 %) was significantly better than that of the 17 patients with positive nodes (65 %; p = 0.022). The operative morbidity was 44 %. Recurrence was recognized in 17 patients (24 %). The median disease-free interval (DFI) until recurrence was 20.5 months. With respect to the initial tumor recurrence, among the 16 patients with a recurrence, there were 9 with a cervical lymph node recurrence, 3 with a hematogenous recurrence, 2 with a combined recurrence, 1 with an abdominal lymph node recurrence in the paraaortic site, and 1 in the anastomotic site. The median DFI and survival times of the patients with a cervical lymph node recurrence were 26 and 55 months, respectively. Of the 9 patients with a cervical lymph node recurrence, 3 disease-free patients survived: 2 received surgery and 1 received radiotherapy. Two-field lymphadenectomy might be enough for patients with clinical stage IA carcinoma of the middle and lower thoracic esophagus in regard to prognosis, but close follow-up for lymph node recurrence, especially at the cervical site, should be conducted.

Recent and not-so-recent critiques of teaching English as a second or other language (TESOL) have explored the relationship between English language teaching and colonialism. Consequently, native speaker and non-native speaker practitioners have started to question their pedagogies and to re/consider their roles in relation not only to minority languages and local knowledges but also to one another. Adding to this discussion, this article raises a different perspective on teaching English in a postcolonial present, asserting that English is, for some Indigenous peoples and local knowledge holders, a decolonizing agent that “trumps” immediate oppressor languages. To become agents or assistants in decolonizing in contexts such as this, the role for native English speaking (foreigner) language teachers and for many non-native English speaking language teachers (Japanese) may not be to continue developing more critical (and possibly more intrusive) pedagogies but rather to allow themselves to be used to the e...

Background The 8th edition of the American Joint Committee on Cancer staging (AJCC-8th) of esophageal cancer presents independent stage grouping for patients who underwent neoadjuvant therapy followed by esophagectomy (ypTNM). The aim of this study is to elucidate the clinical utility of ypTNM stage grouping in Japanese patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 146 patients (121 men and 25 women, with a median age of 65 years) who underwent curative esophagectomy following neoadjuvant chemotherapy with cisplatin and 5-fluorouracil (CF) for ESCC between 2005 and 2011 were enrolled in this retrospective study. We compared the distribution of patients and disease-specific survival after esophagectomy (DSS) stratified by ypStage between AJCC-7th and 8th. Additionally, we evaluated the association between clinicopathological features including ypStage in AJCC-8th and DSS. Results The number of patients classified into ypStage 0/IA/IB/IIA/IIB/IIIA/IIIB/IIIC/IV was 5/1/14/11/35/40/18/18/4 in AJCC-7th, and that classified into ypStage I/II/IIIA/IIIB/IVA/IVB was 27/18/21/58/18/4 in AJCC-8th. According to the revision from AJCC-7th to 8th, ypStage of 85 and 7 patients was up- and down-graded, respectively. Up-grading of ypStage was observed in 83% of patients with ypT4 tumor and in 78% of patients with ypN1–3. The 5-year DSS of ypStage 0/IA/IB/IIA/IIB/IIIA/IIIB/IIIC/IV was 100/100/93/91/75/62/50/28/50% in AJCC-7th, and that of ypStage I/II/IIIA/IIIB/IVA/IVB was 96/83/68/58/28/50% in AJCC-8th. The 5-year DSS of ypStage III was 61% in AJCC-8th comparing to 51% in AJCC-7th, and that of ypStage IV was 31% in AJCC-8th comparing to 50% in AJCC-7th. Univariate analyses identified ypT-8th (P = 0.028), ypN-8th (P Conclusion ypTNM stage grouping in AJCC-8th can more accurately stratify the prognosis of patients who underwent neoadjuvant CF therapy for ESCC, by classifying patients with residual tumor invasion to adjacent structures and regional lymph node metastasis into more unfavorable prognostic group than that in AJCC-7th. ypStage according to AJCC-8th is the most reliable prognosticator for this disease. Disclosure All authors have declared no conflicts of interest.

e16068Background: Defective homologous recombination (HR) due to genetic aberrations of HR genes contributes to a high response of platinum therapy in ovarian and breast cancers. The aim of this st...

