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Pancreatic Neoplasms: HELP
Articles by Kenji Yamao
Based on 49 articles published since 2010
(Why 49 articles?)
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Between 2010 and 2020, Kenji Yamao wrote the following 49 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. 2012

Tanaka, Masao / Fernández-del Castillo, Carlos / Adsay, Volkan / Chari, Suresh / Falconi, Massimo / Jang, Jin-Young / Kimura, Wataru / Levy, Philippe / Pitman, Martha Bishop / Schmidt, C Max / Shimizu, Michio / Wolfgang, Christopher L / Yamaguchi, Koji / Yamao, Kenji / Anonymous6680728. ·Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. masaotan@med.kyushu-u.ac.jp ·Pancreatology · Pubmed #22687371.

ABSTRACT: The international consensus guidelines for management of intraductal papillary mucinous neoplasm and mucinous cystic neoplasm of the pancreas established in 2006 have increased awareness and improved the management of these entities. During the subsequent 5 years, a considerable amount of information has been added to the literature. Based on a consensus symposium held during the 14th meeting of the International Association of Pancreatology in Fukuoka, Japan, in 2010, the working group has generated new guidelines. Since the levels of evidence for all items addressed in these guidelines are low, being 4 or 5, we still have to designate them "consensus", rather than "evidence-based", guidelines. To simplify the entire guidelines, we have adopted a statement format that differs from the 2006 guidelines, although the headings are similar to the previous guidelines, i.e., classification, investigation, indications for and methods of resection and other treatments, histological aspects, and methods of follow-up. The present guidelines include recent information and recommendations based on our current understanding, and highlight issues that remain controversial and areas where further research is required.

2 Review Current concept of endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer. 2011

Mizuno, Nobumasa / Hara, Kazuo / Hijioka, Susumu / Bhatia, Vikram / Shimizu, Yasuhiro / Yatabe, Yasushi / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. nobumasa @ aichi-cc.jp ·Pancreatology · Pubmed #21464586.

ABSTRACT: Endoscopic ultrasound (EUS) provides detailed, high-resolution images of the pancreas. However, whether a lesion is malignant or benign cannot be diagnosed solely from its imaging features on EUS. The introduction of EUS-guided fine needle aspiration (EUS-FNA) offers the possibility to obtain a cytological or histological diagnosis of pancreatic lesions with a high sensitivity and specificity. Although the clinical utility of EUS-FNA for pancreatic diseases is widely accepted, the indication for preoperative tissue diagnosis of pancreatic lesions suspected to be malignant is still controversial. This review highlights the diagnostic potential of EUS-FNA, as well as its current indications and contraindications, complications, and techniques.

3 Clinical Trial Phase II clinical trial using novel peptide cocktail vaccine as a postoperative adjuvant treatment for surgically resected pancreatic cancer patients. 2017

Miyazawa, Motoki / Katsuda, Masahiro / Maguchi, Hiroyuki / Katanuma, Akio / Ishii, Hiroshi / Ozaka, Masato / Yamao, Kenji / Imaoka, Hiroshi / Kawai, Manabu / Hirono, Seiko / Okada, Ken-Ichi / Yamaue, Hiroki. ·Second Department of Surgery, Wakayama Medical University School of Medicine, Japan. · Center for Gastroenterology, Teine-Keijinkai Hospital, Japan. · Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan. · Department of Gastroenterology, Aichi Cancer Center Hospital, Japan. ·Int J Cancer · Pubmed #27861852.

ABSTRACT: We investigated peptide cocktail vaccine OCV-C01 containing epitope peptides derived from KIF20A, vascular endothelial growth factor receptor (VEGFR)1 and VEGFR2 combined with gemcitabine in the adjuvant treatment for resected pancreatic cancer patients. A single-arm multicenter phase II study was performed on 30 patients with pancreatic ductal carcinoma who underwent pancreatectomy. At each 28-day treatment cycle, patients received weekly subcutaneous injection of OCV-C01 for 48 weeks and gemcitabine was administered intravenously at 1,000 mg/m

4 Clinical Trial Clinical outcome of elderly patients with unresectable pancreatic cancer treated with gemcitabine plus S-1, S-1 alone, or gemcitabine alone: Subgroup analysis of a randomised phase III trial, GEST study. 2016

Imaoka, Hiroshi / Kou, Tadayuki / Tanaka, Masao / Egawa, Shinichi / Mizuno, Nobumasa / Hijioka, Susumu / Hara, Kazuo / Yazumi, Shujiro / Shimizu, Yasuhiro / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. Electronic address: hiroshi.imaoka.md@me.com. · Digestive Disease Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. · Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. ·Eur J Cancer · Pubmed #26741729.

ABSTRACT: BACKGROUND: In the GEST study of unresectable pancreatic cancer, S-1 demonstrated non-inferiority compared to gemcitabine, but gemcitabine plus S-1 (GS) did not show superiority over gemcitabine for overall survival (OS). We performed subgroup analysis of these data focused on the efficacy and safety of these regimens as a first-line treatment for elderly patients. METHODS: Elderly patients (≥ 70 years, n = 261) treated for unresectable pancreatic cancer (GS: n = 90, S-1: n = 85 and gemcitabine: n = 86) were analysed. RESULTS: No significant differences between the GS, S-1, or gemcitabine groups in OS (median: 10.2, 8.0 and 8.5 months, respectively) or objective response rates (27.6%, 25.3% and 14.3%, respectively) were noted. Grade ≥ III adverse haematological events were observed more frequently in GS-treated than in S-1- or gemcitabine-treated elderly patients (p < 0.001 and p = 0.016, respectively). Four of 8 patients aged ≥ 80 years experienced serious adverse events. CONCLUSIONS: S-1 and gemcitabine are both efficacious options for treatment of elderly patients with unresectable pancreatic cancer. Conversely, first-line treatment of elderly patients with GS should only be used after careful consideration.

5 Clinical Trial Randomized phase II/III clinical trial of elpamotide for patients with advanced pancreatic cancer: PEGASUS-PC Study. 2015

Yamaue, Hiroki / Tsunoda, Takuya / Tani, Masaji / Miyazawa, Motoki / Yamao, Kenji / Mizuno, Nobumasa / Okusaka, Takuji / Ueno, Hideki / Boku, Narikazu / Fukutomi, Akira / Ishii, Hiroshi / Ohkawa, Shinichi / Furukawa, Masayuki / Maguchi, Hiroyuki / Ikeda, Masafumi / Togashi, Yosuke / Nishio, Kazuto / Ohashi, Yasuo. ·Second Department of Surgery Wakayama Medical University, Wakayama, Japan. · Department of Gastroenterology Aichi Cancer Center Hospital, Aichi, Japan. · Hepatobiliary and Pancreatic Oncology Division National Cancer Center Hospital, Tokyo, Japan. · Department of Gastroenterology Shizuoka Cancer Center, Shizuoka, Japan. · Hepatobiliary and Pancreatic Division Cancer Institute Hospital, Tokyo, Japan. · Hepatobiliary and Pancreatic Medical Oncology Division Kanagawa Cancer Center Hospital, Kanagawa, Japan. · Department of Gastroenterology National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan. · Center for Gastroenterology Teine-Keijinkai Hospital, Hokkaido, Japan. · Division of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital East, Chiba, Japan. · Dept Genome Biology Kinki University School of Medicine, Osaka, Japan. · Department of Integrated Science and Engineering for Sustainable society Chuo University, Tokyo, Japan. ·Cancer Sci · Pubmed #25867139.

