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This study suggests that radical resection provides the best survival rate for patients with hilar bile duct carcinoma. For patients with stage IVA disease, following complete gross resection radiotherapy improved treatment outcome.

The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus‐based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual‐energy x‐ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic‐ and sex‐specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.

To define the involvement of p16/CDKN2 and p15/MTS2 tumor-suppressor genes for response to chemotherapy in primary epithelial ovarian cancer, we analyzed alterations of the gene in 45 patients who were treated with primary cytoreductive surgery followed by 6 courses of cis-diamminedichloroplatinum (II) (cisplatin)-based combination chemotherapy. Homozygous deletion of p16/CDKN2 and p15/MTS2 genes was found in 8 (18%) and 15 (33%) cases, respectively. Response to the chemotherapy was confirmed by finding at second surgery after the chemotherapy in 26 patients, resulting in 17 responders and 9 nonresponders. The abundance of gene deletion in nonresponders (56%) was significantly higher (p ‫؍‬ 0.0463) when compared to that in responders (18%). Moreover, the deletion of genes was a significant poor prognostic factor (p ‫؍‬ 0.0441) in advanced ovarian cancer. These results suggest that deletion of p16/CDKN2 and/or p15/MTS2 is a potential indicator for poor chemotherapy response and adverse prognosis in ovarian cancer patients. © 2002 Wiley-Liss, Inc. Key words: p16/CDKN2; p15/MTS2; chemotherapy; ovarian cancerOvarian cancer is the leading cause of death from gynecologic malignancy. Cisplatin-based chemotherapy has played an important role in the treatment of ovarian cancer and has resulted in a substantially improved response rate of approximately 60%. 1,2 However, the overall survival of the advanced cancer has remained unimproved at around 20% because considerable numbers of patients harbor resistant or refractory tumor to chemotherapy. 3 The mechanism of cisplatin resistance is estimated to be multifactorial and it remains unclear how genetic events are associated with the resistance in ovarian cancer. 4 The putative tumor-suppresser genes, p16/CDKN2 and p15/ MTS2, are known to be inactivated by deletion, mutation and hypermethylation in a variety of human tumors. 5,6 Since several studies indicate controversial impacts of the gene inactivation on in vitro sensitivity to chemotherapeutic agents including cisplatin, 7-10 its contribution to the drug-resistance phenotype in cancer patients is not well understood.To clarify the involvement of p16/CDKN2 and p15/MTS2 inactivation with response to cisplatin-based chemotherapy, we examined the alteration of the genes in 45 primary ovarian cancers using the PCR method and analyzed the relationship between gene inactivation and sensitivity to the chemotherapy retrospectively. MATERIAL AND METHODS Patients, chemotherapy and response evaluationForty-five primary epithelial ovarian cancer patients who were treated at National Defense Medical College hospital (Saitama, Japan) during 1988 -1996 were enrolled in our study. Samples analyzed were obtained from the patients at the first surgery with an appropriate informed consent. Multiple specimens with characteristic appearance of cancer (i.e., papillary growth) were removed from the bulk tissue and the adjacent portion was examined microscopically to eliminate samples with rich interstitial tissue to minimize normal tissue cont...