201
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Camacho JC, Petre EN, Sofocleous CT. Thermal Ablation of Metastatic Colon Cancer to the Liver. Semin Intervent Radiol 2019; 36:310-318. [PMID: 31680722 DOI: 10.1055/s-0039-1698754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.
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Affiliation(s)
- Juan C Camacho
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
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202
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Kron P, Linecker M, Jones RP, Toogood GJ, Clavien PA, Lodge JPA. Ablation or Resection for Colorectal Liver Metastases? A Systematic Review of the Literature. Front Oncol 2019; 9:1052. [PMID: 31750233 PMCID: PMC6843026 DOI: 10.3389/fonc.2019.01052] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Successful use of ablation for small hepatocellular carcinomas (HCC) has led to interest in the role of ablation for colorectal liver metastases (CRLM). However, there remains a lack of clarity about the use of ablation for colorectal liver metastases (CRLM), specifically its efficacy compared with hepatic resection. Methods: A systematic review of the literature on ablation or resection of colorectal liver metastases was performed using MEDLINE, Cochrane Library, and Embase until December 2018. The aim of this study was to summarize the evidence for ablation vs. resection in the treatment of CRLM. Results: This review identified 1,773 studies of which 18 were eligible for inclusion. In the majority of the studies, overall survival (OS) and disease-free survival (DFS) were significantly higher and local recurrence (LR) rates were significantly lower in the resection groups. On subgroup analysis of solitary CRLM, resection was associated with improved OS, DFS, and reduced LR. Three series assessed the outcome of resection vs. ablation for technically resectable CRLM, and showed improved outcome in the resection group. In fact, there were no studies showing a survival advantage of ablation compared to resection in the treatment of CRLM. Conclusions: Resection remains the "gold standard" in the treatment of CRLM and should not be replaced by ablation at present. This review supports the use of ablation only as an adjunct to resection and as a single treatment option when resection is not safely possible.
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Affiliation(s)
- Philipp Kron
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Michael Linecker
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert P Jones
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Giles J Toogood
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, Swiss HPB and Transplant Center, University Hospital Zurich, Zurich, Switzerland
| | - J P A Lodge
- Department of HPB and Transplant Surgery, St. James's University Hospital, NHS Trust, Leeds, United Kingdom
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203
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Narayan RR, Harris JW, Chou JF, Gönen M, Bao F, Shia J, Allen PJ, Balachandran VP, Drebin JA, Jarnagin WR, Kemeny NE, Kingham TP, D'Angelica MI. Prediction of Recurrence Patterns from Hepatic Parenchymal Disease After Resection of Colorectal Liver Metastases. Ann Surg Oncol 2019; 27:188-195. [PMID: 31617122 DOI: 10.1245/s10434-019-07934-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obesity and metabolic syndrome are associated with inflammatory hepatic parenchymal disease (HPD) and increased risk for recurrence after resection of colorectal liver metastases (CRLM). The independent impact of HPD on recurrence patterns has not been well defined. METHODS The nonalcoholic fatty liver disease activity score (NAS) was used to quantify HPD including steatosis and fibrosis for all patients with completely resected CRLM between April 2003 and March 2007. Clinicopathologic factors, perioperative history, and outcomes were compared with the NAS. Fisher's exact test was used to examine the association between severe HPD (NAS ≥ 3) with clinical and perioperative characteristics. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS). The cumulative incidences of recurrence [any intrahepatic recurrence (IHR), extrahepatic recurrence only (EHR), and death without recurrence (DWR)] were estimated using competing risks methods. RESULTS Among the 357 patients included in this study, microsteatosis was noted in 124 (35%) patients, severe HPD in 31 (9%), steatohepatitis in 14 (4%), and sinusoidal injury in 36 (10%). After median follow-up of 127 months (range 4-175 months), 10-year RFS was 22% [95% confidence interval (CI) 17-27%]. Ten-year cumulative incidence for IHR, EHR, and DWR was 37%, 30%, and 12%, respectively. After controlling for confounders, NAS ≥ 3 was independently associated with higher risk of IHR [hazard ratio (HR) 1.76, 95% CI 1.07-2.90, p = 0.027] and lower risk of EHR (HR 0.18, 95% CI 0.04-0.75, p = 0.019) on multivariable analysis. CONCLUSIONS Severe HPD was associated with increased IHR risk and decreased EHR risk. Future investigation into whether improving HPD from reversible etiologies can reduce the risk for IHR is warranted.
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Affiliation(s)
- Raja R Narayan
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer W Harris
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanne F Chou
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gönen
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fei Bao
- Department of Pathology, Scripps Clinic, La Jolla, CA, USA
| | - Jinru Shia
- Department of Pathology, Gastrointestinal Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter J Allen
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy E Kemeny
- Department of Medicine, Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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204
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Jin B, Du S, Xu H, Zheng Y, Lu X, Sang X, Mao Y. Laparoscopic hepatectomy for patients who received enterostomy. J Minim Access Surg 2019; 15:325-330. [PMID: 30106029 PMCID: PMC6839349 DOI: 10.4103/jmas.jmas_78_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Laparoscopic hepatectomy is more conducive to the rapid rehabilitation of patients after surgery compared with open hepatectomy. However, there have been no reports on performing laparoscopic resection for liver metastases in enterostomy patients. MATERIALS From December 2016 to April 2017, the Liver Surgery Department of the Peking Union Medical College Hospital received three patients who had focal liver lesions after colorectal cancer surgery and enterostomy. We performed laparoscopic hepatectomy for these three patients and reviewed relevant literature. RESULTS All of these three patients' post-operative recovery was good. We found three different positions of the stomas and the corresponding abdominal adhesions in these three patients. We also summarised several possible related surgical techniques. CONCLUSION For patients with colorectal cancer and enterostomy after an operation, implementation of laparoscopic hepatectomy is feasible. Further research is still required for a more comprehensive assessment of this surgical approach.
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Affiliation(s)
- Bao Jin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Shunda Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Yongchang Zheng
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Beijing, China
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205
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Huang C, Huang J, Luo H, Zong Z, Zhu Z. Comparative Efficacy of Preoperative, Postoperative, and Perioperative Treatments for Resectable Colorectal Liver Metastases: A Network Meta-Analysis. Front Pharmacol 2019; 10:1052. [PMID: 31619998 PMCID: PMC6759603 DOI: 10.3389/fphar.2019.01052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/20/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Several treatment strategies are used for management of resectable colorectal liver metastases. We performed a Bayesian network meta-analysis to compare preoperative, postoperative, or perioperative treatments, identifying the optimal approach. Methods: We searched reports of randomized controlled trials through the relevant databases. The primary outcome criterion was overall survival (OS). The secondary outcome measure was disease-free survival (DFS). We calculated the hazard ratio (HR) with the 95% credible interval (Crl) of the time-to-event data. Rank probabilities were evaluated by the probability of treatment rankings. Multiple treatment comparisons based on a Bayesian network integrated the efficacy of all included approaches. Results: Twenty-two eligible randomized controlled trials with 6,115 patients were included in the network meta-analysis. One treatment that resulted in a significant improvement in OS compared with surgery alone was hepatic arterial infusion (HAI) plus postoperative chemotherapy (CT) [HR = 0.74 with 95% Crl: (0.60, 0.94)]. With regard to the secondary outcome measure, three approaches that led to a significant improvement in DFS compared with surgery alone were HAI plus postoperative CT [HR = 1.44 with 95% Crl: (1.19, 1.75)], postoperative CT [HR = 1.14 with 95% Crl: (1.01, 1.29)], preoperative hepatic and regional arterial chemotherapy (PHRAC) plus preoperative CT [HR = 1.41 with 95% Crl: (1.03, 1.89)]. According to the results for the rank probabilities of the 11 treatments, the combination of HAI and bevacizumab plus postoperative CT showed the highest probability of benefitting OS, and PHRAC plus preoperative CT was most likely to benefit DFS. Conclusions: The combination of HAI and bevacizumab plus postoperative CT exhibited the greatest odds of being the most effective treatment for improving OS, and PHRAC plus preoperative CT exhibited the greatest odds of improving DFS. Further clinical studies are needed and justified.
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Affiliation(s)
| | | | | | | | - Zhengming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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206
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Džunić M, Pejčić B, Andjelković-Apostolović M, Vrbić S, Pejčić I, Petković I. PREDICTORS OF THERAPY RESPONSE AND EARLY RECURRENCE IN PATIENTS WITH POTENTIALLY RESECTABLE COLORECTAL LIVER METASTASES TREATED WITH BEVACIZUMAB AND FOLFOX4 AS A CONVERSION THERAPY. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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207
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Salvage RFA in patients with intrahepatic recurrence after major hepatic surgery for colorectal cancer liver metastases: mid-term outcome. Eur Radiol 2019; 30:1221-1227. [PMID: 31493210 DOI: 10.1007/s00330-019-06421-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the mid-term outcome of salvage radiofrequency ablation (RFA) treatment in patients who exhibited intrahepatic recurrence after major hepatectomy for colorectal liver metastases (CRCLM). METHODS Observational study on 23 consecutive patients (mean age 59 ± 9 years; 14/9 male/female) who, after a single (11/23) or multiple rounds (12/23) of major hepatic surgery, developed recurrent CRCLM in the liver remnant. Patients with a maximum of three metastases measuring up to 3 cm, and without relevant extrahepatic disease, underwent CT-guided RFA. Using the Kaplan-Meier-method, median intrahepatic progression-free-survival (ihPFS) and overall survival (OS) times after salvage RFA were compared with the same patients' time between the respective last round of surgery and diagnosis of intrahepatic recurrence leading to RFA. RESULTS Median follow-up was 26 months (range 12-103 months). Median ihPFS time after RFA was 8 months (range 1-81 months). Median ihPFS time after the respective last round of surgery and RFA in the same patients had been 5 months (range 1-23 months), thus yielding similar ihPFS times after surgery vs. after salvage RFA (p = 0.238; Mood's median test). After RFA, 15/23 (65%) of patients developed new hepatic metastases within the first year post-RFA. Median OS was 37 months, with a 1-year OS rate of 100%, 3-year OS rate of 57%, and 5-year OS rate of 24%. No major complications were observed. CONCLUSIONS Patients who exhibit intrahepatic recurrence of CRCLM after major hepatectomy will experience intrahepatic recurrence after salvage RFA as well, and after similar time intervals. However, long-term ihPFS may still be achieved in some patients. KEY POINTS • Patients who exhibit intrahepatic recurrence of colorectal liver metastases after major hepatectomy will experience intrahepatic recurrence after salvage RFA as well, and after similar time intervals. • About two-thirds of all patients develop new metastases elsewhere in the liver within 1 year after RFA. • However, long-term intrahepatic progression-free survival may still be achieved in some patients.