Background: The relationship between Helicobacter pylori infection and iron metabolism has not been well studied in Japan. We examined the association of H. pylori infection and its eradication to iron metabolism. Methods: A total of 654 adults who completed a health survey in 2012 were enrolled. H. pylori stool antigen was tested and serum antibody titer and serum iron, ferritin and pepsinogen levels were estimated. Subjects reported on their daily intake of the diets to calculate daily intake of iron and vitamin C. Among the H. pylori-infected patients surveyed in 2012, 177 patients completed the same health survey in 2014. For these patients, the change of daily intake of iron and vitamin C and serum iron and ferritin levels were examined. Results: In 2012, 244 subjects (37.3%) were considered as infected with H. pylori. In male subjects aged 35–64 years, serum level of ferritin was 77.5 (SD 53.1) ng/mL in infected patients and 130.6 (114.3) ng/mL in non-infected subjects (p

A case of carcinosarcoma arising from the area of intraepithelial spread of relapsed esophageal squamous cell carcinoma (SCC) after definitive chemoradiotherapy (CRT) is reported herein. A 71-year-old man was referred to our hospital because of a superficial esophageal carcinoma. Definitive CRT was performed because the patient refused surgical treatment. Complete response was recognized after CRT, but tumor relapse was diagnosed 3 months later. The relapsed tumor initially revealed a minimal depression with a small white nodule. This nodule developed to a sessile elevated mass after 1 month and finally to a polypoid tumor 3.2 × 2.3 × 1.5 cm in size within 125 days. A subtotal esophagectomy with two-field lymph node dissection was performed. Histologically, the polypoid tumor was composed mainly of spindle-shaped sarcomatous cells and invaded the muscularis propria of the esophageal wall. An area of intraepithelial spread of SCC was found at the base of its stalk. No lymph node metastases were found. The postoperative course was uneventful, and the patient has remained free of disease for 45 months. To our knowledge, this is the only reported case of esophageal carcinosarcoma arising from an area of intraepithelial spread of relapsed SCC that showed such rapid growth by serial endoscopies.

はじめに：大腸癌取扱い規約第7版（以下，第7版）では，腫瘍下縁がRSまたはRaの癌で3 cm，腫瘍下縁がRbの癌で2 cmの肛門側切離が必要であるとされている．直腸癌における肛門側癌進展（distal spread；以下，DS）に関する病理組織学的検討から直腸癌の肛門側切離範囲について検討した．方法：対象は直腸S状部癌および直腸癌213例．直腸間膜を含めた全割標本から，腸管壁内DSと直腸間膜内DSを検出し，それぞれの危険因子について検討した．また，第7版の定める肛門側切離範囲を超えるDSを高度DSとし，その特徴を明らかにした．結果：213例中31例（15％）にDSを認めた．内訳は，腸管壁内DSのみが20例，直腸間膜内DSのみが5例，腸管壁内DSと直腸間膜内DSの両者が6例であった．多変量解析では，腸管壁内DSの危険因子は組織型（tub2，por）と遠隔転移であり，直腸間膜内DSの危険因子は遠隔転移であった．高度DSは213例中3例（1.4％）に認め，全例がリンパ節転移を4個以上有するpN2症例であり，また3例中2例が遠隔転移を有していた．考察：遠隔転移を有する症例はDSを念頭においた手術が必要である．第7版の定める肛門側切離範囲は大部分の症例において妥当であるが，pN2症例や遠隔転移を有する症例の中には，高度DSを有する症例もあり，注意が必要である．

今回, 我々は極めてまれとされている残胃に発生した悪性リンパ腫と癌腫の衝突腫瘍症例を経験したので報告する. 症例は79歳の男性で, 67歳時に十二指腸悪性リンパ腫 (Non Hodgkin lymphoma, diffuse, small B cell type) にて幽門側胃切除術, Billroth II法再建を施行された. 2005年5月, 糖尿病の治療目的で入院した際の上部消化管内視鏡検査で残胃吻合部後壁に2型胃癌を指摘された. 2005年6月, 当科にて残胃全摘術, D1リンパ節郭清を施行された. 病理組織学的診断の結果, 悪性リンパ腫 (Non Hodgkin lymphoma, diffuse, small B cell type, 深達度fSM) と低分化腺癌 (深達度fMP) との衝突腫瘍と診断された. リンパ節転移は認めなかった. 術後, 肺炎および全身衰弱のため長期の入院加療を要した. 退院後は悪性リンパ腫, 癌腫ともに明らかな再発を認めずに経過したが, 術後2年目に重症肺炎にて死亡した.

症例は60歳の男性で, 家族歴として, 一卵性双生児の兄が家族性大腸腺腫症で加療中である. 1974年, 家族性大腸腺腫症と診断され, 結腸全摘術, 回腸直腸吻合術を施行された. 1991年, 残存直腸の多発ポリープに対し残存直腸切除, 回腸. 肛門吻合術を施行された. 2000年, 多発胃癌に対し, 幽門側胃切除術を施行, 2002年, 残胃癌に対し内視鏡的粘膜切除術, 2006年, 局所切除術を施行された. 2007年3月, 上部消化管内視鏡検査で食道胃接合部直下に0-IIa病変を認め, また十二指腸に密生する多発ポリープを認めた. いずれも生検で高分化腺癌と診断された. 5月下旬, 胃局所切除術, 膵頭温存十二指腸全摘術を施行した. 病理組織学的診断は, 胃は高分化腺癌, 十二指腸は高分化腺癌および腺腫の混在する病変で, いずれも粘膜内癌であった. 術後, 縫合不全, 膵液瘻, 胆汁瘻などの合併症なく順調に経過し, 第11病日に退院した.

