Esophageal carcinoma cases surviving for more than ten years in Japan

The early results of surgical treatment of esophageal cancer were unfavorable, but have steadily improved. At present, more than 1,000 surgical procedures for carcinoma of the esophagus are performed annually in Japan, with an operative mortality of around 6%; long-term results are steadily improving. In a survey of the 256 institutional members of the Japanese Society for Esophageal Diseases, 387 patients were found to have survived for 10 years or more. The main factors affecting prognosis are the size of the lesion, degree of invasion, extent of metastasis, and stage. Mild problems of regurgitation or heartburn in 25.5% of cases point to a need for improved operative procedures; the fact that 31.2% have died due to malignant disease, including recurrence, emphasizes the need for follow-up.     

A long-term follow-up and management study of hepatocellular carcinoma patients surviving for 10 years or longer after curative hepatectomy

BACKGROUND: The aims of the current study were to elucidate the clinicopathologic characteristics and disease recurrence patterns of patients with hepatocellular carcinoma (HCC) who survived for 10 years or longer after undergoing an initial hepatectomy. METHODS: Between January 1987 and December 1993, 578 patients underwent potentially curative hepatectomy at the study institution. Disease recurrence and follow-up data were available for 481 of these patients, who then were followed for more than 10 years after the initial hepatectomy. Fourteen clinicopathologic features were compared between the 10-year survivors and those patients who died within 10 years after the surgery. The risk factors for disease recurrence, the recurrence status, time to recurrence, and treatment modalities for recurrence were examined among the 10-year survivors. RESULTS: There were 105 10-year survivors (21.8%), including 42 disease-free survivors (8.7%). Favorable independent factors found to be correlated with 10-year survival were age < 55 years, a plasma retention rate of indocyanine green at 15 minutes of < 15%, the presence of a solitary tumor, the absence of intrahepatic metastases, the absence of portal vein invasion, and the absence of underlying cirrhosis. A negative test for the the hepatitis C antibody and the absence of intrahepatic metastases were found to be independent predictive factors for 10-year disease-free survival among the 10-year survivors. CONCLUSIONS: The results suggest that younger patients without underlying cirrhosis who have a solitary HCC that does not demonstrate vascular invasion might survive for longer than 10 years after the initial hepatectomy. In addition to close surveillance in such patients after hepatectomy, repeat hepatectomy, local ablation therapy, and transhepatic arterial chemoembolization may contribute to long-term survival, even if disease recurrence occurs.     

Lipiodolization for unresectable hepatocellular carcinoma: An analysis of 205 patients using univariate and multivariate analysis

Since 1982 we have developed and successfully performed lipiodolization on 205 patients with unresectable hepatocellular carcinoma. The 1-, 2-, 3-, 4-, and 5-year survival rates were 55.6%, 31.7%, 16.3%, 8.7%, and 2.9%, respectively, while the median survival was 413 days, and 20 patients survived longer than 3 years after the first lipiodolization. Our study demonstrated that the factors for a comparatively good prognosis were as follows: patient older than 50 years, nodular type hepatocellular carcinoma <5 cm in diameter, negative tumor invasion of portal vein, <10 intrahepatic metastases, serum alpha-fetoprotein level <400 ng/ml, and Okuda stage I. Lipiodolization did not cure hepatocellular carcinoma. It did, however, in this study, achieve a prolongation of the patient's survival. © 1994 Wiley-Liss, Inc.     

Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion: A prospective cohort study

BACKGROUNDThe long-term effect of anatomic resection (AR) is better than that of non-anatomic resection (NAR). At present, there is no study on microvascular invasion (MVI) and liver resection types.AIMTo explore whether AR improves long-term survival in patients with hepatocellular carcinoma (HCC) by removing the peritumoral MVI.METHODSA total of 217 patients diagnosed with HCC were enrolled in the study. The surgical margin was routinely measured. According to the stratification of different tumor diameters, patients were divided into the following groups: ≤ 2 cm group, 2-5 cm group, and > 5 cm group.RESULTSIn the 2-5 cm diameter group, the overall survival (OS) of MVI positive patients was significantly better than that of MVI negative patients (P = 0.031). For the MVI positive patients, there was a statistically significant difference between AR and NAR (P = 0.027). AR leads to a wider surgical margin than NAR (2.0 ± 2.3 cm vs 0.7 ± 0.5 cm, P < 0.001). In the groups with tumor diameters < 2 cm, both AR and NAR can obtain a wide surgical margin, and the surgical margins of AR are wider than that of NAR (3.5 ± 5.8 cm vs 1.6 ± 0.5 cm, P = 0.048). In the groups with tumor diameters > 5 cm, both AR and NAR fail to obtain wide surgical margin (0.6 ± 1.0 cm vs 0.7 ± 0.4 cm, P = 0.491). CONCLUSIONFor patients with a tumor diameter of 2-5 cm, AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin, reduce postoperative recurrence, and improve prognosis.     

Long term survival of radiotherapy for esophageal cancer: analysis of 1136 patients surviving for more than 5 years

One thousand one hundred and thirty-six patients surviving for more than five years after radiotherapy were studied. The important prognostic factors are: lesion less than 5 cm in length, lesion located in the upper-third segment and lesion that is radiosensitive. The radiation dose given to long term survivors varies greatly, i.e., 2700 to 9300 rad. Yet, for the sensitive type of lesion, doses lower than 5000 rad could also effect a cure. The delivery of an optimum dose determined by serial examinations during radiotherapy could improve the result of treatment. For local recurrent lesions, the value of a second course of radiation is extremely limited and surgery is the only means to offer a cure. For metastasis in the lymph nodes, radiation offers some hope of cure, although the long term outcome may not be satisfactory. For second primary cancer of the esophagus, aggressive radiation still gives encouraging results.     

A case of esophageal carcinoma with the lung and liver metastases surviving more than 3 years

A case of advanced esophageal carcinoma with liver and lung metastases who survived more than 3 years by combination chemotherapy consisting of Cisplatin and continuous 120 hours infusion of 5-Fluorouracil was reported. The primary lesion and liver metastases achieved complete response (CR) but the lung metastases attained only partial response. CR was, however, achieved by another regimen of chemotherapy. Forty months after the initiation of treatment, brain metastasis was recognized, which was controlled by radiotherapy. The patient is still alive three years after the onset of disease but with lung metastases. Quality of life in these 3 years was considered to be relatively good.     

The prognosis of patients with local recurrence more than five years after breast conservation therapy for invasive breast carcinoma.

AIMS: The increasing use of breast-conserving therapy (BCT) and the rising incidence and improved prognosis of early breast are causing a substantial increase in the absolute number of patients with a late local recurrence following BCT. This study examined the characteristics and the prognosis of patients with a local recurrence occurring more than 5 years after BCT. METHODS: In the period 1982-1997, 3280 patients with invasive breast cancer underwent breast-conserving therapy in one of the eight community hospitals in the South-eastern part of The Netherlands. Of these patients, 98 developed a local recurrence in the breast more than 5 years after BCT. RESULTS: Eighty-five of the 98 recurrences were invasive, 12 were purely in situ and for one patient this information was not available. The 5 years distant recurrence-free survival rate of 85 patients with a late invasive local recurrence was 68% (95% confidence interval [CI], 56-80) and significantly better than the rate of 41% (95% CI, 33-48) in an existing cohort of 173 patients with invasive recurrence within 5 years after BCT (p=0.007). Local excision of the recurrence was followed by a significantly lower local control rate than salvage mastectomy (50 vs 89%; p=0.004). CONCLUSION: The prognosis of patients with a local recurrence more than 5 years after BCT is significantly better than of patients with local recurrence within 5 years after BCT.     