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208
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Ito T, Sugiura T, Okamura Y, Yamamoto Y, Ashida R, Uesaka K. The impact of posthepatectomy liver failure on long-term survival after hepatectomy for colorectal liver metastasis. HPB (Oxford) 2019; 21:1185-1193. [PMID: 30777694 DOI: 10.1016/j.hpb.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/04/2019] [Accepted: 01/18/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Postoperative complications affect both the short-term and long-term outcomes. The aim of this study was to identify specific prognostic factors among complications after hepatectomy for colorectal liver metastasis (CRLM). METHODS Between 2002 and 2014, 427 patients underwent initial hepatectomy for CRLM. The clinicopathological parameters including postoperative complications were evaluated to identify the prognostic factors for the overall (OS) and relapse-free survival (RFS). RESULTS One hundred and forty-nine patients (34%) developed postoperative complications, including surgical site infection (n = 49, 11.4%), bile leakage (n = 41, 9.6%), posthepatectomy liver failure (PHLF) (n = 26, 6.0%), and pulmonary complication (n = 20, 4.6%). The independent predictors of RFS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, bilateral CRLMs, ≥5 CRLMs, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year RFS rates in patients with and without PHLF were 8% and 32%, respectively (P < 0.001). The independent prognostic factors for OS included primary nodal metastasis, abnormal CA19-9 levels, extrahepatic metastasis, positive surgical margins, preoperative chemotherapy, lack of adjuvant chemotherapy and PHLF. The 5-year OS rates in patients with and without PHLF were 31% and 63%, respectively (P = 0.004). CONCLUSIONS Among the complications, only PHLF was associated with decreased long-term survival after hepatectomy for CRLM as well as tumor-specific prognostic factors.
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Affiliation(s)
- Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
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209
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Poulsen MH, Jakobsen JS, Mortensen MA, Høilund-Carlsen PF, Lund L. Does therapy of the primary tumor matter in oligometastatic prostate cancer? A prospective 10-year follow-up study. Res Rep Urol 2019; 11:215-221. [PMID: 31440485 PMCID: PMC6679689 DOI: 10.2147/rru.s190140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/15/2019] [Indexed: 11/23/2022] Open
Abstract
Objective: The effect of curative treatment for oligometastatic prostate cancer patients is unsolved, both with regard to morbidity and mortality. With this study, we provide some of the first long-term follow-up data on progression and mortality in oligometastatic prostate cancer patients after curative treatment of their primary tumor. Methods: A cohort of 210 patients with diagnosed prostate cancer was established between 2008 and 2010. All patients were scheduled for intended curative treatment, and all underwent blinded 18F-choline positron-emission tomography/computed tomography at inclusion prior to curative treatment. Upon unblinding, 12 patients (6%) were recategorized as being oligometastatic. They had a mean age of 64 years,
median prostate-specific antigen of 18 ng/mL, and median Gleason score of 7. Six patients were staged as T3, one T2, and five T1. The patients had a median
of one bone metastasis (range 1–2). All underwent intended curative radiotherapy or prostatectomy. Mean follow-up was 10.1 (8.9–11.0) years. Results: During follow-up of the 12 patients, three (25%) had biochemical recurrence, two developed castration-resistant disease, and one died due to prostate cancer. Conclusion: Our results suggest that intended curative treatment of the primary tumor in oligometastatic prostate cancer may have a role in highly selected patients.
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Affiliation(s)
- Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | | | - Mike Allan Mortensen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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210
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ALPPS Improves Resectability Compared With Conventional Two-stage Hepatectomy in Patients With Advanced Colorectal Liver Metastasis: Results From a Scandinavian Multicenter Randomized Controlled Trial (LIGRO Trial). Ann Surg 2019; 267:833-840. [PMID: 28902669 PMCID: PMC5916470 DOI: 10.1097/sla.0000000000002511] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: The aim of the study was to evaluate if associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) could increase resection rates (RRs) compared with two-stage hepatectomy (TSH) in a randomized controlled trial (RCT). Background: Radical liver metastasis resection offers the only chance of a cure for patients with metastatic colorectal cancer. Patients with colorectal liver metastasis (CRLM) and an insufficient future liver remnant (FLR) volume are traditionally treated with chemotherapy with portal vein embolization or ligation followed by hepatectomy (TSH). This treatment sometimes fails due to insufficient liver growth or tumor progression. Methods: A prospective, multicenter RCT was conducted between June 2014 and August 2016. It included 97 patients with CRLM and a standardized FLR (sFLR) of less than 30%. Primary outcome—RRs were measured as the percentages of patients completing both stages of the treatment. Secondary outcomes were complications, radicality, and 90-day mortality measured from the final intervention. Results: Baseline characteristics, besides body mass index, did not differ between the groups. The RR was 92% [95% confidence interval (CI) 84%–100%] (44/48) in the ALPPS arm compared with 57% (95% CI 43%–72%) (28/49) in the TSH arm [rate ratio 8.25 (95% CI 2.6–26.6); P < 0.0001]. No differences in complications (Clavien–Dindo ≥3a) [43% (19/44) vs 43% (12/28)] [1.01 (95% CI 0.4–2.6); P = 0.99], 90-day mortality [8.3% (4/48) vs 6.1% (3/49)] [1.39 [95% CI 0.3–6.6]; P = 0.68] or R0 RRs [77% (34/44) vs 57% (16/28)] [2.55 [95% CI 0.9–7.1]; P = 0.11)] were observed. Of the patients in the TSH arm that failed to reach an sFLR of 30%, 12 were successfully treated with ALPPS. Conclusion: ALPPS is superior to TSH in terms of RR, with comparable surgical margins, complications, and short-term mortality.
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211
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Georgakis GV, Goldberg I, Sasson AR. Current Trends in the Surgical Management of Colorectal Cancer Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00440-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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212
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Matsumura M, Yamashita S, Ishizawa T, Akamatsu N, Kaneko J, Arita J, Nakajima J, Kokudo N, Hasegawa K. Oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases. Am J Surg 2019; 219:80-87. [PMID: 31217074 DOI: 10.1016/j.amjsurg.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases (SLLM) have not been fully investigated. METHODS Patients undergoing initial hepatectomy for colorectal liver metastases (CLM) from 2005 to 2016 were divided into three groups: patients with isolated CLM undergoing complete resection (Group1, n = 317), SLLM undergoing complete metastasectomy (Group2, n = 33), and SLLM undergoing complete hepatectomy but incomplete lung resection (Group3, n = 20). A staged strategy (hepatectomy followed by lung resection) without interval chemotherapy was mainly applied for SLLM. RESULTS The 5-year overall survival rate of Group2 was significantly better than that of Group3 (71.7% vs. 10.2%, P < 0.001) and similar to that of Group1 (63.9%, P = 0.779). The 5-year disease-free survival rate was significantly worse in Group2 than Group1 (15.7% vs. 29.0%, P = 0.035). On multivariable analysis, CEA>200 ng/ml was the sole predictor of incomplete resection of lung metastases (odds ratio, 13.7; 95% confidence interval, 1.30-145; P = 0.011). CONCLUSIONS The prognosis in patients with SLLM who achieve complete metastasectomy is acceptable and might be improved by appropriate selection based on operative indications.
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Affiliation(s)
- Masaru Matsumura
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Suguru Yamashita
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeaki Ishizawa
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobuhisa Akamatsu
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Kaneko
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junichi Arita
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Nakajima
- Departments of Thoracic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Norihiro Kokudo
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyoshi Hasegawa
- Departments of Hepato-Biliary-Pancreatic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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213
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Giuliante F, Panettieri E, Ardito F, De Rose A, Pocino K, Autilio C, Paolillo C, Capoluongo ED. Circulating tumor cell-related transcripts in blood as prognostic biomarkers of early recurrence after liver resection for colorectal metastases. Int J Biol Markers 2019; 34:269-275. [PMID: 31213130 DOI: 10.1177/1724600819849438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several prognostic factors were proposed to improve early detection of recurrence after liver resection of metastases of colorectal cancer. Circulating tumor cell-related transcripts were evaluated in colorectal cancer patients with conflicting results. The aim of this study was to investigate usefulness of carcinoembryonic antigen CAM5, epidermal growth factor receptor, and ERCC1 transcripts in the bloodstream as predictive factors of recurrence in patients who underwent liver resection for metastases of colorectal cancer. METHODS Peripheral blood was collected from 29 patients at the time of the colorectal cancer liver metastasis resection, and from 25 normal controls. Follow-up draws (FUDs) were also performed at 30 days, and 3 and 12 months since surgery. On each sample, carcinoembryonic antigen CAM5, ERCC1, and GAPDH mRNAs were examined by quantitative reverse transcription (qRT). RESULTS Carcinoembryonic antigen transcript levels were linearly correlated to the number of spiked cells (qRT analytical limit = five cells). Among 29 patients (20 M/9 F; mean age 63 years (range 32-79), highly significant levels of carcinoembryonic antigen, if compared to the baseline, were detected in those relapsing after surgery (P <0.05). The main differences were between the 1st- and 12th-month FUDs. Significantly higher levels of carcinoembryonic antigen were also detected in patients who died from disease progression during the follow-up (as evaluated at 30 days and 90 days FUDs). CONCLUSIONS Blood carcinoembryonic antigen-mRNA absolute copy number overtime variation can represent a valid early predictor of relapse after liver resection in colorectal liver metastases patients. Prospective studies, in the context of large clinical trials, will provide further data to also qualify ERCC1 as a predictive biomarker for decisions on therapeutic strategies.
