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Hull MA, Ow PL, Ruddock S, Brend T, Smith AF, Marshall H, Song M, Chan AT, Garrett WS, Yilmaz O, Drew DA, Collinson F, Cockbain AJ, Jones R, Loadman PM, Hall PS, Moriarty C, Cairns DA, Toogood GJ. Randomised, placebo-controlled, phase 3 trial of the effect of the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) on colorectal cancer recurrence and survival after surgery for resectable liver metastases: EPA for Metastasis Trial 2 (EMT2) study protocol. BMJ Open 2023; 13:e077427. [PMID: 38030258 PMCID: PMC10689403 DOI: 10.1136/bmjopen-2023-077427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION There remains an unmet need for safe and cost-effective adjunctive treatment of advanced colorectal cancer (CRC). The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) is safe, well-tolerated and has anti-inflammatory as well as antineoplastic properties. A phase 2 randomised trial of preoperative EPA free fatty acid 2 g daily in patients undergoing surgery for CRC liver metastasis showed no difference in the primary endpoint (histological tumour proliferation index) compared with placebo. However, the trial demonstrated possible benefit for the prespecified exploratory endpoint of postoperative disease-free survival. Therefore, we tested the hypothesis that EPA treatment, started before liver resection surgery (and continued postoperatively), improves CRC outcomes in patients with CRC liver metastasis. METHODS AND ANALYSIS The EPA for Metastasis Trial 2 trial is a randomised, double-blind, placebo-controlled, phase 3 trial of 4 g EPA ethyl ester (icosapent ethyl (IPE; Vascepa)) daily in patients undergoing liver resection surgery for CRC liver metastasis with curative intent. Trial treatment continues for a minimum of 2 years and maximum of 4 years, with 6 monthly assessments, including quality of life outcomes, as well as annual clinical record review after the trial intervention. The primary endpoint is CRC progression-free survival. Key secondary endpoints are overall survival, as well as the safety and tolerability of IPE. A minimum 388 participants are estimated to provide 247 CRC progression events during minimum 2-year follow-up, allowing detection of an HR of 0.7 in favour of IPE, with a power of 80% at the 5% (two sided) level of significance, assuming drop-out of 15%. ETHICS AND DISSEMINATION Ethical and health research authority approval was obtained in January 2018. All data will be collected by 2025. Full trial results will be published in 2026. Secondary analyses of health economic data, biomarker studies and other translational work will be published subsequently. TRIAL REGISTRATION NUMBER NCT03428477.
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Affiliation(s)
- Mark A Hull
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Pei Loo Ow
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sharon Ruddock
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Tim Brend
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Alexandra F Smith
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Helen Marshall
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mingyang Song
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wendy S Garrett
- Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Omer Yilmaz
- Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - David A Drew
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fiona Collinson
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Robert Jones
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Paul M Loadman
- Institute of Cancer Therapeutics, University of Bradford, Bradford, UK
| | - Peter S Hall
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | | | - David A Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Giles J Toogood
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Jiang YJ, Zhou SC, Chen JH, Liang JW. Oncological outcomes of neoadjuvant chemotherapy in patients with resectable synchronous colorectal liver metastasis: A result from a propensity score matching study. Front Oncol 2022; 12:951540. [PMID: 36330479 PMCID: PMC9623041 DOI: 10.3389/fonc.2022.951540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/27/2022] [Indexed: 09/07/2024] Open
Abstract
Background The efficacy and safety of neoadjuvant chemotherapy (NAC) in treating resectable synchronous colorectal liver metastases (CRLM) remain controversial. Methods Data from CRLM patients who underwent simultaneous liver resection between January 2015 and December 2019 were collected from the Surveillance, Epidemiology, and End Results (SEER) database (SEER cohort, n=305) and a single Chinese Cancer Center (NCC cohort, n=268). Using a 1:2 ratio of propensity score matching (PSM), the prognostic impact of NAC for patients who underwent NAC before surgical treatment and patients who underwent surgical treatment alone was evaluated. Results After PSM, there was no significant difference in overall survival (OS) between patients receiving NAC prior to CRLM resection and those undergoing surgery only, in both the NCC and SEER cohorts (each P > 0.05). Age was an independent predictor of OS only in the SEER cohort (P = 0.040), while the pN stage was an independent predictor for OS only in the NCC cohort (P = 0.002). Furthermore, Disease-free survival (DFS) was comparable between the two groups in the NCC cohort. In a subgroup analysis, the DFS and OS in the NAC- group were significantly worse than those in the NAC+ group for patients with more than two liver metastases in the NCC cohort (P < 0.05 for both). Conclusion NAC did not have a significant prognostic impact in patients with resectable synchronous CRLM. However, patients with more than two liver metastases could be good candidates for receiving NAC.