Factors predictive for long-term survival of male patients with hepatocellular carcinoma after curative resection

BACKGROUND AND OBJECTIVES: Curative hepatic resection (CHR) was a modality that provides possibility of long-term survival for hepatocellular carcinoma (HCC). So far, prognostic factors of male patients with HCC after CHR remain unclear. Purposes of the present study were to identify these factors and to compare them with those for females. METHODS: Consecutive 151 male and 23 female patients with HCC undergoing CHR were enrolled in this retrospective study. Their prognostic factors were identified by uni- and multi-variate statistical analysis. RESULTS: One-, three- and five-year overall and disease-free survival of male patients were 82.4, 51.5, and 43.6%, and 65.8, 33.7, and 21.7%, respectively, with no significant differences compared to females. Univariate analysis showed that tumor size, TNM staging, Edmondson-Steiner grade, serum alpha-fetoprotein (AFP) level, presence of portal vein tumor thrombosis (PVTT) and satellite nodule were significant for males with HCC, but only Edmondson-Steiner grade, presence of PVTT and satellite nodule were independent. For females, Edmondson-Steiner grade was the single potential indicator for survival. CONCLUSIONS: Malignant degree and invasive phenotypes were main factors that independently influenced survival of male patients with HCC after CHR. Among them, histological grade, which was also potentially significant for females, was the most powerful survival predictor.     

生存5年以上多发性骨髓瘤患者43例临床观察

目的 分析生存期大于5年多发性骨髓瘤(MM)患者的临床特点及其与预后的关系.方法 收集2005年9月至2009年9月确诊的43例生存期大于5年MM患者的临床资料,总结患者临床特征、实验室指标和治疗情况,并分析其与生存期的关系.结果 43例患者中,男性23例,女性20例,中位年龄59岁,中位生存期80个月,不同的国际ISS分期对应的中位生存期分别为Ⅰ期120个月,Ⅱ期93个月,Ⅲ期80个月.所有患者均接受过硼替佐米化疗;复发患者接受了含硼替佐米方案、DECP方案、来那度胺、三氧化二砷及脂质体多柔比星等药物治疗.化疗中位疗程数25个(15 ～ 46个).结论 MM的预后不仅与肿瘤负荷、宿主因素及肿瘤生物学特征等有关,还与治疗方案及对治疗的反应密切相关.硼替佐米、来那度胺等新型靶向药物对初诊及复发难治MM均有较好疗效.     

Epigenetic combination therapy as a tumor-selective treatment approach for hepatocellular carcinoma

BACKGROUND: Innovative epigenetic therapeutics comprise histone deacetylase inhibitors (HDAC-I) and demethylating agents (DA). It was recently found that HDAC-I compounds exhibit profound therapeutic activities against hepatocellular carcinoma (HCC). A comprehensive preclinical investigation was performed on the potential of a combined HDAC-I/DA epigenetic regimen for the highly chemotherapy-resistant HCC entity. METHODS: Human HCC-derived cell lines or primary human hepatocytes (PHH) were treated with HDAC-I compound suberoylanilide hydroxamic acid (SAHA) or DA compound 5-aza-2'-deoxycytidine (5-aza-dC) or both and examined for cellular damage, proliferation, histone acetylation pattern, and DNA methylation. In vivo activities were investigated in a xenograft hepatoma model. RESULTS: Monotherapeutic application of SAHA or 5-aza-dC was found to induce substantial antiproliferative effects in HCC-derived cells, strongly enhanced by combined SAHA and 5-aza-dC treatment. PHH from different human donors did not exhibit any relevant cellular damage even when applying high doses of the combination regimen, whereas HCC-derived cell lines showed a dose-dependent damage. In vivo testing demonstrated a statistical significant inhibition of hepatoma cell growth for the combined treatment regime. CONCLUSIONS: Because the combined HDAC-I/DA epigenetic approach was found to produce significant antitumor effects in HCC model systems and did not impair cellular integrity of untransformed hepatocytes, this combination therapy is now considered for further investigation in clinical trials.     

