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Toniutto P, Shalaby S, Mameli L, Morisco F, Gambato M, Cossiga V, Guarino M, Marra F, Brunetto MR, Burra P, Villa E. Role of sex in liver tumor occurrence and clinical outcomes: A comprehensive review. Hepatology 2024; 79:1141-1157. [PMID: 37013373 DOI: 10.1097/hep.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 12/06/2022] [Indexed: 04/05/2023]
Abstract
Clinical research on sex-based differences in the manifestations, pathophysiology, and prevalence of several diseases, including those affecting the liver, has expanded considerably in recent years. Increasing evidence suggests that liver diseases develop, progress, and respond to treatment differently depending on the sex. These observations support the concept that the liver is a sexually dimorphic organ in which estrogen and androgen receptors are present, which results in disparities between men and women in liver gene expression patterns, immune responses, and the progression of liver damage, including the propensity to develop liver malignancies. Sex hormones play protective or deleterious roles depending on the patient's sex, the severity of the underlying disease, and the nature of precipitating factors. Moreover, obesity, alcohol consumption, and active smoking, as well as social determinants of liver diseases leading to sex-related inequalities, may interact strongly with hormone-related mechanisms of liver damage. Drug-induced liver injury, viral hepatitis, and metabolic liver diseases are influenced by the status of sex hormones. Available data on the roles of sex hormones and gender differences in liver tumor occurrence and clinical outcomes are conflicting. Here, we critically review the main gender-based differences in the molecular mechanisms associated with liver carcinogenesis and the prevalence, prognosis, and treatment of primary and metastatic liver tumors.
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Affiliation(s)
- Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, Department of Medical Area, University of Udine, Udine, Italy
| | - Sarah Shalaby
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Laura Mameli
- Liver and Pancreas Transplant Center, Azienda Ospedaliera Brotzu Piazzale Ricchi 1, Cagliari, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Departmental Program "Diseases of the Liver and Biliary System," University of Naples "Federico II," Napoli, Italy
| | - Martina Gambato
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Valentina Cossiga
- Department of Clinical Medicine and Surgery, Departmental Program "Diseases of the Liver and Biliary System," University of Naples "Federico II," Napoli, Italy
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Departmental Program "Diseases of the Liver and Biliary System," University of Naples "Federico II," Napoli, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Patrizia Burra
- Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy
| | - Erica Villa
- Gastroenterology Department, University of Modena and Reggio Emilia, Modena, Italy
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Chávez-Villa M, Ruffolo LI, Al-Judaibi BM, Fujiki M, Hashimoto K, Kallas J, Kwon CHD, Nair A, Orloff MS, Pineda-Solis K, Raj R, Sasaki K, Tomiyama K, Aucejo F, Hernandez-Alejandro R. The High Incidence of Occult Carcinoma in Total Hepatectomy Specimens of Patients Treated for Unresectable Colorectal Liver Metastases With Liver Transplant. Ann Surg 2023; 278:e1026-e1034. [PMID: 36692112 PMCID: PMC10549889 DOI: 10.1097/sla.0000000000005803] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe the rate of occult carcinoma deposits in total hepatectomy specimens from patients treated with liver transplant (LT) for colorectal liver metastases (CRLM). BACKGROUND Previous studies have shown that patients with CRLM treated with systemic therapy demonstrate a high rate of complete radiographic response or may have disappearing liver metastases. However, this does not necessarily translate into a complete pathologic response, and residual invasive cancer may be found in up to 80% of the disappearing tumors after resection. METHODS Retrospective review of 14 patients who underwent LT for CRLM, at 2 centers. Radiographic and pathologic correlation of the number of tumors and their viability before and after LT was performed. RESULTS The median (interquartile range) number of tumors at diagnosis was 11 (4-23). The median number of chemotherapy cycles was 24 (16-37). Hepatic artery infusion was used in 5 patients (35.7%); 6 (42.9%) underwent surgical resection, and 5 (35.7%) received locoregional therapy. The indication for LT was unresectability in 8 patients (57.1%) and liver failure secondary to oncologic treatment in the remaining 6 (42.9%). Before LT, 7 patients (50%) demonstrated fluorodeoxyglucose-avid tumors and 7 (50%) had a complete radiographic response. Histopathologically, 11 patients (78.6%) had a viable tumor. Nine (64.2%) of the 14 patients were found to have undiagnosed metastases on explant pathology, with at least 22 unaccounted viable tumors before LT. Furthermore, 4 (57.1%) of the 7 patients who demonstrated complete radiographic response harbored viable carcinoma on explant pathology. CONCLUSIONS A complete radiographic response does not reliably predict a complete pathologic response. In patients with unresectable CRLM, total hepatectomy and LT represent a promising treatment options to prevent indolent disease progression from disappearing CRLM.
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Affiliation(s)
- Mariana Chávez-Villa
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Luis I. Ruffolo
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Bandar M. Al-Judaibi
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Masato Fujiki
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Koji Hashimoto
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Jeffrey Kallas
- Department of Radiology, University of Rochester Medical Center, Rochester, NY
| | | | - Amit Nair
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Mark S. Orloff
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Karen Pineda-Solis
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Roma Raj
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Kazunari Sasaki
- Division of Abdominal Transplantation, Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Koji Tomiyama
- Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, Rochester, NY
| | - Federico Aucejo
- Department of Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
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3
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Dueland S, Smedman TM, Syversveen T, Grut H, Hagness M, Line PD. Long-Term Survival, Prognostic Factors, and Selection of Patients With Colorectal Cancer for Liver Transplant: A Nonrandomized Controlled Trial. JAMA Surg 2023; 158:e232932. [PMID: 37494056 PMCID: PMC10372758 DOI: 10.1001/jamasurg.2023.2932] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
Importance Liver transplant for colorectal cancer with liver metastases was abandoned in the 1990s due to poor overall survival. From 2006, liver transplant for in nonresectable colorectal liver metastases has been reexamined through different prospective trials. Objective To determine predictive factors for transplant long-term survival and cure after liver transplant. Design, Setting, and Participants This was a prospective, nonrandomized controlled cohort study derived from different clinical trials on liver transplant for colorectal liver metastases from 2006 to 2020 at Oslo University Hospital. The trials differed in prognostic inclusion criteria, but the design was otherwise identical regarding follow-up scheme to determine disease recurrence, overall survival, and survival after relapse. Final data analysis was performed on December 31, 2021. All patients with colorectal liver metastases from comparable prospective liver transplant studies were included. Exposure Liver transplant. Main outcomes and measures Disease-free survival, overall survival, and survival time after recurrence were determined in all participants. Results A total of 61 patients (median [range] age, 57.8 [28.7-71.1] years; 35 male [57.4%]) underwent liver transplant at Oslo University Hospital. Posttransplant observation time ranged from 16 to 165 months, and no patient was lost to follow-up. Median disease-free period, overall survival, and survival after relapse were 11.8 (95% CI, 9.3-14.2) months, 60.3 (95% CI, 44.3-76.4) months, and 37.1 (95% CI, 4.6-69.5) months, respectively. Negative predictive factors for overall survival included the following: largest tumor size greater than 5.5 cm (median OS, 25.3 months; 95% CI, 15.8-34.8 months; P <.001), progressive disease while receiving chemotherapy (median OS, 39.8 months; 95% CI, 28.8-50.7 months; P = .02), plasma carcinoembryonic antigen values greater than 80 μg/L (median OS, 26.6 months; 95% CI, 22.7-30.6 months; P <.001), liver metabolic tumor volume on positron emission tomography of greater than 70 cm3 (26.6 months; 95% CI, 11.8-41.5 months; P <.001), primary tumor in the ascending colon (17.9 months; 95% CI, 0-37.5 months; P <.001), tumor burden score of 9 or higher (23.3 months; 95% CI, 19.2-27.4 months; P = .02), and 9 or more liver lesions (42.5 months; 95% CI, 17.2-67.8 months; P = .02). An Oslo score of 0 or Fong Clinical Risk Score of 1 yielded 10-year survival of 88.9% and 80.0%, respectively. Conclusions and relevance Results of this nonrandomized controlled trial suggest that selected patients with liver-only metastases and favorable pretransplant prognostic scoring had long-term survival comparable with conventional indications for liver transplant, thus providing a potential curative treatment option in patients otherwise offered only palliative care.