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Affiliation(s)
- Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Agostino De Rose
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Krizia Pocino
- Laboratory of Molecular Diagnostics and Genomics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Autilio
- Laboratory of Molecular Diagnostics and Genomics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmela Paolillo
- Laboratory of Molecular Diagnostics and Genomics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ettore Domenico Capoluongo
- Laboratory of Molecular Diagnostics and Genomics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Ghiasloo M, Kahya H, Van Langenhove S, Grammens J, Vierstraete M, Berardi G, Troisi RI, Ceelen W. Effect of treatment sequence on survival in stage IV rectal cancer with synchronous and potentially resectable liver metastases. J Surg Oncol 2019; 120:415-422. [PMID: 31218689 DOI: 10.1002/jso.25516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The optimal treatment sequence in stage IV rectal cancer (RC) with synchronous liver metastases (SLM) remains undefined. Here, we compared outcomes between patients treated with the bowel-first approach (BFA) or the liver-first approach (LFA). METHODS Consecutive patients diagnosed with stage IV RC with SLM and who underwent complete resection were included. Both groups were matched using propensity scores. Differences in postoperative outcome, local control, and long-term survival were studied. In addition, a decision analysis (DA) model was built using TreeAge Pro to define the approach that results in the highest treatment completion rate. RESULTS During a 12-year period, 52 patients were identified, 21 and 31 of whom underwent the BFA and the LFA, respectively. Twenty-eight patients were matched; patients treated with the BFA experienced a longer median OS (50.0 vs 33.0 months; P = .40) and higher 5-year OS (42.9% vs 28.6%). The DA defined the BFA to be superior when the failure threshold (ie, no R0 resection, treatment discontinuation regardless of cause) for colectomy is less than 28.6%. CONCLUSIONS In stage IV rectal cancer with SLM, either the BFA or the LFA result in similar long-term outcomes. Treatment should be tailored according to clinicopathological variables.
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Affiliation(s)
| | - Hasan Kahya
- Department of GI Surgery, Ghent University Hospital, Belgium
| | | | - Julien Grammens
- Department of GI Surgery, Ghent University Hospital, Belgium
| | | | | | - Roberto I Troisi
- Department of GI Surgery, Ghent University Hospital, Belgium.,Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Belgium.,Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
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215
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Arrazubi V, Mata E, Antelo ML, Tarifa A, Herrera J, Zazpe C, Teijeira L, Viudez A, Suárez J, Hernández I, Vera R. Circulating Tumor Cells in Patients Undergoing Resection of Colorectal Cancer Liver Metastases. Clinical Utility for Long-Term Outcome: A Prospective Trial. Ann Surg Oncol 2019; 26:2805-2811. [PMID: 31209673 DOI: 10.1245/s10434-019-07503-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with resected colorectal cancer liver metastases display heterogeneous clinical behavior. The identification of new prognostic factors would help in making more accurate decisions. OBJECTIVE The aim of this study was to evaluate the survival impact of circulating tumor cells (CTCs) in this setting. METHODS We conducted a prospective study of patients with resected liver metastases of colorectal cancer. Patients were included in the study from February 2009 to January 2013. The CellSearch System™ was employed for the detection of pre- and postsurgery CTCs. A positive test was defined as two or more CTCs/7.5 mL of blood. Recurrence rate, disease-free survival, and overall survival were calculated, and univariate and multivariate analyses were performed. RESULTS Forty-four patients were included in our study. After a median follow-up of 60 months (range 28-74), 32 patients experienced recurrence (72.7%). The CTCs number was determined and the test was positive in 8 patients (18.6%) before surgery and 13 patients (29.5%) after surgery. The postoperative detection of CTCs was not related to any clinical outcome; however, the preoperative detection of CTCs was significantly related to behavior. All patients in the preoperative CTC-positive group relapsed, versus 65% in the CTC-negative group (p = 0.051). Disease-free survival was 19 months in the preoperative CTC-negative group versus 7 months in the CTC-positive group (p = 0.01). Additionally, overall survival was 69 months in the preoperative CTC-negative group versus 17 months in the CTC-positive group (p = 0.004). Preoperative CTC count remained significant in multivariate analysis. CONCLUSIONS In this cohort of colorectal cancer liver metastases patients, the presence of two or more preoperative CTCs was associated with disease progression and poor survival despite complete resection.
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Affiliation(s)
- Virginia Arrazubi
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain.
| | - Elena Mata
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - María Luisa Antelo
- Department of Hematology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Antonio Tarifa
- Department of Gastrointestinal Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Javier Herrera
- Department of Gastrointestinal Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Cruz Zazpe
- Department of Gastrointestinal Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Lucía Teijeira
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Antonio Viudez
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Javier Suárez
- Department of Gastrointestinal Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Irene Hernández
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ruth Vera
- Department of Medical Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
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216
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Kawaguchi Y, Lillemoe HA, Panettieri E, Chun YS, Tzeng CWD, Aloia TA, Kopetz S, Vauthey JN. Conditional Recurrence-Free Survival after Resection of Colorectal Liver Metastases: Persistent Deleterious Association with RAS and TP53 Co-Mutation. J Am Coll Surg 2019; 229:286-294.e1. [PMID: 31054911 DOI: 10.1016/j.jamcollsurg.2019.04.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/19/2019] [Accepted: 04/22/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Conditional recurrence-free survival (RFS) probability, that is, the probability of remaining recurrence-free after a given interval without recurrence, has not been reported after resection of colorectal liver metastases (CLMs). We aimed to estimate conditional RFS and identify factors affecting conditional RFS. STUDY DESIGN Patients undergoing initial resection of CLMs during 2000-2016 with mutation data were identified. The RFS and risk factors for recurrence were evaluated at the time of resection for all patients and at 1 year and 2 years after resection for patients who remained recurrence-free. RESULTS Of 2,118 patients, 485 met the inclusion criteria, of which 225 were recurrence-free at 1 year and 109 were recurrence-free at 2 years. The 5-year RFS rates were 17.3%, 36.8%, and 70.7% for all patients and the 1-year and 2-year recurrence-free groups, respectively, when assessed from the time of initial CLM resection. RAS/TP53 co-mutation was the only factor independently associated with increased risk of recurrence for all groups (all patients, hazard ratio 1.47; 95% CI 1.19 to 1.82; p < 0.001; 1-year recurrence-free, hazard ratio 1.69; 95% CI 1.17 to 2.43; p = 0.005; 2-year recurrence-free, hazard ratio 2.41; 95% CI 1.12 to 5.17; p = 0.024). T category, extrahepatic disease, multiple CLMs, largest CLM diameter, and surgical margin status were risk factors for recurrence in all patients and/or the 1-year recurrence-free group, but not the 2-year recurrence-free group. Median RFS was lower for patients with RAS/TP53 co-mutation than for those with RAS/TP53 wild-type in the 1-year (1.5 vs 2.8 years; p = 0.006) and 2-year recurrence-free groups (3.0 vs 5.9 years; p = 0.024). CONCLUSIONS Conditional RFS is useful for updating prognosis after a given time interval without recurrence after CLM resection. Importantly, RAS/TP53 co-mutation has a persistent deleterious association with recurrence.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elena Panettieri
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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217
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Zhang J, Gong Z, Gong Y, Guo W. Development and validation of nomograms for prediction of overall survival and cancer-specific survival of patients with Stage IV colorectal cancer. Jpn J Clin Oncol 2019; 49:438-446. [PMID: 30924498 PMCID: PMC6487593 DOI: 10.1093/jjco/hyz035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/04/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical resection of patients with resectable Stage IV colorectal cancer (CRC) is regarded as first choice if possible. However, its influence on overall survival (OS) has not been thoroughly explored. In this study, we aimed to construct nomograms to help predict 1-, 3- and 5-year OS rate and colorectal cancer-specific survival (CCSS) rate. METHODS A total of 2996 cases who underwent primary and metastatic resection were selected in the study from surveillance, epidemiology and end results (SEER) database. About 48 Stage IV CRC patients after resection from the Fudan University Shanghai Cancer Center (FUSCC) were assigned as an independent external validation group. Log-rank and multivariate Cox regression analysis were used. The competing-risks model was used to estimate the cumulative incidence of death. Nomograms were built for prediction of OS and CCSS after surgical resection in patients with Stage IV CRC. RESULTS The 1-, 3- and 5-year probabilities of OS were 76.6%, 41.4% and 23.2%, respectively. The 1-, 3- and 5-year colorectal cumulative incidence of death were 23.0%, 54.9% and 71.3%, respectively. The calibration curves for probability of 1-, 3- and 5-year OS and CCSS showed optimal agreement between nomogram prediction and actual observation, and the Harrell's C-indexes for the nomograms to predict OS and CCSS were 0.662 and 0.650, respectively. For FUSCC validation set, the C-index for this model to predict OS was 0.657. CONCLUSION Nomograms for prediction of OS and CCSS of patients with Stage IV CRC who underwent primary and metastatic resection were built. Performance of the model was excellent. These nomograms may be helpful for patients and physicians when making a decision.
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Affiliation(s)
- Jieyun Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Zhe Gong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Yiwei Gong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Weijian Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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218
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Conditional Survival Analysis of Metastatic Colorectal Cancer Patients Living ≥24 Months: A Single Institutional Study. Am J Clin Oncol 2019; 42:512-518. [PMID: 30973370 DOI: 10.1097/coc.0000000000000535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The survival of patients with metastatic colorectal cancer (CRC) has been increasing over recent decades due to improvements in chemotherapy and surgery. There is a need to refine prognostic information to more accurately predict survival as patients survive for any given length of time to assist multidisciplinary cancer management teams in treatment decisions. MATERIALS AND METHODS We performed a single center retrospective analysis of patients treated with metastatic CRC (unresectable and resectable) who survived >24 months between 2005 and 2015 (N=155). Patient tumor and treatment related variables were collected. Overall survival (OS) estimates conditional on surviving >24 months were compared with actuarial survival estimates of a cohort of patients (33,104 resected, 39,382 unresected) from the National Cancer Database (NCDB). RESULTS With a median follow-up of 44.2 months, the median OS of resected patients (n=86) was not reached. The median OS of unresected patients was 75.9 months. The conditional survival probabilities of living 1, 2, or 3 years longer after 24 months of survival are 92%, 72%, and 52%, respectively, in unresectable patients and 98%, 92%, and 89% in patients who were resected. The corresponding NCDB 1, 2, and 3 year actuarial survival was 38%, 20%, and 11% for unresected patients and 68%, 46%, and 32% for resected. CONCLUSIONS These results indicate that CRC patients who survive 24 months with metastatic colorectal cancer have an excellent prognosis and surgery may be appropriate in a subset of patients initially deemed unresectable.
