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Evaluation of hepatic arterial infusion chemotherapy for advanced gallbladder cancer
right lobes The mean patent periods were calculated using the Kaplan-Meier method. RESULPS: The mean patent periods of SEMS in the patients with carcinoma of bile duct, pancreas, gall bladder, liver, and other organs were 509 days, 343 days, 223days, 122 days, and 159 days, respectively. The patency of bile duct carcinoma was the longest. The mean patent periods ot covered SEMS (n = 74) and uncovered SEMS (n = 71) were 329 days and 442 days, respectively (NS: p=0.98). However, in the patients with carcinoma of gall bladder, the patent period of' covered SEMS (n= 13:356 days) was significantly more prolonged than that of uncovered gEMS (n = 9:84 days), (p = 0.003). In the other diseases no improvement of patency was noted (bile duct: covered SEMS 358 days vs uncovered SEMS 588 days, pancreas: 333 day's vs 267 days, liver: 127 days vs 56 days, others: 159 days vs 95 days, respecuvely). In the case of hilar bile duct stricture the patent periods of unilateral steming (n=41) and bilateral stenting (n=31) were 240 days and 357 days, respecns'ely (NS: p = 0.14). Excluding the cases of carcinoma of hilar bile duct because of the extremely long patency, the patent p.eriod of the bilateral stenting (n = 17:252 days) was sigmificantly more prolonged than (hat of unilateral stenting (n = 28:101 days), (p = 0,004). CONCLUSION: Using covered SEMS, the patency was prolonged especially in the patients ,,,nth can:inoma of gall bladder. In addition in the cases with hilar bile duct stricture, bilateral stenting is necessary to prolong the patency
histopathological or molecular biological examinations of ampullary carcinoma has been reported, but endocrine component in ampullary carcinoma has not been noted. We examined endocrine component in ampullary carcinoma immunohistuchemically, and studied the clinieopathological differences between endocrine component-positive cases and negative cases. Methods: Filly-one cases of ampullary carcinoma were studied clinically and bistopathotogically. Fommlin-fixed, paraffin-embedded serial sections were stained immunohistochemically tot chromogranin-A, insulin, sonmtostatin, pancreatic polypeptide, ~mtonin, gastrin, CA19-9, CEA, p 5 3 K-ras codon 12 mutation was analyzed by ennched PCR-EL?vta_ (enzyme-linked minisequence assay) in genomic DNA extracted from paraffin-embedded sections. Results: Endocrine ceils positive for cbromogranin A were detected in 13 cases; 10 cases had many endocrine ceils (10-30% in a high-power field) and 3 cases bad scattered endocrine ceils (1-10%). Paneth cells were detected in 6 cases. Immunohistochemically, many or some serotonin-positive cells were observed in all 13 cases A tew somatostatinpositive cells were detected in 3 cases, but the other pancreaticognt hormones were negative. Histologies of ampullary carcinomas with endocrine cells were 12 papillary adenocareinoma and 1 tubular adenocarcinoma (92% vs 50% of ampullary carcinomas without endocrine ceils, p<0.01), p53 overexpression was tbund in 31% of ampullary carcinomas with endocrine cells, which was significantly" less frequent than 63% of those without endocrine cells (p<0.05). K-ras mutation rates for ampullary carcinomas with endocrine cells was 8%, which was significantly" lower than 17~ Dr those without endocrine ceils. There were no signifcant ditterences between ampullary carcinoma with and without endocrine cells in size, ulce>formation, pancreatic invasion, lymph node metastasis, prognosis, and rates of CA19-9- or CEA-immunoreactivity. Conclusions: Endocrine cells were detected in 25% of ampullary carcinoma, and most of the endocrine cells were immunoreactive tot serotonin. p53 overexpression and K-ras mutation were detected less frequently in those cases.