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Affiliation(s)
- Svein Dueland
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Magnus Smedman
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Morten Hagness
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Transplant Oncology Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chávez-Villa M, Ruffolo LI, Hernandez-Alejandro R. Liver transplantation for unresectable colorectal liver metastasis. Curr Opin Organ Transplant 2023; 28:245-253. [PMID: 37339517 DOI: 10.1097/mot.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE OF REVIEW To summarize the current state of liver transplantation (LT) for unresectable colorectal liver metastases (uCRLM), and to address future directions. RECENT FINDINGS The Norwegian secondary cancer (SECA) I and SECA II studies demonstrated that after LT the 5-year survival of a highly selected group of patients with uCRLM could be as high as 60% and 83%, respectively. After long-term follow-up, the 5- and 10-year survival was shown to be 43% and 26%, respectively. Furthermore, data has accumulated in other countries and a North American study reported a 1.5-year survival of 100%. In addition, steady growth has been demonstrated in the US, with 46 patients transplanted to date and 19 centers enrolling patients for this indication. Lastly, although recurrence is almost universal in patients with a high tumor burden, it has not been an accurate surrogate for survival, reflecting the relatively indolent nature of recurrence after LT. SUMMARY Growing evidence has shown that excellent survival and even cure can be achieved in highly selected patients with uCRLM, with survival rates far superior than in patients treated with chemotherapy. The next step is to create national registries to standardize selection criteria and establish the optimal approach and best practices for incorporating LT for uCRLM into the treatment armamentarium.
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Affiliation(s)
- Mariana Chávez-Villa
- Department of Surgery, Division of Transplantation, University of Rochester Medical Center, Rochester, New York, USA
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Ros J, Salva F, Dopazo C, López D, Saoudi N, Baraibar I, Charco R, Tabernero J, Elez E. Liver transplantation in metastatic colorectal cancer: are we ready for it? Br J Cancer 2023; 128:1797-1806. [PMID: 36879000 PMCID: PMC10147684 DOI: 10.1038/s41416-023-02213-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Colorectal cancer (CRC) is a prevalent disease worldwide, with more than 50% of patients developing metastases to the liver. Five-year overall survival remains modest among patients with metastatic CRC (mCRC) treated with conventional therapies however, liver transplantation in a highly selected population can improve clinical outcomes with an impressive 5-year overall survival of 83%. Despite liver transplantation appearing to be a promising therapeutical option for well-selected patients with mCRC with the liver-limited disease, these data come from small monocentric trials which included a heterogeneous population. Currently, several clinical trials are evaluating liver transplantation in this scenario, aiming for a more accurate patient selection by integrating liquid biopsy, tissue profiling, and nuclear medicine to the already known clinical biomarkers that eventually may lead to a survival improvement. In this paper, the clinical outcomes and inclusion criteria from the most relevant clinical trials and clinical series involving liver transplantation in patients with liver-limited disease colorectal cancer are reviewed as well as the trials currently recruiting.
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Affiliation(s)
- Javier Ros
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain.
- Medical Oncology, Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80131, Naples, Italy.
| | - Francesc Salva
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Cristina Dopazo
- Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Daniel López
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Nadia Saoudi
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Iosune Baraibar
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Ramon Charco
- Department of HPB Surgery and Transplants, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Josep Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
| | - Elena Elez
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), 08035, Barcelona, Spain
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6
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McDonald EO, Amanullah AA, Park PSU, Song W, Werner TJ, Alavi A, Revheim ME. The role of 18F-FDG PET/CT in primary cutaneous lymphoma: an educational review. Ann Nucl Med 2023; 37:328-348. [PMID: 37095393 DOI: 10.1007/s12149-023-01830-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/05/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Primary cutaneous lymphoma (PCL) is a cutaneous non-Hodgkin's lymphoma that originates in the skin and lacks extracutaneous spread upon initial diagnosis. The clinical management of secondary cutaneous lymphomas is different from that of PCLs, and earlier detection is associated with better prognosis. Accurate staging is necessary to determine the extent of disease and to choose the appropriate treatment. The aim of this review is to investigate the current and potential roles of 18F- fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis, staging, and monitoring of PCLs. METHODS A focused review of the scientific literature was performed using inclusion criteria to filter results pertaining to human clinical studies performed between 2015 and 2021 that analyzed cutaneous PCL lesions on 18F PET/CT imaging. RESULTS & CONCLUSION A review of 9 clinical studies published after 2015 concluded that 18F-FDG PET/CT is highly sensitive and specific for aggressive PCLs and proved valuable for identifying extracutaneous disease. These studies found 18F-FDG PET/CT highly useful for guiding lymph node biopsy and that imaging results influenced therapeutic decision in many cases. These studies also predominantly concluded that 18F-FDG PET/CT is more sensitive than computed tomography (CT) alone for detection of subcutaneous PCL lesions. Routine revision of nonattenuation-corrected (NAC) PET images may improve the sensitivity of 18F-FDG PET/CT for detection of indolent cutaneous lesions and may expand the potential uses of 18F-FDG PET/CT in the clinic. Furthermore, calculating a global disease score from 18F-FDG PET/CT at every follow-up visit may simplify assessment of disease progression in the early clinical stages, as well as predict the prognosis of disease in patients with PCL.
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Affiliation(s)
| | - Amir A Amanullah
- Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Peter Sang Uk Park
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William Song
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, University of Pennsylvania Hospital, Philadelphia, PA, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway.
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Menon K, Vijayashanker A, Murphy J, Line PD, Isaac J, Adair A, Prasad R, Thorburn D. Liver transplantation for isolated unresectable colorectal liver metastases - Protocol for a service evaluation in the United Kingdom - UKCoMET study. HPB (Oxford) 2023:S1365-182X(23)00049-7. [PMID: 36948901 DOI: 10.1016/j.hpb.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/13/2023] [Accepted: 02/13/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Liver transplantation (LT) for unresectable colorectal liver metastases (CRCLM) demonstrates good overall survival for selected patients in contemporary studies, with 5-year survival of 80%. A Fixed Term Working Group (FTWG), set up by NHS Blood and Transplant (NHSBT) Liver Advisory Group (LAG), advised whether CRCLM should be considered for LT in United Kingdom. Their recommendation was that LT may be undertaken for isolated and unresectable CRCLM using strict selection criteria as a national clinical service evaluation. METHODS Opinions were sought from colorectal cancer/LT patient representatives, experts in colorectal cancer surgery/oncology, LT surgery, hepatology, hepatobiliary radiology, pathology, and nuclear medicine, and appropriate patient selection criteria, referral and transplant listing pathways were identified. RESULTS This paper summarises selection criteria for LT in United Kingdom for isolated and unresectable CRCLM patients, and highlights referral framework and pre-transplant assessment criteria. Finally, oncology-specific outcome measures to be utilised for assessing applicability of LT are described. CONCLUSION This service evaluation represents a significant development for colorectal cancer patients in United Kingdom and a meaningful step forward in the field of transplant oncology. This paper details the protocol for the pilot study, scheduled to begin in the fourth quarter of 2022 in United Kingdom.