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219
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Imai K, Yamashita YI, Miyamoto Y, Nakao Y, Yusa T, Itoyama R, Nakagawa S, Okabe H, Hiyoshi Y, Nitta H, Chikamoto A, Baba H. Implication of primary tumor location for the indication of preoperative chemotherapy in patients with colorectal liver metastases. HPB (Oxford) 2019; 21:405-412. [PMID: 30266494 DOI: 10.1016/j.hpb.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/04/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The benefit of preoperative chemotherapy for colorectal liver metastases (CRLM) remains uncertain. The aim was to clarify the effect of preoperative chemotherapy on CRLM according to the primary tumor location. METHODS Among a total cohort of 163 patients who underwent curative hepatectomy for CRLM, 36 patients had a right-sided and 127 had a left-sided primary tumor. According to the performance of preoperative chemotherapy, survival analysis was conducted and prognostic factors were identified. RESULTS Preoperative chemotherapy was administered to 17 patients (47.2%) with a right-sided and 74 (58.3%) with a left-sided primary tumor (P = 0.24). Among the patients who received preoperative chemotherapy, overall survival (OS) and disease-free survival (DFS) were similar between patients with right- and left-sided primary tumors (P = 0.36 and P = 0.44, respectively). Among the patients who underwent upfront hepatectomy, the OS and DFS of patients with a right-sided primary tumor were worse than those with a left-sided primary tumor (P = 0.02 and P = 0.025, respectively). Among the patients who underwent upfront surgery, the right-sided primary tumor was identified as an independent poor prognostic factor for OS (hazard ratio 3.44, P = 0.021). CONCLUSION The existence of a right-sided primary tumor may be an indication of preoperative chemotherapy for patients with CRLM.
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Affiliation(s)
- Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshihiko Yusa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Rumi Itoyama
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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220
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Nierop PMH, Galjart B, Höppener DJ, van der Stok EP, Coebergh van den Braak RRJ, Vermeulen PB, Grünhagen DJ, Verhoef C. Salvage treatment for recurrences after first resection of colorectal liver metastases: the impact of histopathological growth patterns. Clin Exp Metastasis 2019; 36:109-118. [PMID: 30843120 PMCID: PMC6445820 DOI: 10.1007/s10585-019-09960-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/04/2019] [Indexed: 12/23/2022]
Abstract
The majority of patients recur after resection of colorectal liver metastases (CRLM). Patients with CRLM displaying a desmoplastic histopathological growth pattern (dHGP) have a better prognosis and lower probability of recurrence than patients with non-dHGP CRLM. The current study evaluates the impact of HGP type on the pattern and treatment of recurrences after first resection of CRLM. A retrospective cohort study was performed, including patients with known HGP type after complete resection of CRLM. All patients were treated between 2000 and 2015. The HGP was determined on the CRLM resected at first partial hepatectomy. The prognostic value of HGPs, in terms of survival outcome, in the current patient cohort were previously published. In total 690 patients were included, of which 492 (71%) developed recurrent disease. CRLM displaying dHGP were observed in 103 patients (21%). Amongst patients with dHGP CRLM diagnosed with recurrent disease, more liver-limited recurrences were seen (43% vs. 31%, p = 0.030), whereas patients with non-dHGP more often recurred at multiple locations (34% vs. 19%, p = 0.005). Patients with dHGP CRLM were more likely to undergo curatively intended local treatment for recurrent disease (adjusted odds ratio: 2.37; 95% confidence interval (CI) [1.46-3.84]; p < 0.001) compared to patients with non-dHGP. The present study demonstrates that liver-limited disease recurrence after complete resection of CRLM is more often seen in patients with dHGP, whereas patients with non-dHGP more frequently experience multi-organ recurrence. Recurrences in patients with dHGP at first CRLM resection are more likely to be salvageable by local treatment modalities, but no prognostic impact of HGPs after salvage therapy for recurrent disease was found.
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Affiliation(s)
- Pieter M H Nierop
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Boris Galjart
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Diederik J Höppener
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric P van der Stok
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - Peter B Vermeulen
- Translational Cancer Research Unit, (GZA Hospitals and University of Antwerp), Antwerp, Belgium
| | - Dirk J Grünhagen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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221
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Nonresectional regional therapies for metastatic colorectal cancer to the liver. J Surg Oncol 2019; 119:636-641. [DOI: 10.1002/jso.25423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/20/2023]
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Editorial: Advances in clinical liver transplantation: expanding indications and improving peri- and post-transplant care. Curr Opin Organ Transplant 2019; 24:111-112. [PMID: 30730355 DOI: 10.1097/mot.0000000000000626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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223
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Immune modulation of liver sinusoidal endothelial cells by melittin nanoparticles suppresses liver metastasis. Nat Commun 2019; 10:574. [PMID: 30718511 PMCID: PMC6361944 DOI: 10.1038/s41467-019-08538-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/30/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022] Open
Abstract
Liver sinusoidal endothelial cells (LSECs) are responsible for the immunologic tolerance of liver which is a common site for visceral metastases, suggesting its potential role as an target for cancer immunotherapy. However, targeted modulation of LSECs is still not achieved thus far. Here, we report LSECs are specifically targeted and modulated by melittin nanoparticles (α-melittin-NPs). Intravital imaging shows that LSECs fluoresce within 20 s after intravenous injection of α-melittin-NPs. α-melittin-NPs trigger the activation of LSECs and lead to dramatic changes of cytokine/chemokine milieu in the liver, which switches the hepatic immunologic environment to the activated state. As a result, α-melittin-NPs resist the formation of metastatic lesions with high efficiency. More strikingly, the survival rate reaches 80% in the spontaneous liver metastatic tumor model. Our research provides support for the use of α-melittin-NPs to break LSEC-mediated immunologic tolerance, which opens an avenue to control liver metastasis through the immunomodulation of LSECs. Liver sinusoidal endothelial cells are known to promote immune tolerance in liver. Here, the authors target these cells using melittin nanoparticles and show alterations in the liver immune environment and suppression of liver metastases.
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224
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van Dijk DP, Krill M, Farshidfar F, Li T, Rensen SS, Olde Damink SW, Dixon E, Sutherland FR, Ball CG, Mazurak VC, Baracos VE, Bathe OF. Host phenotype is associated with reduced survival independent of tumour biology in patients with colorectal liver metastases. J Cachexia Sarcopenia Muscle 2019; 10:123-130. [PMID: 30378742 PMCID: PMC6438330 DOI: 10.1002/jcsm.12358] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/24/2018] [Accepted: 09/13/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Most prognostic scoring systems for colorectal liver metastases (CRLMs) account for factors related to tumour biology. Little is known about the effects of the host phenotype to the tumour. Our objective was to delineate the relationship of systemic inflammation and body composition features [i.e. low skeletal muscle mass (sarcopenia) and low visceral adipose tissue (VAT)], two well-described host phenotypes in cancer. METHODS Clinical data and pre-operative blood samples were collected from 99 patients who underwent resection of CRLM. Pre-operative computed tomography scans were available for 97 patients; body composition was analysed at the L3 level, stratified for sex and age. Clinicopathological variables, serum C-reactive protein (CRP), and various body composition variables were evaluated. Overall survival was evaluated as a function of these same variables in multivariate Cox regression analysis. RESULTS Skeletal muscle was significantly correlated with VAT (r = 0.46, P < 0.001). Of patients with sarcopenia, 35 (65%) also had low VAT. C-reactive protein was elevated (≥5 mg/mL) in 42 patients (43.3%). Elevated CRP was more common in patients with sarcopenia (73.8% vs. 51.1%, P = 0.029). The most significant prognostic factors were the coincidence of elevated CRP and adverse body composition features (sarcopenia and/or low VAT; hazard ratio 4.3, 95% confidence interval 1.5-13.0, P = 0.008), as well as Fong clinical prognostic score (hazard ratio 2.9, 95% confidence interval 1.5-5.5, P = 0.002). CONCLUSIONS Body composition in patients with CRLM is not directly linked to the presence of systemic inflammation. However, when systemic inflammation coincides with sarcopenia and/or low VAT, prognosis is adversely affected, independent of the Fong clinical prognostic score.
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Affiliation(s)
- David P.J. van Dijk
- Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Matthew Krill
- Department of Surgery and Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
| | | | - Ting Li
- Department of Surgery and Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
| | - Sander S. Rensen
- Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Steven W.M. Olde Damink
- Department of SurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
- NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
- Department of General, Visceral and Transplantation SurgeryRWTH University Hospital AachenAachenGermany
- Institute for Liver and Digestive HealthUniversity College LondonLondonUK
| | - Elijah Dixon
- Department of Surgery and Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
| | - Francis R. Sutherland
- Department of Surgery and Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
| | - Chad G. Ball
- Department of Surgery and Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
| | - Vera C. Mazurak
- Division of Human Nutrition, Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonCanada
| | | | - Oliver F. Bathe
- Department of Surgery and Oncology, Tom Baker Cancer CentreUniversity of CalgaryCalgaryCanada
- Arnie Charbonneau Cancer InstituteCalgaryCanada
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225
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Impact of Surgical Treatment for Recurrence After 2-Stage Hepatectomy for Colorectal Liver Metastases, on Patient Outcome. Ann Surg 2019; 269:322-330. [DOI: 10.1097/sla.0000000000002472] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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226
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Narayan RR, Goldman DA, Gonen M, Reichel J, Huberman KH, Raj S, Viale A, Kemeny NE, Allen PJ, Balachandran VP, D'Angelica MI, DeMatteo RP, Drebin JA, Jarnagin WR, Kingham TP. Peripheral Circulating Tumor DNA Detection Predicts Poor Outcomes After Liver Resection for Metastatic Colorectal Cancer. Ann Surg Oncol 2019; 26:1824-1832. [PMID: 30706231 DOI: 10.1245/s10434-019-07201-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Liver resection can be curative for well-selected metastatic colorectal cancer (CRC) patients. Circulating tumor DNA (ctDNA) has shown promise as a biomarker for tumor dynamics and recurrence following CRC resection. This prospective pilot study investigated the use of ctDNA to predict disease outcome in resected CRC patients. METHODS Between November 2014 and November 2015, 60 patients with CRC were identified and prospectively enrolled. During liver resection, blood was drawn from peripheral (PERIPH), portal (PV), and hepatic (HV) veins, and 3-4 weeks postoperatively from a peripheral vein (POSTOP). Kappa statistics were used to compare mutated (mt) genes in tissue and ctDNA. Disease-specific and disease-free survival (DSS and DFS) were assessed from surgery with Kaplan-Meier and Cox methods. RESULTS For the 59 eligible patients, the most commonly mutated genes were TP53 (mtTP53: 47.5%) and APC (mtAPC: 50.8%). Substantial to almost-perfect agreement was seen between ctDNA from PERIPH and PV (mtTP53: 89.8%, κ = 0.73, 95% confidence interval [CI] 0.53-0.93; mtAPC: 94.9%, κ = 0.83, 95% CI 0.64-1.00), as well as HV (mtTP53: 91.5%, κ = 0.78, 95% CI 0.60-0.96; mtAPC: 91.5%, κ = 0.73, 95% CI 0.51-0.95). Tumor mutations and PERIPH ctDNA had fair-to-moderate agreement (mtTP53: 72.9%, κ = 0.44, 95% CI 0.23-0.66; mtAPC: 61.0%, κ = 0.23, 95% CI 0.04-0.42). Detection of PERIPH mtTP53 was associated with worse 2-year DSS (mt+ 79% vs. mt- 90%, P = 0.024). CONCLUSIONS Peripheral blood reflects the perihepatic ctDNA signature. Disagreement between tissue and ctDNA mutations may reflect the true natural history of tumor genes or an assay limitation. Peripheral ctDNA detection before liver resection is associated with worse DSS.