Long-term survivors after resection for primary liver cancer. Clinical analysis of 19 patients surviving more than ten years

From July 1958 to June 1978, a total of 333 cases with pathologically proven primary liver cancer (PLC) were admitted to the Zhong Shan Hospital, Shanghai Medical University, Shanghai, the people's Republic of China. Of these, 39.6% (132 of 333) were resected and 14.4% (19 of 132) survived over 10 years after resection for PLC. These 19 patients surviving over 10 years were investigated in this paper. All 19 patients underwent radical resection, including right hemihepatectomy in two cases, left hemihepatectomy in ten cases, left lateral segmentectomy in three cases, and local resection in four cases. By the end of June 1988, follow-up varied from 10 years and 1 month to 26 years and 7 months, with a mean follow-up of 15 years and 4 months. All 19 patients are still alive with free of disease. The longest survival patient had a tumor measuring 10 X 8 X 6 cm in size and underwent local resection. Upon follow-up after 26 years and 7 months, the patient was found to be still living and well. Two patients with intraperitoneal ruptured PLC have survived for 19 years and 4 months, and 16 years and 11 months, respectively, after resection of the tumors free of disease and have returned to work. Subclinical recurrence of PLC was discovered in one patient in whom reoperation with cryosurgery was carried out. The patient has been in good condition with negative alpha-fetoprotein (AFP) for 8 years and 10 months after cryosurgery. Subclinical solitary pulmonary metastasis was detected in two patients because of a secondary rise in AFP level. Reoperations were carried out and the metastatic tumors were removed. These two patients are still in good health with negative AFP 9 years and 6 months, and 10 years and 1 months, respectively, after reoperation. These results indicate that early and radical resection are the principal factors influencing long-term survival; reoperation for subclinical recurrence and solitary metastasis remains an important approach to prolong survival further; intraperitoneal rupture of PLC does not exclude the possibility of cure; new surgical techniques, such as cryosurgery and bloodless hepatectomy, have been shown to be effective in some patients.     

A case of hepatocellular carcinoma with survival of more than 7 years after extended right lobectomy

A 48-year-old male was referred to our hospital because of a space occupying lesion that had been revealed by hepatic scintigraphy, which had been seen because of an evaluation of his serum alpha-fetoprotein level while under therapy for chronic hepatitis. Laboratory data revealed an impaired liver function and a hepatic angiography showed a hypervascular tumor of the right hepatic branch. An extended right lobectomy was performed. Postoperatively, this case was histologically diagnosed as hepatocellular carcinoma. Despite having had an intraportal tumor thrombus, the patient survived for 7 years and 3 months and died of a cancer recurrence with hepatic failure. In this case surgical resection proved very useful for survival over a long period.     

Prevalence of lymphoedema more than five years after breast cancer treatment

Aim

A lack of consistency in the definition of breast cancer related lymphoedema (BCRL) and of uniform measurement criteria contribute to the wide prevalence range found in current literature. This report aims to describe the long-term prevalence of BCRL and secondly, to compare the long-term prevalence of BCRL when assessed by two objective measures and one subjective measure.

Methods

The upper-limbs of 145 post-surgical breast cancer patients were evaluated for the presence of lymphoedema using the water displacement method. Two circumference methods and patient perceived swelling were applied secondarily for comparison. Limb measurements were performed once, more than five years after surgery.

Results

The long-term prevalence of BCRL using water displacement was 8%. Prevalence varied when the sum of arm circumference (SOAC), the arm circumference and the self-report methods were used: 16, 31 and 17% [P < 0.001], respectively. Of the women identified with BCRL using the water displacement technique, 82% were detected with the SOAC method, 82% with the arm circumference method and 91% by self-report. Using water displacement as the gold standard the methods with the highest specificities were the SOAC (90%) and self-report method (89%), arm circumference resulted in a low specificity of 73%.

Conclusion

The prevalence of BCRL more than five years after surgical treatment differs depending on the measuring method used. Our data underlines the necessity for consensus on the diagnostic criteria for BCRL.     