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Affiliation(s)
- Krishna Menon
- Institute of Liver Studies, King's College Hospital, London, UK; Digestive Diseases and Surgery Institute, Cleveland Clinic London, UK.
| | | | - Jamie Murphy
- Department of Surgery and Cancer, Imperial College London, UK; Digestive Diseases and Surgery Institute, Cleveland Clinic London, UK
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John Isaac
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Anya Adair
- Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, UK
| | - Raj Prasad
- Liver Transplantation and HPB Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Douglas Thorburn
- Sheila Sherlock Liver Centre and UCL Institute for Liver & Digestive Health, Royal Free Hospital, London, UK
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8
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Dueland S, Smedman TM, Grut H, Syversveen T, Jørgensen LH, Line PD. PET-Uptake in Liver Metastases as Method to Predict Tumor Biological Behavior in Patients Transplanted for Colorectal Liver Metastases Developing Lung Recurrence. Cancers (Basel) 2022; 14:cancers14205042. [PMID: 36291826 PMCID: PMC9599638 DOI: 10.3390/cancers14205042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 12/02/2022] Open
Abstract
The objective of the study was to determine the impact of PET uptake on liver metastases on overall survival (OS) after resection of pulmonary metastases in patients who had received liver transplantation (LT) due to unresectable colorectal liver-only metastases. Resection of pulmonary colorectal metastases is controversial. Some hospitals offer this treatment to selected patients, whereas other hospitals do not perform the procedure in colorectal cancer patients who develop pulmonary metastases. All patients included in the LT studies who developed pulmonary metastases as first site of relapse, and had resection of these as first treatment, were included in this report. Metabolic tumor volume (MTV) in liver was derived from the pre-transplant PET examinations. OS from time of resection was calculated by the Kaplan−Meier method. Patients with low MTV (<70 cm3) had significantly longer OS from time of resection of pulmonary metastases compared to patients with high MTV (>70 cm3). Patients with low MTV in the liver had 10-year OS from time of pulmonary resections of 86%. Liver MTV values from pre-transplant PET examinations may predict long OS in colorectal cancer patients with a resection of pulmonary metastases developing after LT. Thus, in selected colorectal cancer patients developing pulmonary metastases resection of these metastases should be the treatment of choice.
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Affiliation(s)
- Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, 0424 Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, 0424 Oslo, Norway
- Correspondence: ; Tel.: +47-930-56-548; Fax: +47-23-07-05-10
| | - Tor Magnus Smedman
- Department of Oncology, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| | - Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Pål-Dag Line
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, 0424 Oslo, Norway
- Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, 0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
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9
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Grut H, Line PD, Syversveen T, Dueland S. Metabolic tumor volume predicts long-term survival after transplantation for unresectable colorectal liver metastases: 15 years of experience from the SECA study. Ann Nucl Med 2022; 36:1073-1081. [PMID: 36241941 PMCID: PMC9668778 DOI: 10.1007/s12149-022-01796-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/05/2022] [Indexed: 11/25/2022]
Abstract
Objective To report 15 years of experience with metabolic tumor volume (MTV) of liver metastases from the preoperative 18F-FDG PET/CT to predict long-term survival after liver transplantation (LT) for unresectable colorectal liver metastases (CRLM). Methods The preoperative 18F-FDG PET/CT from all SECA 1 and 2 patients was evaluated. MTV was obtained from all liver metastases. The patients were divided into one group with low MTV (< 70 cm3) and one group with high MTV (> 70 cm3) based on a receiver operating characteristic analysis. Overall survival (OS), disease-free survival (DFS) and post recurrence survival (PRS) for patients with low versus high MTV were compared using the Kaplan–Meier method and log rank test. Clinopathological features between the two groups were compared by a nonparametric Mann–Whitney U test for continuous and Fishers exact test for categorical data. Results At total of 40 patients were included. Patients with low MTV had significantly longer OS (p < 0.001), DFS (p < 0.001) and PRS (p = 0.006) compared to patients with high values. The patients with high MTV had higher CEA levels, number of liver metastases, size of the largest liver metastasis, N-stage, number of chemotherapy lines and more frequently progression of disease at LT compared to the patients with low MTV. Conclusion MTV of liver metastases is highly predictive of long-term OS, DFS and PRS after LT for unresectable CRLM and should be implemented in risk stratification prior to LT.
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Affiliation(s)
- Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, 3004, Drammen, Norway.
| | - Pål-Dag Line
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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10
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Chávez-Villa M, Ruffolo LI, Tomiyama K, Hernandez-Alejandro R. Where Are We Now With Liver Transplant for Colorectal Metastasis? CURRENT TRANSPLANTATION REPORTS 2022. [DOI: 10.1007/s40472-022-00373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Langen Stokmo H, Aly M, Bowitz Lothe IM, Borja AJ, Mehdizadeh Seraj S, Ghorpade R, Miao X, Hjortland GO, Malinen E, Sorbye H, Werner TJ, Alavi A, Revheim M. Volumetric parameters from [ 18 F]FDG PET/CT predicts survival in patients with high-grade gastroenteropancreatic neuroendocrine neoplasms. J Neuroendocrinol 2022; 34:e13170. [PMID: 35729738 PMCID: PMC9539477 DOI: 10.1111/jne.13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022]
Abstract
A positive fluorine-18 labelled 2-deoxy-2-fluoroglucose ([18 F]FDG) positron emission tomography/computed tomography (PET/CT) has been associated with more aggressive disease and less differentiated neuroendocrine neoplasms (NEN). Although a high maximum standardized uptake value (SUVmax ) predicts poor outcome in NEN, volumetric parameters from [18 F]FDG PET have not been evaluated for prognostication in a pure high-grade gastroenteropancreatic (GEP) NEN cohort. In this retrospective observational study, we evaluated the volumetric PET parameters total metabolic tumour volume (tMTV) and total total lesion glycolysis (tTLG) for independent prognostication of overall survival (OS). High-grade GEP NEN patients with [18 F]FDG PET/CT examination and biopsy within 90 days were included. Total MTV and tTLG were calculated using an adaptive thresholding software. Patients were dichotomised into low and high metabolic groups based on median tMTV and tTLG. OS was compared using Kaplan-Meier estimator and log-rank test. Uni and multivariable Cox regression was used to estimate effect sizes and adjust for tumour differentiation and SUVmax . Sixty-six patients (median age 64 years) were included with 14 NET G3 and 52 NEC cases after histological re-evaluation. Median tMTV was 208 cm3 and median tTLG 1899 g. Median OS in the low versus high tMTV-group was 21.2 versus 5.7 months (HR 2.53, p = 0.0007) and 22.8 versus 5.7 months (HR 2.42, p = 0.0012) in the tTLG-group. Adjusted for tumour differentiation and SUVmax , tMTV and tTLG still predicted for poor OS, and both tMTV and tTLG were stronger prognostic parameters than SUVmax . Both regression models showed a strong association between volumetric parameters and OS for both neuroendocrine tumours (NET) G3 and neuroendocrine carcinomas (NEC). OS for the tTLG low metabolic NEC was much higher than for the tTLG high metabolic NET G3 (18.3 vs. 5.7 months). High-grade GEP NEN patients with high tMTV or tTLG had a worse OS regardless of tumour differentiation (NET G3 or NEC). Volumetric PET parameters were stronger prognostic parameters than SUVmax .
