Neoplasms In Japan Research Articles

Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of intraductal papillary mucinous neoplasm in Japan.

This study aimed to clarify whether several single-nucleotide polymorphisms (SNPs)-related chronic pancreatitis such as carboxypeptidase A1 (CPA1), carboxypeptidase B1 (CPB1), Gamma-glutamyltransferase 1 (GGT1), G-protein-coupled receptor Class C Group 6 Member A (GPRC6A), and serine protease inhibitor, Kazal type 1 (SPINK-1) genotypes were associated with clinical characteristics of patients with intraductal papillary mucinous neoplasm (IPMN) and worrisome features of IPMN. We enrolled 100 patients with IPMN and 116 patients as a control. Serum p-amylase, lipase, trypsin, phospholipase A2 (PLA2), and elastase-1 levels were measured. An Olympus EUS (GF-UCT 260) was used to perform endosonography in 100 patients with IPMN. Total EUS score was evaluated using endosonography. DNA was isolated from the duodenal tissue using a commercial system and polymerase chain reaction (PCR) was performed on 7500 Fast PCR System. There were no associations between glucose tolerances, lipid levels and genotypes of CPA1, GGT1, GPRC6A, and SPINK-1 in patients with IPMN. CPA1 genotype was significantly associated with the pathophysiology of IPMN. Then, GGT1 genotype was also significantly associated with EUS total score and the size of cyst more than 20 mm and more than 30 mm as one of worrisome features of IPMN. Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of IPMN.

Real-world status of treatment for lymphoid neoplasms developed during the course of myeloproliferative neoplasms in Japan

ABSTRACT Objectives: Patients with myeloproliferative neoplasms (MPNs) are at higher risk of developing secondary malignancies. In this study, we focused on patients with MPNs that complicated lymphoid neoplasms. To analyze the real-world status of lymphoid neoplasm treatment in patients with pre-existing MPNs in Japan, we conducted a multicenter retrospective study. Methods: Questionnaires were sent to collect the data on patients who were first diagnosed with either polycythemia vera, essential thrombocythemia or myelofibrosis and who later were complicated with lymphoid neoplasms defined as malignant lymphoma, multiple myeloma, or chronic lymphocytic leukemia/small cell lymphoma. Results: Twenty-four patients with MPNs complicated by lymphoid neoplasms were enrolled (polycythemia vera, n = 8; essential thrombocythemia, n = 14; and primary myelofibrosis, n = 2). Among these, diffuse large B-cell lymphoma (DLBCL) was the most frequently observed (n = 13, 54.1%). Twelve (92.3%) of the patients with DLBCL received conventional chemotherapy. Among these 12 patients, regarding cytoreductive therapy for MPNs, 8 patients stopped treatment, one continued treatment, and two received a reduced dose. Consequently, most patients were able to receive conventional chemotherapy for DLBCL with a slightly higher dose of granulocyte colony-stimulating factor support than usual without worse outcomes. All 3 patients with multiple myeloma received a standard dose of chemotherapy. Conclusion: Our data indicate that if aggressive lymphoid neoplasms develop during the course of treatment in patients with MPNs, it is acceptable to prioritize chemotherapy for lymphoma.

Management of pancreatic neuroendocrine neoplasms in Japan's rapidly aging society

Management of pancreatic neuroendocrine neoplasms in Japan's rapidly aging society

Abstract 1060: Phosphoproteomic subtyping of gastric cancer reveals dynamic transformation with chemotherapy

