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Jiang Y, Shao T, Zhao M, Xue Y, Zheng X. A network meta-analysis of efficacy and safety for first-line and maintenance therapies in patients with unresectable colorectal liver metastases. Front Pharmacol 2024; 15:1374136. [PMID: 39130637 PMCID: PMC11310042 DOI: 10.3389/fphar.2024.1374136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/01/2024] [Indexed: 08/13/2024] Open
Abstract
Background: Evidence comparing the efficacy of different treatments for patients with unresectable colorectal liver metastases (CRLM) receiving first-line or maintenance therapy is sparse. We aimed to assess the efficacy and safety of these treatments, with a distinct focus on evaluating first-line and maintenance treatments separately. Methods: We conducted Bayesian network meta-analyses, sourcing English-language randomized controlled trials (RCTs) published through July 2023 from databases including PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and key conference proceedings. Phase Ⅱ or Ⅲ trials that assessed two or more therapeutic regimens were included. Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), objective response rate (ORR), adverse events graded as 3 or above (SAE), and R0 liver resection rate. Hazards Ratios (HRs) and 95% confidence intervals (CI) were used as effect size for OS and PFS, Odds Ratios (ORs) and 95% CI were used for ORR, SAEs and R0 resection rate. Subgroup and sensitive analyses were conducted to analysis the model uncertainty (PROSPERO: CRD42023420498). Results: 56 RCTs were included (50 for first-line treatment, six for maintenance therapies), with a total of 21,323 patients. Regarding first-line, for OS, the top three mechanisms were: local treatment + single-drug chemotherapy (SingleCT), Targeted therapy (TAR)+SingleCT, and TAR + multi-drug chemotherapy (MultiCT). Resection or ablation (R/A)+SingleCT, S1, and Cetuximab + intensified fluorouracil-based combination chemotherapy (ICTFU) were identified as the best treatments. For PFS, the top three mechanisms were: Immune therapy + TAR + MultiCT, multi-targeted therapy (MultiTAR), TAR + SingleCT. The top three treatments were: Atezolizumab + Bevacizumab + fluorouracil-based combination chemotherapy (CTFU), TAS-102+bevacizumab, Bevacizumab + ICTFU. Cetuximab + CTFU was the best choice for RAS/RAF wild-type patients. Regarding maintenance treatment, Bevacizumab + SingleCT and Adavosertib were the best options for OS and PFS, respectively. For safety, MultiCT was the safest, followed by local treatment + MultiCT, TAR + MultiCT caused the most SAEs. Bevacizumab plus chemotherapy was found to be the safest among all targeted combination therapies. Conclusion: In first-line, local treatment or targeted therapsy plus chemotherapy are the best mechanisms. R/A + SingleCT or CTFU performed the best for OS, Atezolizumab + Bevacizumab + ICTFU was the best option regarding PFS. For RAS/RAF wild-type patients, Cetuximab + CTFU was the optimal option. Monotherapy may be preferred choice for maintenance treatment. Combination therapy resulted in more SAEs when compared to standard chemotherapy.
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Affiliation(s)
- Yunlin Jiang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
- Graduate School of Nanjing University of Chinese Medicine, Nanjing, China
| | - Taihang Shao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Mingye Zhao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yahong Xue
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Xueping Zheng
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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Sun Y, Kong D, Zhang Q, Xiang R, Lu S, Feng L, Zhang H. DNA methylation biomarkers for predicting lymph node metastasis in colorectal cancer. Clin Transl Oncol 2024:10.1007/s12094-024-03601-6. [PMID: 39026026 DOI: 10.1007/s12094-024-03601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
Colorectal cancer is one of the most common cancers worldwide. Lymph node metastasis is an important marker of colorectal cancer progression and plays a key role in the evaluation of patient prognosis. Accurate preoperative assessment of lymph node metastasis is crucial for devising appropriate treatment plans. However, current clinical imaging methods have limitations in many aspects. Therefore, the discovery of a method for accurately predicting lymph node metastasis is crucial clinical decision-making. DNA methylation is a common epigenetic modification that can regulate gene expression, which also has an important impact on the development of colorectal cancer. It is considered to be a promising biomarker with good specificity and stability and has promising application in predicting lymph node metastasis in patients with colorectal cancer. This article reviews the characteristics and limitations of currently available methods for predicting lymph node metastasis in patients with colorectal cancer and discusses the role of DNA methylation as a biomarker.
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Affiliation(s)
- Yu Sun
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Deyang Kong
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qi Zhang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Renshen Xiang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuaibing Lu
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Feng
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Department of Etiology and Carcinogenesis, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Haizeng Zhang
- State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Pei Y, Wang Z, Hao S, Tong Y, Wu R, Qiao X, Liu Y, Zhang G. Analyzing the value of delayed 18 F-FDG PET/CT images in diagnosing small colorectal cancer liver metastases in patients with hypothyroidism based on diagnostic accuracy and image standardized uptake value. Nucl Med Commun 2024; 45:396-405. [PMID: 38372033 DOI: 10.1097/mnm.0000000000001825] [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: 02/20/2024]
Abstract
PURPOSE The objective of this study was to investigate the value of delayed 18F fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) images in patients with small colorectal cancer liver metastases (CRLMs) with hypothyroidism. METHOD We performed a retrospective analysis of 66 small-CRLM patients with hypothyroidism and 66 small-CRLM patients with euthyroidism, all of whom underwent dual-time-point 18 F-FDG PET/CT imaging. First, the diagnostic accuracy of PET/CT early imaging and PET/CT delayed imaging on lesions was analyzed. Next, the correlation of metabolic parameters between PET/CT early imaging and PET/CT delayed imaging was analyzed according to the grouping of all lesions. Finally, PET/CT parameters were analyzed for correlation with thyroid hormones. RESULTS The diagnostic accuracy of delayed imaging in small-CRLM patients with hypothyroidism is not as good as that in small-CRLM patients with euthyroidism; PET/CT metabolic parameters are also unfavorable for the diagnosis of small-CRLM. For small-CRLM patients with hypothyroidism, the greater the thyroid-stimulating hormone level, the greater the uptake of 18 F-FDG in normal liver tissue, and the smaller the ratio of tumor lesion uptake to normal liver tissue uptake. CONCLUSION PET/CT-delayed imaging has better performance than early imaging in small-CRLM patients with euthyroidism. However, the more severe the hypothyroidism, the worse the diagnostic delayed imaging performance. The scan time can be extended appropriately to optimize the imaging efficacy.
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Affiliation(s)
- Yusong Pei
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Zhiguo Wang
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Shanhu Hao
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Yanan Tong
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Ruixian Wu
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Xinxin Qiao
- Department of Radiology, The Peoples Hospital of China Medical University, Shenyang, China
| | - Yanqing Liu
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
| | - Guoxu Zhang
- Department of Nuclear Medicine, General Hospital of Northern Theater Command and
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Fan S, Zhou L, Zhang W, Wang D, Tang D. Role of imbalanced gut microbiota in promoting CRC metastasis: from theory to clinical application. Cell Commun Signal 2024; 22:232. [PMID: 38637851 PMCID: PMC11025274 DOI: 10.1186/s12964-024-01615-9] [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: 02/12/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
Metastasis poses a major challenge in colorectal cancer (CRC) treatment and remains a primary cause of mortality among patients with CRC. Recent investigations have elucidated the involvement of disrupted gut microbiota homeostasis in various facets of CRC metastasis, exerting a pivotal influence in shaping the metastatic microenvironment, triggering epithelial-mesenchymal transition (EMT), and so on. Moreover, therapeutic interventions targeting the gut microbiota demonstrate promise in enhancing the efficacy of conventional treatments for metastatic CRC (mCRC), presenting novel avenues for mCRC clinical management. Grounded in the "seed and soil" hypothesis, this review consolidates insights into the mechanisms by which imbalanced gut microbiota promotes mCRC and highlights recent strides in leveraging gut microbiota modulation for the clinical prevention and treatment of mCRC. Emphasis is placed on the considerable potential of manipulating gut microbiota within clinical settings for managing mCRC.
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Affiliation(s)
- Shiying Fan
- Clinical Medical College, Yangzhou University, 225000, Yangzhou, P. R. China
| | - Lujia Zhou
- Clinical Medical College, Yangzhou University, 225000, Yangzhou, P. R. China
| | - Wenjie Zhang
- School of Medicine, Chongqing University, 400030, Chongqing, P. R. China
| | - Daorong Wang
- Department of General Surgery, Institute of General Surgery, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, 225000, Yangzhou, P. R. China
| | - Dong Tang
- Department of General Surgery, Institute of General Surgery, Clinical Medical College, Northern Jiangsu People's Hospital, Yangzhou University, 225000, Yangzhou, P. R. China.
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Wang Y, Ali M, Sun Q, Wang W, Ren J, Wang L, Wang D. Radial resection margin distinguishes between superficial versus deep resection in colorectal cancer: a retrospective study. J Robot Surg 2024; 18:60. [PMID: 38289524 DOI: 10.1007/s11701-024-01836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
Randomized studies showed that robotic surgery was short-term useful and safe for cancer patients. We investigated whether robots improve deep resection margins or superficial resection margins for radial resection margins in terms of short-term results. From an institutional database, we selected all superficial groups (≤ 3 mm) and deeper groups (≥ 4 mm) with rectal cancer treated with resection for a year. We evaluated the short-term post-operative 90-day outcomes on a radial resection size-based margin differentiation, including the first bowel movement, length of hospital stay, sepsis, and harvested lymph node. The main results were grades III-IV on the Clavien-Dindo scale and complications. We found 120 patients who had oncologic resection of rectal cancer; 42 patients with a superficial radial resection margin of ≤ 3 mm, all the following outcomes improved: the harvested lymph node, proximal resection margin, TME, flatus time, liquid diet duration, anastomotic leakage, and sepsis. Among these advantages were a reduced risk of metastasis and an overall reduction in local recurrence.
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Affiliation(s)
- Yang Wang
- Medical College of Yangzhou University, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Muhammad Ali
- Medical College of Yangzhou University, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Qiannan Sun
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China
| | - Wei Wang
- Medical College of Yangzhou University, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Jun Ren
- Medical College of Yangzhou University, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Liuhua Wang
- Medical College of Yangzhou University, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Medical College of Yangzhou University, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, Jiangsu, 225001, People's Republic of China.
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, 98 Nantong West Road, Yangzhou, Jiangsu, 225001, People's Republic of China.
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Lv Y, Zheng P, Mao Y, Xu Y, Chang W, Lin Q, Ji M, Ye L, Tang W, Xu J. Intratumor APOL3 delineates a distinctive immunogenic ferroptosis subset with prognosis prediction in colorectal cancer. Cancer Sci 2024; 115:257-269. [PMID: 37986654 PMCID: PMC10823281 DOI: 10.1111/cas.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
With the essential role of lipid transporting signaling in cancer-related immunity, apolipoprotein L3 (APOL3), a member of the apolipoprotein L gene family, demonstrated significant modulation ability in immunity. However, the expression profile and critical role of APOL3 in colorectal cancer (CRC) remain unclear. This study aimed to investigate the prognostic significance of APOL3 expression and its biological predictive value in CRC. The study enrolled multiple cohorts, consisting of 911 tumor microarray specimens of CRC patients from Zhongshan Hospital, 412 transcriptional data from The Cancer Genome Atlas, and 30 single-cell RNA sequencing (scRNA-seq) from internal and external CRC patients. APOL3 mRNA expression was directly acquired from public datasets, and APOL3 protein expression was detected using immunohistochemistry. Finally, the associations of APOL3 expression with clinical outcomes, immune context, and genomic and ferroptotic features were analyzed. Low APOL3 expression predicted poor prognosis and inferior responsiveness to 5-fluorouracil-based adjuvant chemotherapy (ACT) and targeted therapy. APOL3 fosters an immune-active microenvironment characterized by the promotion of ferroptosis, downregulation of macrophages, and upregulation of CD8+ T cell infiltration. Moreover, the expression of APOL3 in CD8+ T cells is intrinsically linked to ferroptosis and immune activation in CRC. In summary, APOL3 serves as an independent prognosticator and predictive biomarker for immunogenic ferroptosis, ACT, and targeted therapy in CRC. Furthermore, the APOL3 signaling activator could be a novel agent alone or in combination with current therapeutic strategies for CRC.
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Affiliation(s)
- Yang Lv
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Peng Zheng
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Yihao Mao
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Yuqiu Xu
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Wenju Chang
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Qi Lin
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Meiling Ji
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Lechi Ye
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Wentao Tang
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Jianmin Xu
- Department of Colorectal Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
- Cancer Center, Zhongshan HospitalFudan UniversityShanghaiChina
- Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
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Chen H, Zhai C, Xu X, Wang H, Han W, Shen J. Multilevel Heterogeneity of Colorectal Cancer Liver Metastasis. Cancers (Basel) 2023; 16:59. [PMID: 38201487 PMCID: PMC10778489 DOI: 10.3390/cancers16010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Colorectal cancer liver metastasis (CRLM) is a highly heterogeneous disease. Therapies that target both primary foci and liver metastasis are severely lacking. Therefore, understanding the features of metastatic tumor cells in the liver is valuable for the overall control of CRLM patients. In this review, we summarize the heterogeneity exhibited in CRLM from five aspects (gene, transcriptome, protein, metabolism, and immunity). In addition to genetic heterogeneity, the other four aspects exhibit significant heterogeneity. Compared to primary CRC, the dysregulation of epithelial-mesenchymal transition (EMT)-related proteins, the enhanced metabolic activity, and the increased infiltration of immunosuppressive cells are detected in CRLM. Preclinical evidence shows that targeting the EMT process or enhancing cellular metabolism may represent a novel approach to increasing the therapeutic efficacy of CRLM.