This paper reports on the results of survey data examining English-speaking preservice teachers' (PSTs) attitudes toward and beliefs about foreign language teaching and learning. Part of a larger international study aimed at answering the research question: ‘What are the national, social, economic, and institutional “socialsuggestive norms” (Miele, 1982) that encourage (or discourage) foreign language learning?’, this survey was administered to PSTs enrolled in the Faculty of Education at the University of Manitoba. The data presented here raise interesting questions about PSTs' attitudes with regard to their futures in multicultural, multilingual classrooms. Findings suggest that this group of PSTs believe that knowing English is sufficient for themselves and their students, and therefore that foreign language learning is not considered important. While English-speaking PSTs respect bilinguals, they do not seem to respect language study.

Walking speed is a key input for various traffic engineering applications. This paper presents the results of research conducted over 18 months to understand the difference between the normal and the crossing walking speeds of pedestrians at signalized intersections and to determine the effect of seasonality on walking speed, taking into account age and gender. For the purposes of this paper, normal walking speed is the speed at which pedestrians walk without needing to cross an intersection, and crossing walking speed is that at which pedestrians walk when they are crossing a signalized intersection. The research found that in all cases the normal walking speed is less than the crossing walking speed. It also found that younger pedestrians walk faster than older pedestrians, regardless of the season and gender, and females walk slower than males, regardless of the season and age. Furthermore, both younger and older pedestrians have a greater normal walking speed in summer than in winter but a lower crossing walking speed in winter than in summer. In addition, the research also found that by use of a design value of 1.2 m/s (4.0 ft/s), as recommended in the current Manual of Uniform Traffic Control Devices, nearly two-thirds of older pedestrians would be excluded in the design process on the basis of their normal walking speed and about 40% would be excluded on the basis of their crossing walking speed. The design value of 1.2 m/s (4.0 ft/s) excludes nearly one-third of younger pedestrians on the basis of their normal walking speed and about 10% on the basis of their crossing walking speed.

Objective There is little information about the patterns of care for elderly esophageal squamous cell carcinoma patients, and a standardized strategy has not been established. Therefore, we conducted a questionnaire survey about the patterns of care for these patients. Methods On September 2014, the questionnaires were sent to all 43 institutions of the Japan Esophageal Oncology Group, which comprised five parts: (i) definition of 'elderly' (age, method), (ii) basic treatment strategy according to stage and elderly status (fit/vulnerable/frail), (iii) patterns of care in each stage, (iv) considerations about conducting future clinical trials and (v) other information about geriatric oncology concerning esophageal squamous cell carcinoma. Results All answers were obtained by January 2015. Nearly half institutions (47%) considered the chronological definition of elderly to be over 80 years old. Among 43 institutions, 36 (84%) reported that the type of comorbidity and performance status were important factors for decision-making; no institution selected geriatric scale as an indicator. The most selected treatment strategy in fit healthy elderly patients was the same as the standard treatment of non-elderly patients. Radiation alone was considered the main treatment for vulnerable and frail esophageal squamous cell carcinoma patients. Most of the institutions answered that clinical trials for the elderly are warranted. Most institutions (70%) chose Stage II/III (non-T4) esophageal squamous cell carcinoma as an important investigational target. Conclusions Fit healthy elderly were considered the same as non-elderly patients, although there are no established treatment selection criteria. Radiation alone plays most important role in the treatment for vulnerable and frail esophageal squamous cell carcinoma patients. Stage II/III (non-T4) disease is attractive and warranted for future investigations.

The relationship between ascites, as detected by preoperative computed tomography (CT), and peritoneal metastasis of gastric cancer requires clarification because of its likely significance for clinical outcome.A retrospective analysis of 293 patients with advanced gastric cancer investigated the association between preoperative CT findings of ascites and surgical findings of peritoneal washing cytology and peritoneal metastasis.Forty-five of 293 patients (15%) presented with ascites on preoperative CT. Positive ascites on CT predicted the presence of free tumor cells with 40% sensitivity and 97% specificity, and peritoneal metastasis with 51% sensitivity and 97% specificity. Ascites on CT was an independent prognostic factor by univariate (P.001) and multivariate (relative risk, 2.03; 95% confidence interval, 1.39-2.96; P.001) analyses. The median survival time was 6.0 months in patients with positive ascites on CT.The presence of ascites on CT suggests the presence of peritoneal metastasis and indicates a poor prognosis. The presence of peritoneal metastasis should be confirmed by diagnostic laparoscopy in gastric cancer patients with ascites.