Abstract Background: Gastric cancer (GC) is the third leading cause of death from malignant neoplasms in Japan, and unresectable advanced GC has a poor prognosis, so further therapeutic development is needed. However, genomic medicine has its limitations, and it is imperative to establish precision medicine based on a new concept to match the dynamic changes in cancer. Focusing on phosphorylation signaling in cancer cells, we have been developing deep phosphoproteome analysis from minute endoscopic biopsy specimens frozen within 20 seconds of collection. This is to enable phosphorylation signal profiling that reflects the phosphorylation signal state in the patient's body as much as possible. Methods: We collected endoscopic biopsy specimens from 85 patients with gastric cancer. Post-treatment specimens from nine gastric cancer patients were obtained two months later after the initiation of drug therapy. In a single endoscopic procedure, three tumor specimens and three normal gastric mucosa specimens were collected concomitantly from each patient. Each specimen was separately put in a screw-cap tube and immediately snap-frozen in liquid nitrogen within 20 s after collection. Frozen specimens were stored at -80 °C until further sample preparation. Proteome and phosphoproteome analysis were performed by multiplex analysis using Tandem Mass Tag reagent. Genomic analysis was performed by using a targeted high-multiplex PCR-based NGS panel (OncoMine Comprehensive Assay). Results: Using this system, we obtained phosphorylation profiles of 340 specimens from 85 untreated gastric cancer patients. Ultrasensitive mass spectrometry-based proteomics quantified an average of 21000 phosphorylation sites and divided gastric cancer patients into subtype 1 (CDK active, 35%), subtype 2 (EMT, 15%), and subtype 3. (Others, 50%). The association with the four subtypes defined by TCGA was low. Furthermore, EMT type increased to 67% after chemotherapy. These results strongly suggest that gastric cancer undergoes dynamic transformation with treatment. The kinase activity profile of each subtype is useful information to provide therapeutic options for each subtype. Furthermore, our method of quantifying phosphorylation signals in cancer using biopsy specimens is expected to be a powerful driver of signaling-based precision medicine, not only for determining subtypes, but also for selecting treatment options and measuring drug efficacy. Conclusions: We succeeded in developing the ultra-sensitive phosphorylation analysis system, which can quantify phosphorylation at more than 20,000 sites from endoscopic biopsy specimens, and propose a molecular classification dividing gastric cancer into three subtypes. Citation Format: Jun Adachi, Masahiko Aoki, Hidekazu Hirano, Yuichi Abe, Ryohei Narumi, Kazufumi Honda, Takeshi Tomonaga, Kenji Mizuguchi, Takaki Yoshikawa, Narikazu Boku. Phosphoproteomic subtyping of gastric cancer reveals dynamic transformation with chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1060.

The real-world selection of first-line systemic therapy regimen for metastatic gastroenteropancreatic neuroendocrine neoplasm in Japan

In November 2013, the first edition of evidence-based guidelines for treatment of gastroenteropancreatic neuroendocrine neoplasm (GEP-NEN) was published in Japan. However, whether medical practitioners have adopted the first-line regimens recommended for metastatic GEP-NEN in clinical practice is not yet known. The purpose of this study was to identify which first-line systemic therapy regimens have been selected and the proportion of cases that are adherent to the guidelines (i.e., number of patients receiving recommended therapy/total number of patients). We combined hospital-based cancer registry data and insurance claims-equivalent data for patients with GEP-NEN treated between January 2013 and December 2014 and extracted those with metastatic GEP-NEN who received systemic therapy. The proportions that were adherent with the guideline were calculated according to tumor classification (neuroendocrine tumor [NET] or neuroendocrine carcinoma [NEC]), primary site (gastrointestinal or pancreatic), and hospital volume (high, medium, or low). The study included 109 patients with GEP-NET and 424 with GEP-NEC. Overall, guideline-adherent treatment was provided in only 54.8% of cases (58.1% for gastrointestinal NET, 63.6% for pancreatic NET, 56.6% for gastrointestinal NEC, and 44.9% for pancreatic NEC). The recommended therapy for GEP-NET was used in 16.5% of patients with GEP-NEC, and 21.5% received fluoropyrimidine-containing chemotherapy. This report is the first to describe real-world selection of first-line regimens for metastatic GEP-NEN. About half of all these patients received systemic therapy that was not recommended in the guidelines.