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Affiliation(s)
- Raja R Narayan
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan Reichel
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kety H Huberman
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandeep Raj
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Agnes Viale
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy E Kemeny
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter J Allen
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I D'Angelica
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald P DeMatteo
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey A Drebin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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227
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Guraya SY. Pattern, Stage, and Time of Recurrent Colorectal Cancer After Curative Surgery. Clin Colorectal Cancer 2019; 18:e223-e228. [PMID: 30792036 DOI: 10.1016/j.clcc.2019.01.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 02/07/2023]
Abstract
Surgery remains the mainstay of curative treatment for colorectal cancer (CRC). Despite curative surgery, some patients experience cancer recurrence. However, the pattern, stage, and time of recurrent disease (RD) remain unknown. We aimed to determine the pattern and stage of RD after curative open and laparoscopic surgery for CRC. Databases were searched using selected keywords for clinical studies that analyzed the pattern, stage, and time of RD from CRC. A systematic protocol was used for data extraction, data synthesis, and interpretation of results. Of 455 publications retrieved from databases, 9 clinical studies were selected for this systematic review. There is substantial evidence that pulmonary recurrence is most commonly associated with rectal tumors, and multisite RD appears more frequently with right-sided CRC. RD from colon cancers predominantly appears early in liver, while recurrences from rectal cancer appear late in lungs. Approximately 30% to 50% of RD after curative resection of CRC occurs within the first 2 years; however, median time to recurrence is gradually increasing, particularly for patients with rectal cancers. Advanced primary CRC is significantly correlated with more locoregional and distant RD, with worse disease-free survival. There is a decrease in the 5-year incidence of RD that is associated with prolongation of time of RD for both locoregional and metastatic disease. The duration and design of postoperative follow-up protocols for recurrences from CRC should be tailored to site and stage of primary tumor, as rectal cancers demand longer surveillance times than colon cancer.
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Affiliation(s)
- Salman Yousuf Guraya
- Head Surgery Unit, Clinical Sciences Department, College of Medicine University of Sharjah, Sharjah, United Arab Emirates.
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228
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Significance of Glisson's capsule invasion in patients with colorectal liver metastases undergoing resection. Am J Surg 2019; 218:887-893. [PMID: 30712864 DOI: 10.1016/j.amjsurg.2019.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/17/2019] [Accepted: 01/22/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Significance of Glisson's capsule invasion in colorectal liver metastases (CLM) patients undergoing resection has been little investigated. METHODS CLM patients (244) with curative resection (2011-2016) were divided into two groups: patients with (Group 1; n = 49 [20%]) and without (Group 2; n = 195 [80%]) histologically-proven Glisson invasion. Eight (16%) Group 1 patients were identified by pre- or intra-operative findings. We compared characteristics between Groups 1 and 2 and determined independent prognosticators. RESULTS Group 1 was more commonly associated with right-sided primary, CLM>5 cm, and R1 resections. Independent factors on reduced OS in entire cohort were pre-surgical chemotherapy [hazard ratio (HR): 2.68, P = 0.001], CLM>5 cm (HR: 4.39, P = 0.002), moderate or poor differentiation (HR: 2.38, P = 0.004), and R1 resection (HR: 1.92, P = 0.035). CONCLUSIONS CLM Glisson invasion was significantly associated with R1 resection. Advancements in determining Glisson invasion pre- or intra-operatively might produce benefits for CLM patients undergoing resection by reducing R1 resection.
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229
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Hasan O, Greco S, Kennedy T, Carpizo D, Kempf J, Nosher J. Aberrant arc between the common hepatic artery and a replaced right hepatic artery resulting in misperfusion in a patient with a hepatic arterial infusion pump. Surg Radiol Anat 2019; 41:355-358. [PMID: 30612141 DOI: 10.1007/s00276-018-2158-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
Hepatic arterial infusion pumps are increasingly utilized as an option for liver directed therapy in the treatment of metastatic colorectal carcinoma. After skeletonization of the hepatic artery through the ligation of extra-hepatic branches, these pumps are implanted surgically with their tip placed in the common hepatic artery. Subsequently, a nuclear medicine pump study is performed to ensure homogeneous perfusion of the liver and detect any extrahepatic perfusion. We report a peripheral arc between the superior mesenteric artery and celiac axis, which caused misperfusion on the SPECT nuclear medicine scan.
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Affiliation(s)
- Omar Hasan
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA
| | - Stephanie Greco
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Timothy Kennedy
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Darren Carpizo
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Jeffrey Kempf
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA
| | - John Nosher
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, MEB #404, New Brunswick, NJ, 08901, USA.
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230
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Xu J, Fan J, Qin X, Cai J, Gu J, Wang S, Wang X, Zhang S, Zhang Z. Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (version 2018). J Cancer Res Clin Oncol 2018; 145:725-736. [PMID: 30542791 DOI: 10.1007/s00432-018-2795-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
The liver is the most common anatomical site for hematogenous metastases of colorectal cancer, and colorectal liver metastases is one of the most difficult and challenging points in the treatment of colorectal cancer. To improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, improve the resection rate of liver metastases and survival. The revised Guideline includes the diagnosis and follow-up, prevention, MDT effect, surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, and with advanced experience, latest results, detailed content, and strong operability.
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Affiliation(s)
- Jianmin Xu
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China.
| | - Jia Fan
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China
| | - Xinyu Qin
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive, Shanghai, China
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Gu
- Gastrointestinal Cancer Center, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
- Peking University Shougang Hospital, Beijing, China
| | - Shan Wang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Suzhan Zhang
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, Hangzhou, Zhejiang, China
- The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Cancer Invasion and Metastasis Research and National Clinical Research Center for Digestive Diseases, Beijing, China
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231
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Xu F, Tang B, Jin TQ, Dai CL. Current status of surgical treatment of colorectal liver metastases. World J Clin Cases 2018; 6:716-734. [PMID: 30510936 PMCID: PMC6264988 DOI: 10.12998/wjcc.v6.i14.716] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/14/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Liver metastasis (LM) is one of the major causes of death in patients with colorectal cancer (CRC). Approximately 60% of CRC patients develop LM during the course of their illness. About 85% of these patients have unresectable disease at the time of presentation. Surgical resection is currently the only curative treatment for patients with colorectal LM (CRLM). In recent years, with the help of modern multimodality therapy including systemic chemotherapy, radiation therapy, and surgery, the outcomes of CRLM treatment have significantly improved. This article summarizes the current status of surgical treatment of CRLM including evaluation of resectability, treatment for resectable LM, conversion therapy and liver transplantation for unresectable cases, liver resection for recurrent CRLM and elderly patients, and surgery for concomitant hepatic and extra-hepatic metastatic disease (EHMD). We believe that with the help of modern multimodality therapy, an aggressive oncosurgical approach should be implemented as it has the possibility of achieving a cure, even when EHMD is present in patients with CRLM.
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Affiliation(s)
- Feng Xu
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Bin Tang
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tian-Qiang Jin
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Chao-Liu Dai
- Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
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232
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Zhang XF, Beal EW, Chakedis J, Chen Q, Lv Y, Ethun CG, Salem A, Weber SM, Tran T, Poultsides G, Son AY, Hatzaras I, Jin L, Fields RC, Buettner S, Scoggins C, Martin RCG, Isom CA, Idrees K, Mogal HD, Shen P, Maithel SK, Schmidt CR, Pawlik TM. Defining Early Recurrence of Hilar Cholangiocarcinoma After Curative-intent Surgery: A Multi-institutional Study from the US Extrahepatic Biliary Malignancy Consortium. World J Surg 2018; 42:2919-2929. [PMID: 29404753 DOI: 10.1007/s00268-018-4530-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Time to tumor recurrence may be associated with outcomes following resection of hepatobiliary cancers. The objective of the current study was to investigate risk factors and prognosis among patients with early versus late recurrence of hilar cholangiocarcinoma (HCCA) after curative-intent resection. METHODS A total of 225 patients who underwent curative-intent resection for HCCA were identified from 10 academic centers in the USA. Data on clinicopathologic characteristics, pre-, intra-, and postoperative details and overall survival (OS) were analyzed. The slope of the curves identified by linear regression was used to categorize recurrences as early versus late. RESULTS With a median follow-up of 18.0 months, 99 (44.0%) patients experienced a tumor recurrence. According to the slope of the curves identified by linear regression, the functions of the two straight lines were y = -0.465x + 16.99 and y = -0.12x + 7.16. The intercept value of the two lines was 28.5 months, and therefore, 30 months (2.5 years) was defined as the cutoff to differentiate early from late recurrence. Among 99 patients who experienced recurrence, the majority (n = 80, 80.8%) occurred within the first 2.5 years (early recurrence), while 19.2% of recurrences occurred beyond 2.5 years (late recurrence). Early recurrence was more likely present as distant disease (75.1% vs. 31.6%, p = 0.001) and was associated with a worse OS (Median OS, early 21.5 vs. late 50.4 months, p < 0.001). On multivariable analysis, poor tumor differentiation (HR 10.3, p = 0.021), microvascular invasion (HR 3.3, p = 0.037), perineural invasion (HR 3.9, p = 0.029), lymph node metastases (HR 5.0, p = 0.004), and microscopic positive margin (HR 3.5, p = 0.046) were independent risk factors associated with early recurrence. CONCLUSIONS Early recurrence of HCCA after curative resection was common (~35.6%). Early recurrence was strongly associated with aggressive tumor characteristics, increased risk of distant metastatic recurrence and a worse long-term survival.