ABSTRACT: Gemcitabine is a key drug for the treatment of pancreatic cancer; however, with its limitation in clinical benefits, the development of another potent therapeutic is necessary. Vascular endothelial growth factor receptor 2 is an essential target for tumor angiogenesis, and we have conducted a phase I clinical trial using gemcitabine and vascular endothelial growth factor receptor 2 peptide (elpamotide). Based on the promising results of this phase I trial, a multicenter, randomized, placebo-controlled, double-blind phase II/III clinical trial has been carried out for pancreatic cancer. The eligibility criteria included locally advanced or metastatic pancreatic cancer. Patients were assigned to either the Active group (elpamotide + gemcitabine) or Placebo group (placebo + gemcitabine) in a 2:1 ratio by the dynamic allocation method. The primary endpoint was overall survival. The Harrington-Fleming test was applied to the statistical analysis in this study to evaluate the time-lagged effect of immunotherapy appropriately. A total of 153 patients (Active group, n = 100; Placebo group, n = 53) were included in the analysis. No statistically significant differences were found between the two groups in the prolongation of overall survival (Harrington-Fleming P-value, 0.918; log-rank P-value, 0.897; hazard ratio, 0.87, 95% confidence interval [CI], 0.486-1.557). Median survival time was 8.36 months (95% CI, 7.46-10.18) for the Active group and 8.54 months (95% CI, 7.33-10.84) for the Placebo group. The toxicity observed in both groups was manageable. Combination therapy of elpamotide with gemcitabine was well tolerated. Despite the lack of benefit in overall survival, subgroup analysis suggested that the patients who experienced severe injection site reaction, such as ulceration and erosion, might have better survival.

6 Clinical Trial Phase I/II clinical trial using HLA-A24-restricted peptide vaccine derived from KIF20A for patients with advanced pancreatic cancer. 2013

Asahara, Shingo / Takeda, Kazuyoshi / Yamao, Kenji / Maguchi, Hiroyuki / Yamaue, Hiroki. ·Department of Internal Medicine, Chiba Tokushukai Hospital, Chiba, Japan. s.asahara@chibatoku.or.jp. ·J Transl Med · Pubmed #24237633.

ABSTRACT: BACKGROUND: We previously developed an immunotherapy treatment utilizing a cancer vaccine reagent KIF20A-66 in order to treat pancreatic cancer. KIF20A-66 is HLA-A24-restricted epitope peptide derived from KIF20A, a member of kinesin super family protein 20A that is significantly transactivated in pancreatic cancer. In this report, we further demonstrated non-randomized, open-label, single centered phase I/II clinical trial of immunotherapy using the KIF20A-66 peptide for the patients with advanced pancreatic cancer. METHODS: Vaccination was performed to the patients with metastatic pancreatic cancer, in whom gemcitabine-based therapy had failed. In phase I study, KIF20A-66 peptide was subcutaneously injected weekly in a dose-escalation manner (doses of 1.0 and 3.0 mg/body, 6 patients/1 cohort). After safety was assessed, phase II study was conducted using 3.0 mg of KIF20A-66 peptide. RESULTS: KIF20A-66 peptide vaccination was well tolerated in the doses we examined and tumor responses after 1 month of the treatment were evaluated. Among 29 patients who completed one course of the treatment at least, stable disease (SD) was found in 21 cases, while progressive disease (PD) was found in 8 cases, indicating that the disease control rate was 72%. Objective tumor shrinkage was observed in 8 cases, including 1 case of complete response (CR). The median survival time (MST) and progression free survival time (PFS) were 142 days and 56 days, respectively. These results clearly demonstrate that overall survival of the patients was significantly prolonged, compared to the historical controls of 9 cases with unmatched HLA in the same hospital (MST: 83 days), as well as 81 cases in our and other hospitals (MST: 63 days). CONCLUSION: The patients vaccinated with KIF20A-66 peptide had better prognosis than the control group with best supportive care (BSC). Thus, we concluded that KIF20A-66 vaccination is significantly effective as an immunotherapy against advanced pancreatic cancer. KIF20A-66 peptide was well tolerable in the dose of either 1.0 mg or 3.0 mg/body, and effectively induced peptide-specific response of cytotoxic T lymphocyte (CTL). Further clinical study using this peptide is a promising approach for advanced pancreatic cancer to achieve high potential benefit for better prognosis. CLINICAL TRIAL REGISTRATION: UMIN-CTR, number UMIN000004919.

7 Clinical Trial Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. 2013

Ueno, Hideki / Ioka, Tatsuya / Ikeda, Masafumi / Ohkawa, Shinichi / Yanagimoto, Hiroaki / Boku, Narikazu / Fukutomi, Akira / Sugimori, Kazuya / Baba, Hideo / Yamao, Kenji / Shimamura, Tomotaka / Sho, Masayuki / Kitano, Masayuki / Cheng, Ann-Lii / Mizumoto, Kazuhiro / Chen, Jen-Shi / Furuse, Junji / Funakoshi, Akihiro / Hatori, Takashi / Yamaguchi, Taketo / Egawa, Shinichi / Sato, Atsushi / Ohashi, Yasuo / Okusaka, Takuji / Tanaka, Masao. ·Taiho Pharmaceutical, Tokyo, Japan. ·J Clin Oncol · Pubmed #23547081.