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Affiliation(s)
- Henning Langen Stokmo
- Division of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
| | - Mahmoud Aly
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of RadiologyAsyut University HospitalAsyutEgypt
| | | | - Austin J. Borja
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Rina Ghorpade
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Xuan Miao
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Eirik Malinen
- Department of Medical PhysicsOslo University HospitalOsloNorway
- Department of PhysicsUniversity of OsloOsloNorway
| | - Halfdan Sorbye
- Department of OncologyHaukeland University HospitalBergenNorway
- Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Thomas J. Werner
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Abass Alavi
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mona‐Elisabeth Revheim
- Division of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
- Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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12
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Cui X, Geng XP, Zhou DC, Yang MH, Hou H. Advances in liver transplantation for unresectable colon cancer liver metastasis. World J Gastrointest Surg 2021; 13:1615-1627. [PMID: 35070067 PMCID: PMC8727191 DOI: 10.4240/wjgs.v13.i12.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/19/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
It is estimated that 50% of patients with colorectal cancer will develop liver metastasis. Surgical resection significantly improves survival and provides a chance of cure for patients with colorectal cancer liver metastasis (CRLM). Increasing the resectability of primary unresectable liver metastasis provides more survival benefit for those patients. Considerable surgical innovations have been made to increase the resection rate and decrease the potential risk of hepatic failure postoperation. Liver transplantation (LT) has been explored as a potential curative treatment for unresectable CRLM. However, candidate selection criteria, chemotherapy strategies, refined immunity regimens and resolution for the shortage of grafts are lacking. This manuscript discusses views on surgical indication, peritransplantation anti-tumor and anti-immunity therapy and updated advances in LT for unresectable CRLM. A literature review of published articles and registered clinical trials in PubMed, Google Scholar, and Clinicaltrials.gov was performed to identify studies related to LT for CRLM. Some research topics were identified, including indications for LT for CRLM, oncological risk, antitumor regimens, graft loss, administration of anti-immunity drugs and solutions for graft deficiency. The main candidate selection criteria are good patient performance, good tumor biological behavior and chemosensitivity. Chemotherapy should be administered before transplantation but is not commonly administered posttransplantation for preventive purposes. Mammalian target of rapamycin regimens are recommended for their potential oncological benefit, although there are limited cases. In addition to extended criterion grafts, living donor grafts and small grafts combined with two-stage hepatectomy are efficient means to resolve organ deficiency. LT has been proven to be an effective treatment for selected patients with liver-only CRLM. Due to limited donor grafts, high cost and poorly clarified oncological risks, LT for unresectable CRLM should be strictly performed under a well-organized study plan in selected patients. Some vital factors, like LT indication and anti-tumor and anti-immune treatment, remain to be confirmed. Ongoing clinical trials are expected to delineate these topics.
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Affiliation(s)
- Xiao Cui
- Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Xiao-Ping Geng
- Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Da-Chen Zhou
- Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Ming-Hao Yang
- Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Hui Hou
- Department of General Surgery, The Second Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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13
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Dueland S, Smedman TM, Røsok B, Grut H, Syversveen T, Jørgensen LH, Line PD. Treatment of relapse and survival outcomes after liver transplantation in patients with colorectal liver metastases. Transpl Int 2021; 34:2205-2213. [PMID: 34792825 DOI: 10.1111/tri.13995] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023]
Abstract
Liver transplantation (LT) in selected colorectal cancer (CRC) patients with nonresectable liver-only metastases may result in 5-year overall survival of up to about 70-100%. However, the majority will have recurrent disease. All patients included in this report were included in prospective studies. Forty-four out of 56 patients had a relapse, and all 44 patients received treatment for recurrent disease. The organ of the first relapse was lung metastases in 23 of the 44 patients. The first treatment modality of the relapse was the treatment with curative intent in 55.8% of the patients, and chemotherapy was the first treatment administered to 25.6% of the patients. Patients receiving surgery of lung metastases had a 5-year overall survival of 66.5% from the time of metastasectomy. Patients receiving treatment with curative intent for metastases to other organs had a 5-year overall survival of 24.8%. Nine of the 44 patients had no evidence of disease (NED) at the end of the follow-up. Median time of NED in these patients was 54.3 months, and median overall survival from the time of LT was 8.4 years. Because of the high incidence of recurrent disease, these patients should have a systematic long-term follow-up since many of the relapses may be treated with curative intent.
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Affiliation(s)
- Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor M Smedman
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bård Røsok
- Department of Hepatobiliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Harald Grut
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Department of Radiology, Vestre Viken Hospital Trust, Drammen, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Lars H Jørgensen
- Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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14
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Bonney GK, Chew CA, Lodge P, Hubbard J, Halazun KJ, Trunecka P, Muiesan P, Mirza DF, Isaac J, Laing RW, Iyer SG, Chee CE, Yong WP, Muthiah MD, Panaro F, Sanabria J, Grothey A, Moodley K, Chau I, Chan ACY, Wang CC, Menon K, Sapisochin G, Hagness M, Dueland S, Line PD, Adam R. Liver transplantation for non-resectable colorectal liver metastases: the International Hepato-Pancreato-Biliary Association consensus guidelines. Lancet Gastroenterol Hepatol 2021; 6:933-946. [PMID: 34506756 DOI: 10.1016/s2468-1253(21)00219-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
Colorectal cancer is a prevalent disease worldwide, with more than 50% of patients developing metastases to the liver. Despite advances in improving resectability, most patients present with non-resectable colorectal liver metastases requiring palliative systemic therapy and locoregional disease control strategies. There is a growing interest in the use of liver transplantation to treat non-resectable colorectal liver metastases in well selected patients, leading to a surge in the number of studies and prospective trials worldwide, thereby fuelling the emerging field of transplant oncology. The interdisciplinary nature of this field requires domain-specific evidence and expertise to be drawn from multiple clinical specialities and the basic sciences. Importantly, the wider societal implication of liver transplantation for non-resectable colorectal liver metastases, such as the effect on the allocation of resources and national transplant waitlists, should be considered. To address the urgent need for a consensus approach, the International Hepato-Pancreato-Biliary Association commissioned the Liver Transplantation for Colorectal liver Metastases 2021 working group, consisting of international leaders in the areas of hepatobiliary surgery, colorectal oncology, liver transplantation, hepatology, and bioethics. The aim of this study was to standardise nomenclature and define management principles in five key domains: patient selection, evaluation of biological behaviour, graft selection, recipient considerations, and outcomes. An extensive literature review was done within the five domains identified. Between November, 2020, and January, 2021, a three-step modified Delphi consensus process was undertaken by the workgroup, who were further subgrouped into the Scientific Committee, Expert Panel, and Transplant Centre Representatives. A final consensus of 44 statements, standardised nomenclature, and a practical management algorithm is presented. Specific criteria for clinico-patho-radiological assessments with molecular profiling is crucial in this setting. After this, the careful evaluation of biological behaviour with bridging therapy to transplantation with an appropriate assessment of the response is required. The sequencing of treatment in synchronous metastatic disease requires special consideration and is highlighted here. Some ethical dilemmas within organ allocation for malignant indications are discussed and the role for extended criteria grafts, living donor transplantation, and machine perfusion technologies for non-resectable colorectal liver metastases are reviewed. Appropriate immunosuppressive regimens and strategies for the follow-up and treatment of recurrent disease are proposed. This consensus guideline provides a framework by which liver transplantation for non-resectable colorectal liver metastases might be safely instituted and is a meaningful step towards future evidenced-based practice for better patient selection and organ allocation to improve the survival for patients with this disease.
