Tumor budding and human chorionic gonadotropin-β expression correlate with unfavorable patient outcome in colorectal carcinoma

Tumor budding is thought to represent a manifestation of epithelial-to-mesenchymal transition (EMT) and it has been correlated with poor patient outcomes in colorectal cancer (CRC). Our group recently demonstrated that human chorionic gonadotropin-β (hCGβ) modulates EMT in CRC. In the current study, based on the likely relationships between tumor budding and hCGβ expression, we examined their clinicopathologic significance in CRC. Twenty-eight of 80 (35.0%) CRC showed tumor budding. Tumor budding significantly correlated with lymph node metastasis (P < 0.01), pathologic stage (P < 0.01), lymphatic invasion (P = 0.044), and vascular invasion (P = 0.013). Thirteen of 80 (16.3%) CRC were hCGβ positive on immunohistochemistry. More tumor buds were present in the hCGβ-positive cases (P < 0.01), and tumor budding was significantly correlated with hCGβ positivity (P < 0.01). Cases with both tumor budding and hCGβ expression had the poorest prognosis compared with all other groups (P < 0.01). In conclusion, tumor budding and hCGβ expression are closely associated with EMT, and they are independent prognostic factors in CRC. They identify patients with an "EMT phenotype" who may respond to targeted molecular therapies

Living Donor Liver Transplantation in an Elderly Recipient with Preserved Performance Status : A Case Report

Background : Living donor liver transplantation (LDLT) in an elderly recipient is controversial. Case presentation : We report a case of LDLT in a 74-year-old female who had decompensated liver cirrhosis and hepatocellular carcinoma (HCC). She was the oldest recipient who received LDLT in Japan ever. She was rejected for LDLT at a nearby hospital because of her age.We decided to perform LDLT because her general condition was good (the Eastern Cooperative Oncology Group (ECOG) performance status 2 ). The surgery was uncomplicated and the postoperative course was uneventful, and the patient was discharged 35 days after the surgery. Currently she is living at home, and she has maintained a good quality of life. Conclusions : We believe that a recipient in good general condition is capable of undergoing LDLT despite advanced age.【はじめに】高齢者に生体肝移植を行うべきかどうかについては，議論のあるところである．【症例】74 歳女性．検診で肝機能異常を指摘され，原発性胆汁性肝硬変と診断，経過観察されていた．その後肝予備能が低下し，他院にて生体肝移植が検討されたが，70 歳を超えていたため適応外とされた．当院では70 歳以上の肝移植症例の経験もあり，レシピエントの全身状態が良好であったこと（PS2），グラフト条件も満たしていたことから，生体肝移植可能と判断し，生体肝移植術（拡大左葉グラフト）施行．術後経過は概ね良好で，術後35 日目退院となった．現在も在宅・生存中であり，非常に良好なQOLを維持している．【考察】生体肝移植は，高齢レシピエントに対してもPS が保たれている場合は，安全に施行出来る可能性が高く，良好な術後成績を得られると考える