ABSTRACT: PURPOSE: The present phase III study was designed to investigate the noninferiority of S-1 alone and superiority of gemcitabine plus S-1 compared with gemcitabine alone with respect to overall survival. PATIENTS AND METHODS: The participants were chemotherapy-naive patients with locally advanced or metastatic pancreatic cancer. Patients were randomly assigned to receive only gemcitabine (1,000 mg/m(2) on days 1, 8, and 15 of a 28-day cycle), only S-1 (80, 100, or 120 mg/d according to body-surface area on days 1 through 28 of a 42-day cycle), or gemcitabine plus S-1 (gemcitabine 1,000 mg/m(2) on days 1 and 8 plus S-1 60, 80, or 100 mg/d according to body-surface area on days 1 through 14 of a 21-day cycle). RESULTS: In the total of 834 enrolled patients, median overall survival was 8.8 months in the gemcitabine group, 9.7 months in the S-1 group, and 10.1 months in the gemcitabine plus S-1 group. The noninferiority of S-1 to gemcitabine was demonstrated (hazard ratio, 0.96; 97.5% CI, 0.78 to 1.18; P < .001 for noninferiority), whereas the superiority of gemcitabine plus S-1 was not (hazard ratio, 0.88; 97.5% CI, 0.71 to 1.08; P = .15). All treatments were generally well tolerated, although hematologic and GI toxicities were more severe in the gemcitabine plus S-1 group than in the gemcitabine group. CONCLUSION: Monotherapy with S-1 demonstrated noninferiority to gemcitabine in overall survival with good tolerability and presents a convenient oral alternative for locally advanced and metastatic pancreatic cancer.

8 Clinical Trial Phase II study of sunitinib in Japanese patients with unresectable or metastatic, well-differentiated pancreatic neuroendocrine tumor. 2013

Ito, Tetsuhide / Okusaka, Takuji / Nishida, Toshirou / Yamao, Kenji / Igarashi, Hisato / Morizane, Chigusa / Kondo, Shunsuke / Mizuno, Nobumasa / Hara, Kazuo / Sawaki, Akira / Hashigaki, Satoshi / Kimura, Nobuyuki / Murakami, Mami / Ohki, Emiko / Chao, Richard C / Imamura, Masayuki. ·Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, Japan, itopapa@intmed3.med.kyushu-u.ac.jp. ·Invest New Drugs · Pubmed #23269537.

ABSTRACT: BACKGROUND: Pancreatic neuroendocrine tumors (NETs) are rare but are frequently diagnosed at advanced stages and require systemic therapy. PATIENTS AND METHODS: This multicenter, open-label, phase II study evaluated sunitinib in Japanese patients with well-differentiated pancreatic NET. Patients received sunitinib 37.5 mg/day on a continuous daily dosing (CDD) schedule. The primary endpoint was clinical benefit rate (CBR; percentage of complete responses [CRs] plus partial responses [PRs] plus stable disease [SD] ≥ 24 weeks). Secondary endpoints included objective response rate (ORR), tumor shrinkage, progression-free survival (PFS) probability, safety, pharmacokinetics, and biomarkers. RESULTS: Twelve patients received treatment. The CBR was 75 % (95 % confidence interval [CI], 43-94) and included 6 patients with a PR and 3 with SD. The ORR was 50 % (95 % CI, 21-79). PFS probability was 91 % (95 % CI, 54-99) at 6 months and 71 % (95 % CI, 34-90) at 12 months. Commonly reported treatment-emergent (all-causality), any-grade adverse events included diarrhea (n=10), hand-foot syndrome and hypertension (both n=8), fatigue and headache (both n=7), and neutropenia (n=6). No deaths on study were reported; one death due to disease progression occurred >28 days after end of treatment. Sunitinib on a CDD schedule resulted in sustained drug concentrations without accumulation across cycles. Tumor responses in all 12 patients did not appear to correlate with decreases in chromogranin A levels. CONCLUSIONS: Sunitinib 37.5 mg/day on a CDD schedule demonstrated antitumor activity in Japanese patients with unresectable, well-differentiated pancreatic NET. Commonly reported adverse events were consistent with the known safety profile of sunitinib.

9 Clinical Trial A multicenter phase II trial of S-1 with concurrent radiation therapy for locally advanced pancreatic cancer. 2013

Ikeda, Masafumi / Ioka, Tatsuya / Ito, Yoshinori / Yonemoto, Naohiro / Nagase, Michitaka / Yamao, Kenji / Miyakawa, Hiroyuki / Ishii, Hiroshi / Furuse, Junji / Sato, Keiko / Sato, Tosiya / Okusaka, Takuji. ·Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan. masikeda@east.ncc.go.jp ·Int J Radiat Oncol Biol Phys · Pubmed #22677367.

ABSTRACT: PURPOSE: The aim of this trial was to evaluate the efficacy and toxicity of S-1 and concurrent radiation therapy for locally advanced pancreatic cancer (PC). METHODS AND MATERIALS: Locally advanced PC patients with histologically or cytologically confirmed adenocarcinoma or adenosquamous carcinoma, who had no previous therapy were enrolled. Radiation therapy was delivered through 3 or more fields at a total dose of 50.4 Gy in 28 fractions over 5.5 weeks. S-1 was administered orally at a dose of 80 mg/m2 twice daily on the day of irradiation during radiation therapy. After a 2- to 8-week break, patients received a maintenance dose of S-1 (80 mg/m2/day for 28 consecutive days, followed by a 14-day rest period) was then administered until the appearance of disease progression or unacceptable toxicity. The primary efficacy endpoint was survival, and the secondary efficacy endpoints were progression-free survival, response rate, and serum carbohydrate antigen 19-9 (CA19-9) response; the safety endpoint was toxicity. RESULTS: Of the 60 evaluable patients, 16 patients achieved a partial response (27%; 95% confidence interval [CI], 16%-40%). The median progression-free survival period, overall survival period, and 1-year survival rate of the evaluable patients were 9.7 months (95% CI, 6.9-11.6 months), 16.2 months (95% CI, 13.5-21.3 months), and 72% (95%CI, 59%-82%), respectively. Of the 42 patients with a pretreatment serum CA19-9 level of ≥100 U/ml, 34 (81%) patients showed a decrease of greater than 50%. Leukopenia (6 patients, 10%) and anorexia (4 patients, 7%) were the major grade 3-4 toxicities with chemoradiation therapy. CONCLUSIONS: The effect of S-1 with concurrent radiation therapy in patients with locally advanced PC was found to be very favorable, with only mild toxicity.

10 Clinical Trial Multicenter phase II study of gemcitabine and S-1 combination therapy (GS Therapy) in patients with metastatic pancreatic cancer. 2011

Ueno, Hideki / Okusaka, Takuji / Furuse, Junji / Yamao, Kenji / Funakoshi, Akihiro / Boku, Narikazu / Ohkawa, Shinichi / Yokosuka, Osamu / Tanaka, Katsuaki / Moriyasu, Fuminori / Nakamori, Shoji / Sato, Tosiya. ·Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. hiueno@ncc.go.jp ·Jpn J Clin Oncol · Pubmed #21715364.

