Nuclear heat shock protein 110 expression is associated with poor prognosis and hyperthermo-chemotherapy resistance in gastric cancer patients with peritoneal metastasis

AIM To investigate the significance of heat shock protein 110(HSP110) in gastric cancer(GC) patients with peritoneal metastasis undergoing hyperthermochemotherapy.METHODS Primary GC patients(n = 14) with peritoneal metastasis or positive peritoneal lavage cytology who underwent distal or total gastrectomy between April 2000 and December 2011 were enrolled in this study. The patients underwent postoperative intraperitoneal hyperthermo-chemotherapy using a Thermotron RF-8 heating device two weeks after surgery. We analyzed nuclear HSP110 expression in surgically resected tumors using immunohistochemistry. Additionally, the effect of HSP110 suppression on hyptherthermochemosensitivity was assessed in vitro in the MKN45 GC cell line using the HSP inhibitor KNK437. RESULTS HSP110 immnohistochemical staining in 14 GC patients showed that five(35.7%) samples belonged to the low expression group, and nine(64.3%) samples belonged to the high expression group. Progression-free survival was significantly shorter in the HSP110 high-expression group than in the low-expression group(P = 0.0313). However, no significant relationships were identified between HSP110 expression and the clinicopathological characteristics of patients. Furthermore, high HSP110 expression was not an independent prognostic factor in GC patients with peritoneal metastasis(P = 0.0625). HSP110 expression in MKN45 cells was suppressed by KNK437 at the hyperthermic temperature of 43 ℃ in vitro. Comparison of MKN45 cell proliferation in the presence and absence of KNK437 at 43 ℃, revealed that proliferation was significantly decreased when HSP110 was inhibited by KNK437. Additionally, HSP110 suppression via HSP inhibitor treatment increased cellular sensitivity to hyperthermo-chemotherapy in vitro.CONCLUSION The expression of nuclear HSP110 in GC patients might be a new marker of chemosensitivity and a therapeutic target for patients who are tolerant to existing hyperthermo-chemotherapies.

Gastrojejunostomy for pyloric stenosis after acute gastric dilatation due to overeating

A 34-year-old woman presented at our hospital withabdominal distention due to overeating.Acute gastric dilatation was diagnosed.The patient was hospitalized,and nasogastric decompression was initiated.On hospitalization day 3,she developed shock,and her respiratory state deteriorated,requiring intubation and mechanical ventilation.Nasogastric decompression contributed to the improvement in her clinical condition.She was discharged 3 mo after admission.During outpatient follow-up,her dietary intake decreased,and her body weight gradually decreased by 14 kg.An upper gastrointestinal series and endoscopy revealed pyloric stenosis; therefore,we performed gastrojejunostomy 18 mo after her initial admission.The patient was discharged from the hospital with no postoperative complications.Gastric necrosis and perforation due to overeating-induced gastric dilatation are life-threatening conditions.Surgical intervention may be required if delayed pyloric stenosis occurs after conservative treatment.We report a case of pyloric stenosis due to overeating-induced gastric dilatation treated by gastrojejunostomy 18 mo after the initial presentation.