We here report on the clinicopathological characteristics of three cases of esophageal composite tumor showing tirpartite differentiation toward distinct squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. All tumors had in situ squamous cell carcinoma components and the deeply invasive parts of adenocarcinoma and small cell carcinoma components, which showed positive immunoreactivity for neuroendocrine markers and intracytoplasmic argyrophil granules. All three patients suffered disseminated tumor recurrence soon after esophagectomy and died of the disease within 14 months after operation. The metastatic tumors were predominantly composed of small cell carcinoma, and serum levels of neuron-specific enolase (NSE) were abnormally elevated at the time of recurrence in all cases. Esophageal composite tumors with tripartite differentiation are extremely aggressive; this aggression is primarily the result of the small cell carcinoma component, indicating the necessity for clinicians to treat such tumors as small cell carcinoma.

Patients with advanced esophageal carcinoma including clinical T4 tumor, extensive lymph node metastasis, or intramural metastasis have a dismal prognosis, despite recent multimodality treatments. The aim of this study was to evaluate the efficacy and toxicity of neoadjuvant chemotherapy using fluorouracil, doxorubicin, and cisplatin or nedaplatin (FAP/N) in these patients.Twenty-six patients were enrolled in this study. The first 9 patients received 600 mg/m2 fluorouracil on days 1-7 and days 29-35, and 30 mg/m2 doxorubicin and 60 mg/m2 cisplatin on days 1 and 29 (FAP). The next 17 patients received modified FAP, in which 50 mg/m2 nedaplatin was given instead of cisplatin (FAN).Grade 3 or 4 toxicities developed in 6 patients (23.1%) during chemotherapy, but there was no discontinuation of treatment. The clinical response rate was 46.2%. Twenty-one patients (80.8%) underwent esophagectomy, and R0 resection was achieved in 16 patients (61.5%). The 1-year survival rates of 26 patients, 21 patients with resectable tumor, 16 with R0 resection, and 12 clinical responders, were 31.3%, 32.1%, 33.3%, and 45.5%, respectively, each with a median survival time of 9 months. The median progression-free survival time of 26 patients was 6 months; in 16 patients with R0 resection progression-free survival was 6.5 months. There was no correlation between the recurrence pattern and tumor spread before treatment.FAP/N was found to have acceptable toxicities and the ability to control locoregional tumors, but made little contribution to patient survival. The efficacy of this treatment for patients with advanced esophageal carcinoma, however, may not yet be apparent.

PURPOSE: NY-ESO-1, a member of the cancer/testis antigen (CTA) family, elicits humoral and cellular immune responses in patients with advanced cancer. Unresectable or metastatic esophageal carcinoma patients do not benefit from the present multimodality treatment regimens in terms of survival. The objectives of this study were to analyze the antibody response to NY-ESO-1 antigen in patients with esophageal cancer and to determine the potential of NY-ESO-1 for use in tumor-specific immunotherapy. METHODS: Serum from 69 patients with esophageal cancer was investigated for antibody production against NY-ESO-1 by Western blot analysis. Also analyzed by immunohistochemistry were 56 tissue samples from these patients for NY-ESO-1 protein expression. RESULTS: NY-ESO-1 protein expression was found in 18 of 56 (32%) esophageal carcinomas. Serum immunoreactivity specific for NY-ESO-1 was found in 9 patients (13%) of whom 8 were in the advanced stage (stages III and IV). There was no relationship between clinicopathologic features and serum immunoreactivity for NY-ESO-1. NY-ESO-1 protein expression was detected in three of five antibody-positive patients whose tissue was available for analysis. Survival analysis showed no significant difference between antibody-positive and antibody-negative patient groups. CONCLUSIONS: A humoral immune response to NY-ESO-1 antigen was established in patients with advanced esophageal cancer. NY-ESO-1 is a good candidate for vaccine-based immunotherapy for advanced esophageal carcinoma.