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Affiliation(s)
| | | | | | | | - Weidong Han
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; (H.C.); (C.Z.); (X.X.); (H.W.)
| | - Jiaying Shen
- Department of Medical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China; (H.C.); (C.Z.); (X.X.); (H.W.)
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Xu Y, Wang G, Zheng X, Chang W, Fu J, Zhang T, Lin Q, Lv Y, Zhu Z, Tang W, Xu J. Treatment of metastatic colorectal cancer with BRAF V600E mutation: A multicenter real-world study in China. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106981. [PMID: 37455182 DOI: 10.1016/j.ejso.2023.07.007] [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: 05/07/2023] [Revised: 06/30/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND BRAF V600E mutant-metastatic colorectal cancer (mCRC) is characterized by its short survival time. Treatment approaches vary depending on whether or not the metastases are initially resectable. The benefit of metastasectomy remains unclear, and the optimal first-line treatment is controversial. This study aimed to describe the prognosis of BRAF V600E mutant-mCRC, analyze the recurrence pattern in resectable patients, and explore the optimal first-line treatment for unresectable patients. METHODS Patients diagnosed with BRAF V600E mutant-mCRC between February 2014 and January 2022 in five hospitals were enrolled. Date on clinical and pathological characteristics, treatment features, and survival outcomes were collected. RESULTS Of the 220 included patients, 64 initially resectable patients had a significantly longer overall survival (OS) (37.07 vs. 20.20 months, P < 0.001) than initially unresectable patients. Of 156 unresectable patients, 54 received doublet (FOLFOX, XELOX or FOLFIRI) or triplet (FOLFOXIRI) chemotherapies (Chemo), 55 received Chemo plus Bevacizumab (Chemo+Bev), and 33 received vemurafenib plus cetuximab and irinotecan (VIC). The VIC regimen had a better progression-free survival (PFS) (12.70 months) than the Chemo (6.70 months, P < 0.001) and Chemo+Bev (8.8 months, P = 0.044) regimens. Patients treated with VIC had the best overall response rate (60.16%, P < 0.001), disease control rate (93.94%, P < 0.001) and conversional resection rate (24.24%, P = 0.003). CONCLUSIONS Metastasectomy is beneficial to the survival of patients with BRAF V600E mutant-mCRC. For initially unresectable patients, VIC as first-line therapy is associated with a better prognosis and efficacy than doublet and triplet chemotherapy with or without bevacizumab.
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Affiliation(s)
- Yuqiu Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guiying Wang
- Department of General Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China; The Second Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xuzhi Zheng
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wenju Chang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jihong Fu
- Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Lin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Lv
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhehui Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wentao Tang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jianmin Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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Liao L, Sun H, He J, Liu Y, Pan Z, Wu X, Fan W, Peng J, Li C. Neoadjuvant chemotherapy weakens the prognostic value of the pathological tumor burden score for colorectal cancer liver metastases. BMC Surg 2023; 23:271. [PMID: 37689651 PMCID: PMC10492270 DOI: 10.1186/s12893-023-02145-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/09/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND The pathological tumor burden score (TBS) has been proven to be a better risk stratification tool for liver metastasis of colorectal cancer than the traditional clinical risk score (CRS). The aim of this study was to evaluate the prognostic value of the pathological tumor burden score in patients with or without neoadjuvant chemotherapy (NAC). METHODS A total of 348 patients with colorectal liver metastases (CRLM) who underwent curative hepatic resection were retrospectively enrolled from September 1999 to December 2016. Univariable and multivariable Cox regression analyses were conducted to identify the independent predictors of prognosis. Kaplan-Meier curves and log-rank tests were used to determine whether TBS has enough discriminatory ability under certain grouping. RESULTS Patients who received NAC had a higher median TBS than patients who did not receive NAC (4.07 vs. 2.69, P < 0.001). Among patients who did not receive NAC, those with TBS > 3 showed a significantly worse 3-year RFS (41.1% vs. 63.6%, P < 0.001) and 3-year OS rate (73.3% vs. 84.1%, P = 0.003) than those with TBS ≤ 3. Among the patients who received NAC, those with TBS ≤ 3 or TBS > 3 showed comparable 3-year RFS (33.3% vs. 26.4%, P = 0.400) and 3-year OS rates (76.5% vs. 58.2%, P = 0.064) to those who did not. Regardless of the regimen and response to NAC, there was no significant difference about 3-year RFS and 3-year OS rates between the TBS ≤ 3 and TBS > 3 groups. CONCLUSION Pathological TBS can be applied to predict the RFS and OS of patients suffering from CRLM who did not receive NAC. However, pathological TBS might not be regard as prognosis in patients who did receive NAC.
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Affiliation(s)
- Leen Liao
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Hui Sun
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P. R. China
| | - Jiahua He
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Yujun Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P. R. China
| | - Zhizhong Pan
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Xiaojun Wu
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Wenhua Fan
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Jianhong Peng
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
| | - Cong Li
- Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China.
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Yue L, Xu X, Dai S, Xu F, Zhao W, Gu J, Dai X, Qian X. Orosomucoid 1 promotes colorectal cancer progression and liver metastasis by affecting PI3K/AKT pathway and inducing macrophage M2 polarization. Sci Rep 2023; 13:14092. [PMID: 37640741 PMCID: PMC10462626 DOI: 10.1038/s41598-023-40404-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
Approximately 25-30% of those affected by colorectal cancer (CRC), the most prevalent gastrointestinal malignancy, develop metastases. The survival rate of patients with liver metastasis of CRC (CRLM) remains low owing to its unpredictability and a lack of biomarkers that can be applied to distinguish groups at higher risk for CRLM among patients with CRC. Therefore, our study aimed to find biomarkers that can predict the risk of CRLM. Screening of the Gene Expression Omnibus database, supported by an analysis of clinically obtained tissue and serum data using qPCR and ELISA, in an attempt to identify relevant biomarkers, enabled us to determine that orosomucoid 1 (ORM1) was differentially expressed in liver metastases and primary tumors of patients with CRC. Functionally, overexpression of ORM1 promoted the epithelial-mesenchymal transition and the proliferative, migratory, and invasive activities of MC38 cells and activated the PI3K/AKT signaling pathway. Moreover, MC38 cells overexpressing ORM1 enhanced the tumor immune microenvironment by promoting macrophage M2 polarization and elevating interleukin-10 (IL-10) expression. In vivo experiments further confirmed in vitro results, indicating that liver metastases elevated by ORM1 were partially attenuated by the depletion of macrophages or IL-10. Considered together, ORM1 promotes CRC progression and liver metastasis by regulating tumor cell growth and inducing macrophage M2 polarization, which mediates tumor immune tolerance, and thus acts as a potential predictive marker and therapeutic target in CRLM.
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Affiliation(s)
- Lei Yue
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Xiaozhang Xu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Shipeng Dai
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Fan Xu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Wenhu Zhao
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Jian Gu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China
| | - Xinzheng Dai
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China.
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
| | - Xiaofeng Qian
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
- Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, Nanjing, 210029, Jiangsu Province, China.
- NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing Medical University, Nanjing, 210029, Jiangsu Province, China.
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Li J, Liu G, Xie X, Zhang D, Zheng R, Yang H, Zhong H, Dai G, Yu J, Liang P. Outcomes Following Different Thermal Ablation Strategies in Patients with Unresectable Colorectal Liver Metastases. Radiology 2023; 308:e223135. [PMID: 37581502 DOI: 10.1148/radiol.223135] [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: 08/16/2023]
Abstract
Background For patients with unresectable colorectal liver metastases (CRLM), clinical guidelines recommend imaging-guided thermal ablation combined with systemic therapy. However, the optimal thermal ablation strategy remains unclear. Purpose To compare long-term outcomes between patients who underwent upfront ablation or delayed ablation for unresectable CRLM. Materials and Methods This retrospective study included patients with unresectable CRLM (three or fewer lesions; diameter, <3 cm) admitted to one of seven hospitals between October 2009 and December 2020. Upfront ablation was performed 2-4 weeks before the start of systemic therapy, and delayed ablation was performed 2-3 months after the start of systemic therapy. Propensity score matching was applied to adjust for differences in baseline variables between groups. Disease-free survival (DFS) was the primary outcome. Overall survival (OS), complications, and adverse events were secondary outcomes. Outcomes were compared between groups by using the log-rank test. Results In total, 255 patients who underwent delayed ablation (mean age, 57 years ± 11 [SD]; 184 men [72%]) and 103 patients who underwent upfront ablation (mean age, 56 years ± 12; 72 men [70%]) were included. After propensity score matching (n = 100 in both groups), the 5-year DFS for patients who underwent upfront ablation was better compared with patients who underwent delayed ablation (36% vs 21%; P = .02). For 5-year OS, no evidence of a difference was observed between ablation strategies (delayed ablation, 59% vs upfront ablation, 64%; P = .49). Additionally, no differences were observed between ablation strategies with respect to the rates of ablative complications (delayed ablation, 6% vs upfront ablation, 5%; P = .76) or drug-related adverse events (delayed and upfront ablation both 9%; P = .99). Conclusion In patients with relatively few (three or fewer) and small (<3 cm) unresectable CRLM, upfront thermal ablation combined with adjuvant systemic therapy led to better DFS compared with delayed ablation. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.
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Affiliation(s)
- Jianming Li
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Guangjian Liu
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Xiaoyan Xie
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Dezhi Zhang
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Rongqin Zheng
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Hong Yang
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Huage Zhong
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Guanghai Dai
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Jie Yu
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
| | - Ping Liang
- From the Departments of Interventional Ultrasound (J.L., J.Y., P.L.) and Medical Oncology (G.D.), Fifth Medical Center of Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China; Department of Medical Ultrasonics, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (G.L.); Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (X.X.); Department of Abdominal Ultrasound, The First Affiliated Hospital of Jilin University, Changchun, China (D.Z.); Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (R.Z.); Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China (H.Y.); and Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China (H.Z.)
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He J, Li W, Zhou J, Sun H, Zhou C, Liu Y, Quan T, Fan W, Pan Z, Lin J, Peng J. Evaluation of total tumor volume reduction ratio in initially unresectable colorectal liver metastases after first-line systemic treatment. Eur J Radiol 2023; 165:110950. [PMID: 37437437 DOI: 10.1016/j.ejrad.2023.110950] [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: 04/23/2023] [Revised: 05/30/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Total tumor volume (TTV) may play an essential role in the estimation of tumor burden. This study is aimed to investigate the clinical value of the reduction ratio of TTV as a valuable indicator of clinical outcomes in patients with colorectal liver metastases (CRLM). METHODS A total of 240 initially unresectable CRLM patients who underwent first-line systemic treatment were enrolled in this study. TTV at baseline and at the end of first-line treatment were assessed using a three-dimensional reconstruction system according to CT or MRI images. Survival was evaluated using Kaplan-Meier analysis and compared using Cox proportional hazard ratios (HR). RESULTS A total of 212 (88.3%) patients achieved tumor regression with a median reduction ratio of TTV of 86.0%. An increasing reduction ratio of TTV was associated with a gradually ascending successful conversion outcome. Patients with a reduction ratio >86.0% had better survival than those with a reduction ratio 0-86.0% or <0 (5-year overall survival (OS) rates, 64.4% vs. 44.9% vs. 23.5%, P < 0.001; 5-year progression-free survival (PFS) rates, 36.3% vs. 28.2% vs. 6.5%, P < 0.001). Multivariate analysis indicated that the reduction ratio of TTV ≤ 86.0% (OR [95%CI]: 4.956 [2.654-9.253], P < 0.001) was an independent factor for conversion failure outcome. Cox analyses revealed that the reduction ratio of TTV ≤ 86.0% was an independent factor for both unfavorable OS (HR [95%CI]: 2.216 [1.332-3.688], P = 0.002) and PFS (HR [95%CI]: 2.023 [1.376-2.974], P < 0.001). CONCLUSIONS The reduction ratio of TTV was an effective indicator for conversion outcome and long-term prognosis in patients with initially unresectable CRLM after first-line systemic treatment.
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Affiliation(s)
- Jiarui He
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, PR China.
| | - Weihao Li
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Jian Zhou
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China; South China Hospital, Medical School, Shenzhen University, Shenzhen 518116, PR China.
| | - Hui Sun
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, PR China.
| | - Chi Zhou
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Yujun Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, PR China.
| | - Tingting Quan
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou 510060, PR China.
| | - Wenhua Fan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Zhizhong Pan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Junzhong Lin
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
| | - Jianhong Peng
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, PR China.
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Schnitzer ML, Buchner J, Biechele G, Grawe F, Ingenerf M, von Münchhausen N, Kaiser CG, Kunz WG, Froelich MF, Schmid-Tannwald C, Rübenthaler J. Economic evaluation of 18F-FDG PET/CT, MRI and CE-CT in selection of colorectal liver metastases eligible for ablation – A cost-effectiveness analysis. Eur J Radiol 2023; 163:110803. [PMID: 37004464 DOI: 10.1016/j.ejrad.2023.110803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/23/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Colorectal cancers (CRC) are among the world's most prevailing cancer entities. In a third of all cases, the patients have already developed distant metastases - mainly in the liver - at the time of detection. Colorectal liver metastases (CRLM) can be treated by surgical resection or, as is possible in most cases, by percutaneous ablation. For selecting the liver metastases eligible for radiofrequency ablation (RFA) or microwave ablation (MWA), the common imaging modalities are magnetic resonance imaging (MRI), positron emission tomography/computed tomography (PET/CT), and contrast-enhanced computed tomography (CE-CT). This study aims to evaluate those imaging modalities for selecting liver lesions eligible for ablation according to their long-term cost-effectiveness. MATERIALS AND METHODS A Markov model was applied, calculating quality-adjusted life years (QALYs) and accumulative costs for every diagnostic strategy, according to predefined input parameters obtained from published research. Further, sensitivity analyses were executed to prove the certainty of the calculations by running Monte-Carlo simulations with 30,000 reiterations. The Willingness-to-pay (WTP) is at $ 100,000. All calculations are based on the U.S. healthcare system. RESULTS CE-CT caused cumulative costs of $ 31,940.98 and 8,99 QALYs, whereas MRI caused $ 32,070.83 and 9,01 QALYs. PET/CT caused cumulative costs of $ 33,013.21 and 8,99 QALYs. CONCLUSION In conclusion, according to our analysis, MRI is the most cost-effective strategy for detecting liver metastases eligible for ablation and therefore should be seen as the gold standard.