Epidemiological analysis of lung and mediastinal neuroendocrine neoplasms in Japan based on the national database

BackgroundNeuroendocrine neoplasms (NENs) are rare and can originate from any body part. However, there are only few epidemiological studies, especially on lung and mediastinal NENs. This study investigated the epidemiological trends and differences between lung and mediastinal NENs in Japan. MethodsPatients with lung and mediastinal NENs were identified in a national hospital-based cancer registry between 2009 and 2015 in Japan. NENs were subclassified into neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). NECs were further subdivided into large neuroendocrine carcinomas (LCNECs) and small cell carcinomas (SCCs). We examined the patient characteristics: sex, age, histology, year of diagnosis, diagnostic opportunity, and initial treatment. ResultsWe identified 48,433 patients with 47,888 lung (98.9%) and 545 mediastinal (1.1%) NENs. The commonest subtype of lung NENs was SCCs (87%), followed by LCNECs (10%) and NETs (3%). In the mediastinum, SCCs were also the commonest (48%), followed by NETs (38%) and LCNECs (14%). The number of lung NEN annually increased; however, that of mediastinal NENs did not change over time. The mean age of patients with lung NETs was lower than that of patients with lung LCNECs and SCCs (NETs, 62 ± 14 years; LCNECs, 70 ± 9 years; SCCs, 71 ± 9 years; p < .001). The lung and mediastinal NENs were mainly detected based on symptoms, except for lung NETs. Surgical intervention, including multimodal therapy, was performed for 89.3% of lung NETs (surgery alone: 83.6%), while only 15.6% of lung NECs were treated with surgery. For the mediastinum, 75.9% of NETs were treated with surgery, with 27.1% of cases treated with surgery plus multimodal therapy. Surgery was performed more frequently for mediastinal NECs (37%) than for lung NECs (15.6%). ConclusionsThis study highlights differences in trends of lung and mediastinal NENs. This study’s findings support the importance of epidemiological evaluations based on the primary sites and histological subtypes.

Real world data on myeloproliferative neoplasms in Japan

Since the discovery of the JAK2V617F, MPL gene, and Calreticulin gene mutations, remarkable changes have occurred in the identification of the pathology of Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs). The diagnostic criteria of polycythemia vera, essential thrombocythemia, and primary myelofibrosis in the world health organization classification systems have also been amended to include these driver gene mutations. Additionally, treatment algorithms for each disease have been reviewed. Following these changes, real world data form several countries based on national surveys have been reported. In Japan, the Japanese Society of Hematology has conducted a prospective study, named the JSH-MPN-15 study, to investigate the overall survival and risk factors of patients with MPNs. Furthermore, the retrospective JSH-MPN-R18 study was conducted and the results have been coming out. In this lecture, the results of these studies will be discussed.

Clinical impact of gene mutations on myeloproliferative neoplasms in Japan

Myeloproliferative neoplasms (MPN) are caused by somatic mutations in hematopoietic stem/progenitor cells and result in excessive increase in the blood cell mass in the peripheral blood and/or fibrosis in the bone marrow. JAK2, CALR, and MPL mutations are well-known driver mutations of MPN and are widely applied as diagnostic markers of MPN. Moreover, several studies using massive parallel sequencing technologies have shown that mutations in ASXL1, EZH2, SRSF2, and IDH1/2 affect the prognosis of overt primary myelofibrosis and have further clarified that the mutation order may influence the MPN phenotype. More recently, our group identified that CREB3L1 mRNA was overexpressed in a platelet- and megakaryocyte-specific manner in driver mutation positive MPN and that the quantitation of this gene expression can be used as a diagnostic marker for MPN. In this educational lecture, we discuss the clinical impacts of the mutations frequently identified in MPN patients.

Hematologic neoplasms incidence categorised by WHO classification and centralization of treatment facilities in Japan: Analysing a nationwide Hospital-Based Cancer Registry data.