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Affiliation(s)
- Glenn K Bonney
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore.
| | - Claire Alexandra Chew
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Peter Lodge
- Department of Transplantation and Hepatobiliary Surgery, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Karim J Halazun
- Division of Liver Transplantation and Hepato-Pancreato-Biliary Surgery, Department of Surgery, Weill Cornell Medicine, New York City, NY, USA
| | - Pavel Trunecka
- Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Paolo Muiesan
- Department of Hepatobiliary Surgery, Careggi University Hospital, Florence, Italy
| | - Darius F Mirza
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Isaac
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard W Laing
- Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Shridhar Ganpathi Iyer
- Division of Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore
| | - Cheng Ean Chee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Wei Peng Yong
- Department of Haematology-Oncology, National University Cancer Institute, Singapore
| | - Mark Dhinesh Muthiah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore
| | - Fabrizio Panaro
- Division of Hepato-Pancreato-Biliary Surgery and Transplantation, Department of Surgery, Saint Eloi Hospital, Montpellier University Hospital-School of Medicine, Montpellier, France
| | - Juan Sanabria
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Axel Grothey
- Department of Medical Oncology, West Cancer Center and Research Institute, Germantown, TN, USA
| | - Keymanthri Moodley
- The Centre of Medical Ethics and Law, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, London, UK
| | - Albert C Y Chan
- Division of Liver Transplantation, Hepatobiliary & Pancreatic Surgery, Queen Mary Hospital, Hong Kong
| | - Chih Chi Wang
- Department of Surgery, Liver Transplantation Centre, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Krishna Menon
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Gonzalo Sapisochin
- Abdominal Transplant and Hepato-Pancreato-Biliary Surgical Oncology, Multi-Organ Transplant Program, Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Svein Dueland
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - René Adam
- Hepato Biliary Surgery, Cancer and Transplantation Unit, AP-HP Paul Brousse Hospital, University Paris-Saclay, Villejuif, France
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15
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Lanari J, Hagness M, Sartori A, Rosso E, Gringeri E, Dueland S, Cillo U, Line PD. Liver transplantation versus liver resection for colorectal liver metastasis: a survival benefit analysis in patients stratified according to tumor burden score. Transpl Int 2021; 34:1722-1732. [PMID: 34448271 DOI: 10.1111/tri.13981] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022]
Abstract
Liver transplantation (LT) for colorectal liver metastasis (CRLM) may provide excellent survival rates in patients with unresectable disease. High tumor load is a risk factor for recurrence and low overall survival (OS) after liver resection (LR). We tested the hypothesis that LT could offer better survival than LR in patients with high tumor load. LR performed at Padua University Hospital for CRLM was compared with LT for unresectable CRLM performed both at Oslo and Padua. High tumor load was defined as tumor burden score (TBS) ≥ 9, and inclusion criteria were as in the SECA-I transplant study. 184 patients were eligible: 128 LRs and 56 LTs. 5-year OS after LR and LT was 40.5% and 54.7% (P = 0.102). In the high TBS cohort, 5-year OS after LR and LT was 22.7% and 52.2% (P = 0.055). In patients with Oslo score ≤ 2 and TBS ≥ 9 (13 LR; 24 LT) the 5-year OS after LR and LT was 14.6% and 69.1% (P = 0.002). The corresponding disease-free survival (DFS) was 0% and 22.9% (P = 0.005). Selected CRLM patients with low Oslo score and high TBS could benefit from LT with survival outcomes that are far better than what is achieved by LR.
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Affiliation(s)
- Jacopo Lanari
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy.,Department of Transplantation Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Alessandra Sartori
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Eugenia Rosso
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Enrico Gringeri
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Svein Dueland
- Institute of Clinical Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, Padua, Italy
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Oslo universitetssykehus Rikshospitalet, Oslo, Norway.,Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo universitetssykehus Rikshospitalet, Oslo, Norway
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16
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Finotti M, Vitale A, Gringeri E, D'Amico FE, Boetto R, Bertacco A, Lonardi S, Bergamo F, Feltracco P, Cillo U. Colon Rectal Liver Metastases: The Role of the Liver Transplantation in the Era of the Transplant Oncology and Precision Medicine. Front Surg 2021; 8:693387. [PMID: 34355016 PMCID: PMC8329096 DOI: 10.3389/fsurg.2021.693387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/21/2021] [Indexed: 12/24/2022] Open
Abstract
The development of liver metastases in colon rectal cancer has a strong impact on the overall survival (OS) of the patient, with a 5-year survival rate of 5% with palliative treatment. Surgical resection combined with pharmacological treatment can achieve a 5-year OS rate of 31–58%. However, in only 20% of patients with colon rectal liver metastases (CRLMs), liver resection is feasible. In highly selected patients, recent trials and studies proved that liver transplantation (LT) for non-resectable CRLM is a surgical option with an excellent long-term OS. The paper aims to review the indications and outcome of LT for CRLMs, with a special focus on immunosuppressive therapy and the management of local and extrahepatic recurrence after LT.
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Affiliation(s)
- Michele Finotti
- University of Padova, Transplantation and Hepatobiliary Surgery, Padua, Italy
| | - Alessandro Vitale
- University of Padova, Transplantation and Hepatobiliary Surgery, Padua, Italy
| | - Enrico Gringeri
- University of Padova, Transplantation and Hepatobiliary Surgery, Padua, Italy
| | | | - Riccardo Boetto
- University of Padova, Transplantation and Hepatobiliary Surgery, Padua, Italy
| | - Alessandra Bertacco
- University of Padova, Transplantation and Hepatobiliary Surgery, Padua, Italy
| | - Sara Lonardi
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Francesca Bergamo
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology IOV - Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Paolo Feltracco
- Anesthesia and Intensive Care Unit, Azienda Ospedaliera di Padova, Padua, Italy
| | - Umberto Cillo
- University of Padova, Transplantation and Hepatobiliary Surgery, Padua, Italy
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17
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Dueland S, Yaqub S, Syversveen T, Carling U, Hagness M, Brudvik KW, Line PD. Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases. JAMA Surg 2021; 156:550-557. [PMID: 33787838 DOI: 10.1001/jamasurg.2021.0267] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Portal vein embolization (PVE) has been implemented in patients with extensive colorectal liver metastases to increase the number of patients able to undergo liver resection. Liver transplant could be an alternative in selected patients with extensive liver-only disease, and we have recently shown promising survival outcomes. Objective To compare overall survival (OS) among patients with colorectal cancer and high liver metastasis tumor load who were treated with liver transplant or with PVE and liver resection. Design, Setting, and Participants This comparative effectiveness research study assessed 50 patients with colorectal cancer liver metastases who were previously enrolled in liver transplant studies between November 2006 and August 2019 at Oslo University Hospital in Norway. Those patients were compared with a retrospective cohort of 53 patients in the Oslo University Hospital PVE database from March 2006 through November 2015 with similar selection criteria who underwent PVE and liver resection. Main Outcomes and Measures The OS among patients with high tumor load after liver transplant was compared with that among patients with high tumor load who underwent PVE and liver resection. High tumor load was defined as 9 or more metastatic tumors or a diameter of 5.5 cm or longer for the largest liver lesion. Results In the PVE cohort of 53 patients, the median age was 61.8 years (range, 34.3-71.3 years), and 36 patients (68%) were men. The 5-year OS rate among 38 patients who underwent liver resection after PVE was 44.6%. The 5-year OS rate for patients with high tumor load was 33.4% for those who underwent liver transplant and 6.7% for those who underwent PVE. Among patients with high tumor load and left-sided primary tumors, the 5-year OS rate was 45.3% for those receiving a liver allograft and 12.5% for those treated with PVE and liver resection. Conclusions and Relevance Patients with nonresectable disease, an extensive liver tumor load, and left-sided primary tumors had long OS after liver transplant, exceeding the survival outcome for those patients treated with PVE and liver resection.