T1764
Combination Therapy of Percutaneous Radiofrequency Ablation after Transcatheter Arterial Chemoembolization for Patients with Hepatocellular Carcinoma Provides Larger Coagulation Areas Nobuyqaki Toshikuni, Sbmichiro Nakamura, Yoshiyuki Kobayashi, Hironori Tanaka, Eiji Matsumoto, Kazuhiro Nouso, Kousaku Sakagnchi, Yasushi Shiratori
T1767
PURPOSE: Although pereutaneous radiofrequeucy ablation (PRFA) tins been widely pertormed tor the treatment of hepatocellular carcinoma (HCC), cooling effect of blood tlow within tumor nodules and of the surrounding tissue is a factor limiting PRFA-induced coagulation areas. We conducted this stud?," on the assumption that transeatheter arterial chemoembolization (TACE) could prevent this heat dissipation @e to blood flow at the time of PRFA and assist in enlarging the PRFA-mduced coagulatiun areas of tumors, and evaluated the efficacy oI the combination of PRFA and TACE METHODS: Thirty-seven patients 'aath 43 HCC nodules stnaller than 3.0 cm in diameter underwent PRFA combined with EACE (23 patients with 26 nodules) or PRFA alone (14 patients with 17 nodules). All PRFA treatments were performed using a cooled-tip RF probe sTstem (3
Evaluation of Hepatic Arterial Infusion Chemotherapy for Advanced Gallbladder Cancer Koji Uno, Masatsugu Nakajima, Kenjiru Yasuda, Moose Ueda [Purposel Despite of the recent development ot chemotherapy, prognosis of unresectable gallbladder cancer is poor, The purpose of this study is to evaluate hepatic arterial intnsion chemotherapy- tor unresectable advanced gallbladder cancer, [Patients and Methods] From 1990 to 2001, we studied 39 patients with unresectable stage IlI or IV (TNM classificatior~) carcinoma of the gallbladder (14 men and 25 women; age range 41~89 years; mean age 72.1 years) Among them, 23 tumors were stage II1, and 16 were stage IV with hver metastasis. Nineteen patients were treated with repeated hepatic arterial inthsion chemotherapy. Twenty patients as controls were treated without chemotherapy or radiotherapy. The regimen of chemotherapy was fluomumci1330 mg/m2/week, epimbicin 30 mg/m2/4 weeks and mitomycin C 2.7 rag/m2/2 weeks (FEM). Three of these patients were treated with combination of hepatic arterial intusion chemotherapy" and radiotherapy The way of evaluation was response rate, rate of grade IV toxicity, and median survival period calculated by the Kaplan-Meier method. We defined patients with complete response or partial response as responders Median survival period of patients with hepatic arterial infusion chemotherapy was compared with that of 20 historical controls by the log-rank test. We pertbrmed univariate analysis with the log-rank test and multivariate analysis with the Cox proportional hazards model to assess tactoi~ in relation to survival. [Results] Response rate of hepatic arterial infusion chemotherapy was 21%. No grade 4 toxicity was observed. Median survival period of patients with hepatic arterial infusion chemotherapy was 252 days, and that of controls was 151 days (p = 0.064). Multivariate analysis demonstrated that only stage was identified as a factor independently associated with survival. [Conclusionsl 1.Response rate of hepatic arterial infusion chemotherapy with FEM was not satisfactory, 2.Median survival of patients treated with hepatic arterial infusion chemotherapy was longer than those of controls, but there was no significant difference between them.
T1765
Does Aflatoxin interact with Hepatitis C virus in the Etio-Pathogenesis of Hepatocellular Carcinoma among Egyptians? Dina A Shokry, Abla Abdel Maguid, Ahnmd A El Ray, Alaa Taha, Moataz Hassanein Background/airn: Two major classes of risk tacturs for Hepatocellular Carcinoma (HCC) have been identified viral infection and chemical carcinogens Previous studies have demonstrated the synergetic interaction between chronic hepatitis B virus infection and afiatoxins exposure in the patbogenesis of HCC Tfe current study was designed to evaluate the cancer potency of atlatoxins, and whether this environmental carcinogens interacts with Hepatitis C v~rns (HCV) intecuon in the ettopathogenesis of HCC ira Egypt. Methods: A total of 140 patients w~th HCC attending to Theodore Bilharz Research instrmte hospital during the years 1998 - 2001 and 70 matched comrol patients with non-hepatic disease were included in the study. The sere of all cases as well as the controls were tested for afiatoxins (AFBI and AFG1) both qualitatively and quantitatively. In addition, the liver tissues of all cases were tested for both allatoxm subtypes HCV antibodies (HCV ab) -ELISA 3- was also determined for all participants. Resuhs: The detection rates for AFB1 in cases and control subjects were 64.2% and 40% respectively. On the other hand, HCV Ab was detected in 5929% of HCC patients compared to 18.57% in controls. The percentage estimation of abnormal AFB1 and AFG1 levels among HCV sempositive patients were 84.5% and 13.25% respectively. Moreover, muhivariante logistic regression revealed that OR for HCC in seropositive HCV individuals was 6 (95 CI = 1.29 - 29). The ratio increased when AFB1 entered into the model (OR = 13.22 95% CI = 3.6 -51.1). In HC*~seropositive subjects OR were 2.0 (95% CI = 1 26 -3.17) for detectable compared to non-detectable AFB1 and 4.2 (C1 = 167 - 10.7) for abnormal AFB1 compared with normal AFB1 levels. Conclusion: Collectively, current evidence str(mgly suggests that HCC is muhifactorial origin, with probable interaction ~tween HCV intection and aflatoxins predominantly AFB1 m Egyptian who concurrently exposed to both classes of risk factors