e19348 Background: More than 55,000 patients are diagnosed as hematologic neoplasms in Japan. In this study incidence of hematologic neoplasms was categorised based on the World Health Organisation (WHO) classification, and centralisation of treatment facilities was analysed, using the nationwide Hospital-Based Cancer Registries (HBCR) which covers more than 65% of new cancer patients. Methods: The HBCR data for patients diagnosed in 2017 was used. We categorized patients in line with the 2017 Revision of WHO classification of lymphoid, myeloid neoplasms, and acute leukaemia. Incidence and age distribution was analysed by subtype. Centralisation of treatment facilities for haematological malignancy patients was also analysed. Hospitals were classified into four approximately equal groups based on patient volume per year (very high: over 108 patients; high: 43-107; low: 10-42; and very low: under 10). Results: In total, 51,936 patients in 809 hospitals were identified. Overall average age was 68.4 years (SD 16.5). 43.6% were diagnosed as mature B-cell neoplasms except plasma cell neoplasms, followed by 12.6% of myelodysplastic/myeloproliferative neoplasms and myelodysplastic syndromes, 10.1% of plasma cell neoplasms, 9.4% of myeloproliferative neoplasms, and 8.8% of acute myeloid leukaemia and related precursor neoplasms. 1,438 patients (2.8%) were diagnosed as precursor lymphoid neoplasms and 54.7% of these patients were under 10 years old. Looking at the age distribution of mature B-cell neoplasms, 70s were accounted for 32.6% and 60s were accounted for 26.4%. Among hematologic patients aged 70s, 46.4% were mature B-cell neoplasms and remaining 14.3% of myelodysplastic/myeloproliferative neoplasms. Most of patients received treatment at very high (62.1%, 206 hospitals) or high patient volume hospitals (28.5%, 200 hospitals). Only 1.8% of patients received treatment at very low patient volume hospitals (221 hospitals) which have less than 10 hematologic patients per year. Most of patients received treatment at very low patient volume hospitals were mature B-cell neoplasms. Conclusions: In this study, the first detailed analysis of the number of hematologic neoplasms by subtype was performed. Treatment facilities for hematologic neoplasms patients was almost centralised.

Advances in the diagnosis and treatment of pancreatic neuroendocrine neoplasms in Japan.

Several new developments have occurred in the field of pancreatic neuroendocrine neoplasm (PNEN) recently in Japan. First, the utility of chromogranin A (CgA), useful for the diagnosis and monitoring of the treatment response of neuroendocrine neoplasm (NEN), has been demonstrated in Japan. For PNEN diagnosis and treatment, grading and correct histological diagnosis according to the WHO 2010 classification is important. Regarding the histological diagnosis, the advent of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has enabled correct pathological diagnosis and suitable treatment for the affected tissue. Furthermore, EUS-FNA has also facilitates the assessment of the presence or absence of gene mutations. In addition, patients who have a well-differentiated neuroendocrine tumor (NET) showing a Ki-67 index of higher than 20% according to the WHO 2010 classification, have also been identified, and their responses to treatment were found to be different from those of patients with poorly differentiated neuroendocrine carcinoma (NEC). Therefore, the concept of NET G3 was proposed. Additionally, somatostatin receptor type 2 is expressed in several cases of NET, and somatostatin receptor scintigraphy (111In-octreoscan) has also been approved in Japan. This advancement will undoubtedly contribute to the localization diagnosis, the identification of remote metastasis, and assessments of the treatment responses of PNEN. Finally, regarding the treatment strategy for PNEN, the management of liver metastasis is important. The advent of novel molecular-targeted agents has dramatically improved the prognosis of advanced PNEN. Multimodality therapy that accounts for the tumor stage, degree of tumor differentiation, tumor volume, and speed of tumor growth is required.

Japan Society of Gynecologic Oncology guidelines 2013 for the treatment of uterine body neoplasms.

The third version of the Japan Society of Gynecologic Oncology guidelines for the treatment of uterine body neoplasms was published in 2013. The guidelines comprise nine chapters and nine algorithms. Each chapter includes a clinical question, recommendations, background, objectives, explanations, and references. This revision was intended to collect up-to-date international evidence. The highlights of this revision are to (1) newly specify costs and conflicts of interest; (2) describe the clinical significance of pelvic lymph node dissection and para-aortic lymphadenectomy, including variant histologic types; (3) describe more clearly the indications for laparoscopic surgery as the standard treatment; (4) provide guidelines for post-treatment hormone replacement therapy; (5) clearly differentiate treatment of advanced or recurrent cancer between the initial treatment and the treatment carried out after the primary operation; (6) collectively describe fertility-sparing therapy for both atypical endometrial hyperplasia and endometrioid adenocarcinoma (corresponding to G1) and newly describe relapse therapy after fertility-preserving treatment; and (7) newly describe the treatment of trophoblastic disease. Overall, the objective of these guidelines is to clearly delineate the standard of care for uterine body neoplasms in Japan with the goal of ensuring a high standard of care for all Japanese women diagnosed with uterine body neoplasms.