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Affiliation(s)
- Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Sheraz Yaqub
- Department of Hepatobiliary Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ulrik Carling
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Hagness
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Pål-Dag Line
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Kim YI, Lee HS, Choi JY. Prognostic Significance of Pretreatment 18F-FDG PET/CT Volumetric Parameters in Patients With Colorectal Liver Metastasis: A Systematic Review and Meta-analysis. Clin Nucl Med 2021; 46:206-213. [PMID: 33443946 DOI: 10.1097/rlu.0000000000003479] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE Colorectal liver metastasis (CRLM) remains a clinical challenge due to the lack of reliable prognostic parameters. We performed a systematic review and meta-analysis of the prognostic value of pretreatment 18F-FDG PET/CT volumetric parameters for hepatic metastatic lesions (HMLs) in patients with CRLM. METHODS A systematic search was performed using the following combination of keywords: CRLM, FDG, PET, and prognosis. The inclusion criteria were studies using 18F-FDG PET/CT as an imaging tool before treatment, including volumetric parameters (metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) for HMLs, and reported survival data. Event-free survival and overall survival were considered as survival markers. The effect on survival was determined by the effect size of the hazard ratio (HR) with 95% confidence interval (CI). RESULTS Our systematic search identified 668 records, and a total of 10 studies comprising 494 patients were included. The pooled HRs of the prognostic value of the MTV and TLG for event-free survival were 1.55 (95% CI, 1.21-1.99; P = 0.0006) and 1.64 (95% CI, 1.23-2.19; P = 0.0009) with significance, respectively. The pooled HRs of the prognostic value of the MTV and TLG for overall survival were 1.72 (95% CI, 1.32-2.23; P < 0.0001) and 2.09 (95% CI, 1.48-2.96; P < 0.0001) with significance, respectively. CONCLUSIONS Higher MTV and TLG for HMLs before treatment were identified as worse prognostic parameters in patients with CRLM. The MTV and TLG of 18F-FDG PET/CT could be used as predictors of prognosis.
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Affiliation(s)
- Yong-Il Kim
- From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hyo Sang Lee
- Department of Nuclear Medicine, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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19
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Wang X, Ye H, Yan Y, Wu J, Wang N, Chen M. The Preoperative Enhanced Degree of Contrast-enhanced CT Images: A Potential Independent Predictor in Gastric Adenocarcinoma Patients After Radical Gastrectomy. Cancer Manag Res 2020; 12:11989-11999. [PMID: 33262649 PMCID: PMC7695603 DOI: 10.2147/cmar.s271879] [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: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Aim To discover the value of contrast-enhanced CT parameters in predicting the prognosis of gastric adenocarcinoma (GAC) patients after radical gastrectomy. Methods The patients with a clinical diagnosis of GAC were retrospectively enrolled. Two radiologists drew the regions of interest (ROIs) in CT images and measured the CT attenuate value (CAV) in each phase and the corrected CAV (cCAV) in each contrast-enhanced phase. Patients were divided into two groups (high/low-enhancement) according to receiver operating characteristic (ROC) curve. Kaplan–Meier curve and Cox proportional hazards regression analysis were performed to evaluate correlation between prognosis and variables. Subgroup analysis was used to further analyze the prognostic value of variables. Results In total 435 patients were included. According to ROC curve, the cCAV in delayed phase (DP-cCAV) with maximum AUC and Youden index was chosen. A total of 312 patients (71.7%) entered DP-cCAVlow group and remaining 123 (28.3%) patients were in DP-cCAVhigh group. According to univariate (high vs low, HR=2.120, p<0.001) and multivariate (high vs low, HR=1.623, p<0.001) Cox regression analysis, the low-enhancement state was considered as an independent protective factor. Subgroup analysis was based on age, maximum diameter of tumor, differentiation, vascular invasion status, and TNM staging. In most subgroups, the overall survival (OS) of DP-cCAVlow group was overwhelmingly satisfactory (all HR >1, expect TNM stage I, IV and differentiated type subgroups). Conclusion The prognostic effectiveness of CT parameters as biomarkers for OS in GAC patients treated with radical gastrectomy has potential value.
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Affiliation(s)
- Xinxin Wang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Huajun Ye
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Ye Yan
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Jiansheng Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Na Wang
- Health Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Mengjun Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
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20
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Abstract
Abstract
Purpose of Review
Accumulating evidence suggest that selected patients with nonresectable liver only metastases from colorectal cancer can be offered liver transplantation with acceptable outcome. This review provides an update on the scientific literature.
Recent Findings
The SECA-I study showed an estimated 5-year survival of 60% in a heterogenous patient population and guided the development of the first clinical selection criteria. In the sequel SECA-II trial, an estimated 5-year survival of 83% was obtained. A recent study shows that an Oslo score of 0–2, a metabolic tumor volume below 70 cm3 on PET-CT or Fong score of 0–2 at time of listing, can stratify patients with superior survival. Recurrence is common, but about 70% are slow-growing lung metastases, whereof the majority are resectable.
Summary
Liver transplantation for colorectal liver metastasis is an option in highly selected patients. Futile use of grafts can be avoided by applying stringent selection criteria.
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21
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Abstract
International colon cancer guidelines suggest F-FDG PET/CT in a few circumstances: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma; (2) in the workup of recurrent colon cancer with metachronous metastases documented by CT, MRI, or biopsy and in case of serial CEA elevation with negative colonoscopy and negative CT; and (3) in case of contraindication to iodine- and gadolinium-based contrast agents. However, review of the literature has shown that PET/CT can also be used in other scenarios with significant levels of diagnostic advantage. This review aims to emphasize differences between guidelines and scientific literature for the use of PET/CT in colon cancer.