ABSTRACT: OBJECTIVE: The aim of this multicenter Phase II study was to assess the efficacy and toxicity of gemcitabine and S-1 combination therapy for metastatic pancreatic cancer. METHODS: Chemotherapy-naïve patients with histologically or cytologically proven metastatic pancreatic adenocarcinoma were eligible for this study. Gemcitabine was administered at a dose of 1000 mg/m(2) over 30 min on days 1 and 8, and oral S-1 at a dose of 40 mg/m(2) twice daily from days 1 to 14, repeated every 3 weeks. RESULTS: A total of 55 patients were included and the efficacy and toxicity were analyzed in 54 patients who received at least one dose of gemcitabine and S-1 combination therapy. Although no complete response was seen, a partial response was achieved in 24 patients, resulting in an overall response rate of 44.4% (95% confidence interval: 30.9-58.6%). The median progression-free survival was 5.9 months (95% confidence interval: 4.1-6.9 months) and the median overall survival was 10.1 months (95% confidence interval: 8.5-10.8 months) with a 1-year survival rate of 33.0%. The major Grade 3-4 toxicities were neutropenia (80%), leucopenia (59%), thrombocytopenia (22%), anorexia (17%) and rash (7%). Hematological toxicity was mostly transient and there was only one episode of febrile neutropenia ≥Grade 3. CONCLUSIONS: Gemcitabine and S-1 combination therapy produced a high response rate with good survival in patients with metastatic pancreatic cancer. A randomized Phase III study to confirm the efficacy of gemcitabine and S-1 combination therapy is ongoing.

11 Clinical Trial Prospective clinical study of EUS-guided choledochoduodenostomy for malignant lower biliary tract obstruction. 2011

Hara, Kazuo / Yamao, Kenji / Niwa, Yasumasa / Sawaki, Akira / Mizuno, Nobumasa / Hijioka, Susumu / Tajika, Masahiro / Kawai, Hiroki / Kondo, Shinya / Kobayashi, Yuji / Matumoto, Kazuya / Bhatia, Vikram / Shimizu, Yasuhiro / Ito, Akihiro / Hirooka, Yoshiki / Goto, Hidemi. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. khara@aichi-cc.jp ·Am J Gastroenterol · Pubmed #21448148.

ABSTRACT: OBJECTIVES: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has recently been reported as an alternative to percutaneous transhepatic biliary drainage (PTBD) in cases of biliary obstruction, when endoscopic biliary drainage (EBD) is unsuccessful. However, prospective studies of EUS-CDS have not yet been performed. We conducted a prospective study to evaluate the safety, feasibility, and efficacy of EUS-CDS in patients with malignant lower biliary tract obstruction. METHODS: A prospective study to confirm the safety of EUS-CDS was carried out in 6 patients, followed by a trial to evaluate the feasibility and efficacy of EUS-CDS in 12 additional patients. We placed a plastic stent from the duodenal bulb into the extrahepatic bile duct under EUS guidance using an oblique viewing echoendoscope, needle knife, guidewire, and biliary dilators. RESULTS: The site of extrahepatic bile duct puncture was the common hepatic duct in 15 patients and the common bile duct in 3 patients. Mean diameter of the punctured extrahepatic bile ducts was 10 mm (range: 6-20 mm). Technical and functional success rates were 94% (17/18) and 100% (17/17), respectively. Median procedure time was 30 min (range: 10-52 min). Median duration to first oral intake after the procedure was 1 day (range: 1-3 days). Early complications were encountered in three (17%) patients, including focal peritonitis in two patients and hemobilia in one patient. During the follow-up period (median: 163 days; range: 46-484 days), 12 stent occlusion events were observed in nine patients. Re-intervention with exchange of the occluded stent was successful in 8 of 12 (66%) times. Severe early and late complications were not encountered in any patients in this study. Median duration of stent patency by Kaplan-Meier analysis was 272 days. CONCLUSIONS: EUS-CDS is safe, feasible, and effective as an alternative to PTBD and EBD in cases of malignant distal biliary tract obstruction. Prospective randomized studies are needed to compare the safety and efficacy of various kinds of endoscopic devices used in EUS-CDS and to compare EUS-CDS with PTBD or EBD.

12 Clinical Trial Phase II study of erlotinib plus gemcitabine in Japanese patients with unresectable pancreatic cancer. 2011

Okusaka, Takuji / Furuse, Junji / Funakoshi, Akihiro / Ioka, Tatsuya / Yamao, Kenji / Ohkawa, Shinichi / Boku, Narikazu / Komatsu, Yoshito / Nakamori, Shoji / Iguchi, Haruo / Ito, Tetsuhide / Nakagawa, Kazuhiko / Nakachi, Kohei. ·National Cancer Center Hospital, Tokyo, Japan. tokusaka@ncc.go.jp ·Cancer Sci · Pubmed #21175992.

ABSTRACT: Erlotinib combined with gemcitabine has not been evaluated in Japanese patients with unresectable pancreatic cancer. This two-step phase II study assessed the safety and pharmacokinetics of erlotinib 100 mg/day (oral) plus gemcitabine 1000 mg/m(2) (i.v. days 1, 8, 15) in a 28-day cycle in the first step, and efficacy and safety in the second step. The primary end-point was safety. One hundred and seven patients were enrolled (first step, n = 6; second step, n = 101). The most common adverse event was RASH (compiled using the preferred terms rash, acne, exfoliative rash, dermatitis acneiform, erythema, eczema, dermatitis and pustular rash) in 93.4% of patients. One treatment-related death occurred. While interstitial lung disease-like events were reported in nine patients (8.5%; grade 1/2/3, 3.8/2.8/1.9%), all patients recovered or improved. The median overall survival, the 1-year survival rate and median progression-free survival were 9.23 months, 33.0% and 3.48 months, respectively. The overall response and disease control rates were 20.3% and 50.0%, respectively. In Japanese patients with unresectable pancreatic cancer, erlotinib plus gemcitabine had acceptable toxicity and efficacy that was not inferior to that seen in Western patients.

13 Article Invasive Ductal Carcinoma Arising in Mucinous Cystic Neoplasm of Pancreas: A Case Report. 2019

Sawai, Hirozumi / Kurimoto, Masaaki / Koide, Shuji / Kiriyama, Yuka / Haba, Shin / Matsuo, Yoichi / Morimoto, Mamoru / Koide, Hajime / Kamiya, Atsushi / Yamao, Kenji. ·Department of Surgery, Narita Memorial Hospital, Toyohashi, Aichi, Japan. · Department of Pathology, Narita Memorial Hospital, Toyohashi, Aichi, Japan. · Department of Gastroenterology, Narita Memorial Hospital, Toyohashi, Aichi, Japan. · Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan. ·Am J Case Rep · Pubmed #30798329.