Role of magnifying colonoscopy for diagnosis of colorectal neoplasms: From the perspective of Japanese colonoscopists.

Colorectal cancer is the third leading cause of cancer-related death. As the therapeutic strategy for colorectal cancer depends on the clinical stage of the tumor, precise and accurate staging is necessary prior to treatment decision-making. Colonoscopy is an essential tool for detection and prevention of colorectal cancer, as it also allows for removal of adenomatous lesions. Using conventional endoscopy, however, it is sometimes difficult to differentiate neoplastic lesions from non-neoplastic lesions. Several new endoscopic technologies have been developed to provide a more precise diagnosis. Magnifying chromoendoscopy and narrow-band imaging endoscopy with or without magnification are invaluable not only for distinction of colorectal neoplastic lesions from non-neoplastic lesions, but also for the accurate diagnosis of invasion depth in colorectal cancers. Based on an accumulation of a large number of clinical data, the use of magnifying colonoscopy has become inevitable for the prediction of histology and the diagnosis of invasion depth of colorectal neoplasms in Japan.

Outcome and Risk Factors for Therapy-Related Myeloid Neoplasms Treated with Allogeneic Stem Cell Transplantation

BackgroundTherapy-related myeloid neoplasms (t-MN) have a poor prognosis with conventional chemotherapy and a median survival of ≤1 year. Allogeneic stem cell transplantation (HCT) is considered the only effective treatment. EBMT and CIBMTR analyzed their registry data on HCT against t-MN and reported its outcome and developed scoring systems using identified risk factors in HCT. This study aimed to investigate outcome and risk factors in adult patients with t-MN who underwent HCT in Japan.MethodsData sourceFor this retrospective observational study, recipients' clinical data were provided by the Transplant Registry Unified Management Program of Japan society for Hematopoietic Cell Transplantation.DefinitionTherapy-related myeloid neoplasms include therapy-related AML (t-AML), t-MDS, and t-MDS/MPN occurring as late complications of cytotoxic chemotherapy and/or radiation therapy administered for a prior neoplastic or non-neoplastic disorder. Cases with past history of MDS or MPN were excluded because it was not possible to clearly distinguish their neoplasms from an original myeloid neoplasm or therapy-related neoplasm.The primary outcome of the analysis was overall survival (OS), whereas the secondary endpoints included incidence of relapse and transplantation-related mortality (TRM).Cytogenetic risk groups in AML were classified according to the MRC (2010). In MDS, three risk groups were defined using the revised International Scoring System: favorable (very good and good), intermediate (intermediate), poor (poor and very poor). HLA mismatch was defined as incompatibility between the recipient and donor when at least a single allele mismatch was detected at HLA-A, -B, and -DR in related and unrelated donors. In cord blood, HLA mismatch was defined as at least two antigen mismatches detected at HLA-A, -B, and -DR.Statistical analysisOS was estimated using the Kaplan-Meier method and was compared using the log-rank test. Cox's proportional-hazards regression model was used