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22
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Giannis D, Sideris G, Kakos CD, Katsaros I, Ziogas IA. The role of liver transplantation for colorectal liver metastases: A systematic review and pooled analysis. Transplant Rev (Orlando) 2020; 34:100570. [DOI: 10.1016/j.trre.2020.100570] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
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23
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Grut H, Stern NM, Dueland S, Labori KJ, Dormagen JB, Schulz A. Preoperative 18F-FDG PET/computed tomography predicts survival following resection for colorectal liver metastases. Nucl Med Commun 2020; 41:916-923. [PMID: 32796480 DOI: 10.1097/mnm.0000000000001235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The liver is the most frequent metastatic site from colorectal cancer and about 20% of these patients are treated by surgical resection. However, the 5-year disease-free survival (DFS) following resection is only about 25% and 5-year overall survival (OS) about 38%. The aim of the study was to evaluate the ability of metabolic and volumetric measurements from fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) prior to resection for colorectal liver metastases (CLM) to predict survival. PATIENTS AND METHODS Preoperative F-FDG PET/CT examinations were assessed. Metabolic tumor volume (MTV), total lesion glycolysis (TLG), maximum, mean and peak standardized uptake values and tumor to background ratio, were obtained for all CLM. Cutoff values were determined for each of these parameters by using receiver operating characteristic analysis dividing the patients into two groups. DFS, liver recurrence-free survival (LRFS), OS and cancer-specific survival (CSS) for patients over and under the cutoff value were compared by using the Kaplan-Meier method and log-rank test. RESULTS Twenty-seven patients who underwent F-FDG PET/CT prior to resection for CLM were included. Low values of total MTV and TLG were significantly correlated to improved 5-year LRFS (P = 0.016 and 0.006) and CSS (P = 0.034 and 0.008). Patients who developed liver recurrence had significantly higher total MTV and TLG compared to patients without liver recurrence (P = 0.042 and 0.047). CONCLUSION Low values of total MTV and TLG were significantly correlated to improved LRFS and CSS and may improve the risk stratification of patients considered for resection for CLM.
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Affiliation(s)
- Harald Grut
- Department of Radiology, Vestre Viken Hospital Trust, Drammen
- Department of Radiology and Nuclear Medicine
| | | | | | | | | | - Anselm Schulz
- Department of Radiology and Nuclear Medicine
- Department of Diagnostic Physics, Norwegian Imaging Technology Research and Innovation Center (ImTECH), Oslo University Hospital, Oslo, Norway
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24
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Andres A, Toso C. Liver transplantation for colorectal metastasis: a stepwise approach. Hepatobiliary Surg Nutr 2020; 9:336-338. [PMID: 32509822 DOI: 10.21037/hbsn.2019.10.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Axel Andres
- Abdominal Surgery and Transplantation, Geneva University Hospital, Geneva, Switzerland
| | - Christian Toso
- Abdominal Surgery and Transplantation, Geneva University Hospital, Geneva, Switzerland
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25
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Smedman TM, Line PD, Hagness M, Syversveen T, Grut H, Dueland S. Liver transplantation for unresectable colorectal liver metastases in patients and donors with extended criteria (SECA-II arm D study). BJS Open 2020; 4:467-477. [PMID: 32333527 PMCID: PMC7260412 DOI: 10.1002/bjs5.50278] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
Background Patients with metastatic colorectal cancer receiving palliative chemotherapy have a 5‐year survival rate of approximately 10 per cent. Liver transplantation using strict selection criteria in patients with colorectal cancer and unresectable liver‐only disease will result in a 5‐year survival rate of 56–83 per cent. The aim of this study was to evaluate survival of patients with colorectal liver metastases (CRLM) after liver transplantation using extended criteria for both patients and donors. Methods This was a prospective single‐arm study. Patients with synchronous unresectable CRLM who were not suitable for arms A, B or C of the SEcondary CAncer (SECA) II study who had undergone radical resection of the primary tumour and received chemotherapy were included; they underwent liver transplantation with extended criteria donor grafts. Patients who had resectable pulmonary metastases were eligible for inclusion. The main exclusion criteria were BMI above 30 kg/m2 and liver metastases larger than 10 cm. Survival was estimated using Kaplan–Meier analysis. Results Ten patients (median age 54 years; 3 women) were included. They had an extensive liver tumour load with a median of 20 (range 1–45) lesions; the median size of the largest lesion was 59 (range 15–94) mm. Eight patients had (y)pN2 disease, six had poorly differentiated or signet ring cell‐differentiated primary tumours, and five had primary tumour in the ascending colon. The median Fong clinical risk score was 3 (range 2–5) and the median Oslo score was 1 (range 1–4). The median plasma carcinoembryonic antigen level was 4·3 (range 2–4346) μg/l. Median disease‐free and overall survival was 4 and 18 months respectively. Conclusion Patients with unresectable liver‐only CRLM undergoing liver transplantation with extended patient and donor criteria have relatively short overall survival.
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Affiliation(s)
- T M Smedman
- Department of Oncology, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P-D Line
- Department of Transplantation Medicine, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Hagness
- Department of Transplantation Medicine, Oslo, Norway
| | | | - H Grut
- Radiology and Nuclear Medicine, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - S Dueland
- Department of Oncology, Oslo, Norway.,Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
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26
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Liver transplantation for non-resectable colorectal liver metastasis: where we are and where we are going. Langenbecks Arch Surg 2020; 405:255-264. [PMID: 32333096 DOI: 10.1007/s00423-020-01883-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/15/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Almost 50% of patients diagnosed with colorectal cancer (CRC) will develop liver metastasis (LM). Although their only long-term curative treatment is surgery, less than half of these patients can be eventually resected. Therefore, palliative chemotherapy is offered as a definitive option, though with poor results. Recently, the University of Oslo group has published encouraging results in the treatment of these patients with liver transplantation (LT), whereby worldwide interest in this option has been renewed. METHODS A literature review of LT for patients with unresectable colorectal metastasis was performed. This included information regarding patient selection, complications, overall survival (OS) and disease-free survival (DFS), immunosuppression, chemotherapy, and description of the ongoing trials. RESULTS Improvements in OS and DFS have been observed in consecutive published prospective trials, as patient selection has been refined. Papers reporting OS of patients who randomly presented similar selection criteria also exhibited good results. CONCLUSION LT within the available therapeutic options in patients with CRC-LM seems to be a compelling alternative in carefully selected patients. The ongoing trials will provide valuable information regarding selection criteria, immunosuppressive therapy and different modalities of adjuvant chemotherapy, which are, to our knowledge, the vital platform of LT in CRC-LM. Although some of the developing techniques involve living donors, graft availability for these patients remains a matter of major concern.
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27
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Line PD, Ruffolo LI, Toso C, Dueland S, Nadalin S, Hernandez-Alejandro R. Liver transplantation for colorectal liver metastases: What do we need to know? Int J Surg 2020; 82S:87-92. [PMID: 32305529 DOI: 10.1016/j.ijsu.2020.03.079] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
Adenocarcinoma of the colon and rectum (CRC) is the second leading cause of cancer mortality, driven by stage IV disease (Rahib et al., 2014) [1]. While surgical resection of liver metastases has demonstrated a survival advantage, a minority of patients are candidates for resection due to anatomic involvement of disease. Recent advances in liver surgery, chemotherapy, and decision making guided by stratification at the time of presentation has better equipped us to perform aggressive metastasectomies, with resulting improved survival (Fong et al., 1999; Abdalla et al., 2001; Cremolini et al., 2017) [2-4]. As a result, there is a resurgent interest in the concept of total hepatectomy and liver transplantation (LT) for colorectal liver metastases (CRLM). As of this writing, eight prospective clinical trials in six countries are assessing the viability of split or whole LT for CRLM. However, LT for CRLM remains controversial. Recent prospective trials have illustrated the importance of patient selection, and a disciplined respect for tumor biology. Here we present the current status of LT for CRLM, and suggest clinical decision criteria aimed at matching survival benefit comparable to other indications for LT.