Background Extended radical esophagectomy with three-field lymphadenectomy for patients with thoracic esophageal cancer has been shown to be effective. But even if this operation is performed, some patients still experience relapse of the disease. The purpose of this study was to clarify the pattern and timing of recurrence after extended radical esophagectomy. Study design Recurrence of esophageal squamous cell carcinoma was examined in 171 of 174 patients who underwent extended radical esophagectomy with three-field lymphadenectomy. Recurrence patterns were classified as locoregional (at the site of the primary tumor, the anastomotic site, or the lymph nodes), hematogenous, and other (pleura or site of gastrostomy). Factors associated with recurrence were identified using univariate and multivariate statistical methods for survival analysis. Results The overall 5-year survival rate was 55.6%. Recurrence was recognized in 74 patients (43.3%). The median disease-free interval until recurrence was 11 months. Thirty patients (17.5%) developed a locoregional recurrence, and 24 (14.0%) developed a hematogenous recurrence. Five patients (2.9%) developed both recurrences simultaneously and were classified as hematogenous recurrences. Of 30 patients with cervical lymph node metastasis, recurrent disease was recognized in 19 patients (63.3%). In multivariate analysis of 160 patients, the depth of invasion and pM-lym (cervical or celiac lymph node metastasis) were significant factors for locoregional recurrence; the depth of invasion and number of lymph node metastases at operation were significant factors for hematogenous recurrence. Survival time for patients with hemotogenous recurrence (median 16 months) was significantly shorter than that of patients with locoregional recurrence (median 25.5 months). Conclusions Locoregional recurrence is associated mainly with the extent of the local tumor and lymph node metastasis; hematogenous recurrence is not only associated with tumor stage but also with the tumor's oncologic behavior.

扁桃悪性リンパ腫の精査中に発見された早期胃癌と胃悪性リンパ腫の衝突腫瘍の1例を経験したので報告する. 症例は62歳の男性で, 2002年7月, 左扁桃腫脹を主訴に当院耳鼻咽喉科を受診し, 左扁桃悪性リンパ腫 (diffuse large B cell type) と診断された. 全身検索のために施行した上部消化管内視鏡検査にて胃体下部後壁に早期胃癌を発見され, 2002年9月10日, 当科にて幽門側胃切除, D2 リンパ節郭清を施行した. 病理診断の結果, 病変は高分化型腺癌 (深達度m) と悪性リンパ腫 (diffuse large B cell type, 深達度sm2) の衝突腫瘍を形成しており, リンパ節転移は認めなかった. 術後, 2002年10月18日より左扁桃悪性リンパ腫に対して, 当院関連病院内科にてCyclOBEAP療法を6コース施行し, 完全寛解を得た. 現在までに胃悪性リンパ腫, 胃癌および扁桃悪性リンパ腫の再発を認めていない.

The role of cervical lymphadenectomy for thoracic esophageal cancer is controversial. This study evaluated the impact of cervical lymphadenectomy on the cervical lymph node metastasis (LNM) and survival rates of patients with esophageal cancer. We analyzed 199 patients who received radical esophagectomy with three-field lymphadenectomy. The overall 5-year survival rate was 49.4%. Cervical LNM was found in 36 (18.1%) out of the 199 patients. The 5-year survival rates of the patients with cervical LNM from upper and mid-esophageal cancers were 71.4% and 35.9%, respectively. However, none of the patients with cervical LNM from lower esophageal cancer survived more than 4 years after esophagectomy. The overall survival of patients with five or more metastatic nodes (5.9%) was significantly worse than that of patients with less than five positive nodes (45.5%). Cervical lymphadenectomy is beneficial for patients with carcinoma of the upper and mid-thoracic esophagus, and with less than five positive nodes.

BACKGROUND: Adequate extent of surgical resection of simultaneous primary esophageal and extraesophageal carcinomas is controversial. STUDY DESIGN: Clinicopathologic records and treatment outcomes of 57 patients undergoing simultaneous resection of both synchronous esophageal and extraesophageal carcinomas (SC group) were reviewed and compared with those of 316 patients receiving esophagectomy for solitary esophageal carcinoma (EC group). RESULTS: Mortality and morbidity rates were 3.5% and 45.6% in the SC group, and 3.2% and 44.3% in the EC group, respectively. No significant difference was detected in either of the rates between the two patient groups. The overall 5-year survival rate of the SC group was 40%. Survival of the patients undergoing curative resection of both esophageal and extraesophageal tumors (n = 30) was significantly better than that of the patients receiving palliative resection of at least one of the two tumors in the SC group (n = 27)(5-year survival, 54.2% versus 19.9%, respectively)(p CONCLUSIONS: Simultaneous resection of synchronous esophageal and extraesophageal carcinomas can be safely performed, and complete tumor clearance of both tumors is needed for favorable longterm results.