for multivariate analysis of prognostic factors. Cumulative incidence curves were used in a competing-risk setting to calculate the probability of relapse and TRM. Relapse and therapy-related deaths were considered a competing risk event for each other and were compared using Gray's test.ResultsBetween 1992 and 2012, 641 adult patients who had undergone HCTs for confirmed t-MN (not de novo myeloid neoplasms) were identified. Median age at HCT was 53 (range; 16-80) years, with a female proportion of 49%. In total, 414 (64.6%) patients had AML, 215 (33.5%) had MDS, and 12 (1.9%) had MPN. Approximately 50% of patients had a prior history of lymphoma, 14.6% had acute leukemia, and 13.3% had breast cancer. Karyotype was available in 310 cases. Favorable karyotypes were detected in 11 (3.5%) cases, whereas intermediate and poor karyotypes were detected in 122 (39.4%) and in 177 (57.1%) cases, respectively. HLA mismatched HCT was 25.7%. Bone marrow or peripheral HCT from related donors was used in 189 (28.7%) cases, whereas bone marrow HCT from unrelated donor was used in 228 (35.7%) cases, and cord blood HCT was used in 229 (35.6%) cases. Approximately 30% of patients were in remission at HCT.Overall survival was 45.3% [95% confident interval (CI) 45-48], 33% (CI 29-37), and 28% (CI 24-32) at 1, 3, and 5 years, respectively. In multivariate analysis, the significant factors for poor survival were ECOG Performance Status (PS) 2-4 (HR 1.99; CI 1.45-2.72), disease status of non-remission at the time of HCT (HR 1.82; CI 1.33-2.50), patient age of >55 years (HR 1.72; CI 1.32-2.24), and poor karyotype (HR 1.54; CI 1.15-2.05).The cumulative incidence of non-relapse mortality and relapse at 3 years was 37% and 36%, respectively. In a multivariate analysis, the significant factor for non-relapse mortality was patient age of >55 years (HR 1.48; CI 1.09-2.02). For relapse, poor karyotype (HR 2.29; CI 1.65-3.18) was a significant factor.ConclusionsPS 2-4, non-remission, higher patient age, and poor cytogenetics were predictive of poor survival. The outcome of HCT against therapy-related myeloid neoplasms in Japan was comparable to those of EBMT and CIBMTR. DisclosuresUsuki:Novartis: Other: personal fees, Research Funding; GlaxoSmithKline: Other: personal fees, Research Funding; Taiho Pharmaceutical: Other: personal fees, Research Funding; Fuji Film RI Pharma: Other: personal fees; Chugai Pharmaceutical: Other: personal fees; Sumitomo Dainippon Pharma: Other: personal fees, Research Funding; Celgene: Other: personal fees, Research Funding; Boehringer Ingelheim: Other: personal fees, Research Funding; Nippon Shinyaku: Other: personal fees, Research Funding; Shionogi: Other: personal fees; Sanofi: Other: personal fees, Research Funding; MSD: Other: personal fees, Research Funding; SymBio Pharmaceutical: Other: personal fees, Research Funding; Eisai: Research Funding; Otsuka Pharmaceutical: Research Funding; Kyowa Hakko Kirin: Other: personal fees, Research Funding; Shire: Research Funding; Takeda Pharmaceutical: Research Funding; Fujimoto Pharmaceutical: Research Funding; Bristol-Myers Squibb: Other; Astellas: Research Funding. Miyazaki:Chugai: Honoraria, Research Funding; Sumitomo Dainippon: Honoraria; Celgene Japan: Honoraria; Kyowa-Kirin: Honoraria, Research Funding; Shin-bio: Honoraria.