ABSTRACT: BACKGROUND Mucinous cystic neoplasm (MCN) of the pancreas is a rare mucin-producing cystic neoplasm that has a characteristic histological feature referred to as ovarian-type stroma (OS) underlying the epithelium. Pancreatic ductal carcinoma arises from MCN as a precursor lesion, but data on progression pathways are limited. CASE REPORT A 40-year-old female was referred to our hospital for further investigation of a pancreatic cyst. Further examination showed a 7.0 cm multilocular cyst in the pancreatic tail and a solid mass in the thick septum of the cystic tumor. Distal pancreatectomy and splenectomy were performed. Histological examination revealed a moderately differentiated invasive ductal carcinoma (IDC) with a diameter of 0.5 cm in the thick septum of the cystic lesion and a cyst wall composed of epithelium with low-grade to severe dysplasia. The epithelium covered an OS. Pathological diagnosis was IDC arising in MCN of the pancreas. Immunohistochemical examination showed that MUC1 expression was negative in MCN but positive in IDC. KRAS mutation was observed in both MCN and IDC regions. CONCLUSIONS We present a rare case of moderately differentiated pancreatic IDC arising in MCN. To elucidate the underlying progression pathway, we explored the correlation between KRAS mutation and MUC expression as a clinicopathological parameter.

14 Article Spontaneous Development of Acute Obstructive Suppurative Pancreatic Ductitis Associated with Pancreatic Carcinoma: A First Case Report. 2018

Iwatsuka, Kunio / Nakagawara, Hiroshi / Ogawa, Masahiro / Gotoda, Takuji / Hayashi, Shigeoki / Kinukawa, Noriko / Hemmi, Akihiro / Yamao, Kenji / Yanagisawa, Akio / Moriyama, Mitsuhiko. ·Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Japan. · Department of Digestive Surgery, Nihon University School of Medicine, Japan. · Division of Pathology, Nihon University School of Medicine, Japan. · Department of Gastroenterology, Narita Memorial Hospital, Japan. · Department of Pathology and Laboratory Medicine, Kyoto First Red Cross Hospital, Japan. ·Intern Med · Pubmed #29279516.

ABSTRACT: A 68-year-old man with a history of diabetes mellitus was admitted to our hospital with a diagnosis of acute pancreatitis. Abdominal computed tomography revealed a suspicious tumor in the body of the pancreas, along with a dilated main pancreatic duct and edema of the pancreatic tail. Endoscopic retrograde pancreatography was performed after treating the patient's pancreatitis. When a cannula tip was advanced beyond the stenosis, deep into the distal pancreatic duct, thick white pus was evacuated. A bacteriological examination of the aspirated pancreatic juice revealed Enterobacter cloacae, and a cytological examination revealed adenocarcinoma. The diagnosis was acute obstructive suppurative pancreatic ductitis associated with pancreatic carcinoma.

15 Article Health-related quality of life in a randomised phase III study of gemcitabine plus S-1, S-1 alone and gemcitabine alone for locally advanced or metastatic pancreatic cancer: GEST study. 2017

Hagiwara, Yasuhiro / Ohashi, Yasuo / Okusaka, Takuji / Ueno, Hideki / Ioka, Tatsuya / Boku, Narikazu / Egawa, Shinichi / Hatori, Takashi / Furuse, Junji / Mizumoto, Kazuhiro / Ohkawa, Shinichi / Yamaguchi, Taketo / Yamao, Kenji / Funakoshi, Akihiro / Cheng, Ann-Lii / Kihara, Kiyohiro / Sato, Atsushi / Tanaka, Masao. ·Department of Biostatistics, The University of Tokyo, Tokyo, Japan. · Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan. · Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan. · Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. · Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan. · Department of Surgery, Tohoku University, Sendai, Japan. · Digestive Diseases Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan. · Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan. · Kyushu University Hospital Cancer Center, Fukuoka, Japan. · Division of Hepatobiliary and Pancreatic Oncology, Kanagawa Cancer Center, Yokohama, Japan. · Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan. · Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. · Division of Pancreatology, Fukuoka Sanno Hospital, Fukuoka, Japan. · Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. · Department of Medical Oncology, Hirosaki University Graduate School of Medicine, Aomori, Japan. · Department of Surgery, Shimonoseki City Hospital, Shimonoseki, Japan. ·ESMO Open · Pubmed #28761731.

ABSTRACT: OBJECTIVE: This study was performed to compare health-related quality of life (HRQOL) of gemcitabine plus S-1 (GS), S-1 alone and gemcitabine alone as first-line chemotherapy for locally advanced or metastatic pancreatic cancer in the GEST (Gemcitabine and TS-1 Trial) study and to assess the impacts of adverse events and tumour response on HRQOL. METHODS: Patients were randomly assigned to receive gemcitabine alone (1000 mg/m RESULTS: Including EQ-5D scores after death as 0, the mean profile was significantly better in the GS than gemcitabine group (difference, 0.069; p=0.003), but not the S-1 group (difference, -0.011; p=0.613). The mean profiles until death were similar in the three groups. QALMs, QAPFMs and TUDD were significantly longer in the GS than gemcitabine group (p<0.001, p<0.001 and p=0.004, respectively), but not the S-1 group (p=0.563, p=0.741 and p=0.701, respectively). Fatigue, anorexia and tumour response were significantly associated with changes in EQ-5D scores. CONCLUSIONS: GS achieved better HRQOL than gemcitabine alone, resulting a good balance between overall survival and HRQOL benefits. S-1 alone provides HRQOL similar to that provided by gemcitabine alone. Preventing fatigue and anorexia and maintaining better response would improve HRQOL.

16 Article Functional single nucleotide polymorphisms within the cyclin-dependent kinase inhibitor 2A/2B region affect pancreatic cancer risk. 2016