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Wang Y, Yi Y, Pan S, Zhang Y, Fu J, Wu X, Qin X. Angiopoietin-like protein 3 promotes colorectal cancer progression and liver metastasis partly via the mitogen-activated protein kinase 14 pathway. Mol Carcinog 2023; 62:546-560. [PMID: 36692110 DOI: 10.1002/mc.23506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/20/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
Colorectal cancer (CRC) remains one of the most common malignancies worldwide, and liver metastasis represents a considerable challenge during CRC treatment. Aberrant expression of angiopoietin-like protein 3 (ANGPTL3) has been reported in several human cancer types. However, the function and mechanism of ANGPTL3 in CRC remain unclear. In this study, we first explored ANGPTL3 expression profiles in CRC datasets from ONCOMINE and in local samples from patients with CRC. We then elucidated the function of ANGPTL3 via knockdown and overexpression experiments. Bioinformatic analyses were performed to investigate the biological function and associated molecular mechanisms of ANGPTL3 in CRC oncogenesis and development. Finally, a xenograft model of liver metastasis was used to determine the role of ANGPTL3 in CRC metastasis. Our findings indicated that ANGPTL3 expression was upregulated in human CRC tissues, with high ANGPTL3 expression significantly correlated with poor survival of patients with CRC. ANGPTL3 overexpression promoted the proliferation and migration of CRC cells partially through mitogen-activated protein kinase 14 (MAPK14), while ANGPTL3 silencing had the opposite effect. Moreover, ANGPTL3 downregulation suppressed tumor growth and liver metastasis in xenograft mice. Collectively, the results presented here indicate that ANGPTL3 promotes cell proliferation and liver metastasis partly via MAPK14, suggesting that ANGPTL3 plays a tumor-promoting role in CRC progression and thus may represent a therapeutic target for CRC treatment.
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Affiliation(s)
- Yuexia Wang
- Department of General Surgery, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
| | - Yi Yi
- Department of General Surgery, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
| | - Shengli Pan
- Department of General Surgery, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
| | - Yuhao Zhang
- Department of General Surgery, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
| | - Jun Fu
- Department of General Surgery, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
| | - Xiaolin Wu
- Central Laboratory, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
| | - Xianju Qin
- Department of General Surgery, Jiangsu University Affiliated Shanghai Eighth People's Hospital, Shanghai, China
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Li J, Yu J, Liu G, Xie X, Zhang DZ, Zheng R, Yang H, Zhong H, Lu S, Xiang H, Cai X, Dai G, Luo Y, Liang P. Up-Front Versus Delayed Thermal Ablation for Colorectal Liver Oligometastases: A Multicenter Retrospective Study Using Propensity Score Matching. AJR Am J Roentgenol 2023; 220:885-899. [PMID: 36516005 DOI: 10.2214/ajr.22.28603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND. Thermal ablation combined with systemic therapy is an accepted treatment of colorectal liver oligometastases (CLOM). Consensus is lacking regarding the optimal timing of thermal ablation relative to systemic therapy. OBJECTIVE. The purpose of our study was to compare delayed and up-front thermal ablation in terms of efficacy and safety in the treatment of patients with CLOM. METHODS. This retrospective multicenter study included 440 patients (316 men, 124 women; mean age, 57.1 ± 11.1 [SD] years) with CLOM from nine hospitals between October 2009 and December 2020. Patients underwent delayed (n = 322) or up-front (n = 118) thermal ablation in combination with systemic therapy. Analyses included all patients using crude data, all patients using inverse probability treatment weighting (IPTW), and a subset of patients using propensity score matching (PSM) at a 1:1 ratio to balance baseline variables (108 matched patients for each group [i.e., delayed ablation and up-front ablation]). Patients were classified as having a low or high tumor burden score (TBS) on the basis of the number and size of the liver metastases. The primary outcome was progression-free survival (PFS); secondary outcomes included overall survival (OS), complications from ablation, and adverse events (AEs) from systemic therapy. Survival analysis used the Kaplan-Meier method. RESULTS. The median follow-up was 2.9 years. The 5-year PFS was 17.1% for delayed ablation versus 33.6% for up-front ablation in all patients and 17.9% versus 34.7% after PSM. Delayed ablation was associated with worse PFS in the crude analysis (HR = 0.62), IPTW analysis (HR = 0.66), and PSM analysis (HR = 0.62) (all p < .05). No analysis showed a significant difference in OS between delayed and up-front ablation. Crude, IPTW, and PSM analyses showed better PFS for up-front compared with delayed ablation in patients with a low TBS (HR = 0.62-0.67; all p < .05); none of these analyses showed significant difference in PFS in patients with a high TBS. Delayed ablation and up-front ablation groups showed no difference in frequency of grade III or IV ablation complications (4.7% vs 6.8%, p = .38) or grade III or IV systemic therapy AEs (12.4% vs 10.2%, p = .53). CONCLUSION. In patients with CLOM, up-front ablation achieved better PFS compared with delayed ablation, although only among patients with a low TBS. CLINICAL IMPACT. These findings could help optimize clinical implementation of thermal ablation in patients who are not candidates for surgical resection.
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Affiliation(s)
- Jianming Li
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 8 Dongda Rd, Beijing, 100853 China
| | - Jie Yu
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 8 Dongda Rd, Beijing, 100853 China
| | - Guangjian Liu
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - De-Zhi Zhang
- Department of Abdominal Ultrasound, First Affiliated Hospital of Jilin University, Changchun, China
| | - Rongqin Zheng
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong Yang
- Department of Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Huage Zhong
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Nanning, China
- Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Shaolong Lu
- Department of Gastrointestinal Surgery, Guangxi Clinical Research Center for CRC, Nanning, China
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Hua Xiang
- Department of Interventional Vascular Surgery, First Affiliated Hospital of Hunan Normal University & Hunan Provincial People's Hospital, Changsha, China
| | - Xiaoyong Cai
- Department of General Surgery, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Guanghai Dai
- Department of Medical Oncology, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 8 Dongda Rd, Beijing, 100853 China
| | - Ping Liang
- Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, 8 Dongda Rd, Beijing, 100853 China
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16
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Targeting LAYN inhibits colorectal cancer metastasis and tumor-associated macrophage infiltration induced by hyaluronan oligosaccharides. Matrix Biol 2023; 117:15-30. [PMID: 36805871 DOI: 10.1016/j.matbio.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/19/2023]
Abstract
The accumulation of hyaluronan oligosaccharides (oHA) in colorectal cancer (CRC) is closely related to tumor metastasis, but the underlying mechanism remains unclear. In this study, we first described that LAYN, a novel HA receptor, was upregulated in CRC tissue. Aberrant LAYN expression correlated with CRC metastasis and poor prognosis and positively correlated with tumor-associated macrophage (TAM) infiltration and M2 macrophage polarization in the tumor environment. Both in vitro and in vivo studies demonstrated that LAYN is activated by oHA and subsequently induces CRC metastasis and macrophage infiltration. Mechanistic studies demonstrated that oHA activates LAYN by binding to the 60-68th amino acid region of the extracellular segment. oHA-induced LAYN activation promoted metastasis and CCL20 secretion through the NF-kB pathway in CRC cells. Furthermore, targeting LAYN using a blocking antibody prevented oHA-mediated tumor metastasis, TAM infiltration and M2 polarization. This study revealed the LAYN activation mechanism and identified a potential target for the treatment of CRC tumor exhibiting high oHA levels.
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Robinson TP, Pebror T, Krosin ME, Koniaris LG. Ablative Therapy in Non-HCC Liver Malignancy. Cancers (Basel) 2023; 15:cancers15041200. [PMID: 36831543 PMCID: PMC9954041 DOI: 10.3390/cancers15041200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Surgical extirpation of liver tumors remains a proven approach in the management of metastatic tumors to the liver, particularly those of colorectal origin. Ablative, non-resective therapies are an increasingly attractive primary therapy for liver tumors as they are generally better tolerated and result in far less morbidity and mortality. Ablative therapies preserve greater normal liver parenchyma allowing better post-treatment liver function and are particularly appropriate for treating subsequent liver-specific tumor recurrence. This article reviews the current status of ablative therapies for non-hepatocellular liver tumors with a discussion of many of the clinically available approaches.
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Affiliation(s)
- Tyler P. Robinson
- Department of Surgery, Indiana University, Indianapolis, IN 46202, USA
- Correspondence: ; Tel.: +1-312-371-8360
| | - Travis Pebror
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
| | - Matthew E. Krosin
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
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18
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Li HJ, Lin YY, Ma XD, Liang ZX, Wang CS, Wen DY, Sun DL, Duan YQ. Systematic evaluation of guidelines for laparoscopic surgery and endoscopic management for colon cancer. Langenbecks Arch Surg 2023; 408:76. [PMID: 36729303 DOI: 10.1007/s00423-023-02795-7] [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: 09/03/2022] [Accepted: 11/22/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To understand the methodological quality of recent guidelines for laparoscopic surgery and endoscopic management for colon cancer and to analyze the heterogeneity and possible reasons for the main recommendations. METHODS A systematic and comprehensive search of databases and relevant websites was conducted to collect guidelines for laparoscopic surgery for colon cancer in the last 10 years that met the inclusion criteria. The AGREE II manual was used to evaluate the included guidelines and to assess and analyze the heterogeneity and reasons for key recommendations about the surgery. RESULTS A total of fifteen guidelines were included in this study. Only two guidelines had an overall score greater than 60% and were recommended for clinical use. Eleven guidelines had an overall score of 30-60%, and two guidelines had an overall score of less than 30%. Further analysis of the reasons for heterogeneity in the guideline recommendations and evidence was performed for nine guidelines. This study found that only 36.1% of the evidence levels recommended in the guidelines were high. Significant heterogeneity exists in the main recommendations, mainly because the relevant content is not mentioned or described in detail. CONCLUSION The quality of guidelines for laparoscopic colon cancer surgery is variable, and there is significant heterogeneity among key recommendations. And the level of evidence underlying the recommendations was generally not high. Further guideline updates should address the causes of the above heterogeneity.
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Affiliation(s)
- Hai-Jing Li
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Yue-Ying Lin
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Xu-Dong Ma
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Zhang-Xiong Liang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Chao-Si Wang
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Dai-Yan Wen
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China
| | - Da-Li Sun
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
| | - Yong-Qing Duan
- Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming, 650101, China.
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Blankenburg M, Elhamamy M, Zhang D, Fujikawa N, Corbin A, Jin G, Harris J, Knobloch G. Evaluation of health economic impact of initial diagnostic modality selection for colorectal cancer liver metastases in suspected patients in China, Japan and the USA. J Med Econ 2023; 26:219-232. [PMID: 36705988 DOI: 10.1080/13696998.2023.2173436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To compare cost offsets and contributing factors (false-negative rates and confirmatory imaging requirements, potentially leading to longer waiting times for diagnosis) as well as long-term cost effectiveness associated with the diagnostic and treatment pathways for colorectal cancer liver metastases (CRCLM) in the US, Japan, and China according to initial imaging modality used. Gadoxetate disodium (ethoxylbenzyl-diethylenetriaminepentaacetic acid)-enhanced magnetic resonance imaging (EOB-MRI) was compared to multidetector computed tomography (MDCT), extracellular contrast media enhanced-MRI (ECCM-MRI) (the US and China only) and contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS Decision tree models were developed to simulate the clinical pathway, from first diagnostic test to initial treatment decision, based on local clinical guidelines and validated by experts. Input data were derived from the literature (up to 31st December 2020) as well as from interviews with local experts. A Markov model extension was built to evaluate the number of false-negative patients and associated costs, over a lifetime horizon. RESULTS The decision-tree models showed that, increasing proportionate use of initial EOB-MRI resulted in a cost-offset per patient (excluding false-negative patients) in all countries (USD 201 for the US, JPY 6,284 for Japan and CNY 446 for China) driven by reductions in follow-on diagnostic procedures and unnecessary treatment. The use of EOB-MRI was also associated with a shorter average waiting time to a final diagnosis and treatment decision compared to MDCT, ECCM-MRI and CEUS. The Markov model showed that with an increase in EOB-MRI use, there are fewer false-negative diagnoses over a lifetime horizon. In all three countries, the incremental cost-effectivenes ratio (ICER) was below standard willingness-to-pay thresholds. CONCLUSION The findings of these models demonstrate that use of EOB-MRI early in the diagnostic pathway for CRCLM results in short-term cost savings, as well as being cost effective in the long term.