Current problems in the diagnosis of Philadelphia-negative myeloproliferative neoplasms in Japan

To investigate the current situation and issues regarding the diagnosis of Philadelphia-negative myeloproliferative neoplasms (MPN) in Japan, we retrospectively analyzed an accumulated cohort consisting of 1,081 patients with suspected MPN. Based on WHO2008 diagnostic criteria, we diagnosed 101 of these patients with polycythemia vera, 179 with essential thrombocythemia, 36 with primary myelofibrosis, 45 with unclassifiable MPN, and 4 with myelodysplastic syndromes. Out of 716 patients, 235 were not diagnosed with MPN despite the detection of a JAK2, CALR, or MPL mutation. Among 156 patients with undefined MPN receiving further follow-up, none underwent bone marrow examination and screening for BCR-ABL1 was not performed in 88 cases. Thus, diagnosis was not possible in these cases due to a lack of essential examinations. Since the prognosis and treatment strategy associated with MPN differ among disease types, in addition to mutation analysis, the importance of bone marrow examination and screening for BCR-ABL1 must be re-recognized.

Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection

groups, respectively (P!0.001). Median follow up period was 32 months (range, 0147.4 months). The five-year overall survival rates were 96.7% and 95.3% for absolute and expanded indication group, respectively (pZ0.940). Local recurrence was observed in five tumors (0.3%) at 2, 2, 6, 19 and 34 months after first ESD (3 en bloc and 2 piecemeal resection). Extragastric recurrence occurred in two EGC cases (0.13%) meeting each AI and EI. The extragastric recurrence interval was 62 months in the AI group and 46 months in the EI group. At that time, endoscopic examination showed no evidence of local recurrence around ER scar area. Metachronous recurrence occurred in 49 EGC cases (2.7%) during follow-up period. The median metachronous recurrence interval was 27.0 months (range, 13-115 months). The cumulative incidence of metachronous recurrence is increased steadily. Conclusions: The expanded indication of ER for EGCs showed acceptable long-term outcomes. Endoscopic examination is required more than 5 years after ER for EGC because the cumulative incidence of metachronous recurrence is increased steadily. Extragatric recurrence occurred at least two years after ESD in most cases unlikely ordinary recurrence pattern of AGC. CT should be performed together with endoscopy for surveillance of recurrence after ER for EGC in the AI group as well as the EI group. Sa1508 Long-Term Follow-up of Extremely Elderly Patients With Early Gastric Neoplasms Treated by Endoscopic Submucosal Dissection Tatsuya Toyokawa*, Tomoki Inaba, Koichi Izumikawa, Isao Fujita, Shigenao Ishikawa, Jun Tomoda Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, Fukuyama, Japan; Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan Background: Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early gastric neoplasms in Japan. Recently, ESD has gained momentum worldwide. With the increase in the aging population, the number of elderly patients undergoing ESD for the treatment of early gastric neoplasms has steadily increased. This study aimed to investigate the long-term clinical outcomes of early gastric neoplasm in patients aged S 85 years who underwent ESD. Methods: The study subjects were 1123 cases with early gastric neoplasms who underwent ESD from May 2003 to August 2010 at Fukuyama Medical Center, Kagawa Prefectural Centrall Hospital, and Mitoyo General Hospital. The patients were classified into two groups as follows: the elderly group (S 85-years-old) and the nonelderly group (! 85-years-old). We compared the characteristics of patients and lesions, treatment outcomes, procedure-related complications and prognosis between the two groups. Statistical analysis was performed using Mann-Whitney U-test and Chi-square test, p! 0.05 was considered to be statistically significant. Results: The elderly group included 62 cases and the non-elderly group included 1061 cases. The mean follow-up period was approximately 51 months. The female to male ratio was significantly higher in the elderly group than in the non-elderly group. The underlying incidences of hypertension and heart disease were significantly higher in the elderly group. The location, size and types of lesions were not significantly different between the two groups. The mean size of resected specimens from the elderly patients was larger than that from the non-elderly patients (39 mm vs. 35 mm). The en-bloc resection (97% vs. 93%) and curative resection rates (89% vs 84%) were high in both groups. The procedure time was similar between the two groups. No significant procedure-related complications, such as perforation or delayed bleeding, were observed in the two groups. The rates of residual disease or recurrence in both groups were very low (0% vs. 1.1%), and the differences were not significant. The death rate was significantly higher in the elderly group (26% vs. 7.1%) during the follow-up period. However the original disease was not the cause in either of the groups, and there were no significant differences in the reason for death or the period from ESD to death between the two groups. Conclusions: In this study, the treatment of early gastric neoplasms by ESD was equally effective in extremely elderly patients and non-elderly patients. Furthermore, it was elucidated that the death rate because of other diseases is higher in extremely elderly patients and that they have Data and Outcomes for Preand Post-Clipping Phases # of Colonscopies # of Patients # of Polyps Male/ Female Mean Age and Range Polypectomy Duration Mean and Range(minutes) Pre-Clipping 2121 55 65 36/19 69.3 (37-87) 17.47 (2-61)

JAK2V617F mutation status and allele burden in classical Ph-negative myeloproliferative neoplasms in Japan

JAK2V617F, a gain-of-function mutation in the tyrosine kinase JAK2, is frequently detected in classical myeloproliferative neoplasms (MPNs). In the present study, we determined the JAK2V617F allele burden in Japanese MPN patients using alternately binding probe competitive-polymerase chain reaction, a highly quantitative method recently developed by our group. Although we observed strong similarities in terms of epidemiological parameters associated with the JAK2V617F allele burden between our cohort and others, we found a higher JAK2V617F allele burden in Japanese polycythemia vera (PV) patients and lower frequencies of thrombosis in Japanese MPN patients compared with previous reports. In addition, despite the presence of high red blood cell counts, some patients bearing the JAK2V617F mutation were not diagnosed as PV, as their hemoglobin values were lower than the WHO PV criterion. In these patients, the JAK2V617F allele burden was strikingly similar to that in PV patients fulfilling the 2008 WHO criteria, suggesting that these patients can be classified as PV. Although isotopic measurement of red cell mass (RCM) is required for definitive diagnosis of PV, our data suggest that precise measurement of the JAK2V617F allele burden may improve the diagnosis of PV when RCM has not been determined.