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Affiliation(s)
- Yu-Juan Jiang
- 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, China
| | - Si-Cheng Zhou
- 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, China
| | - Jing-Hua 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
| | - Jian-Wei Liang
- 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, China
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Serrablo A, Giménez-Maurel T, Utrilla Fornals A, Serrablo L, Azoulay D. Current indications of ex-situ liver resection: A systematic review. Surgery 2022; 172:933-942. [PMID: 35791978 DOI: 10.1016/j.surg.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ex situ liver resection and autotransplantation, a surgical technique introduced for managing advanced and unresectable malignant tumors, never became a popular surgical procedure, due mainly to the high incidence of adverse events and postoperative recurrences. This study aims to assess the clinical outcomes of ex situ liver resection and autotransplantation in the currently available literature. METHODS The PubMed electronic database was used to retrieve studies that meet the inclusion criteria for the topic. RESULTS Twenty-nine studies were included. The mean (range) 90-day mortality rate was 11.6% (0%-50%) and the mean overall survival was 55.8% (12.5%-100.0%). R0 resection was achieved in 100% of cases. In the overall study sample, the maximum tumor size was found to be positively correlated with the 90-day mortality rate (P = .047) and negatively correlated with the overall survival (P = .048). The mean number of total resected segments appeared to be positively correlated with the length of hospital stay (P = .039). In the malignant tumor sample, there was a significant relationship between the maximum tumor size and postoperative liver failure, 90-day mortality rate (P = .027 and P = .034, respectively), and between the mean length of anhepatic phase and mean length of hospital stay (P = .0092). CONCLUSION The ex situ liver resection and autotransplantation appears to be a valuable option in selected patients with conventionally unresectable hepatic tumors and normal liver function. However, it was not possible to provide clear and unequivocal recommendations about this procedure. To rectify this, an international database to help surgeons in their decision-making process ought to be established.
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Affiliation(s)
- Alejandro Serrablo
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza, Spain.
| | | | | | - Leyre Serrablo
- Surgery Department, Medicine School Zaragoza University, Zaragoza, Spain
| | - Daniel Azoulay
- Surgical Department, Centre Hépato-Biliaire Paul Brousse, VIllejuif, France
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Lee H, Lee H, Hong H, Bae H, Lim JS, Kim J. Classification of focal liver lesions in CT images using convolutional neural networks with lesion information augmented patches and synthetic data augmentation. Med Phys 2021; 48:5029-5046. [PMID: 34287951 DOI: 10.1002/mp.15118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE We propose a deep learning method that classifies focal liver lesions (FLLs) into cysts, hemangiomas, and metastases from portal phase abdominal CT images. We propose a synthetic data augmentation process to alleviate the class imbalance and the Lesion INformation Augmented (LINA) patch to improve the learning efficiency. METHODS A dataset of 502 portal phase CT scans of 1,290 FLLs was used. First, to alleviate the class imbalance and to diversify the training data patterns, we suggest synthetic training data augmentation using DCGAN-based lesion mask synthesis and pix2pix-based mask-to-image translation. Second, to improve the learning efficiency of convolutional neural networks (CNNs) for the small lesions, we propose a novel type of input patch termed the LINA patch to emphasize the lesion texture information while also maintaining the lesion boundary information in the patches. Third, we construct a multi-scale CNN through a model ensemble of ResNet-18 CNNs trained on LINA patches of various mini-patch sizes. RESULTS The experiments demonstrate that (a) synthetic data augmentation method shows characteristics different but complementary to those in conventional real data augmentation in augmenting data distributions, (b) the proposed LINA patches improve classification performance compared to those by existing types of CNN input patches due to the enhanced texture and boundary information in the small lesions, and (c) through an ensemble of LINA patch-trained CNNs with different mini-patch sizes, the multi-scale CNN further improves overall classification performance. As a result, the proposed method achieved an accuracy of 87.30%, showing improvements of 10.81%p and 15.0%p compared to the conventional image patch-trained CNN and texture feature-trained SVM, respectively. CONCLUSIONS The proposed synthetic data augmentation method shows promising results in improving the data diversity and class imbalance, and the proposed LINA patches enhance the learning efficiency compared to the existing input image patches.