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20
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Han Y, Zhao W, Wu M, Qian Y. Efficacy and safety of single- and multiple-antenna microwave ablation for the treatment of hepatocellular carcinoma and liver metastases: A systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e32304. [PMID: 36595779 PMCID: PMC9794220 DOI: 10.1097/md.0000000000032304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is a myriad of microwave ablation (MWA) systems used in clinical settings worldwide for the management of liver cancer that offer a variety of features and capabilities. However, an analysis on which features and capabilities result in the most favorable efficacy and safety results has never been completed due to a lack of head-to-head comparisons. The aim of this study is to compare single-antenna and multiple-antenna MWA using radiofrequency ablation (RFA) as a common comparator in the treatment of very-early, early hepatocellular carcinoma (HCC) and ≤5 cm liver metastases. METHODS This network meta-analysis was performed according to PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were searched for comparative studies. Complete ablation (CA) rate, local tumor progression-free (LTPF) rate, overall survival (OS), and major complication rate were assessed. Subgroup analyses were further performed based on synchronous or asynchronous MWA generators and tumor size (<2 cm or ≥2 cm). RESULTS Twenty-one studies (3424 patients), including 3 randomized controlled trials (RCTs) and 18 observational studies, met eligibility criteria. For CA, LTPF and major complications, as compared to single-antenna MWA, multiple-antenna MWA had relative risks (RRs) of 1.051 (95% CI: 0.987-1.138), 1.099 (95% CI: 0.991-1.246), and 0.605 (95% CI: 0.193-1.628), respectively. For 1-year and 3-year OS, as compared to single-antenna MWA, multiple-antenna MWA had odds ratios (ORs) of 0.9803 (95% CI: 0.6772-1.449) and 1.046 (95% CI: 0.615-1.851), respectively. Subgroup analysis found synchronized multi-antenna MWA was associated with significantly better LTPF by 22% (RR: 1.22, 95% CI 1.068, 1.421), and 21.4% (RR: 1.214, 95% CI 1.035, 1.449) compared with single-antenna MWA, and asynchronous multiple-antenna MWA, respectively, with more evident differences in larger tumors (≥2 cm). CONCLUSION Multi-antenna and single-antenna MWA showed similar effectiveness for local treatment of liver tumors, but synchronous multi-antenna MWA exhibited better LTPF compared to other MWA approaches, particularly for larger liver tumors (≥2 cm). Large-scale RCTs should be further conducted.
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Affiliation(s)
- Yi Han
- Health Economics Research Institute, Sun Yat-Sen University, Guangdong, China
| | | | - Min Wu
- Shanghai VMLY&Rx Co., Ltd., Shanghai, China
| | - Yingjun Qian
- Johnson & Johnson Medical (Shanghai) Ltd., Shanghai, China
- * Correspondence: Yingjun Qian, Johnson & Johnson Medical (Shanghai) Ltd., 65 Guiqing Road, Shanghai 200233, China (e-mail: )
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Lu H, Zheng C, Fan L, Xiong B. Efficacy and Safety of TACE Combined with Regorafenib versus TACE in the Third-Line Treatment of Colorectal Liver Metastases. JOURNAL OF ONCOLOGY 2022; 2022:5366011. [PMID: 37251557 PMCID: PMC10219774 DOI: 10.1155/2022/5366011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/06/2022] [Accepted: 11/17/2022] [Indexed: 12/27/2023]
Abstract
BACKGROUND The liver is the most common site of metastasis in colorectal cancer. In patients with unresectable colorectal liver metastases, the 5-year survival rate is less than 5%. Many patients with colorectal liver metastases require effective subsequent therapy after the failure of standard first-line/second-line therapy. The purpose of this study is to investigate the efficacy and safety of TACE combined with Regorafenib versus TACE in the third-line treatment of patients with colorectal liver metastases. METHOD The clinical data of 132 patients with colorectal liver metastases were collected. There were two groups: TACE + Regorafenib group (N = 63); TACE group (N = 69). TACE uses CalliSpheres® drug-loaded microspheres (loaded with irinotecan). Regorafenib is administered at a dose of 120 mg once daily. If the patient is severely intolerable, the regorafenib dose is adjusted to 80 mg once daily. Primary study endpoints were (1) to evaluate the tumor response, ORR, and DCR and (2) to evaluate OS and PFS in the two groups. Secondary study endpoints were (1) to compare the performance status, CEA, CA19-9 after treatment between the two groups and (2) to compare the incidence of adverse events between the two groups. RESULTS There were significant differences in tumor response, ORR, DCR, OS, and PFS after treatment between the two groups. TACE combined with the Regorafenib group versus the TACE group: ORR (57.1% vs 33.3%), DCR (82.5% vs 68.1%), mOS (18.2 months vs 11.3 months), and mPFS (8.9 months vs 5.3 months). The performance status after treatment was better in the TACE + Regorafenib group than in the TACE group (P < 0.05). The CEA and CA19-9 negative rates after treatment were higher in the TACE + Regorafenib group than in the TACE group (P < 0.05). CONCLUSION For the third-line treatment of colorectal liver metastases, the combination of TACE + Regorafenib had better tumor response, OS, and PFS than TACE TACE + Regorafenib combination could be considered as salvage therapy for colorectal liver metastases who failed the first- and second-line standard therapy.
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Affiliation(s)
- Haohao Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Fan
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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22
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He Y, Han Y, Fan AH, Li D, Wang B, Ji K, Wang X, Zhao X, Lu Y. Multi-perspective comparison of the immune microenvironment of primary colorectal cancer and liver metastases. Lab Invest 2022; 20:454. [PMID: 36195882 PMCID: PMC9533561 DOI: 10.1186/s12967-022-03667-2] [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: 06/18/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Liver metastases are a major contributor to the poor immunotherapy response in colorectal cancer patients. However, the distinctions in the immune microenvironment between primary tumors and liver metastases are poorly characterized. The goal of this study was to compare the expression profile of multiple immune cells to further analyze the similarities and differences between the microenvironments of liver metastases and the primary tumor. METHODS Tissues from 17 patients with colorectal cancer who underwent resection of primary and liver metastases was analyzed using multispectral immunofluorescence. The expression of multiple immune cells (CD8, Foxp3, CD68, CD163, CD20, CD11c, CD66b, CD56, PD-L1, INF-γ, Ki67 and VEGFR-2) in the tumor center (TC), tumor invasive front (< 150 µm from the tumor center, TF) and peritumoral region (≥ 150 µm from the tumor center, PT) was evaluated via comparison. The expression of CD68 and CD163 in different regions was further analyzed based on the cell colocalization method. In addition, different immune phenotypes were studied and compared according to the degree of CD8 infiltration. RESULTS The expression trends of 12 markers in the TF and TC regions were basically the same in the primary tumor and liver metastasis lesions. However, in comparison of the TF and PT regions, the expression trends were not identical between primary and liver metastases, especially CD163, which was more highly expressed in the PT region relative to the TF region. In the contrast of different space distribution, the expression of CD163 was higher in liver metastases than in the primary foci. Further analysis of CD68 and CD163 via colocalization revealed that the distribution of macrophages in liver metastases was significantly different from that in the primary foci, with CD68-CD163+ macrophages predominating in liver metastases. In addition, among the three immunophenotypes, CD163 expression was highest in the immune rejection phenotype. CONCLUSIONS The immune cells found in the primary tumors of colorectal cancer differed from those in liver metastases in terms of their spatial distribution. More immunosuppressive cells were present in the liver metastases, with the most pronounced differential distribution found for macrophages. CD68-CD163+ macrophages may be associated with intrahepatic immunosuppression and weak immunotherapeutic effects.
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Affiliation(s)
- Yangsong He
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Yanan Han
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - A-Hui Fan
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Danxiu Li
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Boda Wang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China
| | - Kun Ji
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - Xin Wang
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China.
| | - Xiaodi Zhao
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
| | - Yuanyuan Lu
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi, China.
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Yu Z, Tong S, Wang C, Wu Z, Ye Y, Wang S, Jiang K. PPy@Fe 3O 4 nanoparticles inhibit the proliferation and metastasis of CRC via suppressing the NF-κB signaling pathway and promoting ferroptosis. Front Bioeng Biotechnol 2022; 10:1001994. [PMID: 36177184 PMCID: PMC9513590 DOI: 10.3389/fbioe.2022.1001994] [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: 07/24/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancers of the digestive tract, and patients with advanced-stage cancer have poor survival despite the use of multidrug conventional chemotherapy regimens. Intra-tumor heterogeneity of cancerous cells is the main obstacle in the way to effective cancer treatments. Therefore, we are looking for novel approaches to eliminate just cancer cells including nanoparticles (NPs). PPy@Fe3O4 NPs were successfully synthesized through a portable method. The characterization of transmission electron microscopy (TEM), Fourier-Transformed infrared spectrometer, and X-ray powder diffraction have further proved successful preparation of PPy@Fe3O4 NPs. NIR irradiation was used to test the photothermal properties of NPs and an infrared camera was used to record their temperature. The direct effects of PPy@Fe3O4 NPs on colorectal cancer cell DLD1 were assessed using CCK8, plate clone, transwell, flow cytometry, and western blotting in CRC cell. The effect of PPy@Fe3O4 NPs on neoplasm growth in nude mice was evaluated in vivo. This study demonstrated that PPy@ Fe3O4 NPs significantly inhibit the growth, migration, and invasion and promote ferroptosis to the untreated controls in colorectal cancer cells. Mechanical exploration revealed that PPy@Fe3O4 NPs inhibit the multiplication, migration, and invasion of CRC cells in vitro by modulating the NF-κB signaling pathway. Importantly, Ferroptosis inhibitors Fer-1 can reverse the changes in metastasis-associated proteins caused by NPs treatment. Collectively, our observations revealed that PPy@Fe3O4 NPs were blockers of tumor progression and metastasis in CRC. This study brought new insights into bioactive NPs, with application potential in curing CRC or other human disorders.
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Affiliation(s)
- Zhilong Yu
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, China
| | - Shanshi Tong
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chenyi Wang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, China
| | - Zizhen Wu
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, China
| | - Shan Wang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, China
| | - Kewei Jiang
- Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People’s Hospital, Beijing, China
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Chen Q, Li M, Chen J, Huang Z, Chen X, Zhao H, Cai J. AST·MLR index and operation injury condition are novel prognostic predictor for the prediction of survival in patients with colorectal cancer liver metastases undergoing surgical resection. BMC Cancer 2022; 22:921. [PMID: 36008803 PMCID: PMC9414420 DOI: 10.1186/s12885-022-10009-4] [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: 06/30/2021] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background The prognostic values of preoperative aspartate aminotransferase (AST), monocyte-to-lymphocyte ratio (MLR), AST·MLR index (AMLRI) and operation injury condition in patients with colorectal cancer liver metastases (CRLM) remains unclear. This retrospective study assessed the relationship between these markers, progression-free survival (PFS), and overall survival (OS) in CRLM patients undergoing resection. Methods AMLRI was defined as AST × MLR. Operation injury condition was defined according to operation time and blood loss. Cox regression analyses were used to identify risk factors and to develop nomograms. C-indexes, time-dependent receiver operating characteristic (time-ROC) curves and calibration curves were used to assess the models. Results A total of 379 patients were enrolled. The optimal cut-off value of the AMLRI was 3.33. In the multivariable analysis, AMLRI > 3.33 (hazard ratio [HR] = 2.162, p = 0.002) and serious operation injury condition (HR = 1.539, p = 0.012) were predictive for unfavourable OS, and AMLRI > 3.33 (HR = 1.462, p = 0.021) was predictive for unfavourable PFS. The nomograms were superior to Fong’s Clinical Risk Score (CRS) according to the C-indexes (PFS: 0.682 vs. 0.600; OS: 0.730 vs. 0.586) and time-ROCs. Conclusions Preoperative AMLRI and operation injury condition are easily accessible predictors for prognosis. The nomograms performed better than CRS for the prediction of recurrence and survival. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10009-4.
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Affiliation(s)
- Qichen Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingxia Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Peking Union Medical College, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinghua Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhen Huang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Chen
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Lv Y, Feng Q, Zhang Z, Zheng P, Zhu D, Lin Q, Chen S, Mao Y, Xu Y, Ji M, Xu J, He G. Low ferroptosis score predicts chemotherapy responsiveness and immune-activation in colorectal cancer. Cancer Med 2022; 12:2033-2045. [PMID: 35855531 PMCID: PMC9883409 DOI: 10.1002/cam4.4956] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Existing studies for ferroptosis and prognosis in colorectal cancer (CRC) were limited. In this study, we aim to investigate the prognostic role of ferroptosis markers in patients with CRC and exploration of its micro-environmental distributions. METHODS Immunohistochemical staining was performed for CRC patients' tissue microarray. Selection and prognostic validation of markers were based on mRNA data from the cancer genome atlas (TCGA) database. Gene Set Enrichment Analysis (GSEA) was performed to indicate relative immune landmarks and hallmarks. Ferroptosis and immune contexture were examined by CIBERSORT. Survival outcomes were analyzed by Kaplan-Meier analysis and cox analysis. RESULTS A panel of 42 genes was selected. Through mRNA expression difference and prognosis analysis, GPX4, NOX1 and ACSL4 were selected as candidate markers. By IHC, increased GPX4, decreased NOX1 and decreased FACL4 indicate poor prognosis and worse clinical characteristics. Ferroptosis score based on GPX4, NOX1 and ACSL4 was constructed and validated with high C-index. Low ferroptosis score can also demonstrate the better progression free survival and better adjuvant chemotherapy (ACT) responsiveness. Moreover, tumor with low ferroptosis score tend to be infiltrated with more CD4+ T cells, CD8+ T cells and less M1 macrophage. Finally, we found that IFN-γ was potentially the central molecule at the crossroad between ferroptosis and onco-immune response. CONCLUSION Ferroptosis plays important role on CRC tumor progression, ACT response and prognosis. Ferroptosis contributes to immune-supportive responses and IFN-γ was the central molecule for this process.