e15592 Background: Molecular heterogeneity represents a significant hurdle in realizing precision medicine for gastric cancer (GC). Large-scale whole exome sequencing projects have identified distinct molecular subtypes to help define the heterogeneity of GC. However, it remains unclear whether the targeted gene panel-based sequencing can provide optimum targeted therapies and clinical utility in GC. The aim of this study is to generate comprehensive genomic profiling data and classify Japanese GC into actionable clusters associated with targeted therapies. Methods: FFPE tumor tissues were obtained from surgical or biopsy specimens of 207 Japanese patients with GC. Extracted DNA was subjected to genomic sequencing for 435 cancer related genes including 69 druggable genes with FDA approved targeted therapies. Somatic mutations, copy number alterations (SCNA), microsatellite instability (MSI) and Epstein-Barr virus (EBV) infection were evaluated using sequencing data. Results: Genomic sequencing identified at least one alteration of 435 genes in 194 pts (94%), and that of 69 druggable genes in 141 pts (68%). The most frequently altered druggable gene was ERBB2 (14%), following BRCA2 (11%) and ATM (10%). We successfully classified 207 tumors into four molecular subtypes, similar to the previously report; EBV (4%), MSI (8%), chromosomal instability (58%) and genomically stable subtype (30%). Frequent alterations of druggable genes ( > 5%) were widely observed through these subtypes. To discover the novel classifications associated with targeted therapies, we classified 207 tumors using mutation rate and hierarchical clustering. We identified a hypermutated group (n = 32), and a remaining non-hypermutated group (n = 175) which were sub-divided into six clusters including five actionable ones; ERBB2 (n = 25), CDKN2A and CDKN2B (n = 10), KRAS (n = 10), BRCA2 (n = 9) and ATM cluster (n = 12). Interestingly, we experienced a case of unresectable GC with a remarkable response for anti-HER2 therapy in the ERBB2 cluster. Conclusions: Genomic sequencing using a 435-gene panel has the potential to provide the information of optimum targeted therapies for upcoming precision medicine in Japanese GC.

e23191 Background: Microsatellite instability-high status (MSI-H) and alterations in the DNA mismatch repair pathway associate with the efficacy of 5-FU and immune checkpoint inhibitors in patients with gastrointestinal cancers. The activin type II receptor (ACVR2) that binds to the transforming growth factor beta superfamily of ligands is frequently mutated in MSI-H colorectal cancer. However, the incidence of ACVR2 mutations in gastric cancer patients remains unclear. The aim of this study is to reveal the incidence and to examine the association between the MSI-H and ACVR2A mutations in gastric cancer patients. Methods: 124 archived FFPE gastric cancer tissues (stage I-IV), who were operated at Niigata University Medical and Dental Hospital or Niigata Cancer Center Hospital, were analyzed for ACVR2A mutation and MSI status with the NGS-based comprehensive genomic test platform. Clinicopathological characteristics of the patients were also examined. Results: All 124 gastric cancer patients were successfully analyzed. 13 out of 124 patients (10.4%) showed MSI-H status. Interestingly, 10 of 13 MSI-H patients (76.9%) showed ACVR2A mutation, where none (0%) was found among patients with microsatellite stable status (P < 0.001), indicating the strong association between ACVR2A mutation and MSI status in gastric cancer patients. In the ACVR2A mutated group, there was a female predominance (P < 0.05), and cancers of the lower part of the stomach were more common (P < 0.05), compared with the wild type group. Only one of 10 patients with ACVR2A mutation died, and the patients with ACVR2A mutation show a 5-year overall survival rate of 90%. No statistically significant difference in survival was achieved between patients with ACVR2A mutation and wild type; this is probably due to the small number of patients. Conclusions: 10 of 13 MSI-H patients showed ACVR2A mutation. Our results indicate a strong association between ACVR2A mutation and MSI-H in gastric cancer patients.

The aim of this study was to evaluate the benefit of resection for liver metastasis from gastric cancer.Consecutive 74 patients of gastric cancer who undergone the gastrectomy for primary gastric cancer and simultaneous hepatic resection for synchronous liver metastasis were enrolled. The clinicopathological factors were retrospectively compared to the prognosis.The median survival time and 5-year overall survival rate in 53 patients who accomplished microscopically negative margin resection was 27.4 months and 18.6%, respectively. In the multivariate survival analysis, the number of liver metastasis was identified as an independent prognostic factor (HR;2.232, 95%CI;1.036-4.808, p=0.04). When the patients undergone curative resection were subdivided into solitary and multiple liver metastasis, the median survival time and 5-year overall survival rate in a subgroup with solitary liver metastasis was 24.2 months and 27.2%, which was superior to the corresponding values of 12.6 months and 5.5% in another group with multiple liver metastasis (p=0.02).The resection for liver metastasis might offer a chance for long-term survival in a carefully selected group of patients. The number of liver metastasis was a reliable criterion to discriminate the subgroup of patients who are most likely to benefit from hepatic resection.