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Affiliation(s)
- Xu-Feng Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Eliza W Beal
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jeffery Chakedis
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qinyu Chen
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Yi Lv
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Cecilia G Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Andre Y Son
- Department of Surgery, New York University, New York, NY, USA
| | | | - Linda Jin
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Stefan Buettner
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Charles Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Chelsea A Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kamron Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harveshp D Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Carl R Schmidt
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Surgery, Oncology, Health Services Management and Policy, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
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233
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Lee AJ, Loyer EM, Kang HC, Aloia TA, Tzeng CWD, Vauthey JN, Chun YS. Intrahepatic Recurrence Patterns Predict Survival After Resection of Colorectal Liver Metastases. Ann Surg Oncol 2018; 26:275-281. [DOI: 10.1245/s10434-018-6945-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Indexed: 12/15/2022]
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234
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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235
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Rodriguez J, Castañón E, Perez-Gracia JL, Rodriguez I, Viudez A, Alfaro C, Oñate C, Perez G, Rotellar F, Inogés S, López-Diaz de Cerio A, Resano L, Ponz-Sarvise M, Rodriguez-Ruiz ME, Chopitea A, Vera R, Melero I. A randomized phase II clinical trial of dendritic cell vaccination following complete resection of colon cancer liver metastasis. J Immunother Cancer 2018; 6:96. [PMID: 30268156 PMCID: PMC6164167 DOI: 10.1186/s40425-018-0405-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/06/2018] [Indexed: 12/18/2022] Open
Abstract
Surgically resectable synchronic and metachronic liver metastases of colon cancer have high risk of relapse in spite of standard-of-care neoadjuvant and adjuvant chemotherapy regimens. Dendritic cell vaccines loaded with autologous tumor lysates were tested for their potential to avoid or delay disease relapses (NCT01348256). Patients with surgically amenable liver metastasis of colon adenocarcinoma (n = 19) were included and underwent neoadjuvant chemotherapy, surgery and adjuvant chemotherapy. Fifteen patients with disease-free resection margins were randomized 1:1 to receive two courses of four daily doses of dendritic cell intradermal vaccinations versus observation. The trial had been originally designed to include 56 patients but was curtailed due to budgetary restrictions. Follow-up of the patients indicates a clear tendency to fewer and later relapses in the vaccine arm (median disease free survival –DFS-) 25.26 months, 95% CI 8.74-n.r) versus observation arm (median DFS 9.53 months, 95% CI 5.32–18.88).
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Affiliation(s)
- Javier Rodriguez
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Eduardo Castañón
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Jose Luis Perez-Gracia
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,CIBERONC, Madrid, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Inmaculada Rodriguez
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,CIBERONC, Madrid, Spain
| | - Antonio Viudez
- Complejo Hospitalario de Navarra, Avenida Irunlarrea 5, 31008, Pamplona, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Carlos Alfaro
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,CIBERONC, Madrid, Spain
| | - Carmen Oñate
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Guiomar Perez
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Fernando Rotellar
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Susana Inogés
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Ascensión López-Diaz de Cerio
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Leyre Resano
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Mariano Ponz-Sarvise
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,Centro de Investigacion Medica Aplicada, CIMA, Avenida Pio XII, 36, 31008, Pamplona, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Maria E Rodriguez-Ruiz
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain.,Centro de Investigacion Medica Aplicada, CIMA, Avenida Pio XII, 36, 31008, Pamplona, Spain.,CIBERONC, Madrid, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Ana Chopitea
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain
| | - Ruth Vera
- Complejo Hospitalario de Navarra, Avenida Irunlarrea 5, 31008, Pamplona, Spain.,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain
| | - Ignacio Melero
- Clinica Universidad de Navarra, Avenida Pio XII, 36, 31008, Pamplona, Spain. .,Centro de Investigacion Medica Aplicada, CIMA, Avenida Pio XII, 36, 31008, Pamplona, Spain. .,CIBERONC, Madrid, Spain. .,Instituto de investigación de Navarra, IDISNA, Pamplona, Spain. .,, Pamplona, Spain.
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Han EC, Kwon YH, Park KJ, Jeong SY, Kang SB, Oh JH, Heo SC. Significance of lymph node metastasis in the survival of stage IV colorectal cancer by hematogenous metastasis. Ann Surg Treat Res 2018; 95:201-212. [PMID: 30310803 PMCID: PMC6172352 DOI: 10.4174/astr.2018.95.4.201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/07/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose Although lymph node (LN) metastasis is an important prognostic marker of colorectal cancer (CRC), the effect of LN metastasis on the survival of stage IV CRC is debated yet. Methods LN status and survivals as well as clinicopathological features of synchronous stage IV CRC patients, operated for 8 years, were analyzed. Patients with hematogenous metastases were included only but those with peritoneal seeding or preoperative adjuvant therapy were not included. Results Total 850 patients were enrolled and 77 (9.1%) were without LN metastases (N0M1). N0M1 patients were older and have favorable pathological features including lower CEA than patients with LN metastasis (N + M1). The pathologically poor features accumulated with N stage progression within N + M1. N0M1 had better 5-year overall survival (OS) and disease free survival than N + M1. And 5-year OS's within N + M1 group were stratified and different according to N stage progression, although the effect of N stage progression is different according to curative resection or not. When compared with stage III, 5-year OS of N0M1 with curative resection was comparable to that of anyTN2aM0 and was better than anyTN2bM1. Conclusion LN metastasis is a significant prognostic factor in stage IV by hematogenous metastasis, too. N stage progression accumulates pathologically poor prognostic factors. However, the effect on survival of each N stage progression differs depending on curative resection or not of the hematogenous metastases.
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Affiliation(s)
- Eon Chul Han
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Yoon-Hye Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
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Abbasi A, Rahnemai-Azar AA, Merath K, Weber SM, Abbott DE, Dillhoff M, Cloyd J, Pawlik TM. Role of associating liver partition and portal vein ligation in staged hepatectomy (ALPPS)-strategy for colorectal liver metastases. Transl Gastroenterol Hepatol 2018; 3:66. [PMID: 30363643 DOI: 10.21037/tgh.2018.09.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022] Open
Abstract
Colorectal carcinoma (CRC) is the third leading cause of cancer-related death in the United States. The liver is the most frequent site of metastasis and a key determinant of survival in patients with isolated colorectal liver metastasis (CRLM). Surgical resection remains the only hope for prolonged survival in patients with CRLM. However, most patients are deemed to be unresectable at presentation due to a small future liver remnant (FLR) and fear of post-hepatectomy liver failure. Procedures such as portal vein ligation or embolization (PVL/PVE) followed by hepatectomy have been established as standard methods to increase FLR volume, but have limitations dependent upon extent of disease and patient's ability to grow the liver remnant. Recently, associating liver partition and portal vein ligation in staged hepatectomy (ALPPS) has been introduced as a technique to induce liver hypertrophy over a shorter time period. Being a complex two-stage surgical procedure, initial reports of higher ALPPS-associated complications and mortality limited its worldwide adoption by hepatobiliary surgeons. However, recent studies have showed ALPPS superiority over conventional procedures in terms of feasibility and inducing liver hypertrophy, with comparable morbidity and mortality. We herein review the role of ALPPS in management of patients with CRLM.
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Affiliation(s)
- Arezou Abbasi
- Department of Surgery, Division of Surg Oncol, University of Washington, Seattle, WA, USA
| | - Amir A Rahnemai-Azar
- Department of Surgery, Division of Surg Oncol, University of Wisconsin, Madison, WI, USA
| | - Katiuscha Merath
- Department of Surgery, Division of Surg Oncol, Ohio State University, Columbus, OH, USA
| | - Sharon M Weber
- Department of Surgery, Division of Surg Oncol, University of Wisconsin, Madison, WI, USA
| | - Daniel E Abbott
- Department of Surgery, Division of Surg Oncol, University of Wisconsin, Madison, WI, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surg Oncol, Ohio State University, Columbus, OH, USA
| | - Jordan Cloyd
- Department of Surgery, Division of Surg Oncol, Ohio State University, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surg Oncol, Ohio State University, Columbus, OH, USA
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238
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Kobayashi A, Kaido T, Hamaguchi Y, Okumura S, Shirai H, Kamo N, Yagi S, Taura K, Okajima H, Uemoto S. Impact of Visceral Adiposity as Well as Sarcopenic Factors on Outcomes in Patients Undergoing Liver Resection for Colorectal Liver Metastases. World J Surg 2018; 42:1180-1191. [PMID: 28936708 DOI: 10.1007/s00268-017-4255-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We have reported preoperative low skeletal muscularity as an independent risk factor for poor outcomes after liver transplantation, resection of hepatocellular carcinoma, pancreatic cancer and extrahepatic biliary malignancies. However, the impacts of visceral adiposity and muscularity on outcomes after liver resection for colorectal liver metastases (CLM) have not been fully investigated. METHODS We retrospectively analyzed 124 patients undergoing primary liver resection for CLM between 2005 and 2014. Using preoperative computed tomography at the third lumbar vertebra level, skeletal muscle and abdominal adipose tissue were evaluated by skeletal muscle index (SMI), intramuscular adipose tissue content (IMAC) and visceral-to-subcutaneous adipose tissue area ratio (VSR), respectively. Impacts of preoperative SMI, IMAC and VSR on outcomes after liver resection for CLM were investigated. RESULTS Low SMI and high VSR were not significantly associated with poor overall or recurrence-free survivals (P = 0.324 and P = 0.106, P = 0.964 and P = 0.738, respectively). Overall survival rate tended to be lower in patients with high IMAC than in patients with normal IMAC (P = 0.054). Recurrence-free survival rate did not differ significantly between high and normal IMAC (P = 0.721). Multivariate analysis showed that low SMI, high IMAC and high VSR were not significant risk factors for death or recurrence after liver resection for CLM. CONCLUSION Neither preoperative visceral adiposity nor low muscularity were poor prognostic factors in patients undergoing liver resection for CLM.
