High CEA level is known to have a close relationship with tumor load, such as size and number of tumor. Positive node at colon surgery, or stage of primary tumor has a close relationship to tumor-free interval (time to hepatic recurrence).
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Different facets of cardiac metabolism have been studied with radiotracers. In the current issue of the Journal, Manabe et al.14 comprehensively reviewed the various radiotracers that are used to evaluate cardiac metabolism. Since the heart derives its energy from a variety of sources such as free fatty acids, glucose, lactate, and ketone bodies, it is possible to study cardiac metabolism using these sources. SPECT radiotracers include 123I-BMIPP (beta-methyl-p-iodophenylpentadecanoic acid) and 123I-IPPA (iodophenylpentadecanoic acid), whereas PET tracers include 18F-FDG (fluorodeoxyglucose), 11C-Palmitate, 18F-FTHA (fluoro-6-thia-heptadecanoic acid), and 11C-Acetate.
Tumor involving the middle BD (MID or DIFFUSE) had a higher rate of perineural invasion as compared to the DISTAL group. The overall and disease-free survival rate for the MID or DIFFUSE group was significantly worse than that of DISTAL. In the MID/DIFFUSE group, there was no significant difference of survival according to the type of the operation (pancreaticoduodenectomy or segmental BD resection). The multivariate analysis showed that tumor involving middle BD (MID or DIFFUSE group) and node metastasis were independently poor prognostic factors for the disease free and overall survival.
A statistical analysis were performed using SPSS, version 13.0 for Windows (SPSS,Inc., Chicago IL,USA). Comparison between the groups was performed using an independent t test and ANOVA for continuous variables and Chi-square test for categorical variables. Overall and disease-free survivals were calculated using the Kaplan-Meier method. A univariate analysis of the survival curves was performed using the log-rank test. A multivariate regression analysis was performed using a Cox proportional hazards model to identify the independent prognostic factors for survival. A P value of
An univariate analysis showed that tumor location, gross tumor appearance, differentiation, lymph node metastasis, lymphovascular invasion, and perineural invasion were significant prognostic factors for disease-free and overall survival. The results of the multivariate analysis showed that tumor involving extrapancreatic BD and lymph node metastasis were independently poor prognostic factors for disease-free and overall survival. (Table 2).
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