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Affiliation(s)
- Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Luis I Ruffolo
- Department of Surgery and Division of Abdominal Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, USA
| | - Christian Toso
- Division of Abdominal Surgery, Department of Surgery, University of Geneva, Geneva, Switzerland
| | - Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Silvio Nadalin
- Department of General and Transplant Surgery, University Hospital Tübingen, Germany
| | - Roberto Hernandez-Alejandro
- Department of Surgery and Division of Abdominal Transplantation and Hepatobiliary Surgery, University of Rochester Medical Center, Rochester, USA
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28
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Survival Following Liver Transplantation for Patients With Nonresectable Liver-only Colorectal Metastases. Ann Surg 2020; 271:212-218. [DOI: 10.1097/sla.0000000000003404] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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29
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Dueland S, Grut H, Syversveen T, Hagness M, Line PD. Selection criteria related to long-term survival following liver transplantation for colorectal liver metastasis. Am J Transplant 2020; 20:530-537. [PMID: 31674105 DOI: 10.1111/ajt.15682] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/02/2019] [Accepted: 10/19/2019] [Indexed: 01/25/2023]
Abstract
Patients with nonresectable colorectal cancer receiving palliative chemotherapy have a 5-year overall survival rate of about 10%. Liver transplant provided a Kaplan-Meier-estimated 5-year overall survival of up to 83%. The objective of the study was to evaluate the ability of different scoring systems to predict long-term overall survival after liver transplant. Patients with colorectal cancer with nonresectable liver-only metastases determined by computed tomography (CT)/magnetic resonance imaging/positron emission tomography (PET)-CT scans from 2 prospective studies (SECA-I and -II) were included. All included patients had previously received chemotherapy. PET-CT was performed within 90 days of the liver transplant. Overall survival, disease-free survival, and survival after relapse based on the Fong Clinical Risk Score, total PET liver uptake (metabolic tumor volume), and Oslo Score were compared. At median follow-up of 85 months for live patients, Kaplan-Meier overall survival rates at 5 years were 100%, 78%, and 67% in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume-low group, and Oslo Score 0 to 2, respectively. Median overall survival was 101, 68, and 65 months in patients with Fong Clinical Risk Score 0 to 2, metabolic tumor volume-low, and Oslo Score 0 to 2. These selection criteria may be used to obtain 5-year overall survival rates comparable to other indications for liver transplant.
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Affiliation(s)
- Svein Dueland
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Harald Grut
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Trygve Syversveen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Morten Hagness
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål-Dag Line
- Experimental Transplantation and Malignancy Research Group, Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway.,Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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30
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Deipolyi AR, England RW, Ridouani F, Riedl CC, Kunin HS, Boas FE, Yarmohammadi H, Sofocleous CT. PET/CT Imaging Characteristics After Radioembolization of Hepatic Metastasis from Breast Cancer. Cardiovasc Intervent Radiol 2019; 43:488-494. [PMID: 31732778 DOI: 10.1007/s00270-019-02375-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To define positron emission tomography/computed tomography (PET/CT) imaging characteristics during follow-up of patients with metastatic breast cancer (MBC) treated with yttrium-90 (Y90) radioembolization (RE). MATERIALS AND METHODS From January 2011 to October 2017, 30 MBC patients underwent 38 Y90 glass or resin RE treatments. Pre-RE PET/CT was performed on average 51 days before RE. There were 68 PET/CTs performed after treatment. Response was assessed using modified PERCIST criteria focusing on the hepatic territory treated with RE, normalizing SUVpeak to the mean SUV of liver uninvolved by tumor. An objective response (OR) was defined as a decrease in SUVpeak by at least 30%. RESULTS Of the 68 post-RE scans, 6 were performed at 0-30 days, 15 at 31-60 days, 9 at 61-90 days, 13 at 91-120 days, 14 scans at 121-180 days, and 11 scans at > 180 days after RE. Of the 30 patients, 25 (83%) achieved OR on at least one follow-up. Median survival was 15 months after the first RE administration. Highest response rates occurred at 30-90 days, with over 75% of cases demonstrating OR at that time. After 180 days, OR was seen in only 25%. There was a median TTP of 169 days among responders. CONCLUSION In MBC, follow-up PET/CT after RE demonstrates optimal response rates at 30-90 days, with progression noted after 180 days. These results help to guide the timing of imaging and also to inform patients of expected outcomes after RE.
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Affiliation(s)
- Amy R Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ryan W England
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fourat Ridouani
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher C Riedl
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Kunin
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - F Edward Boas
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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31
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Auxiliary living donor liver transplantation combined with two-stage hepatectomy for unresectable colorectal liver metastases. Curr Opin Organ Transplant 2019; 24:651-658. [DOI: 10.1097/mot.0000000000000695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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32
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Liver transplantation for unresectable malignancies: Beyond hepatocellular carcinoma. Eur J Surg Oncol 2019; 45:2268-2278. [PMID: 31387755 DOI: 10.1016/j.ejso.2019.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/02/2019] [Accepted: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
Indications for liver transplantation have expanded over the past few decades owing to improved outcomes and better understanding of underlying pathologies. In particular, there has been a growing interest in the field of transplant oncology in recent years that has led to considerable developments which have pushed the boundaries of malignant indications for liver transplantation beyond hepatocellular carcinoma (HCC). In this article, we review and summarise the published evidence for liver transplantation in non-HCC primary and metastatic liver malignancies and highlight ongoing clinical trials that address unresolved questions therein. We also examine the current technical, immunological and oncological challenges that face liver transplantation in this growing field and explore potential approaches to overcome these barriers.
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33
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Recent advances in liver transplantation for cancer: The future of transplant oncology. JHEP Rep 2019; 1:377-391. [PMID: 32039389 PMCID: PMC7005652 DOI: 10.1016/j.jhepr.2019.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation is widely indicated as a curative treatment for selected patients with hepatocellular carcinoma. However, with recent therapeutic advances, as well as efforts to increase the donor pool, liver transplantation has been carefully expanded to patients with other primary or secondary malignancies in the liver. Cholangiocarcinoma, colorectal and neuroendocrine liver metastases, and hepatic epithelioid haemangioendothelioma are amongst the most relevant new indications. In this review we discuss the fundamental concepts of this ambitious undertaking, as well as the newest indications for liver transplantation, with a special focus on future perspectives within the recently established concept of transplant oncology.
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34
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Andres A, Oldani G, Berney T, Compagnon P, Line PD, Toso C. Transplantation for colorectal metastases: on the edge of a revolution. Transl Gastroenterol Hepatol 2018; 3:74. [PMID: 30363763 DOI: 10.21037/tgh.2018.08.04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/23/2018] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation (LT) has become the standard of care for selected primary and secondary malignancies. Considered a contra-indication to transplantation until recently, unresectable colorectal liver metastases (CRLM) have gained interest since the publication of the SECA trial by the University of Oslo. It showed a 5-year overall survival of 60%, comparable to the one of standard transplant indication. This report generated multiple questions about the place of LT for CRLM and gave raise to several trials aiming at answering them. The present review is exploring this topic, defining the current state of the field, and extrapolating the future milestones.
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Affiliation(s)
- Axel Andres
- Transplantation Division, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Graziano Oldani
- Transplantation Division, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Thierry Berney
- Transplantation Division, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Philippe Compagnon
- Transplantation Division, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Pål-Dag Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christian Toso
- Transplantation Division, Department of Surgery, Geneva University Hospital, Geneva, Switzerland
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