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Affiliation(s)
- Atsushi Kobayashi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Toshimi Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yuhei Hamaguchi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinya Okumura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hisaya Shirai
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naoko Kamo
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shintaro Yagi
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kojiro Taura
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideaki Okajima
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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239
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Repeated Resections of Hepatic and Pulmonary Metastases from Colorectal Cancer Provide Long-Term Survival. World J Surg 2018; 42:1171-1179. [PMID: 28948336 DOI: 10.1007/s00268-017-4265-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver and lungs are the two most frequent sites of metastatic spread of colorectal cancer (CRC). Complete resection of liver and/or lung metastases is the only chance of cure, and several studies have reported an improved survival after an aggressive treatment. Nevertheless, CRC liver metastases (CLM) have been recognized as a pejorative factor for patients undergoing pulmonary metastasectomy. We report our experience with patients successively operated on for CRC hepatic and pulmonary metastasis (CPM) and seek to identify prognostic factors. METHODS All consecutive patients who had resection of CPM and CLM between 2001 and 2014 were enrolled in the study. Clinicopathological and survival data were retrospectively analysed. RESULTS Forty-six patients underwent resections of both CLM and CPM. Hepatic resection preceded pulmonary resection in most cases (91.3%). The median intervals between the resection of the primary tumour and the hepatic recurrence and between hepatic and pulmonary recurrences were 12 months [0-72] and 21.5 months [1-84], respectively. The mortality rate following CPM resection was 4.3%. After a median follow-up of 41.5 months [0-126], 35 patients recurred of whom 14 (40%) and 11(31.4%) could benefit from repeated resection of recurrent CLM and CPM, respectively. The median and 5-year overall survivals (OS) were 53 months and 49%, respectively. No prognostic factor was identified. CONCLUSION An aggressive management of CLM and CPM, including repeated resections, may provide a long-term survival comparable to survival of patients with unique metastasectomy. The absence of prognostic factor may reflect the highly selected pattern of the eligible patients.
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240
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Zheng P, Ren L, Feng Q, Zhu D, Chang W, He G, Ji M, Jian M, Lin Q, Yi T, Wei Y, Xu J. Differences in clinical characteristics and mutational pattern between synchronous and metachronous colorectal liver metastases. Cancer Manag Res 2018; 10:2871-2881. [PMID: 30214282 PMCID: PMC6118248 DOI: 10.2147/cmar.s161392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate differences in clinical characteristics and mutational patterns between synchronous and metachronous colorectal liver metastases (CLMs). Patients and methods From June 2008 to December 2014, patients with RAS wild-type CLMs treated at Zhongshan Hospital, Fudan University were included. DNA extracted from formalin-fixed paraffin-embedded tissue of primary tumors was sequenced with next-generation sequencing for single-nucleotide polymorphism of 96 genes according to custom panel. Mutations were compared between synchronous and metachronous liver metastases and correlated with clinical characteristics. Results A total of 161 patients were included: 93 patients with synchronous CLM and 68 patients with metachronous CLM. Patients with metachronous CLM were obviously elder. For pathology of primary tumors, synchronous CLMs were larger in size, poorly differentiated, and more frequently local advanced and lymph node positive. For evaluation of liver metastases, synchronous CLM had more and larger metastatic lesions. The median number of mutations in synchronous CLMs was significantly higher than in metachronous group (22 vs. 18, p<0.001). EGFR rs2227983 is the most prevalent mutation in both groups and only a part of prevalent mutations is shared in both groups. Prevalent mutations were correlated with many clinical characteristics. EGFR rs2227983, RBMXL3 rs12399211, and PTCH1 rs357564 were prognostic for latency of metachronous CLM. Conclusion Clinically, synchronous CLMs, compared with metachronous CLMs, were younger and showed heavier tumor burden for both primaries and liver metastases. Genetically, we identified different mutational patterns between synchronous and metachronous CLMs and several correlations between mutations and clinical characteristics. Further researches were needed to confirm these potential key mutations of CLMs.
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Affiliation(s)
- Peng Zheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Li Ren
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Qingyang Feng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Dexiang Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Wenju Chang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Guodong He
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Meiling Ji
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Mi Jian
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Qi Lin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Tuo Yi
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Ye Wei
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
| | - Jianmin Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China,
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241
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Kim CA, Ahmed S, Ahmed S, Brunet B, Chalchal H, Deobald R, Doll C, Dupre MP, Gordon V, Lee-Ying RM, Lim H, Liu D, Loree JM, McGhie JP, Mulder K, Park J, Yip B, Wong RP, Zaidi A. Report from the 19th annual Western Canadian Gastrointestinal Cancer Consensus Conference; Winnipeg, Manitoba; 29-30 September 2017. ACTA ACUST UNITED AC 2018; 25:275-284. [PMID: 30111968 DOI: 10.3747/co.25.4109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The 19th annual Western Canadian Gastrointestinal Cancer Consensus Conference (wcgccc) was held in Winnipeg, Manitoba, 29-30 September 2017. The wcgccc is an interactive multidisciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer.
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Affiliation(s)
- C A Kim
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - S Ahmed
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - S Ahmed
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - B Brunet
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - H Chalchal
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - R Deobald
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
| | - C Doll
- Alberta-Medical Oncology (Mulder), Cross Cancer Institute, University of Alberta, Edmonton; Medical Oncology (Lee-Ying) and Radiation Oncology (Doll), Tom Baker Cancer Centre, University of Calgary, Calgary
| | - M P Dupre
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - V Gordon
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - R M Lee-Ying
- Alberta-Medical Oncology (Mulder), Cross Cancer Institute, University of Alberta, Edmonton; Medical Oncology (Lee-Ying) and Radiation Oncology (Doll), Tom Baker Cancer Centre, University of Calgary, Calgary
| | - H Lim
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - D Liu
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - J M Loree
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - J P McGhie
- British Columbia-Medical Oncology (Lim, Loree), BC Cancer, University of British Columbia, Vancouver; Medical Oncology (McGhie), BC Cancer, University of British Columbia, Victoria; Radiology (Liu), University of British Columbia, Vancouver
| | - K Mulder
- Alberta-Medical Oncology (Mulder), Cross Cancer Institute, University of Alberta, Edmonton; Medical Oncology (Lee-Ying) and Radiation Oncology (Doll), Tom Baker Cancer Centre, University of Calgary, Calgary
| | - J Park
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - B Yip
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - R P Wong
- Manitoba-Medical Oncology (Kim, Gordon, Wong) and Radiation Oncology (Shahida Ahmed), CancerCare Manitoba, University of Manitoba, Winnipeg; Surgery (Park, Yip) and Pathology (Dupre), University of Manitoba, Winnipeg
| | - A Zaidi
- Saskatchewan- Medical Oncology (Shahid Ahmed, Zaidi), Radiation Oncology (Brunet), and Surgery (Deobald), Saskatchewan Cancer Agency, University of Saskatchewan, Saskatoon; Medical Oncology (Chalchal), Allan Blair Cancer Centre, Regina
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Agas RAF, Co LBA, Jacinto JCKM, Yu KKL, Sogono PG, Bacorro WR, Sy Ortin TT. Neoadjuvant Radiotherapy Versus No Radiotherapy for Stage IV Rectal Cancer: a Systematic Review and Meta-analysis. J Gastrointest Cancer 2018; 49:389-401. [DOI: 10.1007/s12029-018-0141-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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243
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Lieng H, Hayden AJ, Christie DRH, Davis BJ, Eade TN, Emmett L, Holt T, Hruby G, Pryor D, Shakespeare TP, Sidhom M, Skala M, Wiltshire K, Yaxley J, Kneebone A. Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group. Radiother Oncol 2018; 129:377-386. [PMID: 30037499 DOI: 10.1016/j.radonc.2018.06.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/14/2022]
Abstract
The management of patients with biochemical, local, nodal, or oligometastatic relapsed prostate cancer has become more challenging and controversial. Novel imaging modalities designed to detect recurrence are increasingly used, particularly PSMA-PET scans in Australia, New Zealand and some European countries. Imaging techniques such as MRI and PET scans using other prostate cancer-specific tracers are also being utilised across the world. The optimal timing for commencing salvage treatment, and the role of local and/or systemic therapies remains controversial. Through surveys of the membership, the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group (FROGG) identified wide variation in the management of recurrent prostate cancer. Following a workshop conducted in April 2017, the FROGG management committee reviewed the literature and developed a set of recommendations based on available evidence and expert opinion, for the appropriate investigation and management of recurrent prostate cancer. These recommendations cover the role and timing of post-prostatectomy radiotherapy, the management of regional nodal metastases and oligometastases, as well as the management of local prostate recurrence after definitive radiotherapy.
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Affiliation(s)
- Hester Lieng
- Central Coast Cancer Centre, Gosford Hospital, Australia.
| | - Amy J Hayden
- Sydney West Radiation Oncology, Westmead Hospital, Australia
| | - David R H Christie
- Genesis Cancer Care, Australia; Department of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Thomas N Eade
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - Louise Emmett
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, Australia
| | - Tanya Holt
- University of Queensland, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - George Hruby
- Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Thomas P Shakespeare
- North Coast Cancer Institute, Coffs Harbour, Australia; University of New South Wales Rural Clinical School, Australia
| | - Mark Sidhom
- Liverpool Hospital Cancer Therapy Centre, Sydney, Australia; University of New South Wales, Australia
| | | | | | - John Yaxley
- University of Queensland, Australia; Royal Brisbane and Women's Hospital, Australia; Wesley Urology Clinic, Brisbane, Australia
| | - Andrew Kneebone
- Central Coast Cancer Centre, Gosford Hospital, Australia; Genesis Cancer Care, Australia; Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; University of Sydney, Australia
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244
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Madkhali A, Alalem F, Aljuhani G, Alsharaabi A, Alsaif F, Hassanain M. Preoperative Selection and Optimization for Liver Resection in Colorectal Cancer Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2018. [DOI: 10.1007/s11888-018-0405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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245
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Chu PC, Lin PC, Wu HY, Lin KT, Wu C, Bekaii-Saab T, Lin YJ, Lee CT, Lee JC, Chen CS. Mutant KRAS promotes liver metastasis of colorectal cancer, in part, by upregulating the MEK-Sp1-DNMT1-miR-137-YB-1-IGF-IR signaling pathway. Oncogene 2018; 37:3440-3455. [PMID: 29559746 DOI: 10.1038/s41388-018-0222-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/20/2017] [Accepted: 02/25/2018] [Indexed: 02/07/2023]
Abstract
Although the role of insulin-like growth factor-I receptor (IGF-IR) in promoting colorectal liver metastasis is known, the mechanism by which IGF-IR is upregulated in colorectal cancer (CRC) is not defined. In this study, we obtained evidence that mutant KRAS transcriptionally activates IGF-IR gene expression through Y-box-binding protein (YB)-1 upregulation via a novel MEK-Sp1-DNMT1-miR-137 pathway in CRC cells. The mechanistic link between the tumor suppressive miR-137 and the translational regulation of YB-1 is intriguing because epigenetic silencing of miR-137 represents an early event in colorectal carcinogenesis due to promoter hypermethylation. This proposed signaling axis was further verified by the immunohistochemical evaluations of liver metastases from a cohort of 46 KRAS mutant CRC patients, which showed a significant correlation in the expression levels among Sp1, miR-137, YB-1, and IGF-1R. Moreover, suppression of the expression of YB-1 and IGF-IR via genetic knockdown or the pharmacological inhibition of MEK hampers KRAS-driven colorectal liver metastasis in our animal model studies. From a translational perspective, the identification of this KRAS-driven pathway might provide a mechanistic rationale for the use of a MEK inhibitor as an adjuvant, in combination with standard of care, to prevent the recurrence of colorectal liver metastasis in KRAS mutant CRC patients after receiving liver resection, which warrants further investigation.