Campa, Daniele / Pastore, Manuela / Gentiluomo, Manuel / Talar-Wojnarowska, Renata / Kupcinskas, Juozas / Malecka-Panas, Ewa / Neoptolemos, John P / Niesen, Willem / Vodicka, Pavel / Delle Fave, Gianfranco / Bueno-de-Mesquita, H Bas / Gazouli, Maria / Pacetti, Paola / Di Leo, Milena / Ito, Hidemi / Klüter, Harald / Soucek, Pavel / Corbo, Vincenzo / Yamao, Kenji / Hosono, Satoyo / Kaaks, Rudolf / Vashist, Yogesh / Gioffreda, Domenica / Strobel, Oliver / Shimizu, Yasuhiro / Dijk, Frederike / Andriulli, Angelo / Ivanauskas, Audrius / Bugert, Peter / Tavano, Francesca / Vodickova, Ludmila / Zambon, Carlo Federico / Lovecek, Martin / Landi, Stefano / Key, Timothy J / Boggi, Ugo / Pezzilli, Raffaele / Jamroziak, Krzysztof / Mohelnikova-Duchonova, Beatrice / Mambrini, Andrea / Bambi, Franco / Busch, Olivier / Pazienza, Valerio / Valente, Roberto / Theodoropoulos, George E / Hackert, Thilo / Capurso, Gabriele / Cavestro, Giulia Martina / Pasquali, Claudio / Basso, Daniela / Sperti, Cosimo / Matsuo, Keitaro / Büchler, Markus / Khaw, Kay-Tee / Izbicki, Jakob / Costello, Eithne / Katzke, Verena / Michalski, Christoph / Stepien, Anna / Rizzato, Cosmeri / Canzian, Federico. ·Department of Biology, University of Pisa, Pisa, Italy. · Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany. · Department of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland. · Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania. · Institute for Health Research Liverpool Pancreas Biomedical Research Unit, University of Liverpool, Liverpool, United Kingdom. · Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany. · Institute of Experimental Medicine, Czech Academy of Science, Prague, Czech Republic. · Institute of Biology and Medical Genetics, 1st Medical Faculty, Charles University, Prague, Czech Republic. · Digestive and Liver Disease Unit, S. Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy. · Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. · Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom. · Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. · Department of Basic Medical Sciences, Laboratory of Biology, Medical School, National and Kapodistrian University of Athens, Athens, Greece. · Oncological Department Massa Carrara Azienda USL Toscana Nord Ovest, Carrara, Italy. · Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy. · Division Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan. · Institute of Transfusion Medicine and Immunology, German Red Cross Blood Service Baden-Württemberg - Hessen gGmbH, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. · Laboratory of Toxicogenomics, National Institute of Public Health, Prague, Czech Republic. · Laboratory of Pharmacogenomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic. · ARC-Net Research Centre, and Department of Diagnostics and Public Health University and Hospital Trust of Verona, Verona, Italy. · Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. · Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. · Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. · Division of Gastroenterology and Research Laboratory, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy. · Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands. · Biomedical Center, Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic. · Department of Medicine - DIMED, University of Padova, Padova, Italy. · Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic. · Epidemiology Unit Nuffield Department of Population Health University of Oxford, Oxford, UK. · Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy. · Pancreas Unit, Department of Digestive System, Dant'Orsola-Malpighi Hospital, Bologna, Italy. · Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland. · Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic. · Blood Transfusion Service, Azienda Ospedaliero Universitaria Meyer, Florence, Italy. · Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. · Colorectal Unit, First Department of Propaedeutic Surgery, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece. · Department of Surgery, Oncology and Gastroenterology-DiSCOG, University of Padova, Padova, Italy. · Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy. · Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan. · Clinical Gerontology Unit, Addenbrooke’s Hospital, School of Clinical Medicine, University of Cambridge, Cambridge, UK. · Laboratory of Clinical, Transplant Immunology and Genetics, Copernicus Memorial Hospital, Lodz, Poland. · Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. ·Oncotarget · Pubmed #27486979.

ABSTRACT: The CDKN2A (p16) gene plays a key role in pancreatic cancer etiology. It is one of the most commonly somatically mutated genes in pancreatic cancer, rare germline mutations have been found to be associated with increased risk of developing familiar pancreatic cancer and CDKN2A promoter hyper-methylation has been suggested to play a critical role both in pancreatic cancer onset and prognosis. In addition several unrelated SNPs in the 9p21.3 region, that includes the CDNK2A, CDNK2B and the CDNK2B-AS1 genes, are associated with the development of cancer in various organs. However, association between the common genetic variability in this region and pancreatic cancer risk is not clearly understood. We sought to fill this gap in a case-control study genotyping 13 single nucleotide polymorphisms (SNPs) in 2,857 pancreatic ductal adenocarcinoma (PDAC) patients and 6,111 controls in the context of the Pancreatic Disease Research (PANDoRA) consortium. We found that the A allele of the rs3217992 SNP was associated with an increased pancreatic cancer risk (ORhet=1.14, 95% CI 1.01-1.27, p=0.026, ORhom=1.30, 95% CI 1.12-1.51, p=0.00049). This pleiotropic variant is reported to be a mir-SNP that, by changing the binding site of one or more miRNAs, could influence the normal cell cycle progression and in turn increase PDAC risk. In conclusion, we observed a novel association in a pleiotropic region that has been found to be of key relevance in the susceptibility to various types of cancer and diabetes suggesting that the CDKN2A/B locus could represent a genetic link between diabetes and pancreatic cancer risk.

17 Article Prognostic impact of carcinoembryonic antigen (CEA) on patients with metastatic pancreatic cancer: A retrospective cohort study. 2016

Imaoka, Hiroshi / Mizuno, Nobumasa / Hara, Kazuo / Hijioka, Susumu / Tajika, Masahiro / Tanaka, Tsutomu / Ishihara, Makoto / Hirayama, Yutaka / Hieda, Nobuhiro / Yoshida, Tsukasa / Okuno, Nozomi / Shimizu, Yasuhiro / Niwa, Yasumasa / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. Electronic address: hiroshi.imaoka.md@aichi-cc.jp. · Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. ·Pancreatology · Pubmed #27256641.

ABSTRACT: BACKGROUND: Carcinoembryonic antigen (CEA) is one of the most widely used tumor markers, and its level is increased in 30-60% of patients with pancreatic cancer (PC). However, little is known about the implications of CEA as a prognostic marker in metastatic PC. The purpose of this study was to examine the usefulness of CEA levels as a prognostic marker in patients with metastatic PC. METHODS: We conducted a retrospective cohort study using data from a computerized database. A total of 433 patients with metastatic disease were analyzed. RESULTS: Median overall survival (OS) was significantly shorter for patients with high CEA (>5 ng/ml) than with normal CEA (≤5 ng/ml) (6.8 vs. 10.3 months, respectively; p < 0.001). After adjustment, CEA level was an independent predictive factor for OS (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.45-2.26). In the high CEA group, OS in patients treated with combination chemotherapy was similar to that with single-agent chemotherapy (median, 7.1 vs. 6.8 months; HR for OS, 0.99; 95% CI, 0.71-1.40). CONCLUSIONS: The present results show that CEA level is an independent prognostic factor in patients with metastatic PC. A combination chemotherapy regimen may offer modest survival benefit in patients with high CEA.

18 Article Post-adjuvant chemotherapy CA19-9 levels predict prognosis in patients with pancreatic ductal adenocarcinoma: A retrospective cohort study. 2016

Imaoka, Hiroshi / Shimizu, Yasuhiro / Senda, Yoshiki / Natsume, Seiji / Mizuno, Nobumasa / Hara, Kazuo / Hijioka, Susumu / Hieda, Nobuhiro / Tajika, Masahiro / Tanaka, Tsutomu / Ishihara, Makoto / Niwa, Yasumasa / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. Electronic address: hiroshi.imaoka.md@aichi-cc.jp. · Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan. ·Pancreatology · Pubmed #27178104.