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Affiliation(s)
- Yang Lv
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Qing‐Yang Feng
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Zhi‐Yuan Zhang
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Peng Zheng
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - De‐xiang Zhu
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Qi Lin
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Si‐min Chen
- Department of PathologyAffiliated Hospital of Nanjing University of Chinese MedicineNanjingJiangsuChina
| | - Yi‐Hao Mao
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Yu‐Qiu Xu
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Mei‐ling Ji
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Jian‐Min Xu
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
| | - Guo‐dong He
- Department of General SurgeryZhongshan Hospital, Fudan UniversityShanghaiChina,Colorectal Cancer CenterZhongshan Hospital, Fudan UniversityShanghaiChina,Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive SurgeryShanghaiChina
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Vaz da Silva DG, Bredt LC, Diniz AL, Vieira VHR, Fernandes PHS, Ribeiro R, Ribeiro HC, Oliveira AF. Brazilian Society of Surgical Oncology surgical standards for resectable colorectal cancer liver metastases. J Surg Oncol 2022; 126:28-36. [DOI: 10.1002/jso.26879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Diego G. Vaz da Silva
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Mário Covas State Hospital, Centro Universitário Faculdade de Medicina do ABC Santo André São Paulo Brazil
| | - Luis C. Bredt
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Universidade Estadual do Oeste do Paraná Cascavel Paraná Brazil
| | - Alessandro L. Diniz
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Upper GI and HPB Surgical Oncology AC Camargo Cancer Center São Paulo São Paulo Brazil
| | - Victor H. R. Vieira
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Rede D'Or São Luiz, Hospital Federal de Bonsucesso Rio de Janeiro Rio de Janeiro Brazil
| | - Paulo H. S. Fernandes
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Universidade Federal de Uberlândia Uberlândia Minas Gerais Brazil
| | - Reitan Ribeiro
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgical Oncology Erasto Gaertner Hospital Curitiba Paraná Brazil
| | - Héber S. C. Ribeiro
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Upper GI and HPB Surgical Oncology AC Camargo Cancer Center São Paulo São Paulo Brazil
| | - Alexandre F. Oliveira
- Commission on Hepatobiliary Cancer Brazilian Society of Surgical Oncology Rio de Janeiro Rio de Janeiro Brazil
- Department of Surgery Universidade Federal de Juiz de Fora Juiz de Fora Minas Gerais Brazil
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Diao W, Yang B, Sun S, Wang A, Kou R, Ge Q, Shi M, Lian B, Sun T, Wu J, Bai J, Qu M, Wang Y, Yu W, Gao Z. PNA-Modified Liposomes Improve the Delivery Efficacy of CAPIRI for the Synergistic Treatment of Colorectal Cancer. Front Pharmacol 2022; 13:893151. [PMID: 35784721 PMCID: PMC9240350 DOI: 10.3389/fphar.2022.893151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/09/2022] [Indexed: 01/10/2023] Open
Abstract
Tumor-associated antigen mucin 1 (MUC1) is highly expressed in colorectal cancer and is positively correlated with advanced stage at diagnosis and poor patient outcomes. The combination of irinotecan and capecitabine is standard chemotherapy for metastatic colorectal cancer and is known as XELIRI or CAPIRI, which significantly prolongs the progression-free survival and overall survival of colorectal cancer patients compared to a single drug alone. We previously reported that peanut agglutinin (PNA)-conjugated liposomes showed enhanced drug delivery efficiency to MUC1-positive liver cancer cells. In this study, we prepared irinotecan hydrochloride (IRI) and capecitabine (CAP)-coloaded liposomes modified by peanut agglutinin (IRI/CAP-PNA-Lips) to target MUC1-positive colorectal cancer. The results showed that IRI/CAP-PNA-Lips showed an enhanced ability to target MUC1-positive colorectal cancer cells compared to unmodified liposomes. Treatment with IRI/CAP-PNA-Lips also increased the proportion of apoptotic cells and inhibited the proliferation of colorectal cancer cells. The targeting specificity for tumor cells and the antitumor effects of PNA-modified liposomes were significantly increased in tumor-bearing mice with no severe cytotoxicity to normal tissues. These results suggest that PNA-modified liposomes could provide a new delivery strategy for the synergistic treatment of colorectal cancer with clinical chemotherapeutic agents.
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Affiliation(s)
- Wenbin Diao
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Ben Yang
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Sipeng Sun
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Anping Wang
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Rongguan Kou
- School of Life Science and Technology, Weifang Medical University, Weifang, China
| | - Qianyun Ge
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Mengqi Shi
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Bo Lian
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Tongyi Sun
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Jingliang Wu
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Jingkun Bai
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
| | - Meihua Qu
- Translational Medical Center, Second People’s Hospital of Weifang, Weifang, China
| | - Yubing Wang
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
- *Correspondence: Yubing Wang, ; Wenjing Yu, ; Zhiqin Gao,
| | - Wenjing Yu
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
- *Correspondence: Yubing Wang, ; Wenjing Yu, ; Zhiqin Gao,
| | - Zhiqin Gao
- School of Life Science and Technology, Weifang Medical University, Weifang, China
- Shandong Universities Key Laboratory of Biopharmaceuticals, Weifang, China
- *Correspondence: Yubing Wang, ; Wenjing Yu, ; Zhiqin Gao,
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Lin W, Zhu C, Yao J, Liu Y, Lin H, Liu Y. Multifactorial Analysis of Clinical Prognosis of Liver Metastasis and Vascular Intervention Combined with Ablation in Colorectal Cancer. JOURNAL OF ONCOLOGY 2022; 2022:9690401. [PMID: 35726221 PMCID: PMC9206548 DOI: 10.1155/2022/9690401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022]
Abstract
Colorectal cancer is one of the leading causes of deaths in China. The initial stages of colorectal cancer can be treated by surgery, radiation, and chemotherapy. However, in the advanced stages, it warrants an application of multimodality treatment. With advances in the medical field, there are applications of new modality of treatment that could possibly provide the appropriate treatment for the advanced stage tumours. The first site of metastasis after colorectal cancer is the liver and the conventional treatment to cure the metastatic lesion involves the administration of chemotherapy. With further advancement, chemotherapy has been directly administered at the thorough transarterial chemoembolization (TACE) which is a vascular intervention. With further advancement, the nonvascular intervention, such as radiofrequency ablations (RFAs), has been administered to the patients. A large amount of data support the use of vascular intervention (TACE) with ablation for hepatic carcinoma; there is no sufficient literature to support the application of the modality in the metastatic liver lesion. In this prospective observational study, we have enrolled 80 patients with metastatic liver lesion from the adenocarcinoma of colon or rectum, treated the patients with a combination of the TACE and ablation therapy, and followed up the patients for a period of 3 years. A multivariate analysis of the various factors that influence the prognosis and outcome has been studied and it has been concluded that the combination therapy is medically beneficial for individuals with aggressive liver lesions, improving overall as well as progression-free life span.
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Affiliation(s)
- WenJi Lin
- Department of Interventional, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - CongHui Zhu
- Department of Interventional, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - JiaDi Yao
- Department of Interventional, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - YuHuang Liu
- Department of Interventional, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - HuiYu Lin
- Department of Imaging, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Fujian, China
| | - Yan Liu
- Department of Gastrointestinal Surgery, Quanzhou First Hospital Affiliated of Fujian Medical University, Quanzhou 362000, Fujian, China
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Bauer DF, Rosenkranz J, Golla AK, Tönnes C, Hermann I, Russ T, Kabelitz G, Rothfuss AJ, Schad LR, Stallkamp JL, Zöllner FG. Development of an abdominal phantom for the validation of an oligometastatic disease diagnosis workflow. Med Phys 2022; 49:4445-4454. [PMID: 35510908 DOI: 10.1002/mp.15701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/01/2021] [Accepted: 04/14/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The liver is a common site for metastatic disease, which is a challenging and life-threatening condition with a grim prognosis and outcome. We propose a standardized workflow for the diagnosis of oligometastatic disease (OMD), as a gold standard workflow has not been established yet. The envisioned workflow comprises the acquisition of a multimodal image dataset, novel image processing techniques, and cone beam computed tomography (CBCT)-guided biopsy for subsequent molecular subtyping. By combining morphological, molecular, and functional information about the tumor, a patient-specific treatment planning is possible. We designed and manufactured an abdominal liver phantom that we used to demonstrate multimodal image acquisition, image processing, and biopsy of the OMD diagnosis workflow. METHODS The anthropomorphic abdominal phantom contains a rib cage, a portal vein, lungs, a liver with six lesions, and a hepatic vessel tree. This phantom incorporates three different lesion types with varying visibility under computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography CT (PET-CT), which reflects clinical reality. The phantom is puncturable and the size of the corpus and the organs is comparable to those of a real human abdomen. By using several modern additive manufacturing techniques, the manufacturing process is reproducible and allows to incorporate patient-specific anatomies. As a first step of the OMD diagnosis workflow, a pre-interventional CT, MRI, and PET-CT dataset of the phantom was acquired. The image information was fused using image registration and organ information was extracted via image segmentation. A CBCT-guided needle puncture experiment was performed, where all six liver lesions were punctured with coaxial biopsy needles. RESULTS Qualitative observation of the image data and quantitative evaluation using contrast-to-noise ratio (CNR) confirms that one lesion type is visible only in MRI and not CT. The other two lesion types are visible in CT and MRI. The CBCT-guided needle placement was performed for all six lesions, including those visible only in MRI and not CBCT. This was possible by successfully merging multimodal pre-interventional image data. Lungs, bones, and liver vessels serve as realistic inhibitions during needle path planning. CONCLUSIONS We have developed a reusable abdominal phantom that has been used to validate a standardized OMD diagnosis workflow. Utilizing the phantom, we have been able to show that a multimodal imaging pipeline is advantageous for a comprehensive detection of liver lesions. In a CBCT-guided needle placement experiment we have punctured lesions that are invisible in CBCT using registered pre-interventional MRI scans for needle path planning. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Dominik F Bauer
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julian Rosenkranz
- Fraunhofer Institute for Manufacturing Engineering and Automation, Department of Clinical Health Technologies, Mannheim, Germany
| | - Alena-Kathrin Golla
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian Tönnes
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ingo Hermann
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tom Russ
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gordian Kabelitz
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Lothar R Schad
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jan L Stallkamp
- Automation in Medicine and Biotechnology, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Lin J, Sun H, Zhang W, Hong Z, Lu Z, Pan Z, Hou Z, Peng J. Conversion therapy with the intent to perform radical local treatment may not be suitable for patients with 10 or more liver metastases from colorectal cancer. Cancer Med 2022; 11:4225-4235. [PMID: 35466587 DOI: 10.1002/cam4.4775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/18/2022] [Accepted: 04/01/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The number of colorectal cancer liver metastases (CRLMs) is usually considered a contradictory indicator to surgical resection. However, some patients with initially unresectable CRLMs can receive radical local treatment after conversion therapy. This study aimed to evaluate the effect of radical local treatment after conversion therapy and the prognosis of patients with more than 10 initially unresectable CRLMs. METHODS Data for a total of 229 patients with initially unresectable CRLMs were retrospectively reviewed between December 2012 and January 2020. Among these patients, 107 had ≥10 CRLMs, and 122 had <10 CRLMs. Overall survival (OS) and progression-free survival (PFS) were used to reflect the prognosis of different groups of patients. Conversion therapy was defined as an initially unresectable liver metastasis converted into an R0 resectable lesion after systemic chemotherapy. Radical local treatment included hepatectomy and radiofrequency ablation (RFA). RESULTS Patients with ≥10 CRLMs had a lower conversion rate (42.7% vs. 56.6%, p = 0.001). Baseline clinical N stage 1-2, ≥8 first-line chemotherapy courses, and stable disease (SD) according to the Response Evaluation Criteria in Solid Tumours (RECIST) were independent factors predictive of conversion failure. Primary tumour location in the right colon, RECIST response of SD, and the absence of targeted therapy were independent factors predictive of unfavourable OS. The survival curves revealed that the OS of patients with or without conversion could be distinguished only among patients with <10 CRLMs (89.9% [95% CI, 82.5%-98.0%] vs. 58.9% [95% CI, 45.2%-76.7%], p < 0.001); this cut-off point could also distinguish patients with a successful conversion outcome according to OS (89.9% [95% CI, 82.5-98.0%] vs. 58.2% [95% CI, 42.2-80.4%], p = 0.008). CONCLUSION For CRLMs ≥ 10, patients with a successful conversion outcome cannot be distinguished from those without successful conversion outcome according to OS. Thus, conversion therapy with the intent to perform radical local treatment may not be suitable for patients with 10 or more liver metastases from colorectal cancer.
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Affiliation(s)
- Junzhong Lin
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Hui Sun
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, P. R. China
| | - Weili Zhang
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Zhigang Hong
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Zhenhai Lu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Zhizhong Pan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Zhenlin Hou
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Jianhong Peng
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
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Efficacy of Near-Infrared Fluorescence-Guided Hepatectomy for the Detection of Colorectal Liver Metastases: A Randomized Controlled Trial. J Am Coll Surg 2022; 234:130-137. [PMID: 35213433 DOI: 10.1097/xcs.0000000000000029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The application of indocyanine green fluorescence-guided hepatectomy for liver metastases from colorectal cancer is in the preliminary stage of clinical practice; thus, its efficacy needs to be determined. This study compared the number of intrahepatic colorectal liver metastases detected intraoperatively and postoperative recovery data between patients who underwent traditional hepatectomy (nonindocyanine green group) and traditional hepatectomy plus intraoperative indocyanine green fluorescence imaging (indocyanine green group). STUDY DESIGN Between January 2018 and March 2020, patients with potentially resectable colorectal liver metastases were randomly assigned to the nonindocyanine green or indocyanine green group. The number of intrahepatic colorectal liver metastases identified intraoperatively and based on postoperative recovery data were compared between both groups. RESULTS Overall, we recruited 80 patients, among whom 72 eligible patients were randomly assigned. After allocation, 64 patients, comprising 32 in each group, underwent the allocated intervention and follow-up. Compared with the nonindocyanine green group, the mean number of intrahepatic colorectal liver metastases identified intraoperatively in the indocyanine green group was significantly greater (mean [standard deviation], 3.03 [1.58] vs 2.28 [1.35]; p = 0.045), the postoperative hospital stay was shorter (p = 0.012) and the 1-year recurrence rate was also lower (p = 0.017). Postoperative complications and 90-day mortality were comparable, with no statistical differences. CONCLUSIONS Indocyanine green fluorescence imaging significantly increases the number of intrahepatic colorectal liver metastases identified and reduces postoperative hospital stay and 1-year recurrence rate without increasing hepatectomy-related complications and mortality rates.
