Japanese Journal of Cancer and Chemotherapy最新文献

Previous studies have shown that intracorporeal anastomosis(IA)improves postoperative recovery. However, its short-term outcomes remain controversial in elderly patients. This study aimed to compare the short-term outcomes of IA versus extracorporeal anastomosis(EA)for minimally invasive right colectomy in elderly patients aged 80 years or older using a propensity score matching(PSM)analysis based on double centric cohort of patients with right colon cancer between April, 2020, and December, 2024. Initially, 97 patients were selected, including 49 IA patients. After PSM, 64 patients were compared. There was no statistically significant difference between IA and EA in terms of operative time and postoperative morbidity (6.2% in IA vs 12.5% in EA;p=0.67). The IA group had a longer resected distal margin length(130 vs 100 mm, p=0.04) and shorter length of stay(7.5 vs 10 days, p=0.02). This comparison shows several clinical outcomes advantages for the IA in minimally invasive right colectomy in elderly patients.

Background: BRCA pathogenic sequence variants(PSVs)are believed to enhance local immune responses through the generation of tumor neoantigens, leading to increased tumor-infiltrating lymphocytes(TILs).

Methods: In this study, we evaluated the relationship between BRCA-PSVs and both systemic and local tumor immune responses in 93 breast cancer patients who underwent BRCA genetic testing.

Results: Among them, 16 patients(17.2%)were found to harbor BRCA- PSVs. Although no significant correlations were observed between BRCA-PSVs and absolute lymphocyte count(ALC), TILs, or CD8+ T-cell infiltration, a significant association was noted with the neutrophil-to-lymphocyte ratio(NLR)(p=0.006). Prognostic analysis showed that patients with low-TILs or high-CD8+ T-cell infiltration had significantly better overall survival( p=0.026 and p=0.020, respectively).

Conclusions: These results suggest that local immune markers, particularly CD8+ T-cells, may serve as important prognostic factors in breast cancers harboring BRCA-PSVs. Further immunophenotypic and spatial profiling is warranted.

The JSCCR Guidelines 2024 for the Treatment of Colorectal Cancer weakly recommend stent treatment as a bridge to surgery(BTS)for obstructive colorectal cancer in the context of curative surgical resection. We retrospectively examined the backgrounds and treatment outcomes of 10 patients with obstructive colorectal cancer who underwent stent placement for BTS at our hospital between April 2020 and October 2024. The study included 4 males and 6 females, with a median age of 82 years. The lesions were located in the ascending/transverse/descending/sigmoid colon in 2/3/3/2 cases, respectively. CROSS was 0/1/2/3/4 in 2/2/5/1/0 cases. After stent placement, all cases improved to CROSS 3 or higher, and no complications due to stent placement were observed. The median interval time between stent placement and surgery was 32 days. Two patients underwent open surgery, and 8 patients underwent laparoscopic surgery(3 of which were converted to open surgery). No serious postoperative complications were observed. No progression of disease was observed during the BTS period. These results suggest that stent treatment for the purpose of BTS in obstructive colorectal cancer is useful and can be performed safely.

We report the case of an 80-year-old man who presented with acute abdominal pain and was emergently hospitalized. Contrast-enhanced computed tomography revealed a tumor in the ascending colon with free intraperitoneal air and ascites, without evidence of distant metastasis. A diagnosis of acute generalized peritonitis due to perforation of an ascending colon tumor was made, and the patient underwent emergency surgery consisting of primary closure of the perforation and creation of a diverting ileostomy. Postoperative colonoscopy identified a tumor in the ascending colon. Histopathological examination of biopsy specimens confirmed adenocarcinoma with HER2 positivity, RAS mutation, and microsatellite instability- high(MSI-high). The clinical stage was cT4bN1bM0(duodenum), Stage Ⅲc. Pembrolizumab therapy was initiated 1 month after surgery. Progressive tumor regression was observed during treatment, and after 14 courses, colonoscopy demonstrated marked tumor shrinkage with persistent severe luminal stenosis. After 17 courses in total, laparoscopic right hemicolectomy and ileostomy closure were performed. Histopathological examination of the resected specimen showed no residual carcinoma. The histological response was classified as Grade 3 corresponding to a pathological complete response(pCR). No adjuvant chemotherapy was administered. At 5 months after the operation, the patient is alive without any recurrence. This case suggests the potential efficacy of pembrolizumab for MSI-high locally advanced colorectal cancer.

The patient is a 73-year-old woman of Jehovah's witness. A CT scan performed to investigate her anemia and abdominal distention revealed a large retroperitoneal tumor. While she had a profound anemia at the first visit, the tumor of liposarcoma was successfully removed by adopting multidisciplinary treatment, encompassing intense anemia management, embolization of tumor-feeding artery, intraoperative blood conservation and postoperative management. Thus, we report a case of transfusion-free treatment, for removing a large liposarcoma with marked anemia, based on PBM concept.