Cutaneous lymphoma in Japan: A nationwide study of 1733 patients

Types of cutaneous lymphoma (CL) and their incidences may vary among geographic areas or ethnic groups. The present study aimed to investigate the incidences of various CL in Japan, using epidemiological data from a nationwide registration system for CL. Between 2007 and 2011, 1733 new patients with CL were registered from over 600 dermatological institutes in Japan. The 1733 patients registered included 1485 (85.7%) patients with mature T- and natural killer (NK)-cell neoplasms, 224 (12.9%) with B-cell neoplasms and 24 (1.4%) with blastic plasmacytoid dendritic cell neoplasm. Mycosis fungoides (MF) is the most common CL subtype in the present study (750 patients, 43.3%). The proportion of MF patients with early-stage disease was 73%, similar to that of previous studies from other cohorts. The incidence rates of adult T-cell leukemia/lymphoma and extranodal NK/T-cell lymphoma, nasal type were 16.7% and 2.0%, respectively, which may account for the higher incidence of mature T- and NK-cell neoplasms in Japan, as compared with that in the USA and Europe. A male predominance was observed in most types of CL, except for several CL subtypes such as subcutaneous panniculitis-like T-cell lymphoma.

Mo1220 Pneumonia Associated With Endoscopic Submucosal Dissection for Gastric Neoplasms: Prospective Cohort Study

Endoscopic submucosal dissection (ESD) has been established as a standard treatment for gastric neoplasms in Japan. Critical complications such as perforation and bleeding have been reported after ESD. Therefore, care of the physical condition of patient is needed during and after ESD. This prospective cohort study aimed to elucidate the incidence and characteristics of pneumonia associated with ESD for gastric neoplasms using computed tomography (CT).

Mo1575 Comparison of the Outcome of Endoscopic Submucosal Dissection (ESD) Using Sodium Hyaluronate and Needle-Knife Versus Endoscopic Aspiration Mucosectomy (EAM) for Esophageal Squamous Cell Neoplasm

Endoscopic submucosal dissection (ESD) has been developed for superficial esophageal neoplasm in Japan, because ESD enables large en-bloc resection. En-bloc resection for GI tract lesion is desirable to facilitate accuracy of the histopathological assessment. The aim of this study was to compare the long-term outcomes between ESD and endoscopic aspiration mucosectomy (EAM) for esophageal squamous cell neoplasm.

Evidence-based guidelines for treatment of uterine body neoplasm in Japan: Japan Society of Gynecologic Oncology (JSGO) 2009 edition

Endometrial carcinoma is one of the most common gynecologic malignancies in Japan and its incidence has increased recently. Although surgery is the cornerstone of the management of patients with endometrial cancer, there is significant variation in Japan with regard to the type of hysterectomy employed. Additionally, it remains controversial whether full nodal staging is required in all patients. Furthermore, adjuvant therapy differs between Japan and Western countries. To delineate clearly the standard of care for endometrial cancer treatment in Japan, the guidelines for the treatment of endometrial cancer were published in 2006 and revised in 2009. The 2009 edition included topics not addressed in the previous edition including the treatment of mesenchymal tumors, for example leiomyosarcoma, and sections covering the treatment of serous and clear-cell adenocarcinoma. These guidelines are composed of nine chapters and include nine algorithms. The guidelines also contain fifty-one clinical questions (CQs) and each CQ consists of recommendations, background, explanations, and references. The treatment recommendations herein are tailored to reflect current Japanese clinical practice and ensure equitable care for all Japanese women diagnosed with endometrial cancer.