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Qin S, Hu H, Cui R, Lin J, Liu Y, Wang Y, Chen Y, Liu G. A prognostic nomogram for intrahepatic progression-free survival in patients with colorectal liver metastases after ultrasound-guided percutaneous microwave ablation. Int J Hyperthermia 2022; 39:144-154. [PMID: 35012413 DOI: 10.1080/02656736.2021.2023226] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The present study identified predictors of intrahepatic progression-free survival (ihPFS) after ultrasound (US)-guided percutaneous microwave ablation (MWA) for colorectal liver metastases (CRLMs) and developed a nomogram to predict ihPFS. METHODS From January 2013 to December 2018, a total of 314 patients (224 men and 90 women; mean age, 57.1 ± 11.8 years; range, 23-86 years) with 645 CRLMs (mean diameter, 16.6 ± 6.5 mm; range, 6.0-45.0 mm) treated with US-guided percutaneous MWA were included and analyzed. The average number of CRLMs per patient treated was 2 (range, 1-8). A nomogram to predict ihPFS was developed based on a multivariable Cox model. Validation of the nomogram was performed using the concordance index (C-index), calibration curves, and decision curve analyses. RESULTS The 1-, 2-, and 3-year cumulative ihPFS rates were 59.0%, 38.9%, and 30.8%, respectively. Maximal CRLM size, number of CRLMs, ablative margin, primary tumor lymph node status, and chemotherapy were five independent prognostic factors for ihPFS. The C-index of the nomogram was 0.702 (CI: 0.681-0.723). A risk classification system that perfectly classified the patients into three risk groups was constructed. The median ihPFS of patients in the low-, intermediate-, and high-risk groups was 36.3 months (95% CI: 21.4-51.1), 13.4 months (95% CI: 12.1-14.6), and 3.8 months (95% CI: 2.3-5.3), respectively. CONCLUSION The nomogram and risk classification system will facilitate the personalized assessment of ihPFS for patients receiving US-guided percutaneous MWA for CRLMs.
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Affiliation(s)
- Si Qin
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huabin Hu
- Department of Medical Oncology, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Rui Cui
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jing Lin
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yiming Liu
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yimin Wang
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yao Chen
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Guangjian Liu
- Department of Medical Ultrasonics, Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Peng J, Liu Y, Li W, Lin Y, Sun H, Pan Z, Wu X, Fan W, Lin J. Application of Tumor Burden Score for predicting conversion outcome in patients with initially unresectable colorectal liver metastases after first-line systemic therapy. Therap Adv Gastroenterol 2021; 14:17562848211066206. [PMID: 34987612 PMCID: PMC8721375 DOI: 10.1177/17562848211066206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/24/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients with initially unresectable colorectal liver metastases (CRLM) could achieve survival benefit from successful conversion therapy. Recently, Tumor Burden Score (TBS) was proposed as a valuable index to predict outcome following resection of CRLM. The study is aimed to investigate the association of TBS with conversion outcome. METHODS A total of 234 patients who underwent first-line treatment in our center were enrolled as training cohort. The validation cohort was developed from 89 patients in our previous study. Cut-off value of TBS was calculated to stratify patients into two groups. Significance test and logistic regression model were used to examine the prediction value of TBS for conversion outcome after first-line systemic therapy. Kaplan-Meier method and Cox proportional hazard model were applied to assess the prognostic value of TBS. RESULTS TBS showed good discriminatory power [area under curve (AUC) 0.726, p < 0.001] with cut-off value defined as 14.3 in training cohort, which was validated in the validation cohort. Increasing TBS was related to adverse chemotherapy response and conversion outcome. Low TBS group had three times higher conversion rate than that in high TBS group (57.3% versus 19.0%, p < 0.001). Multivariate analysis indicated that high TBS [odds ratio (OR) = 3.676, 95% confidence interval (CI) 1.671-8.429, p = 0.002], first-line treatment response as stable disease (SD) or progressive disease (PD) (OR = 9.247; 95% CI 4.736-18.846, p < 0.001), and absence of targeted therapy (OR = 2.453, 95% CI 1.139-5.455, p = 0.024) were three independent risk factors for failure conversion outcome. High TBS was significantly associated with conversion outcome whatever chemotherapy response, addition of targeted therapy, and Kirsten rat sarcoma viral oncogene homolog (KRAS) status. High TBS was also associated with worse overall survival. CONCLUSION TBS should be applied in clinical practice to predict conversion outcome in patients with initially unresectable CRLM.
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Affiliation(s)
| | | | | | - Yuzhu Lin
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China,State Key Laboratory of Oncology in South China, Guangzhou, P.R. China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Hui Sun
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, P.R. China
| | - Zhizhong Pan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China,State Key Laboratory of Oncology in South China, Guangzhou, P.R. China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Xiaojun Wu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China,State Key Laboratory of Oncology in South China, Guangzhou, P.R. China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
| | - Wenhua Fan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, Guangdong, P.R. China,State Key Laboratory of Oncology in South China, Guangzhou, P.R. China Collaborative Innovation Center for Cancer Medicine, Guangzhou, P.R. China
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Liu M, Yang J, Xu B, Zhang X. Tumor metastasis: Mechanistic insights and therapeutic interventions. MedComm (Beijing) 2021; 2:587-617. [PMID: 34977870 PMCID: PMC8706758 DOI: 10.1002/mco2.100] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 12/18/2022] Open
Abstract
Cancer metastasis is responsible for the vast majority of cancer-related deaths worldwide. In contrast to numerous discoveries that reveal the detailed mechanisms leading to the formation of the primary tumor, the biological underpinnings of the metastatic disease remain poorly understood. Cancer metastasis is a complex process in which cancer cells escape from the primary tumor, settle, and grow at other parts of the body. Epithelial-mesenchymal transition and anoikis resistance of tumor cells are the main forces to promote metastasis, and multiple components in the tumor microenvironment and their complicated crosstalk with cancer cells are closely involved in distant metastasis. In addition to the three cornerstones of tumor treatment, surgery, chemotherapy, and radiotherapy, novel treatment approaches including targeted therapy and immunotherapy have been established in patients with metastatic cancer. Although the cancer survival rate has been greatly improved over the years, it is still far from satisfactory. In this review, we provided an overview of the metastasis process, summarized the cellular and molecular mechanisms involved in the dissemination and distant metastasis of cancer cells, and reviewed the important advances in interventions for cancer metastasis.
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Affiliation(s)
- Mengmeng Liu
- Melanoma and Sarcoma Medical Oncology UnitState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Jing Yang
- Melanoma and Sarcoma Medical Oncology UnitState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Bushu Xu
- Melanoma and Sarcoma Medical Oncology UnitState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xing Zhang
- Melanoma and Sarcoma Medical Oncology UnitState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer CenterGuangzhouChina
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Zhu K, Wang W, Luo R, Song D, Wang X, Gao Q, Fan J, Zhou J, Rao S, Wang X. Newly detected liver nodules with a history of colorectal cancer: are they metastatic? Review of 2,632 cases in a single center. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1079. [PMID: 34422991 PMCID: PMC8339815 DOI: 10.21037/atm-20-8153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/05/2021] [Indexed: 12/13/2022]
Abstract
Background The diagnosis of newly detected liver nodules in patients with colorectal cancer (CRC) is crucial for determining prognosis and treatment. Accurate identification of benign nodules can help avoid unnecessary therapy. The aim of our study was to retrospectively review patients with CRC who underwent liver resection for benign liver nodules misdiagnosed as CRC metastasis (CRLM) in our institution. Methods We reviewed all patients with a history of CRC who underwent liver resection from January 2012 to December 2019 in our institution. We specifically focused on nodules pathologically confirmed as benign. The pathology was rechecked by an independent pathologist. The clinicopathological characteristics of these patients were collected. Preoperative imaging examinations, including ultrasound (US), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) were reviewed. Results From 2012 to 2019, a total of 2,632 patients with CRC who were preoperatively diagnosed CRLM received liver resection, among which 2,584 (98.2%) cases were proven to be malignant, and 48 (1.8%) cases were benign. Among these 48 cases, 24 were pathologically confirmed as focal nodular hyperplasia (FNH), 9 were peliosis, 10 were inflammatory lesions, and 5 were hemangioma. At least one preoperative imaging examination indicated CRLM, with a median size of 2.0 cm (range, 0.4–8.0 cm). Before liver resection, ten patients received chemotherapy after the discovery of liver nodules. Conclusions It should be noted that newly detected liver nodules in patients with a history of CRC could be benign. Accurate diagnosis of liver nodules in CRC is necessary to avoid overtreatment and to identify cost-effective medication.
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Affiliation(s)
- Kai Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China
| | - Wentao Wang
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Danjun Song
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Xi Wang
- Department of Ultrasound, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Qiang Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institute of Biomedical Sciences, Fudan University, Shanghai, China.,State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institute of Biomedical Sciences, Fudan University, Shanghai, China.,State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Key Laboratory of Organ Transplantation, Shanghai, China
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
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Wu Y, Yang S, Ma J, Chen Z, Song G, Rao D, Cheng Y, Huang S, Liu Y, Jiang S, Liu J, Huang X, Wang X, Qiu S, Xu J, Xi R, Bai F, Zhou J, Fan J, Zhang X, Gao Q. Spatiotemporal Immune Landscape of Colorectal Cancer Liver Metastasis at Single-Cell Level. Cancer Discov 2021; 12:134-153. [PMID: 34417225 DOI: 10.1158/2159-8290.cd-21-0316] [Citation(s) in RCA: 329] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/02/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Liver metastasis, the leading cause of colorectal cancer mortality, exhibits a highly heterogeneous and suppressive immune microenvironment. Here, we sequenced 97 matched samples by using single-cell RNA-seq and Spatial Transcriptomics. Strikingly, metastatic microenvironment underwent remarkable spatial reprogramming of immunosuppressive cells such as MRC1+ CCL18+ M2-like macrophages. We further developed scMetabolism, a computational pipeline for quantifying single-cell metabolism, and observed that those macrophages harbored enhanced metabolic activity. Interestingly, neoadjuvant chemotherapy could block this status and restore the antitumor immune balance in responsive patients, while the non-responsive patients deteriorated into a more suppressive one. Our work described the immune evolution of metastasis and uncovered the black box of how tumors respond to neoadjuvant chemotherapy.
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Affiliation(s)
- Yingcheng Wu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University
| | - Shuaixi Yang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University
| | - Jiaqiang Ma
- Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences
| | - Zechuan Chen
- Institut Pasteur of Shanghai, The Center for Microbes, Development and Health, Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences
| | - Guohe Song
- Hepatic oncology, Liver Cancer Institute, Zhongshan Hospital and Shanghai Medical School, Fudan University, Key Laboratory for Carcinogenesis & Cancer Invasion, The Chinese Ministry of Education, Shanghai, China
| | - Dongning Rao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University
| | - Yifei Cheng
- Department of Liver Surgery and Transplantation, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Liver Cancer Institute, Zhongshan Hospital, Fudan University
| | - Siyuan Huang
- Academy for Advanced Interdisciplinary Studies, Peking University
| | - Yifei Liu
- Pathology, Affiliated Hospital of Nantong University
| | - Shan Jiang
- The Center for Microbes, Development and Health, Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences
| | - Jinxia Liu
- Affiliated Hospital of Nantong University; School of Medicine, Nantong University
| | - Xiaowu Huang
- Departmemt of liver surgery and tranplantation, Zhongshan Hospital
| | - Xiaoying Wang
- Liver Cancer Institute, Liver Cancer Institute, Fudan University
| | - Shuangjian Qiu
- Liver Cancer Institute, Zhongshan Hospital, Fudan University
| | - Jianmin Xu
- Department of Gastrointestinal Oncology, The Fifth Medical Center, Chinese PLA General Hospital
| | - Ruibin Xi
- School of Mathematical Sciences and Center for Statistical Science, School of Mathematical Sciences and Center for Statistical Science, Peking University
| | - Fan Bai
- Biomedical Pioneering Innovation Center (BIOPIC), Peking University
| | - Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University
| | - Jia Fan
- Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University
| | - Xiaoming Zhang
- Key Laboratory of Molecular Virology and Immunology, Institute Pasteur of Shanghai, Chinese Academy of Sciences
| | - Qiang Gao
- Depart. of Liver Surgery and Transplantation, Liver Cancer Institute, Zhong Shan Hospital and Shanghai Medical School, Fudan University,
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Preoperative Hepatic and Regional Arterial Chemotherapy in Patients Who Underwent Curative Colorectal Cancer Resection: A Prospective, Multi-center, Randomized Controlled Trial. Ann Surg 2021; 273:1066-1075. [PMID: 33214446 DOI: 10.1097/sla.0000000000004558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effects of the addition of preoperative hepatic and regional arterial chemotherapy (PHRAC) on prognosis of stage II and III colorectal cancer (CRC) in a multicenter setting. SUMMARY OF BACKGROUND DATA Our previous single-center pilot trial suggested that PHRAC in combination with surgical resection could reduce the occurrence of liver metastasis (LM) and improve survival in CRC patients. METHODS A prospective multi-center randomized controlled trial was conducted from December 2008 to December 2012 at 5 hospitals in China. Eligible patients with clinical stage II or III CRC who underwent curative resection were randomized to receive PHRAC plus adjuvant therapy (PHRAC arm) or adjuvant therapy alone (control arm). The primary endpoint was DFS. Secondary endpoints were cumulative LM rates, overall survival (OS), and safety (NCT00643877). RESULTS A total of 688 patients from 5 centers in China were randomly assigned (1:1) to each arm. The five-year DFS rate was 77% in the PHRAC arm and 65% in the control arm (HR = 0.61, 95% CI 0.46-0.81; P = 0.001). The 5-year LM rates were 7% and 16% in the PHRAC and control arms, respectively (HR = 0.37, 95% CI 0.22-0.63; P < 0.001). The 5-year OS rate was 84% in the PHRAC arm and 76% in the control arm (HR = 0.61, 95% CI 0.43-0.86; P = 0.005). There were no significant differences regarding treatment related morbidity or mortality between the two arms. CONCLUSIONS The addition of PHRAC could improve DFS in patients with stage II and III CRC. It reduced the incidence of LM and improved OS without compromising patient safety. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00643877.
