The most important indication for vascular resection in patients with pancreatic cancer is the ability to obtain cancer-free surgical margins. Otherwise, vascular resection is contraindicated. Extended lymphadenectomy may be not of benefit.

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The pituitary tumor transforming gene 1 (PTTG1) protein is cell-cycle regulated and is identified as a human securin that inhibits sister chromatid separation and is involved in transformation and tumorigenesis. PTTG1 has very low or undetectable expression in most normal human tissues, but it is abundantly expressed in malignant cell lines and pituitary tumors. In this study, we investigated human PTTG1 expression in 62 hepatocellular carcinoma (HCC) specimens using quantitative real-time reverse transcription polymerase chain reaction analysis. We found that, compared with corresponding noncancerous liver tissues, PTTG1 was remarkably overexpressed in HCCs (PTTG1/␤-actin; 0.443 ؎ 0.073 vs. 0.068 ؎ 0.007; P < .0001). Furthermore, we found a significant correlation between PTTG1 expression and serum alpha-fetoprotein level (P < .001). Univariate and multivariate analyses revealed that the PTTG1 messenger RNA (mRNA) expression was an independent prognostic factor for disease-free (odds ratio 2.70; P ‫؍‬ .037) and overall (odds ratio 5.35; P ‫؍‬ .007) survival. Moreover, we discovered a significant relationship between PTTG1 expression and intratumoral microvessel density. Our data supported an important role for PTTG1-mediated upregulation of fibroblast growth factor ( H epatocellular carcinoma (HCC) is a common cancer worldwide, especially in Southeast Asia and Africa, and it is the third leading cause of death from malignant disease in Japan. 1 Surgical treatments including hepatic resection and liver transplantation improve the chances of survival for a patient with HCC. However, most patients experience recurrence or metastasis after surgery, and their prognosis remains poor. 2 Therefore, to further improve patient survival, identifying genetic markers of recurrence or metastasis of HCC is important.Recent developments in microarray technology have ushered in a new era in medical science, allowing precise identification of the genetic factors associated with various tumors. [3][4][5] Ramaswamy et al. 6 reported that 17 genes were associated with metastasis in several primary solid tumors and that the pituitary tumor transforming gene 1 (PTTG1) protein was one of them. PTTG1 was originally isolated from cloned rat GH4 pituitary tumor cells, 7 and its human homolog hpttg was cloned from a thymus cDNA library. 8 It is identified as a human securin that inhibits sister chromatid separation and is involved in malignant transformation and tumorigenesis. 9 At the end of metaphase, securin is degraded by an anaphase promoting complex, releasing tonic inhibition of separin, which in turn mediates the degradation of cohesions, the proteins that hold sister chromatid together. Overexpression of the undegradable PTTG1 disrupts the sister chromatid

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Histopathological examination of lymph node metastatic involvement in 139 specimens obtained from patients who underwent pancreatoduodenectomy or total pancreatectomy combined with wide resection of lymph nodes was performed, to clarify the critical areas of lymph node dissection in patients with carcinoma of the head of the pancreas region. Perigastric lymph node involvement in patients with carcinoma of the head of the pancreas was 14 per cent, in those with carcinoma of the distal bile duct 0 per cent and in those with carcinoma of the papilla of Vater 4 per cent. Para-aortic lymph node involvement in patients with carcinoma of the head of the pancreas, the distal bile duct and the papilla of Vater was 26, 9 and 0 per cent, respectively. On the basis of these results, pylorus-preserving pancreatoduodenectomy is indicated in almost all patients with carcinoma of the distal bile duct and the papilla of Vater. In patients with carcinoma of the head of the pancreas, however, wide dissection of lymph nodes, including para-aortic lymph nodes, should be carried out because of the relatively high incidence of para-aortic lymph node involvement.

Hypermethylation and LOH appear to be common mechanisms for inactivation of RUNX3 in HCC. Therefore, RUNX3 may be an important tumor suppressor gene related to hepatocarcinogenesis.