T1768
H}~ercoagulable States in Patients with Hepatocellular Carcinoma Demetrios Samonakis, Ioannis E, Koutroubakis, Aekaterini Sfiridaki, Niki Maharaki, Aekaterini Livadiotaki, Pavlos Antuinou, Elias A. Kouroumalis Background: Hepatocellular carcinoma (HCC) patients have an increased risk for venous thromboembolism, mainly portal venous thrombosis (PVT), Hypercoagnlable states have been suggested to play an important role in the pathogenesis of thromboembolism and PVT. Aim of this study was to assess the role of acquired and hereditary thrombotic risk factors in patients with HCC. Subjects and Methods: 29 patients with HCC (5 with thromboembofic manifestations), 28 patients with cirrhosis but without HCC or P~q" and 48 matched healthy controls were studied, Protein C, protein 5, antithrombin, homocysteine, lipoprotein (a), activated protein C resistance (APCR), factor V Leiden (FVL) and prothrombin (PT) gene nmtation G20210GA were evaluated in all patients and controls with commercially available kits. Results: Mean levels of plasma protein C, protein S, antithrombm and serum iipoprotein (a) were significantly lower" in patients with HCC and in the cirrhotic group compared to healthy controls (P<0.05) Mean serum homocysteine levels were siginficantly higher in patients with HCC compared to cirrhotic patients and heahhy controls (P=0,03) The prevalence of APCR, FVL and PT G20210GA was not significamly different between the three groups, However, the rare PT gene mutation G20210GA was found in three cases with HCC. Among the 5 cases with thromboembolic manifestations in 3 patients (60 %) at least one thrombotic risk factor was found Conclusions : Thrombophilie defects are common in patients with HCC and they could interfere in the observed thrombotic complications. Questions raised by these findings should address the possible benefts from au extensive thrombophilic screening fn' the HCC patients,
T1766
Endocrine Component In Ampullary Carcinoma In Relation To Clinicopathological Factors Terumi Kamisawa, Yukiko Hayasbi, Nobnaki Funata, Shmichirou Horiguchi, Toshikazu Yamaguchi Background/Aim: We reported that panctvatic invasion, lymph node metastasis, histology of the tunmr, and immunohistochemical reactivity tbr C2A19-9 or CEA were significantly correlated with poor prognosis in ampullary carcinoma (Am J Gastroentero183:1118). The
A-563
AGA
Abstracts
histopathological or molecular biological examinations of ampullary carcinoma has been reported, but endocrine component in ampullary carcinoma has not been noted. We examined endocrine component in ampullary carcinoma immunohistuchemically, and studied the clinieopathological differences between endocrine component-positive cases and negative cases. Methods: Filly-one cases of ampullary carcinoma were studied clinically and bistopathotogically. Fommlin-fixed, paraffin-embedded serial sections were stained immunohistochemically tot chromogranin-A, insulin, sonmtostatin, pancreatic polypeptide, ~mtonin, gastrin, CA19-9, CEA, p 5 3 K-ras codon 12 mutation was analyzed by ennched PCR-EL?vta_ (enzyme-linked minisequence assay) in genomic DNA extracted from paraffin-embedded sections. Results: Endocrine ceils positive for cbromogranin A were detected in 13 cases; 10 cases had many endocrine ceils (10-30% in a high-power field) and 3 cases bad scattered endocrine ceils (1-10%). Paneth cells were detected in 6 cases. Immunohistochemically, many or some serotonin-positive cells were observed in all 13 cases A tew somatostatinpositive cells were detected in 3 cases, but the other pancreaticognt hormones were negative. Histologies of ampullary carcinomas with endocrine cells were 12 papillary adenocareinoma and 1 tubular adenocarcinoma (92% vs 50% of ampullary carcinomas without endocrine ceils, p<0.01), p53 overexpression was tbund in 31% of ampullary carcinomas with endocrine cells, which was significantly" less frequent than 63% of those without endocrine cells (p<0.05). K-ras mutation rates for ampullary carcinomas with endocrine cells was 8%, which was significantly" lower than 17~ Dr those without endocrine ceils. There were no signifcant ditterences between ampullary carcinoma with and without endocrine cells in size, ulce>formation, pancreatic invasion, lymph node metastasis, prognosis, and rates of CA19-9- or CEA-immunoreactivity. Conclusions: Endocrine cells were detected in 25% of ampullary carcinoma, and most of the endocrine cells were immunoreactive tot serotonin. p53 overexpression and K-ras mutation were detected less frequently in those cases.