ABSTRACT: BACKGROUND: Carbohydrate antigen 19-9 (CA19-9) is a widely used tumor marker for pancreatic ductal adenocarcinoma (PDAC). In addition, several studies have reported the utility of both pre- and postoperative CA19-9 levels as prognostic factors in resectable PDAC. However, little is known about the implications of post-adjuvant chemotherapy (AC) CA19-9 levels. The purpose of this study was to examine the utility of the post-AC CA19-9 level as a prognostic marker for relapse-free survival (RFS) in resectable PDAC. METHODS: A total of 119 patients who completed AC were analyzed (normal post-AC CA19-9, n = 79; high post-AC CA19-9, n = 40). The upper limit of the normal (ULN) serum level of CA19-9 was 37 U/mL. RESULTS: Median RFS was significantly shorter for patients with high post-AC CA19-9 levels than for those with normal post-AC CA19-9 (10.4 months vs. 29.6 months, respectively; p < 0.001). After adjustment, high post-AC CA19-9 level was an independent predictive factor for short RFS (hazard ratio for RFS, 2.72). Median overall survival was significantly shorter in patients with high post-AC CA19-9 levels than in those with normal postoperative CA19-9 levels (24.7 months vs. 92.1 months, respectively; p < 0.001). The optimal cutoff value of post-AC CA19-9 levels for prediction of early recurrence was >1.5 × UNL (55.5 U/mL), with a 74.2% positive predictive value. CONCLUSIONS: The present results show that high post-AC CA19-9 level is an independent prognostic factor for short RFS in patients with resected PDAC. In addition, it may be useful for predicting early recurrence.

19 Article Diagnostic performance and factors influencing the accuracy of EUS-FNA of pancreatic neuroendocrine neoplasms. 2016

Hijioka, Susumu / Hara, Kazuo / Mizuno, Nobumasa / Imaoka, Hiroshi / Bhatia, Vikram / Mekky, Mohamed A / Yoshimura, Kenichi / Yoshida, Tsukasa / Okuno, Nozomi / Hieda, Nobuhiro / Tajika, Masahiro / Tanaka, Tsutomu / Ishihara, Makoto / Yatabe, Yasushi / Shimizu, Yasuhiro / Niwa, Yasumasa / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan. rizasusu@aichi-cc.jp. · Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan. · Department of Gastroenterology, Fortis Escorts Liver and Digestive Institute, New Delhi, India. · Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt. · Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan. · Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. ·J Gastroenterol · Pubmed #26768605.

ABSTRACT: BACKGROUND: Multiple studies have investigated sampling adequacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic neuroendocrine neoplasms (pNENs). However, none have described the diagnostic performance of EUS-FNA for pNENs, or the influencing factors. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA, with post-operative pathological diagnosis as the gold standard, and factors predictive of inadequate EUS sampling. METHODS: From 1998 to 2014, a total of 698 patients underwent pancreatic resection and 1455 patients underwent EUS-FNA sampling for pancreatic lesions. A total of 410 cases underwent both surgical resection and preceding EUS-FNA. Of these, 60 cases (49 true pNEN, nine non-diagnostic, two misdiagnoses) were included. We studied diagnostic performance of EUS-FNA and factors that were associated with failed diagnosis. RESULTS: Of the 60 cases, EUS-FNA yield was 49 true-positive cases, two misdiagnoses, and nine non-diagnostic cases (including six suggestive cases). Sensitivity, specificity, and accuracy were 84.5, 99.4, and 97.3 %, respectively; including the six suggestive cases, diagnostic values were 94.8 % sensitivity (55/58), 99.4 % specificity (350/352), and 98.7 % accuracy (405/410). In multivariate analysis, sampling adequacy rates were significantly lower when lesions were located in the pancreatic head [odds ratio (OR) = 10.0] and in tumor-rich stromal fibrosis (OR = 10.45). Tumor size, needle type, tumor grading, presence of cystic component, and time period were not significant factors. CONCLUSIONS: EUS-FNA offers high accuracy for pNEN. However, location of the tumor in the pancreatic head and presence of rich stromal fibrosis negatively impacts sampling adequacy.

20 Article Evaluation of Modified Glasgow Prognostic Score for Pancreatic Cancer: A Retrospective Cohort Study. 2016

Imaoka, Hiroshi / Mizuno, Nobumasa / Hara, Kazuo / Hijioka, Susumu / Tajika, Masahiro / Tanaka, Tsutomu / Ishihara, Makoto / Yogi, Tatsuji / Tsutsumi, Hideharu / Fujiyoshi, Toshihisa / Sato, Takamitsu / Shimizu, Yasuhiro / Niwa, Yasumasa / Yamao, Kenji. ·From the Departments of *Gastroenterology and †Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. ·Pancreas · Pubmed #26495775.

ABSTRACT: OBJECTIVES: The modified Glasgow prognostic score (mGPS) is known to be useful in determining the prognosis of cancers. However, the utility of mGPS for pancreatic cancer (PC) has been examined based primarily on a surgical series of early-stage cancers. The purpose of this study was to examine the utility of mGPS for PC of all stages using a retrospective cohort design. METHODS: We conducted a retrospective cohort study using data from a computerized database. A total of 807 patients with pathologically confirmed PC were analyzed (mGPS-0, n = 620; mGPS-1, n = 153; mGPS-2, n = 34). RESULTS: Median overall survival (OS) was significantly worse for the mGPS-1 group than for the mGPS-0 group (5.8 vs 15.8 months, respectively) but was comparable between the mGPS-2 and mGPS-1 groups (4.8 vs 5.8 months, respectively). After adjustment, both mGPS-1 and mGPS-2 were independent predictive factors of OS (mGPS-1: hazard ratio, 1.772; 95% confidence interval, 1.417-2.215; mGPS-2: hazard ratio, 2.033; 95% confidence interval, 1.284-3.219). Subgroup analysis showed that OS was significantly worse in the mGPS-1 and mGPS-2 groups than in the mGPS-0 group for all except the following 2 subgroups: localized disease and curative resection. CONCLUSIONS: The present results show that the mGPS is an independent prognostic factor in patients with PC, especially for advanced-stage disease.

21 Article Risk factors for postoperative recurrence of intraductal papillary mucinous neoplasms of the pancreas based on a long-term follow-up study: proposals for follow-up strategies. 2015

Yogi, Tatsuji / Hijioka, Susumu / Imaoka, Hiroshi / Mizuno, Nobumasa / Hara, Kazuo / Tajika, Masahiro / Tanaka, Tsutomu / Ishihara, Makoto / Shimizu, Yasuhiro / Hosoda, Waki / Yatabe, Yasushi / Niwa, Yasumasa / Yoshimura, Kenichi / Bhatia, Vikram / Fujita, Jiro / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases (First Department of Internal Medicine), Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. · Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. · Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan. · Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan. · Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India. ·J Hepatobiliary Pancreat Sci · Pubmed #26148131.