Objective The Japanese health insurance system approved the use of proton pump inhibitors (PPIs) for the prevention of peptic ulcers in patients using low-dose aspirin (LDA) and/or non-steroidal anti-inflammatory drugs (NSAIDs). However, many orthopedists and physicians do not prescribe PPIs to elderly patients with atrophic gastritis. The aim of this study was to determine whether PPIs are effective in preventing gastrointestinal mucosal injury in elderly Japanese patients with atrophic gastritis. Methods We examined the associations between the use of antiulcer drugs and endoscopic findings in elderly Japanese patients using LDA or NSAIDs. Patients We evaluated 100 patients using LDA and 58 patients using non-aspirin NSAIDs 65 years of age or older. All patients underwent upper GI endoscopy to detect the presence of open ulcers and hemorrhagic lesions and assess the extent of atrophic gastritis. Results Among the patients using LDA, the prevalence of open ulcers was significantly lower in the patients using PPIs than in those using mucosal protective agent only and those not receiving antiulcer treatment (p

Background. Currently, there is only limited information regarding tumor angiogenesis and its clinical implications in cases of esophageal carcinoma. The purpose of this study was to clarify which clinicopathologic parameters correlate with tumor angiogenesis; furthermore, the study was conducted to evaluate whether tumor angiogenesis is an independent prognostic factor in cases of esophageal carcinoma. Methods. Intratumoral microvessel density (MVD) and thymidine phosphorylase (dThdPase) expression were immunohistochemically studied after extended radical esophagectomy in 103 cases of esophageal carcinoma. Results. Increased MVD significantly correlated with the depth of tumor invasion, the frequency of intramural metastasis, and the stage of tumor advancement (P

A case of superior mesenteric artery syndrome with gastric perforation in a 16-year-old woman is reported. The patient was admitted to the hospital because of abdominal pain and vomiting. Conservative therapy was started with a suspicion of superior mesenteric artery syndrome, but 2days later the abdominal pain was intensified. Emergency operation was performed with a diagnosis of generalized peritonitis. At laparotomy, gastric perforation associated with superior mesenteric syndrome was diagnosed. Partial gastrectomy and dissection of the Treitz' ligament were performed. The postoperative course was uneventful. Dissection of the Treitz' ligament that is minimal invasive is thought to be an appropriate procedure for patients with the disease in poor general condition.

To investigate the mechanisms of anti-tumor effects of chemotherapy and radiotherapy on esophageal carcinoma, apoptosis status was assessed by the TUNEL method in 14 esophageal carcinomas resected after preoperative chemotherapy with or without radiotherapy (Preoperative treatment group) and in 14 esophageal carcinomas primarily resected (Primary resection group). P 53 and Bcl-2 protein statuses were also as-sessed in both groups using immunohistochemical staining techniques. Apoptotic index expressed as a number of apoptotic cells per 1, 000 tumor cells was 15.5±3.3 and 8.6±1.8 in the preoperative treatment group and the primary resection group, respectively. There was no significant difference in apoptosis status between these two groups. However, the apoptotic index was significantly greater (p=0.04) in the tumors resected from responders of than that in the tumors resected from non-responders of the preoperative treatment. There was a significant correlation between p 53 and Bcl-2 labeling index (r=0.78, p=0.0017). In concision, the induction of apoptosis in obviously of paramount importance in enhancing the respose rate of the preopera-tive treatment.

CAAF1 and CAAF2, newly identified calcium-binding proteins from bovine amniotic fluid, have been revealed to be members of the S100 protein family preferentially produced by fetal squamous epithelial cells, including epidermal keratinocytes. Having previously cloned the cDNA of human CAAF1 protein from the esophageal epithelium, we report here on the characteristic expression pattern of CAAF1 and related S100 proteins in human esophageal epithelial cells. Normal cells of the human esophageal epithelium expressed CAAF1, and also expressed the homologous novel S100 proteins including CAAF2, MRP8, and MRP14, but not S100alpha. An immunohistochemical study with specific monoclonal antibodies against CAAF1 proteins demonstrated that CAAF1 proteins were produced by the esophageal epithelial cells in the process of cell differentiation. The immature proliferating cells in the epithelium did not produce CAAF1 proteins, but the differentiated cells expressed CAAF1, which overlay the immature cells and were stratifying in the epithelium. These CAA 1-producing cells did not show any proliferating activities. Esophageal carcinoma cells did not express CAAF1, except for the keratinized cells with no proliferating activity. In addition, the forced expression of CAAF1 proteins in the carcinoma cells resulted in a marked decrease in DNA synthesis. These findings indicate that human esophageal epithelial cells express the multiple genes of S100 proteins including CAAF proteins, and that CAAF1 is closely associated with the terminal differentiation of these cells. CAAF1 expression also might play some role in cell growth.

Background The most effective treatment for patients with esophageal small cell carcinoma has not yet been established because of the overall extremely poor prognosis regardless of the mode of treatment. The role of esophagectomy has been controversial in the management of patients with this disease. Methods The clinicopathologic characteristics of 13 patients with primary esophageal small cell carcinoma were retrospectively studied and the prognostic significance of various factors with respect to esophagectomy were evaluated. Results Lymph node metastases and distant metastases were found at the time of presentation in 92.3 and 46.2%, respectively. Two of nine patients treated by surgical resection for local-regional disease survived >5 years after radical esophagectomy with a projected 5-year survival rate of 22.2%. The remaining 4/13 patients were treated by nonsurgical modalities, but died of the disease within 10 months. A significant difference (P < 0.05) was detected between the survival curves of the two groups of patients. Conclusion Radical esophagectomy may be an effective treatment modality in improving survival and the odds of a cure in patients with local-regional small cell carcinoma of the esophagus. J. Surg. Oncol. 64:130–134. © 1997 Wiley-Liss, Inc.