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Song Z, Yang D, Song H, Dong W, Wu J, Yang J, Gu Y. Surgical treatment strategy for locally advanced colorectal cancer with abdominal wall invasion. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:874. [PMID: 34164508 PMCID: PMC8184446 DOI: 10.21037/atm-21-2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background The incidence of abdominal wall metastasis from colorectal cancer (CRC) is very low, but it has a poor prognosis. Despite the advances in radiotherapy, chemotherapy, and targeted therapy, patient prognosis has not improved significantly. Through surgical treatment, some patients with locally advanced CRC with abdominal wall invasion can achieve tumor-free survival or an improved quality of life. Methods The clinical data of 15 patients in our department from January 2015 to January 2020 were retrospectively analyzed. All patients underwent preoperative three-dimensional reconstruction of the tumor and abdominal wall after discussion with a multidisciplinary team (MDT). Patient information, including tumor size, defect size, operation time, intraoperative bleeding, hospital stay, and other factors, was collected. Results All 15 patients underwent resection followed by reconstruction for locally advanced CRC with abdominal wall invasion. The average tumor area and abdominal wall defects were 98.13±71.70 and 270.07±101.95 cm2, respectively; and accurate abdominal wall classification and zoning were obtained for all patients. The average operation time was 431.7±189.2 min, and the average blood loss was 513.3±244.6 mL. The recurrence rates in the incisional hernia and abdominal wall were 6.0% and 13.3%, respectively. The patient survival rate was 87.7%. Conclusions Surgical treatment of locally advanced CRC with abdominal wall invasion is feasible, but requires accurate and comprehensive preoperative evaluation.
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Affiliation(s)
- Zhicheng Song
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongchao Yang
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Song
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenpei Dong
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jugang Wu
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Yang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Gu
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.,Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Liu D, Song T. Changes in and challenges regarding the surgical treatment of hepatocellular carcinoma in China. Biosci Trends 2021; 15:142-147. [PMID: 33716267 DOI: 10.5582/bst.2021.01083] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common malignant tumor with a high morbidity and mortality in China and elsewhere in the world. Due to its tumor heterogeneity and distant metastasis, patients with HCC often have a poor prognosis. A surgical treatment such as a radical hepatectomy is still the treatment of choice for patients with HCC in current clinical practice. However, the high rate of recurrence and rate of metastasis after surgery diminishes the survival of and prognosis for these patients. In an era of targeted therapy and immunotherapy, the surgical treatment of HCC must change. This review focuses on the definition, feasibility, and criteria with which to evaluate neoadjuvant therapy for HCC in order to provide a new perspective on surgical treatment of HCC.
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Affiliation(s)
- Dongming Liu
- Department of Hepatobiliary, HCC Research Center for Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Tianqiang Song
- Department of Hepatobiliary, HCC Research Center for Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
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Wu XA, Shi Y, Du SD. Surgical treatment of colorectal liver metastasis. Shijie Huaren Xiaohua Zazhi 2021; 29:110-115. [DOI: 10.11569/wcjd.v29.i3.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the most common form of distant metastasis in colorectal cancer and is a key factor for prognosis in patients with colorectal cancer. Surgery may be the only way to cure colorectal liver metastases. This paper mainly summarizes the latest progress in surgical treatment of colorectal liver metastases, including how to increase resection rate of liver metastases with neoadjuvant therapy or staged hepatectomy, the effect of surgical margin on the prognosis of patients, the timing of surgery in patients with synchronous colorectal liver metastasis, the impact of laparoscopic hepatectomy of liver metastases, the application of liver transplantation in patients with colorectal liver metastases, etc, with an aim to help develop an optimal treatment for patients with colorectal liver metastases through combination of surgical innovations with individualized treatment, thereby improving patients' disease-free survival and overall survival.
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Affiliation(s)
- Xiang-An Wu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
| | - Yue Shi
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
| | - Shun-Da Du
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and PUMC, Dongcheng District, Beijing 100730, China
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Zhou SN, Pan WT, Pan MX, Luo QY, Zhang L, Lin JZ, Zhao YJ, Yan XL, Yuan LP, Zhang YX, Yang DJ, Qiu MZ. Comparison of Immune Microenvironment Between Colon and Liver Metastatic Tissue in Colon Cancer Patients with Liver Metastasis. Dig Dis Sci 2021; 66:474-482. [PMID: 32193860 DOI: 10.1007/s10620-020-06203-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Liver metastasis is an indicator of unfavorable responses to immunotherapy in colorectal cancer patients. However, the difference of immune microenvironment between primary tumors and liver metastases has not been well understood. PATIENTS AND METHODS Fifty-four colon cancer with liver metastasis patients who received resection of both primary and metastasis lesions have been analyzed. The immune score is based on the density of infiltrating immune cells (CD3+ cell, CD8+ cell, CD11b+ cell, CD11c+ cell, and CD33+ cell) in the center and margin of the tumor. The expression of immune markers between the primary tumor and hepatic metastases was analyzed using Wilcoxon's signed rank test. RESULTS All the five markers had higher expression in tumor margins than center tumor in both primary tumor and hepatic metastases lesions. The expression of CD11c and CD11b had no difference between metastatic lesions and primary tumor. In tumor margins, except CD11b, all the other 4 markers expressed significantly higher in hepatic metastases than in primary tumor. Intra-tumor, CD3 had higher expression in primary tumor than in hepatic metastases, while CD33 had higher expression in hepatic metastases than in primary tumor. CD8+ CD3+ cells of the total CD8+ cell population in primary tumor was significantly higher than in hepatic metastases (36.42% vs. 24.88%, p = 0.0069). CONCLUSIONS The immune microenvironment between primary tumor and hepatic metastasis is different. More immunosuppressing cells in liver may partially explain why immunotherapy in colon cancer is less effective with liver metastatic disease.
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Affiliation(s)
- Su-Na Zhou
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Wen-Tao Pan
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Meng-Xian Pan
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Qiu-Yun Luo
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Lin Zhang
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
- Department of Clinical Laboratory, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Jun-Zhong Lin
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yu-Jie Zhao
- Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Xiang-Lei Yan
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Lu-Ping Yuan
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Yu-Xin Zhang
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Da-Jun Yang
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China
| | - Miao-Zhen Qiu
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China.
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, China.
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Ding S, Lv X, Liu Z, Zhan S, Xu Y, Zhang X, Liu C, Cao L. Overexpression of B7-H4 is associated with infiltrating immune cells and poor prognosis in metastatic colorectal cancer. Int Immunopharmacol 2021; 90:107144. [PMID: 33187907 DOI: 10.1016/j.intimp.2020.107144] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 01/31/2023]
Abstract
Metastasis commonly occurs in colorectal cancer (CRC) patients and confers a poor prognosis. B7-H4, an immune checkpoint molecule, has been found to be expressed in numerous tumor tissues and play critical roles in tumor progression. However, B7-H4 expression and its prognostic significance in different metastases from CRC remain unclear. In the present study, we screened a novel mouse anti-human B7-H4 monoclonal antibody (mAb) which exhibited a higher degree of recognition and sensitivity than the commercial reagent in immunohistochemistry (IHC). Using this antibody, overall 110 metastatic and paired primary lesions of CRC were analyzed for their expression of B7-H4, CD8 and CD68. Our results showed that expression of B7-H4 and CD68 in metastastic lesions was significantly higher than that in matched primary lesions (P = 0.0016, P < 0.0001). We also found a significant increase of CD68-positive immune cell infiltration in the B7-H4 high expressing metastases (P = 0.041). Moreover, upregulated B7-H4 in metastatic lesions was correlated with poor prognosis of patients (P = 0.014), while in primary lesions, B7-H4 combined with CD8 was associated with the overall survival (OS) (P = 0.043). Further, B7-H4 expression in metastatic lesions was significantly correlated with hazard ratio (HR) both in univariate and multivariate analysis. Altogether, B7-H4 in metastatic lesions is promising to be a potential prognostic indicator of CRC, and may promote tumor progression and metastasis of this cancer.
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Affiliation(s)
- Sisi Ding
- Jiangsu Institute of Clinical Immunology & Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinlu Lv
- Department of Laboratory Medicine, The First People's Hospital of Taicang, Taicang Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhiju Liu
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shenghua Zhan
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yunyun Xu
- Institute of Pediatrics, Children's Hospital of Soochow University, Suzhou, China
| | - Xueguang Zhang
- Jiangsu Institute of Clinical Immunology & Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Cuiping Liu
- Jiangsu Institute of Clinical Immunology & Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, China.
| | - Lei Cao
- Jiangsu Institute of Clinical Immunology & Jiangsu Key Laboratory of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Wei XL, Luo X, Sheng H, Wang Y, Chen DL, Li JN, Wang FH, Xu RH. PD-L1 expression in liver metastasis: its clinical significance and discordance with primary tumor in colorectal cancer. J Transl Med 2020; 18:475. [PMID: 33308232 PMCID: PMC7730753 DOI: 10.1186/s12967-020-02636-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The outcomes of immune checkpoint inhibitors in cancer patients with liver metastases are poor, which may be related to a different tumor microenvironment in liver metastases from primary tumors. This study was aimed to analyze PD-L1 expression and the immune microenvironment status in liver metastases and compare the differences of PD-L1 expression between primary tumors and liver metastases of colorectal cancer. METHODS 74 cases of pathologically confirmed colorectal cancer with liver metastasis underwent resection from our hospital were included. Tissue microarrays were used for the interpretation of PD-L1 expression, cluster of differentiation 4 (CD4) and CD8 density by immunohistochemistry. We evaluated the disparity between primary tumor and liver metastasis in PD-L1 expression, CD4 and CD8 density and analyzed the factors associated with obvious PD-L1 disparity. RESULTS The expression of PD-L1 was positively related to the density of CD4 and CD8 in liver metastases. The expression of PD-L1 in liver metastases was higher than in primary tumors in certain subgroups, including patients with concurrent liver metastases (n = 63, p = 0.05), patients receiving concurrent resection of primary and metastatic tumors (n = 56, p = 0.04). The two subgroups generally reflected those without inconsistent external influences, such as treatment and temporal factors, between primary tumors and liver metastases. In these subgroups, the intrinsic differences of microenvironment between primary tumors and liver metastases could be identified. Furthermore, tumor differentiation [moderate vs. poor: OR = 0.23, 95% CI: 0.03-0.99, p = 0.05)] were demonstrated to be associated with obvious discordance of PD-L1 expression between primary tumors and liver metastases. CONCLUSIONS The expression of PD-L1 in liver metastases was higher than in primary tumors in subgroups, reflecting intrinsic microenvironment differences between primary and metastatic tumors. Obvious discordance of PD-L1 expression between primary tumor and liver metastasis was significantly related to the tumor differentiation.
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Affiliation(s)
- Xiao-Li Wei
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Xuan Luo
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Hui Sheng
- State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Yun Wang
- Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Dong-Liang Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China
| | - Jia-Ning Li
- Department of Clinical Trial Center, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Feng-Hua Wang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China.
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, Guangdong, China.
- Research Unit of Precision Diagnosis and Treatment for Gastrointestinal Cancer, Chinese Academy of Medical Sciences, Guangzhou, 510060, China.
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Ma ZH, Wang YP, Zheng WH, Ma J, Bai X, Zhang Y, Wang YH, Chi D, Fu XB, Hua XD. Prognostic factors and therapeutic effects of different treatment modalities for colorectal cancer liver metastases. World J Gastrointest Oncol 2020; 12:1177-1194. [PMID: 33133385 PMCID: PMC7579728 DOI: 10.4251/wjgo.v12.i10.1177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most common malignant tumors in China, and the liver is the most common metastatic site in patients with advanced CRC. Hepatectomy is the gold standard treatment for colorectal liver metastases. For patients who cannot undergo radical resection of liver metastases for various reasons, ablation therapy, interventional therapy, and systemic chemotherapy can be used to improve their quality of life and prolong their survival time.
AIM To explore the prognostic factors and treatments of liver metastases of CRC.
METHODS A retrospective analysis was conducted on 87 patients with liver metastases from CRC treated at the Liaoning Cancer Hospital and Institute between January 2005 and March 2011. According to different treatments, the patients were divided into the following four groups: Surgical resection group (36 patients); ablation group (23 patients); intervention group (15 patients); and drug group (13 patients). The clinicopathological data and postoperative survival of the four groups were analyzed. The Kaplan-Meier method was used for survival analysis, and the Cox proportional hazards regression model was used for multivariate analysis.
