[Factors deciding survival rate after resection of pancreatic neoplasms. 5). Perineural invasion].
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Biomedical subjects
Publications and source records attributed to Y Ogata.
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Two patients with hepatocellular carcinoma combined with liver cirrhosis lived more than 5 years after hepatic resection. One patient with liver cirrhosis combined with schistosomiasis japonica survived 5 years and 2.5 months after left lobectomy and died of liver failure. Two recurrent tumors, each 1 cm in diameter, were present in the remaining lobe but were not responsible for death. Another patient is well 9 years and 2 months after extended right lobectomy. The tumor was bulky, and the resected specimen was 2800 g in weight. These facts show that patients with hepatocellular carcinoma combined with liver cirrhosis can survive for a long period even if a large tumor is involved.
Proliferating cell nuclear antigen (PCNA), also called cyclin, was purified from PBS extract of rabbit thymus by using a combination of ammonium sulfate fractionation, DEAE-Sephacel, HPLC ion exchange, and HPLC gel filtration column chromatography. PCNA was purified more than 600 times and was analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting. SDS-PAGE showed that a 36 kD protein was selectively isolated in this purification process, and this protein was identified as PCNA by immunoblotting. Other previously identified nuclear antigens, Sm, nRNP, SS-A/Ro, SS-B/La, histone, and DNA, were not detected in this preparation by counterimmunoelectrophoresis and enzyme-linked immunosorbent assay (ELISA). Purified PCNA was used as an antigen to develop ELISA for rapid and specific detection of anti-PCNA in human sera. For further purification, the 36 kD band was electrophoretically eluted from SDS gel slices. The amino acid composition and the first 25 residues from the N-terminus of the protein were determined by using electroeluted PCNA. This amino acid sequence was found to be unique and showed little sequence homology with existent proteins in the protein identification resources databank.
To determine the clinical usefulness for diagnosis and monitoring of pancreatic tumor markers, serum levels of CA 19-9 (RIA; less than or equal to 37U/ml), POA (EIA; less than 11 U/ml), CEA (EIA; less than or equal to 4.4 ng/ml) and TPA (RIA; less than or equal to 110 U/ml) were measured in 57 patients with pancreatic cancer and 25 patients with benign diseases of the pancreas. Frequencies of elevation for pancreatic cancers were 73.9% for CA 19-9, 69.2% for POA, 48.9% for CEA and 73.2% for TPA. Furthermore, the frequencies of elevation at relatively early stages of pancreatic cancer were not high. It was therefore thought that these markers were unsuitable for early diagnosis of pancreatic cancers. Although serum levels of CA 19-9 and POA in cases of pancreatic cancer were distributed up to on extremely high level, those for benign diseases of the pancreas were located up to twice the values of the cut-off levels. Therefore, these two markers seem promising for differentiating preoperatively between pancreatic cancer and benign diseases of the pancreas. CA 19-9 and POA were also useful for monitoring the recurrence of pancreatic cancer. In particular, patients with high preoperative levels seem good candidates for postoperative monitoring.
Serum levels of POA (EIA; less than 11.0 U/ml) and CA 19-9 (RIA; less than or equal to 37 U/ml) were measured in 54 patients with pancreatic cancer and 19 patients with benign diseases of the pancreas. Although serum CA 19-9 and POA were elevated in 72.7% and 69.4% of patients with pancreatic cancer, respectively, patients in relatively early stage showed low percent of elevation. Therefore, these markers are unsuitable for early diagnosis of pancreatic cancers. However, these markers seem promising in differentiating preoperatively between pancreatic cancer and benign disease of the pancreas. These markers are also useful for monitoring the recurrence of pancreatic cancers. Of particular, patients with preoperatively high level seem good candidates for postoperative monitoring.
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Hepatic resection was performed in 125 patients. Ninety-three of the 125 patients had malignant neoplasms; primary liver carcinoma in 61, metastatic liver carcinoma in 15, carcinoma of the bifurcation of the hepatic ducts in 16, and carcinoma of the gallbladder in one. Performance of hepatic resection was complicated by the presence of liver cirrhosis and jaundice in 42 and 19 patients, respectively. Nine of the 125 patients died within 30 days of the operations, with an operative mortality of 7.2%. Eight of the nine deaths were due to liver failure in the cirrhotic patients who underwent resection of more than two segments of the liver. None of the jaundiced patients died postoperatively. The three-year actuarial survival rates of the patients with hepatocellular carcinoma, metastatic liver carcinoma, and carcinoma of the bifurcation of the hepatic ducts were 31%, 56%, and 21% respectively.
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Thirty-one patients with carcinoma of the bifurcation of the hepatic ducts were treated during a period of ten years. Sixteen of the 31 patients underwent resection. Left, right, and extended right lobectomy with the resection of the bilateral hepatic ducts, common hepatic and bile ducts were performed on 11, 1, and 3 patients, respectively. In a cirrhotic patient, resection of the left medial segment and bile ducts was carried out. The biliary tract was reconstructed using hepaticojejunostomy or hepatojejunostomy. Four of the 16 patients are still alive for six months, 1 1/2 years, one year and 11 months, and two years and ten months, respectively. The remaining 12 patients died of recurrence at periods ranging from six months to three years and eight months. The treatment is now focused on increasing long-term survival.
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Suitable conditions for assay of the growth factor from Yoshida sarcoma and AH-130 tumor cells were investigated using three different cell lines: baby hamster kidney cells, human embryonic lung cells and Swiss Albino mouse 3T3 embryo fibroblast cells. The results indicated that the 3T3 cell line was more sensitive to the growth stimulating activity than the other two lines. A fraction of Yoshida sarcoma tumor cells containing the growth factor showed less growth stimulating activity than a fraction of AH-130 tumor cells prepared by the same method. Using the 3T3 cell line for assay of activity, the growth factor was partially purified from AH-130 tumor cells by ammonium sulfate fractionation, DEAE-cellulose column chromatography and gel filtration on a Sephacryl S-300 column. It appeared to be thermolabile, and its molecular weight was estimated as about 80,000 by gel filtration on Sephacryl S-300. These findings suggest that it is a high-molecular-weight substance.
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Fourteen jaundiced patients with carcinoma at the bifurcation of the hepatic ducts, primary carcinoma of the liver and congenital cystic dilation of the intrahepatic bile ducts underwent hepatic resection without an operative mortality after the jaundice was relieved preoperatively. All patients did well, with jaundice and fever being absent postoperatively, although nine patients died of a recurrence of carcinoma in the follow-up period. It is now clear that the jaundiced patient become candidates for hepatic resection.
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