ABSTRACT: BACKGROUND: The aim of this study was to examine the associations between postoperative clinicopathological features of intraductal papillary mucinous neoplasm (IPMN) and recurrence over a long follow-up period. METHODS: We retrospectively assessed 153 IPMN patients who underwent resection. RESULTS: The resected tumors showed low/intermediate-grade dysplasia (LGD/IGD), high-grade dysplasia (HGD), T1a (stromal invasion ≤5 mm), and invasive intraductal papillary mucinous carcinoma (IPMC), in 54.9%, 22.2%, 4.6%, and 18.3% of patients, respectively. The median follow-up period after surgery was 46.4 (6.0-216.3) months, with an overall recurrence rate of 17.0%; the recurrence rates by histological type were 6.0%, 5.9%, 42.9%, and 57.1% for LGD/IGD, HGD, T1a, and invasive IPMC, respectively. Multivariate analysis revealed that recurrences related with tumor location, mural nodule size, presence of invasive cancer, lymph node metastasis, IPMN in the remnant pancreas, and main pancreatic duct dilatation after surgery. Recurrence occurred within the remnant pancreas in all LGD-T1a patients and as extrapancreatic metastasis in all patients with invasive IPMC. Of the total recurrences, 15.4% occurred over 5 years postoperatively. CONCLUSIONS: The postoperative follow-up protocol for patients with LGD-T1a should be similar to non-resected IPMN, and that for invasive IPMC should be the same as for pancreatic ductal adenocarcinoma patients.

22 Article Stent migration into the peritoneal cavity following endoscopic ultrasound-guided hepaticogastrostomy. 2015

Okuno, Nozomi / Hara, Kazuo / Mizuno, Nobumasa / Hijioka, Susumu / Imaoka, Hiroshi / Yamao, Kenji. ·Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. ·Endoscopy · Pubmed #26115390.

ABSTRACT: -- No abstract --

23 Article [The clinical practice for the diagnosis of pancreatic cancer]. 2015

Hieda, Nobuhiro / Mizuno, Nobumasa / Yamao, Kenji. · ·Nihon Rinsho · Pubmed #25856997.

ABSTRACT: -- No abstract --

24 Article GNAS mutation is a frequent event in pancreatic intraductal papillary mucinous neoplasms and associated adenocarcinomas. 2015

Hosoda, Waki / Sasaki, Eiichi / Murakami, Yoshiko / Yamao, Kenji / Shimizu, Yasuhiro / Yatabe, Yasushi. ·Department of Pathology and Molecular Diagnostics, Aichi Cancer Centre Hospital, Kanokoden 1-1, Chikusa-ku, Nagoya, 464-8681, Japan. ·Virchows Arch · Pubmed #25796395.

ABSTRACT: In contrast to pancreatic ductal adenocarcinomas (PDAs), intraductal papillary mucinous neoplasms (IPMNs) frequently harbour GNAS mutations. To characterise GNAS-mutated pancreatic carcinomas, we examined mutations of GNAS and KRAS in 290 pancreatic adenocarcinomas and 77 pancreatic intraepithelial neoplasias (PanINs). In 64 % (39/61) of IPMNs and 37 % (11/30) of IPMN-associated adenocarcinomas, a GNAS mutation was found. GNAS mutations were frequent (78 %, 7/9) in mucinous carcinomas, with or without associated IPMN. In contrast, GNAS mutations were rarely observed in PDAs (1 %, 1/88) and PanINs (3 %, 2/77), and not at all in mucinous cystic neoplasms (MCNs) (0/10), neuroendocrine neoplasms (0/52), acinar cell neoplasms (0/16), serous cystadenomas (0/10), and solid-pseudopapillary neoplasms (0/14). We found GNAS mutations in 55/91 IPMNs with or without associated invasive carcinoma, solely in intestinal-type (78 %, 21/27) and gastric-type (62 %, 34/55) IPMNs. Of the IPMN-associated adenocarcinomas, mucinous-subtype tumours harboured GNAS mutations more frequently (83 %, 5/6) than tubular-subtype tumours (25 %, 6/24) (p = 0.02). We separately analysed GNAS in the adenocarcinoma and the IPMN component in the IPMN-associated adenocarcinomas. In all mucinous-subtype tumours, the two components exhibited identical genotypes. In contrast, the two components in 8 of 24 tubular-subtype tumours exhibited different genotypes, indicating intratumour heterogeneity. In conclusion, mucinous carcinomas with or without associated IPMN as well as IPMNs frequently harbour a GNAS mutation, reinforcing the notion that these constitute a spectrum of pancreatic tumours. Clinically and pathologically, these tumours are associated, but GNAS mutation sheds further light on this spectrum.

25 Article Poor prognosis of common-type invasive ductal carcinomas that originate in the branching pancreatic duct. 2015

Ando, Masataka / Shimizu, Yasuhiro / Sano, Tsuyoshi / Senda, Yoshiki / Nimura, Yuji / Yamao, Kenji / Nagino, Masato / Yanagisawa, Akio. ·Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. mando@kj8.so-net.ne.jp. · Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. · Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. · Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. · Department of Pathology, Kyoto Prefectural Medical University Graduate School of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. yanagisa@koto.kpu-m.ac.jp. ·Surg Today · Pubmed #25476465.

ABSTRACT: PURPOSE: To clarify the incidence, clinicopathological features and prognosis of pancreatic invasive ductal carcinomas (IDCs) with different tumor origin sites in the pancreatic duct. METHODS: Based on the relationship between the invasive cancer area (ICA) and the main pancreatic duct (MPD), IDCs less than 2 cm in diameter were classified into two groups: type I, in which the ICA and MPD were separated, and type II, in which the MPD passed through the ICA. The clinicopathological findings and prognosis of each type were compared in a total of 37 patients. RESULTS: The incidences of IDC types I and II were 18.9 and 81.1 %, respectively. Although there was no difference in local invasion, both node involvement and venous invasion tended to occur more frequently in type I IDC, and the three-year survival rate was significantly lower for type I (28.6 %) than type II (71.8 %) IDC. CONCLUSIONS: The prognosis of IDCs that originated in the branching pancreatic duct (BPD) distant from the MPD (type I) was worse than the prognosis of IDCs that originated in either the MPD or the BPD close to the MPD (type II). These data suggest that the progression and degree of malignancy of IDCs may vary depending on the site of tumor origin in the pancreatic duct.

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