体部伽玛刀治疗原发性肝癌的疗效分析

Objective： To evaluate efficacy of the stereotactic body radiotherapy for patients with hepatocellular carcinoma. Methods： Twenty-seven patients with hepatocellular carcinoma were treated by technique of stereotactic body radiotherapy. Planning of treatment was made and the prescribed dose was adjusted depending on the site of the tumor, clinical target volume （GTV）, Kanofsky Performance and aim of treatment. Planning target volume received 50%-80% of the prescribed dose for 3.2-4.2 Gy per-fraction. Treatment total dose was 32-42 Gy （median dose 40 Gy） in daily fractions of 3.2-4.2 Gy for five fractions one week. Results： All the patients completed the planned radiotherapy. The tumor response rate was CR 25.9%, PR 55.6%, NR 18.59%＇, the response rate （CR ＋ PR） was 81.5%. Half-year local recurrence-free survival rate was 75%; 1-year local recurrence-free survival rate was 22%. There were no serious complications during radiotherapy and followup. Pain relieve rate in liver region was 83.3%. Conclusion： Stereotactic body radiotherapy can improve the local control and quality of life on the treatment of primary hepatic neoplasm while not increasing the treatment complication.     

Development of hepatocellular carcinoma in patients with chronic hepatitis C more than 10 years after sustained virological response to interferon therapy

The risk factors for the development of hepatocellular carcinoma (HCC) in patients who have achieved a long-term sustained viral response (SVR) to interferon (IFN) are not fully understood. This study aimed to investigate the characteristics of patients who developed HCC after 10 years of achieving SVR. We retrospectively studied 5 patients with HCC which developed more than 10 years after the termination of IFN therapy. The clinical characteristics at the induction of IFN therapy were male gender, a mean age of 51.6±9.1 years, while 2 patients were moderate alcohol consumers. None of the 5 patients were positive for either HBs Ag or anti-HBc Ab. A histological examination at the initial IFN therapy showed the activity scores to be A2 in all cases, and the fibrosis scores at least F2. The clinical parameters at the diagnosis of HCC included fluctuating transaminase levels in all cases. These levels scarcely fell below the upper limits even after SVR was achieved. In 3 patients, liver tissues were obtained at the treatment of HCC. These tissues showed marked improvement in both activities and fibroses, but severe steatosis in 1 patient. To conclude, chronic hepatitis C patients who respond to IFN therapy should undergo long-term follow-up, even after the eradication of HCV, with special attention particularly to patients who had elevated transaminase levels and steatosis.     

A case of recurrent hepatocellular carcinoma after hepatic resection surviving over five years by hepatic arterial infusion of lipiodol-anticancer drug suspension]

A 63-year-old male with four intrahepatic recurrences of surgically resected hepatocellular carcinoma was admitted to our hospital in June 1985. He underwent lateral segmentectomy of the liver in November 1983. Pathologic finding of Edmondson II with liver cirrhosis had been confirmed by the operative specimen. Sizes of four recurrent tumors were assessed by CT as 3.5 x 2.2 cm, 2.6 x 2.2 cm, 2.2 x 2.2 cm and 2.2 x 2.2 cm, respectively. During five years until July 1990, the patient was treated with hepatic arterial infusion of Lipiodol-anticancer drug suspension eight times (total 5-FU 900 mg, ADM 77 mg, MMC 73 mg, and Lipiodol 36 ml) and hepatic arterial chemoembolization of MMC microcapsules one time. In addition, two hepatic arterial infusions of CDDP (total 70 mg) were given and 5-FU (total 10 g) was administered intravenously. Partial response (PR) was obtained for 19 months. Hepatic arterial infusion of Lipiodol-anticancer drug suspension was given only once every 6 months, and he maintained a good quality of life for over four and half years. The man died in July 1990. In general, multiple intrahepatic recurrence of surgical resected hepatocellular carcinoma has a poor prognosis. Therefore it was considered that hepatic arterial infusion of this drug brought about the relatively long survival of more than five years.