T1764
Combination Therapy of Percutaneous Radiofrequency Ablation after Transcatheter Arterial Chemoembolization for Patients with Hepatocellular Carcinoma Provides Larger Coagulation Areas Nobuyqaki Toshikuni, Sbmichiro Nakamura, Yoshiyuki Kobayashi, Hironori Tanaka, Eiji Matsumoto, Kazuhiro Nouso, Kousaku Sakagnchi, Yasushi Shiratori
T1767
PURPOSE: Although pereutaneous radiofrequeucy ablation (PRFA) tins been widely pertormed tor the treatment of hepatocellular carcinoma (HCC), cooling effect of blood tlow within tumor nodules and of the surrounding tissue is a factor limiting PRFA-induced coagulation areas. We conducted this stud?," on the assumption that transeatheter arterial chemoembolization (TACE) could prevent this heat dissipation @e to blood flow at the time of PRFA and assist in enlarging the PRFA-mduced coagulatiun areas of tumors, and evaluated the efficacy oI the combination of PRFA and TACE METHODS: Thirty-seven patients 'aath 43 HCC nodules stnaller than 3.0 cm in diameter underwent PRFA combined with EACE (23 patients with 26 nodules) or PRFA alone (14 patients with 17 nodules). All PRFA treatments were performed using a cooled-tip RF probe sTstem (3
Evaluation of Hepatic Arterial Infusion Chemotherapy for Advanced Gallbladder Cancer Koji Uno, Masatsugu Nakajima, Kenjiru Yasuda, Moose Ueda [Purposel Despite of the recent development ot chemotherapy, prognosis of unresectable gallbladder cancer is poor, The purpose of this study is to evaluate hepatic arterial intnsion chemotherapy- tor unresectable advanced gallbladder cancer, [Patients and Methods] From 1990 to 2001, we studied 39 patients with unresectable stage IlI or IV (TNM classificatior~) carcinoma of the gallbladder (14 men and 25 women; age range 41~89 years; mean age 72.1 years) Among them, 23 tumors were stage II1, and 16 were stage IV with hver metastasis. Nineteen patients were treated with repeated hepatic arterial inthsion chemotherapy. Twenty patients as controls were treated without chemotherapy or radiotherapy. The regimen of chemotherapy was fluomumci1330 mg/m2/week, epimbicin 30 mg/m2/4 weeks and mitomycin C 2.7 rag/m2/2 weeks (FEM). Three of these patients were treated with combination of hepatic arterial intusion chemotherapy" and radiotherapy The way of evaluation was response rate, rate of grade IV toxicity, and median survival period calculated by the Kaplan-Meier method. We defined patients with complete response or partial response as responders Median survival period of patients with hepatic arterial infusion chemotherapy was compared with that of 20 historical controls by the log-rank test. We pertbrmed univariate analysis with the log-rank test and multivariate analysis with the Cox proportional hazards model to assess tactoi~ in relation to survival. [Results] Response rate of hepatic arterial infusion chemotherapy was 21%. No grade 4 toxicity was observed. Median survival period of patients with hepatic arterial infusion chemotherapy was 252 days, and that of controls was 151 days (p = 0.064). Multivariate analysis demonstrated that only stage was identified as a factor independently associated with survival. [Conclusionsl 1.Response rate of hepatic arterial infusion chemotherapy with FEM was not satisfactory, 2.Median survival of patients treated with hepatic arterial infusion chemotherapy was longer than those of controls, but there was no significant difference between them.
