Objectives To identify blood cell markers that predict the long-term outcomes of patients with colorectal cancer. Methods Data from 892 stage II and III colorectal cancer patients who underwent R0 resection were included. We analyzed the correlations of the preoperative blood data, previously reported prognostic indices, and clinicopathologic factors with the long-term outcomes, such as relapse-free survival and overall survival, using univariate and multivariate analyses. Results Multivariate analysis showed that tumor location, stage, mean corpuscular volume, neutrophil-to-lymphocyte ratio, and lymphocyte-to- monocyte ratio were significantly correlated with relapse-free survival. A mean corpuscular volume ≥80.5 fL, neutrophil-to-lymphocyte ratio ≥5.5, and lymphocyte-to- monocyte ratio <3.4 had hazard ratios for disease relapse between 1.39 and 1.93. The cumulative scores of these three factors were aggregated into a laboratory prognostic score, with a maximum score at 6. The relapse-free survival and overall survival were well stratified by a laboratory prognostic score between 0–3 and 4–6, respectively, independent of the stage. Conclusion The mean corpuscular volume, neutrophil-to-lymphocyte ratio, and lymphocyte-to- monocyte ratio can serve as blood cell markers to predict the long-term outcomes of patients who underwent R0 resection for stage II/III colorectal cancer.

BackgroundAn inguinal hernia is a common disease; however, a malignant tumor within the inguinal hernia sac is rare, and perforated colon cancer in the hernia sac is extremely rare.Case presentationA 73-year-old man presented to our hospital with high fever and painful bulging of the lower abdomen. Computed tomography showed air-containing fluid in the abdominal wall, as well as localized wall thickness of the sigmoid colon in the left groin. An emergency operation revealed a huge subcutaneous abscess and a hard mass of the sigmoid colon within an indirect inguinal hernia sac. Sigmoidectomy and hernia repair using the Marcy method were performed. Lymph node dissection was performed through a transrectal abdominal incision. Histopathological examination of the resected specimen revealed moderately differentiated adenocarcinoma invading the serosal layer with lymph node metastasis.ConclusionsIncarcerated inguinal hernia with perforated colon cancer is rare; an emergent operation should accordingly be performed based on infection control, oncological principles, and secure hernia repair.

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Agents targeting vascular endothelial growth factor (VEGF) have been validated as breast cancer therapeutics, yet efficacy can differ between tumor types and individual patients. Rapid noninvasive determination of response could provide significant benefits. We tested if response to the VEGF antibody bevacizumab and chemo drug paclitaxel could be detected using contrast-enhanced ultrasound imaging (CEUS). The objective of this study was to evaluate contrast-enhanced ultrasound (CEUS) with contrast agent Sonazoid® injection as a predictor of tumor response. Patients and methods: Ten patients with advanced and metastatic breast carcinomas treated were evaluated. Examinations were performed at baseline, after 2 and 4 weeks and every one month on antiangiogenic drug bevacizumab and chemo drug paclitaxel in tumor targets that were accessible to CEUS. Histological findings were obtained in all cases by ultrasound-guided 14 gauge core needle biopsy or 10 gauge vacuum-assisted biopsy. Each examination included a bolus injection of Sonazoid® and 40–60 seconds of raw linear data with an Aplio (Toshiba), Logiq (GE) and Ascendus (Hitachi-ALOKA) with a 8–12 MHz linear transducer. A low reduced mechanical index (MI) of less than 0.24 was chosen to avoid early gas bubble destruction. The ethic committee of our institution approved this study. An informed consent was signed by each patient for the ultrasound examination and before administering for the contrast medium. Results: A total of 60 examinations were performed. Various intratumoral perfusion parameters changed over time, and the signal intensity was significantly impaired in the treated tumors before the treatment efficacy on tumor size could be observed. Conclusion: CEUS has advantages for real-time visualization and is a new noninvasive imaging technique which might be an effective tool for evaluating antiangiogenic drugs and chemo drugs in breast cancer. The use of a noninvasive ultrasound approach may allow for earlier and more effective determination of efficacy of antiangiogenic therapy. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-07.

DepartmentsofSurgery 1) andRadiology 2) ,JapaneseRedCrossNagoyaDaiichiHospital A65-year-oldmandiagnosedwithadenocarcinomaoftheesophagogastricjunctionunderwentsubtotal esophagectomy, total gastrectomy, antethoracic reconstruction using the pedunculated jejunum, jejunum using supercharge and drainage techniques. On the 7th postoperative day (POD), he developed pneumonia.Onthe8thPOD,theantethoracicjejunaltissuewasdistendedandbloodtestsshowedelevatedinflammatorybiomarkers. Contrast-enhancedCTscanrevealedaswollenantethoracicjejunumwithlesscontrastenhancement andamistymesentery.Gastrointestinalendoscopyrevealedanedematous,erythematousjejunalmucosa withmultipleerosions. Three-dimensionalCTangiographyrevealedapatentantethoracicjejunalartery,indicatingischemic jejunitisduetonon-occlusivemesentericischemia(NOMI)withcontractionoftheatraitarteryofthejejunum,whichmightbecausedbypneumonia.Becausetherewasnoevidenceofnecrosisoftheantethoracicjejunum,thepatientwasconservativelytreatedforpneumoniaandhypovolemia.Onthe13thPOD, NOMIresolved.AlthoughNOMIofthereconstructedorgancanoccasionallydevelopafteresophagectomy,conservativetherapymaybeeffectiveinselectedpatientsinwhomNOMIisdiagnosedearly.