Malignant melanoma is a rare and highly aggressive neoplasm originating from melanocytes, typically occurring on the skin and exhibiting early lymphatic and hematogenous metastases. Despite advancements in chemotherapy, immunotherapy, and radiotherapy, a definitive standard treatment has yet to be established;surgical excision remains the most effective modality. We present a case of primary malignant melanoma of the left palate. A 64-year-old man was referred to our department with a chief complaint of a black pigmented lesion on the palate. Clinical examination revealed a 20×25 mm exophytic black mass with an irregular margin and induration, extending from the left hard palate to the maxillary gingiva. Based on clinical findings, imaging, and excisional biopsy, the lesion was diagnosed as primary malignant melanoma of the left palate(cT3aN1M0, Stage Ⅲ), and curative surgical resection was performed. The postoperative pathological diagnosis was pT3aN0M0, Stage ⅡA. Immunotherapy with a checkpoint inhibitor was initiated 2 months after surgery. The patient has remained free of recurrence or metastasis for 1 year postoperatively and has demonstrated favorable oral function and clinical outcome.

We reviewed surgical outcomes of gastric cancer patients aged 90 or older at our institution. The median age was 91; there were 3 men and 7 women. Performance status was 1 in 4 cases and 2 in 6. All patients had comorbidities, and the median PNI was 37.5. Surgical procedures included distal gastrectomy(6), proximal gastrectomy(1), and total gastrectomy (3). Nine underwent open surgery, and 1 had laparoscopic surgery. Lymph node dissection was D1(4), D1+(4), and D2 (2). Tumor stages were Ⅰ(3), Ⅱ(4), Ⅲ(1), and Ⅳ(2). Median operation time and blood loss were 165 minutes and 155 mL, respectively. Complications of Clavien-Dindo grade Ⅱ or higher occurred in 60% within 30 days but were conservatively managed. All resumed oral intake. In-hospital mortality was 20%. Median postoperative survival was 175 days. One patient died of gastric cancer, 8 of other causes(eg, pneumonia, heart failure), and 1 was unknown. With careful patient selection, gastrectomy appears relatively safe even in patients aged 90 and above, though attention to complications is essential.

A 63-year-old man was diagnosed with ulcerative colitis of the proctitis type 12 years ago. Three years ago, his symptoms worsened and he was diagnosed with pancolitis type. Recently, a colonoscopy revealed a stenotic lesion with a submucosal tumor-like protrusion in the rectum. Biopsy of the same area did not reveal any neoplastic lesion. However, because 18F-fluorodeoxyglucose accumulation was observed in the stenotic lesion and the value of carcinoembryonic antigen increased over time, the patient was diagnosed with rectal cancer(cT3N0M0)associated with ulcerative colitis. Robot-assisted low anterior resection was performed. Postoperative histopathological examination revealed a submucosal tumor-like invasive carcinoma in the stenotic lesion with intramucosal lesion corresponding to UC-Ⅲ. Currently, 2 years after surgery, the patient shows no evidence of disease recurrence.

The patient was a 54-year-old woman diagnosed with right breast cancer at the age of 49 with cT4bN1M0, cStage ⅢB, and underwent radical surgery after preoperative chemotherapy. The histopathologic diagnosis was invasive ductal carcinoma, histological treatment effect Grade 1a, HR positive HER2 negative, chest wall irradiation and hormone therapy as postoperative treatment. At 5 years after surgery, there were no signs of recurrence on the imaging, but at a routine checkup 4 months later, left back pain and hip joint pain were observed, and bone metastases were diagnosed by MRI. PET- CT revealed multiple liver, lung, bone and lymph node metastases, and the course of recurrence was rapid in a short period of time. To re-evaluate the subtype, a liver biopsy was performed in combination with TAE to prevent bleeding for liver tumors with abundant blood flow. As a result, PgR turned negative, but there was no change in subtype. After irradiation to the pain area, paclitaxel and bevacizumab therapy was administered, and a marked reduction of pulmonary and liver metastases, and the disappearance of pain were observed. Local hepatic therapy with TAE followed by chemotherapy was thought to have helped the patient overcome the rapid tumor growth.

The patient was a woman in her 60s with a history of congenital patent ductus arteriosus complicated by severe pulmonary hypertension and Eisenmenger syndrome. She had previously undergone surgery for right-sided breast cancer 11 years earlier. Nine years after surgery, she was diagnosed with bilateral breast cancer. At that time, mediastinal lymph node metastasis was suspected, and the disease was considered unresectable, leading to the initiation of pharmacological therapy. Although treatment was started, tumor progression was observed, prompting a shift toward surgery. Due to the presence of severe pulmonary hypertension, general anesthesia was deemed extremely high risk. Therefore, a surgical plan was made to perform bilateral mastectomy under local anesthesia with the aid of nerve blocks. Pectoral nerve blocks(Pecs blocks)combined with local anesthesia were used, resulting in effective pain control. No intraoperative or postoperative complications occurred. This case suggests that surgery using nerve blocks and local anesthesia may be a valuable option for patients with severe underlying and comorbid conditions in whom general anesthesia poses significant risk.