T1765
Does Aflatoxin interact with Hepatitis C virus in the Etio-Pathogenesis of Hepatocellular Carcinoma among Egyptians? Dina A Shokry, Abla Abdel Maguid, Ahnmd A El Ray, Alaa Taha, Moataz Hassanein Background/airn: Two major classes of risk tacturs for Hepatocellular Carcinoma (HCC) have been identified viral infection and chemical carcinogens Previous studies have demonstrated the synergetic interaction between chronic hepatitis B virus infection and afiatoxins exposure in the patbogenesis of HCC Tfe current study was designed to evaluate the cancer potency of atlatoxins, and whether this environmental carcinogens interacts with Hepatitis C v~rns (HCV) intecuon in the ettopathogenesis of HCC ira Egypt. Methods: A total of 140 patients w~th HCC attending to Theodore Bilharz Research instrmte hospital during the years 1998 - 2001 and 70 matched comrol patients with non-hepatic disease were included in the study. The sere of all cases as well as the controls were tested for afiatoxins (AFBI and AFG1) both qualitatively and quantitatively. In addition, the liver tissues of all cases were tested for both allatoxm subtypes HCV antibodies (HCV ab) -ELISA 3- was also determined for all participants. Resuhs: The detection rates for AFB1 in cases and control subjects were 64.2% and 40% respectively. On the other hand, HCV Ab was detected in 5929% of HCC patients compared to 18.57% in controls. The percentage estimation of abnormal AFB1 and AFG1 levels among HCV sempositive patients were 84.5% and 13.25% respectively. Moreover, muhivariante logistic regression revealed that OR for HCC in seropositive HCV individuals was 6 (95 CI = 1.29 - 29). The ratio increased when AFB1 entered into the model (OR = 13.22 95% CI = 3.6 -51.1). In HC*~seropositive subjects OR were 2.0 (95% CI = 1 26 -3.17) for detectable compared to non-detectable AFB1 and 4.2 (C1 = 167 - 10.7) for abnormal AFB1 compared with normal AFB1 levels. Conclusion: Collectively, current evidence str(mgly suggests that HCC is muhifactorial origin, with probable interaction ~tween HCV intection and aflatoxins predominantly AFB1 m Egyptian who concurrently exposed to both classes of risk factors
T1768
H}~ercoagulable States in Patients with Hepatocellular Carcinoma Demetrios Samonakis, Ioannis E, Koutroubakis, Aekaterini Sfiridaki, Niki Maharaki, Aekaterini Livadiotaki, Pavlos Antuinou, Elias A. Kouroumalis Background: Hepatocellular carcinoma (HCC) patients have an increased risk for venous thromboembolism, mainly portal venous thrombosis (PVT), Hypercoagnlable states have been suggested to play an important role in the pathogenesis of thromboembolism and PVT. Aim of this study was to assess the role of acquired and hereditary thrombotic risk factors in patients with HCC. Subjects and Methods: 29 patients with HCC (5 with thromboembofic manifestations), 28 patients with cirrhosis but without HCC or P~q" and 48 matched healthy controls were studied, Protein C, protein 5, antithrombin, homocysteine, lipoprotein (a), activated protein C resistance (APCR), factor V Leiden (FVL) and prothrombin (PT) gene nmtation G20210GA were evaluated in all patients and controls with commercially available kits. Results: Mean levels of plasma protein C, protein S, antithrombm and serum iipoprotein (a) were significantly lower" in patients with HCC and in the cirrhotic group compared to healthy controls (P<0.05) Mean serum homocysteine levels were siginficantly higher in patients with HCC compared to cirrhotic patients and heahhy controls (P=0,03) The prevalence of APCR, FVL and PT G20210GA was not significamly different between the three groups, However, the rare PT gene mutation G20210GA was found in three cases with HCC. Among the 5 cases with thromboembolic manifestations in 3 patients (60 %) at least one thrombotic risk factor was found Conclusions : Thrombophilie defects are common in patients with HCC and they could interfere in the observed thrombotic complications. Questions raised by these findings should address the possible benefts from au extensive thrombophilic screening fn' the HCC patients,
T1766
Endocrine Component In Ampullary Carcinoma In Relation To Clinicopathological Factors Terumi Kamisawa, Yukiko Hayasbi, Nobnaki Funata, Shmichirou Horiguchi, Toshikazu Yamaguchi Background/Aim: We reported that panctvatic invasion, lymph node metastasis, histology of the tunmr, and immunohistochemical reactivity tbr C2A19-9 or CEA were significantly correlated with poor prognosis in ampullary carcinoma (Am J Gastroentero183:1118). The
A-563
AGA
Abstracts