RESULTS The median survival time of the 87 patients was 38.747 ± 3.062 mo, and the 1- and 3-year survival rates were 87.5% and 53.1%, respectively. The Cox proportional hazards model showed that the following factors were independent factors affecting prognosis: The degree of tumor differentiation, the number of metastases, the size of metastases, and whether the metastases are close to great vessels. The results of treatment factor analysis showed that the effect of surgical treatment was better than that of drugs, intervention, or ablation alone, and the median survival time was 48.83 ± 4.36 mo. The drug group had the worst prognosis, with a median survival time of only 13.5 ± 0.7 mo (P < 0.05). For patients with liver metastases of CRC near the great vessels, the median survival time (27.3 mo) of patients undergoing surgical resection was better than that of patients using other treatments (20.6 mo) (P < 0.05).
CONCLUSION Patients with a low degree of primary tumor differentiation, multiple liver metastases (number of tumors > 4), and maximum diameter of liver metastases > 5 cm have a poor prognosis. Among drug therapy, intervention, ablation, and surgical treatment options, surgical treatment is the first choice for liver metastases. When liver metastases are close to great vessels, surgical treatment is significantly better than drug therapy, intervention, and ablation alone.
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Affiliation(s)
- Zuo-Hong Ma
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Yong-Peng Wang
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Wen-Heng Zheng
- Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Ji Ma
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Xue Bai
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Yong Zhang
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Yuan-He Wang
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Da Chi
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Xi-Bo Fu
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
| | - Xiang-Dong Hua
- Department of Hepatopancreatobiliary Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, Liaoning Province, China
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Mao W, Fan Y, Cheng C, Yuan X, Lan T, Mao K, Wang J. Efficacy and safety of Kanglaite injection combined with chemotherapy for colorectal cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22357. [PMID: 32991451 PMCID: PMC7523838 DOI: 10.1097/md.0000000000022357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The incidence and mortality of colorectal cancer are high. Chemotherapy is currently the commonly used therapeutic scheme, but there are drug resistance and toxic and side effects. Kanglaite (KLT) injection is a broad-spectrum anticancer drug extracted from Semen Coicis (Yi Yi Ren), which has been widely used in the treatment of colorectal cancer. Clinical practice shows that KLT injection combined with chemotherapy has certain therapeutic advantages, but there is a lacking of evidence of evidence-based medicine. The purpose of this study is to systematically investigate the efficacy and safety of KLT injection combined with chemotherapy in the treatment of colorectal cancer. METHODS Randomized controlled trials of KLT injection combined with chemotherapy in the treatment of colorectal cancer were retrieved from English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (China National Knowledge Infrastructure, Wanfang, Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database), as well as searching Baidu academic and Google academic manually, and the retrieval time was from their establishment to August 2020. Two researchers independently conducted data extraction and literature quality evaluation on the quality of the included literatures, and meta-analysis was conducted on the included literatures using RevMan 5.3 (developed by the UK's International Cochrane Collaboration). RESULTS This study assessed the efficacy and safety of KLT injection combined with chemotherapy in the treatment of colorectal cancer by effective rate, Karnofsky Performance Status, Carcinoemybryonic Angtigen remission rate, pain remission rate, and incidence of adverse reactions etc. CONCLUSIONS:: This study will provide reliable evidence-based evidence for the clinical application of KLT injection combined with chemotherapy in the treatment of colorectal cancer. ETHICS AND DISSEMINATION The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/EKVAF.
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Affiliation(s)
- Weili Mao
- People's Hospital of QuZhou, Quzhou, Zhejiang province
| | - Yihua Fan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
| | - Chao Cheng
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xingyu Yuan
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tian Lan
- People's Hospital of QuZhou, Quzhou, Zhejiang province
| | - Kaili Mao
- People's Hospital of QuZhou, Quzhou, Zhejiang province
| | - Jun Wang
- People's Hospital of QuZhou, Quzhou, Zhejiang province
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46
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Lv Y, Feng QY, Wei Y, Ren L, Ye Q, Wang X, Cui Y, Liu T, Zhou B, Wang M, Rao S, Wang J, Ding J, He GD, Xu JM. Benefits of multi-disciplinary treatment strategy on survival of patients with colorectal cancer liver metastasis. Clin Transl Med 2020; 10:e121. [PMID: 32627392 DOI: 10.1002/ctm2.121] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Yang Lv
- Department of General Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Qing-Yang Feng
- Department of General Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Ye Wei
- Department of General Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Li Ren
- Department of General Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - QingHai Ye
- Department of Liver Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - XiaoYing Wang
- Department of Liver Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - YueHong Cui
- Department of Oncology, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - TianShu Liu
- Department of Oncology, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Bo Zhou
- Department of Intervention treatment, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - MingLiang Wang
- Department of Radiology, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - ShengXiang Rao
- Department of Radiology, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Jian Wang
- Department of Radiotherapy, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - JianYong Ding
- Department of Thoracic Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Guo-Dong He
- Department of General Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Jian-Min Xu
- Department of General Surgery, ZhongShan Hospital, Fudan University, Shanghai, Shanghai, China
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Zou H, Wang F, Zhou JJ, Liu X, He Q, Wang C, Zheng YW, Wen Y, Xiong L. Application of photodynamic therapy for liver malignancies. J Gastrointest Oncol 2020; 11:431-442. [PMID: 32399283 DOI: 10.21037/jgo.2020.02.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Liver malignancies include primary and metastatic tumors. Limited progress has been achieved in improving the survival rate of patients with advanced stage liver cancer and who are unsuitable for surgery. Apart from surgery, chemoradiotherapy, trans-arterial chemoembolization and radiofrequency ablation, a novel therapeutic modality is needed for the clinical treatment of liver cancer. Photodynamic therapy (PDT) is a novel strategy for treating patients with advanced cancers; it uses a light-triggered cytotoxic photosensitizer and a laser light. PDT provides patients with a potential treatment approach with minimal invasion and low toxicity, that is, the whole course of treatment is painless, harmless, and repeatable. Therefore, PDT has been considered an effective palliative treatment for advanced liver cancers. To date, PDT has been used to treat hepatocellular carcinoma, cholangiocarcinoma, hepatoblastoma and liver metastases. Clinical outcomes reveal that PDT can be considered a promising treatment modality for all liver cancers to improve the quality and quantity of life of patients. Despite the advances achieved with this approach, several challenges still impede the application of PDT to liver malignancies. In this review, we focus on the recent advancements and discuss the future prospects of PDT in treating liver malignancies.
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Affiliation(s)
- Heng Zou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Fusheng Wang
- Department of General Surgery, Fuyang People's Hospital, Fuyang 236000, China
| | - Jiang-Jiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xi Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Qing He
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Cong Wang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yan-Wen Zheng
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yu Wen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Li Xiong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
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He Y, Ma X, Chen K, Liu F, Cai S, Han-Zhang H, Hou T, Xiang J, Peng J. Perioperative Circulating Tumor DNA in Colorectal Liver Metastases: Concordance with Metastatic Tissue and Predictive Value for Tumor Burden and Prognosis. Cancer Manag Res 2020; 12:1621-1630. [PMID: 32184665 PMCID: PMC7061429 DOI: 10.2147/cmar.s240869] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/08/2020] [Indexed: 12/18/2022] Open
Abstract
Background The surgical resection of colorectal cancer with liver metastases (CLM) has proven to be the most important modality for long-term survival, while effective biomarkers for outcome prediction or postoperative surveillance are still lacking. Currently, circulating biomarkers obtained from a liquid biopsy are widely used to assess the treatment response, disease recurrence and progression. In this study, we analyzed the value of the liquid biopsy, which includes circulating tumor DNA (ctDNA) and cell-free DNA (cfDNA), in patients with CLM. Methods Capture-based targeted deep sequencing was performed on matched pre-surgery, post-surgery and liver metastatic tissues of 20 CRC patients who underwent the resection of liver metastases between May and September 2017 using a panel consisting of 41 genes. Mutation landscapes obtained from pre-surgery plasma samples and metastatic tissue samples were compared. Results Collectively, we identified 47 mutations from 17 pre-surgery plasma samples (85%), and the remaining 3 patients had no mutation detected from the panel. We revealed a high by-variant concordance rate of 82.14% between pre-surgery plasma samples and liver metastatic tissue samples. We further analyzed the correlation between ctDNA, cfDNA, CEA and tumor burden and revealed a positive correlation between ctDNA and tumor burden (R=0.69, p=0.002). As of the date for data cutoff, 8/20 patients experienced relapse. Our study also demonstrated that pre-surgery ctDNA (p<0.001), cfDNA (p=0.001) and CEA (p=0.012) levels had predictive value for relapse. Patients with low pre-surgery ctDNA (p<0.001), cfDNA (p=0.001) or CEA (p=0.012) levels were more likely to experience prolonged progression-free survival. Conclusion Our data demonstrate that the genomic profile obtained from ctDNA is comparable with the genomic profile obtained from metastatic liver tumors. Furthermore, our study also show that pre-surgery ctDNA levels are positively correlated with tumor burden. In addition, pre-surgery ctDNA, cfDNA and CEA levels have predictive value for relapse.
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Affiliation(s)
- Yiping He
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Xiaoji Ma
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Ke Chen
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China.,Department of Endoscopy, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Fangqi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Han Han-Zhang
- Burning Rock Biotech, Guangzhou, Guangdong, People's Republic of China
| | - Ting Hou
- Burning Rock Biotech, Guangzhou, Guangdong, People's Republic of China
| | - Jianxing Xiang
- Burning Rock Biotech, Guangzhou, Guangdong, People's Republic of China
| | - Junjie Peng
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
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Lv Y, Ji ML, Feng QY, Zhu DX, Lin SB, Mao YH, Xu YQ, Zheng P, He GD, Xu JM. Combined test of third lumbar skeletal muscle index and prognostic nutrition index improve prognosis prediction power in resected colorectal cancer liver metastasis. Aging (Albany NY) 2019; 11:10301-10315. [PMID: 31760384 PMCID: PMC6914437 DOI: 10.18632/aging.102457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/07/2019] [Indexed: 12/11/2022]
Abstract
Background: In this paper, we aim to explore clinical value of skeletal muscle index (SMI) and prognostic nutrition index (PNI) on resected colorectal cancer liver metastasis (CRLM). Results: Among the 539 patients, 355 were males. Baseline lower SMI was associated with smaller BMI, smaller PNI, smaller pre-albumin and longer hospitalization days (P<0.05). Patients with lower SMI and PNI had significantly shorter duration of PFS and OS (P<0.05). SMI can reflect the postoperative treatment response. Postoperative 6-month’s and 12-month’s SMI and PNI can indicate overall prognosis. When combined SMI and PNI, prognostic AUC of ROC curves improved significantly. Conclusion: Combined monitor of SMI and PNI can improve the power at predicting prognosis. Postoperative 6-month’s record of SMI and PNI was more accurate and predictive for CRLM prognosis. Method: A total of 539 resected CRLM patients between January 2013 to December 2016 with complete clinical data were included. Computed tomography image was collected from each patient. Receiver-operating characteristic (ROC) curves were constructed; area under curves (AUC) were also determined. All clinical variables were analyzed in proper way.
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Affiliation(s)
- Yang Lv
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Mei-Ling Ji
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qing-Yang Feng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - De-Xiang Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Song-Bin Lin
- Department of General Surgery, Zhongshan Hospital Xiamen Branch, Fudan University, Xiamen 361000, China
| | - Yi-Hao Mao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yu-Qiu Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Peng Zheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Guo-Dong He
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian-Min Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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The mechanism of the premetastatic niche facilitating colorectal cancer liver metastasis generated from myeloid-derived suppressor cells induced by the S1PR1-STAT3 signaling pathway. Cell Death Dis 2019; 10:693. [PMID: 31534132 PMCID: PMC6751205 DOI: 10.1038/s41419-019-1922-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 08/03/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022]
Abstract
The tumor-derived factors involved in the expansion and accumulation of myeloid-derived suppressor cells (MDSCs) in metastatic dissemination of colorectal cancer (CRC) to the liver has not been studied. Immunohistochemistry was used to detect sphingosine-1-phosphate receptor 1 (S1PR1) and signal transducer and activator of transcription-3 (STAT3) in human colorectal tumors. IL-6 and interferon-γ were detected by enzyme-linked immunosorbent assay (ELISA). Tumor growth, invasion, and migration were evaluated by MTT, transwell, and wound healing assays, respectively. Subcutaneous tumor-bearing and CRC liver metastasis (CRLM) nude mouse models were constructed. The percentage of MDSCs was measured using multicolor flow cytometry. Western blot assay was used to evaluate S1PR1 and p-STAT3 expression in MDSCs after separation from the liver and tumor by magnetic antibody. T-cell suppression assay was detected by carboxyfluorescein succinimidyl ester (CFSE). Aberrant co-expressed S1PR1 and p-STAT3 was correlated with metachronous liver metastasis and poor prognosis in CRC. A mutual activation loop between S1PR1 and STAT3 can enhance CRC cell proliferation, migration, and invasion in vitro and in vivo. The expression of p-STAT3 and its downstream proteins can be regulated by S1PR1. p-STAT3 was the dependent signaling pathway of S1PR1 in the promotion of cell growth and liver metastasis in CRC. The level of IL-6 and the associated MDSCs stimulated by the S1PR1-STAT3 correlated with the number of liver metastatic nodes in the CRLM mouse models and patients. Increased CD14+HLA-DR-/low MDSCs from CRLM patients inhibited autologous T-cell proliferation and predict poor prognosis. The S1PR1-STAT3-IL-6-MDSCs axis operates in both tumor cells and MDSCs involved in the promotion of growth and liver metastasis in CRC. MDSCs induced by S1PR1-STAT3 in CRC cells formed the premetastatic niche in the liver can promote organ-specific metastasis.
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