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Affiliation(s)
- Po-Chen Chu
- Institute of Biological Chemistry, Academia Sinica, 11529, Taipei, Taiwan
- Institute of New Drug Development, College of Biopharmaceutical and Food Sciences, China Medical University, 40402, Taichung, Taiwan
| | - Peng-Chan Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, Tainan, Taiwan
| | - Hsing-Yu Wu
- Institute of Biological Chemistry, Academia Sinica, 11529, Taipei, Taiwan
- Institute of Biochemical Sciences, College of Life Science, National Taiwan University, 10617, Taipei, Taiwan
| | - Kuen-Tyng Lin
- Institute of Biological Chemistry, Academia Sinica, 11529, Taipei, Taiwan
| | - Christina Wu
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Tanios Bekaii-Saab
- Mayo Clinic College of Medicine and Science, Mayo Clinic Cancer Center, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Yih-Jyh Lin
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, Tainan, Taiwan
| | - Chung-Ta Lee
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, Tainan, Taiwan
| | - Jeng-Chang Lee
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 70403, Tainan, Taiwan
| | - Ching-Shih Chen
- Institute of Biological Chemistry, Academia Sinica, 11529, Taipei, Taiwan.
- Institute of New Drug Development, College of Biopharmaceutical and Food Sciences, China Medical University, 40402, Taichung, Taiwan.
- Institute of Biochemical Sciences, College of Life Science, National Taiwan University, 10617, Taipei, Taiwan.
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Pernot S, Velut G, Kourie RH, Amouyal G, Sapoval M, Pointet AL, Landi B, Zaimi Y, Lepère C, Pellerin O, Taieb J. 5-FU or mitomycin C hepatic arterial infusion after failure of arterial oxaliplatin in patients with colorectal cancer unresectable liver metastases. Clin Res Hepatol Gastroenterol 2018; 42:255-260. [PMID: 29233520 DOI: 10.1016/j.clinre.2017.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/27/2017] [Accepted: 11/13/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hepatic arterial infusion (HAI) chemotherapy with oxaliplatin is an accepted option in the management of colorectal cancer (CRC) with dominant liver metastases (LM). However, despite prolonged control, some patients experience disease progression. On the other hand, oxaliplatin leads to dose-limiting toxicity. In these cases, the use of a second-line HAI with an alternative drug has never been reported to date. We evaluated treatment outcomes in patients receiving second-line HAI with 5-FU or mitomycin C, after first-line HAI of oxaliplatin in heavily pretreated patients. MATERIAL AND METHODS Between March 2010 and June 2016, this observational study included 24 patients with unresectable CRC LM and treated with HAI of 5-FU (17 patients) or mitomycin C (7 patients), after HAI of oxaliplatin. RESULTS Mean age was 61.7 years. Forty-two percent of patients (10/24) had extra-hepatic metastases and 75% (18/24) at least 8 liver metastases. Including HAI of oxaliplatin, all patients had previously received at least 2 lines of chemotherapy±targeted agents (100%) and 96% (23/24) received concomitant systemic therapies together with HAI of 5-FU or mitomycin C. The overall objective response rate and disease control rate were, respectively, 42% (10/24) and 71% (17/24). Median progression-free survival and overall survival (OS) were, respectively, 5.6 and 25.8 months; hepatic progression-free survival was 8.5months. Thirteen percent (3/24) of the patients received further curative intent treatment after HAI 5-FU and mitomycin C. No toxic death occurred and the toxicity profile was acceptable. CONCLUSIONS HAI of 5-FU or mitomycin C is an alternative option in patients with predominant CRC LM, when they experience disease progression or do not tolerate HAI of oxaliplatin.
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Affiliation(s)
- Simon Pernot
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Guillaume Velut
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Rapahel Hampig Kourie
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Gregory Amouyal
- Department of interventional radiology, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Marc Sapoval
- Department of interventional radiology, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Anne Laure Pointet
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Bruno Landi
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Yosra Zaimi
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Céline Lepère
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Olivier Pellerin
- Department of interventional radiology, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - Julien Taieb
- Department of gastroenterology and digestive oncology depart, université Paris Descartes, Sorbonne Paris-cité, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
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247
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Surgical Strategy Based on Indocyanine Green Test for Chemotherapy-Associated Liver Injury and Long-Term Outcome in Colorectal Liver Metastases. J Gastrointest Surg 2018; 22:1077-1088. [PMID: 29488125 DOI: 10.1007/s11605-018-3712-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/06/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains unclear whether the presence of chemotherapy-induced liver injury (CALI) or impaired liver functional reserve affects the long-term outcome. This study assessed the applicability and long-term effects of using criteria based on the indocyanine green (ICG) test results in selecting the operative procedure among patients with colorectal liver metastases (CRLM) who had a risk of CALI. STUDY DESIGN CRLM patients who received preoperative chemotherapy including oxaliplatin and/or irinotecan prior to a curative hepatectomy between 2007 and 2017 were included. For each case, the minimum required future remnant liver volume and operative procedure were decided based on the ICG retention rate at 15 min (ICG R15). Patients with an ICG R15 > 10% and who had undergone a major hepatectomy were categorized in a marginal liver functional reserve (MHML) group. RESULTS Overall, 161 patients were included; 77 of them had an ICG R15 > 10%, and 57 had pathological liver injury (PLI). After the median follow-up time of 30.9 months, the 5-year overall survival rate was 36.1%. The presence of an impaired ICG test result or CALI did not negatively impact the overall and recurrence-free survival outcomes. A multivariate analysis revealed that the presence of four or more nodules of liver metastases was the only independent predictor of a poor overall survival. A significantly larger proportion of patients in the MHML group (n = 37) had a 25% or larger increase in splenic volume (30 vs. 13%; P = 0.024). CONCLUSION The presence of an impaired ICG test result or PLI did not affect the long-term outcome after individually selected operative procedure. However, patients undergoing MHML had a higher possibility of developing a > 25% splenic volume increase after hepatectomy.
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248
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Gill S, Liu DM, Green HM, Sharma RA. Beyond the Knife: The Evolving Nonsurgical Management of Oligometastatic Colorectal Cancer. Am Soc Clin Oncol Educ Book 2018; 38:209-219. [PMID: 30231355 DOI: 10.1200/edbk_200941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In patients with liver-limited oligometastatic disease, the goal of treatment can be curative intent. Historically, this was accomplished in patients presenting with upfront resectable disease. The availability of increasingly efficacious chemotherapy and biologic combinations with encouraging response rates led to the potential to convert unresectable disease to resectability. Beyond the backbone of surgery, we now have a portfolio of locoregional strategies to consider.From an interventional radiology perspective, the use of portal vein embolization can facilitate hypertrophy of the liver in anticipation of resection, thus converting unresectable disease to one amenable to a surgical approach with curative intent. Technological advances in liver-directed ablative therapies have afforded the possibility of eliminate radiographically evident disease with the hope for long-term disease control. Advanced radiotherapy techniques are further increasing the therapeutic options for patients with metastatic colorectal cancer. Improvements in external-beam radiotherapy over the past 2 decades include image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy, and proton-beam therapy. Finally, selective internal radiation therapy (SIRT) with microspheres labeled with the β-emitter 90Y enable targeted delivery of radiation to hepatic tumors. A coordinated multidisciplinary approach is required to integrate these nonsurgical adjuncts in an evidence-based manner to optimize outcomes for patients with potentially resectable metastatic disease. In this article, we summarize recent developments in systemic therapy, radiotherapy, and interventional liver-directed therapies that have changed the treatment landscape for patients with oligometastatic colorectal cancer.
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Affiliation(s)
- Sharlene Gill
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - David M Liu
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - Harshani M Green
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
| | - Ricky A Sharma
- From the BC Cancer-Vancouver and Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada; National Institute for Health Research University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College, London, United Kingdom
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Okuno M, Goumard C, Kopetz S, Vega EA, Joechle K, Mizuno T, Omichi K, Tzeng CWD, Chun YS, Vauthey JN, Conrad C. RAS Mutation is Associated with Unsalvageable Recurrence Following Hepatectomy for Colorectal Cancer Liver Metastases. Ann Surg Oncol 2018; 25:2457-2466. [DOI: 10.1245/s10434-018-6517-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Indexed: 12/14/2022]
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250
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Abnormal Liver Function Induced by Space-Occupying Lesions Is Associated with Unfavorable Oncologic Outcome in Patients with Colorectal Cancer Liver Metastases. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9321270. [PMID: 29862297 PMCID: PMC5976940 DOI: 10.1155/2018/9321270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/25/2018] [Accepted: 02/27/2018] [Indexed: 02/06/2023]
Abstract
An early prediction of prognosis for patients with colorectal liver metastasis (CRLM) may help us determine treatment strategies. Liver function reflects the effect of the overall metastatic burden. We investigated the prognostic value of liver function in CRLM patients. In our study, patients with abnormal LFTs (liver function tests) had a poorer prognosis than did those with normal LFTs (P < 0.05). A multivariate analysis revealed that LFTs was an independent prognostic factor for CRLM. For those patients with abnormal LFTs, novel prognostic contour maps were generated using LFTs, and no positive correlation exists between the values of survival duration and abnormal LFTs. Additionally, the MTVR (metastatic tumor volume ratio) was measured directly by magnetic resonance imaging and was shown to be highly correlated to LFTs by a Pearson correlation analysis. A multivariate logistic regression analysis also demonstrated that the MTVR and hepatectomy were independently predictive of abnormal LFTs. The space-occupying effect of metastatic lesions can cause abnormal LFTs, resulting in a poor prognosis. Biochemical analyses of LFTs at the initial diagnosis of CRLM enable the stratification of patients into low- and high-risk groups; it may help clinicians determine promising treatment strategies.
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