To elucidate the clinical characteristics of patients with elderyly-onset rheumatoid arthritis (EORA), we compared the clinical features, laboratory data, and clinical course of 17 patients with elderly-onset (age at onset; over 60 years, average 63.0 years with) 19 patients with younger-onset (below 50 years, average 38.3 years). The group with EORA had an increased incidence of hypertension, diabetes mellitus, cardiovascular disease, ischemic heart disease. There was no significant difference in the levels of ESR, CRP, IgG-RF titer, serum IgG concentration at entry, and the clinical course during two years follow-up between the 2 groups. In spite of EORA patients having a higher prevalence of complications to drugs including disease-modifying anti rheumatic drugs (DMARDs) and steroids, we considered that DMARDs (especially GST) and steroids must be used to prevent rapid bone destruction. In addition, surgical procedures including joint replacement were recommended to maintain the EORA patients activity of daily living.

An 84-year-old man had the wall thickness of his stomach accidentally detected by CT scan, and was diagnosed as type 2 advanced gastric cancer with liver and lung metastasis. Chemotherapy with docetaxel, cisplatin and S-1 combination therapy was adopted. Grade 4 neutropenia was revealed, but the treatment could be continued by G-CSF or by down dosing the anticancer agents. By maintaining CR of the primary lesion and PR of the liver and lung metastases, he has been kept at a PS 0 state and has been receiving regular outpatient treatment for 28 months now since the beginning of treatment.

The aim of this study was to evaluate the significance of the conversion of the peritoneal cytology from positive to negative following induction chemotherapy in relation to the prognosis after subsequent resection for gastric cancer.This retrospective study was conducted using a prospectively maintained database. A total of 47 patients with free cancer cells in the peritoneal cavity, as evaluated by staging laparoscopy, but no other evidence of distant metastasis, who underwent induction chemotherapy followed by surgery were enrolled in the study. Then, the clinicopathological factors and survival in the study subjects were assessed.The median survival time and 5-year overall survival rate of the 47 study participants were 20.4 months and 25.0 %, respectively. In 23 of the patients, the peritoneal cytology converted from positive to negative after the induction chemotherapy, and a microscopically margin-negative gastrectomy was performed. The median survival time of 30.4 months and the 5-year survival rate of 34.6 % of these patients was significantly more favorable than the corresponding values of 15.0 months and 17.6 % in the patients who had persistently positive cytology (P = 0.03).Based on our findings, the clearance of free cancer cells in the peritoneal cavity by induction chemotherapy improves the prognosis of patients following subsequent gastrectomy.

Posterior lumbar interbody fusion is biomechanically a good procedure. Though recommended many years ago by Cloward, PLIF (posterior lumbar interbody fusion), was not widely used for many years. Recently, many authors have recognized PLIF as a preferred technique for lumbar stabilization. The use of this newfusion device provides immediate stabilization, preservation of discheight due to highly resistant material, and long term fusion with autogenous bone. Nine cases of posterior lumbar interbody fusion using this new fusion device were evaluated. Subjects included eight males and one female with a mean age of 49.3 years, ranging from twenty-four to seventy-four years. Diagnosis was degenerative spondylolisthesis in two cases, herniated disc disease in two, disc degeneration in three, degenerative lumbar scoliosis in two. Seven of nine cases achieved solid union, but union was delayed in three cases. If you select cases carefully, this implant is very useful because it acts as an interbody spacer with its own stabilizing capacity, without reguiring additional fixation.

Category: Midfoot/Forefoot Introduction/Purpose: Metatarsalgia of the lesser metatarsal heads are frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and the position of the first metatarsal head influences the prognosis of metatarsalgia and plantar callosities beneath the lessor metatarsal heads. Methods: A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up period of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiological evaluation was made with standard weight-bearing AP radiographs, and the hallux valgus angle (HVA), inter-metatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton’s technique. Results: The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF- hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm2. Sixty percent of metatarsalgia improved, and 85% of painless callosities disappeared postoperatively. Among radiological parameters, postoperative RML was most significantly associated with JSSF score (P < .0001) and the presence of postoperative metatarsalgia (P < .0001). ROC analysis revealed that the RML cut-off point was -3 mm for avoiding metatarsalgia, with an area under the curve of 0.884, a specificity of 88%, and a sensitivity of 85%. Conclusion: Preservation of RML during first metatarsal osteotomy is important to prevent postoperative metatarsalgia.