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Affiliation(s)
- Hansang Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Haeil Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Helen Hong
- Department of Software Convergence, College of Interdisciplinary Studies for Emerging Industries, Seoul Women's University, Seoul, Republic of Korea
| | - Heejin Bae
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junmo Kim
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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Campanati RG, Sancio JB, Sucena LMDA, Sanches MD, Resende V. PRIMARY TUMOR LYMPHOVASCULAR INVASION NEGATIVELY AFFECTS SURVIVAL AFTER COLORECTAL LIVER METASTASIS RESECTION? ACTA ACUST UNITED AC 2021; 34:e1578. [PMID: 34133525 PMCID: PMC8195463 DOI: 10.1590/0102-672020210001e1578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND About 50% of the patients with colorectal adenocarcinoma will present with liver metastasis and 20% are synchronic. Liver resection is associated with improvement in survival in comparison to chemotherapy alone. AIM To analyze the overall survival in patients submitted to liver resection of colorectal cancer metastasis and prognostic factors related to the primary and secondary tumors. METHODS A retrospective analysis of a prospectively maintained database regarding demographic, primary tumor and liver metastasis characteristics. RESULTS There were 84 liver resections due to colorectal cancer metastasis in the period. The 5-year disease-free and overall survivals were 27.5% and 48.8% respectively. The statistically significant factors for survival were tumor grade (p=0.050), lymphovascular invasion (p=0.021), synchronous metastasis (p=0.020), as well as number (p=0.004), bilobar distribution (p=0.019) and diameter of the liver metastasis over 50 mm (p=0.027). Remained as independent negative predictive factors: lymphovascular invasion (HR=2.7; CI 95% 1.106-6.768; p=0.029), synchronous metastasis (HR=2.8; CI 95% 1.069-7.365; p=0.036) and four or more liver metastasis (HR=1.7; CI 95% 1.046-2.967; p=0.033). CONCLUSION The resection of liver metastasis of colorectal adenocarcinoma leads to good survival rates. Lymphovascular invasion was the single prognostic factor related to the primary tumor. Synchronous disease and four or more metastasis were the most significant factors related to the secondary tumor.
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Affiliation(s)
- Renato Gomes Campanati
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - João Bernardo Sancio
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Marcelo Dias Sanches
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Vivian Resende
- Department of Surgery, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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Bae H, Lee H, Kim S, Han K, Rhee H, Kim DK, Kwon H, Hong H, Lim JS. Radiomics analysis of contrast-enhanced CT for classification of hepatic focal lesions in colorectal cancer patients: its limitations compared to radiologists. Eur Radiol 2021; 31:8786-8796. [PMID: 33970307 DOI: 10.1007/s00330-021-07877-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate diagnostic performance of a radiomics model for classifying hepatic cyst, hemangioma, and metastasis in patients with colorectal cancer (CRC) from portal-phase abdominopelvic CT images. METHODS This retrospective study included 502 CRC patients who underwent contrast-enhanced CT and contrast-enhanced liver MRI between January 2005 and December 2010. Portal-phase CT images of training (n = 386) and validation (n = 116) cohorts were used to develop a radiomics model for differentiating three classes of liver lesions. Among multiple handcrafted features, the feature selection was performed using ReliefF method, and random forest classifiers were used to train the selected features. Diagnostic performance of the developed model was compared with that of four radiologists. A subgroup analysis was conducted based on lesion size. RESULTS The radiomics model demonstrated significantly lower overall and hemangioma- and metastasis-specific polytomous discrimination index (PDI) (overall, 0.8037; hemangioma-specific, 0.6653; metastasis-specific, 0.8027) than the radiologists (overall, 0.9622-0.9680; hemangioma-specific, 0.9452-0.9630; metastasis-specific, 0.9511-0.9869). For subgroup analysis, the PDI of the radiomics model was different according to the lesion size (< 10 mm, 0.6486; ≥ 10 mm, 0.8264) while that of the radiologists was relatively maintained. For classifying metastasis from benign lesions, the radiomics model showed excellent diagnostic performance, with an accuracy of 84.36% and an AUC of 0.9426. CONCLUSION Albeit inferior to the radiologists, the radiomics model achieved substantial diagnostic performance when differentiating hepatic lesions from portal-phase CT images of CRC patients. This model was limited particularly to classifying hemangiomas and subcentimeter lesions. KEY POINTS • Albeit inferior to the radiologists, the radiomics model could differentiate cyst, hemangioma, and metastasis with substantial diagnostic performance using portal-phase CT images of colorectal cancer patients. • The radiomics model demonstrated limitations especially in classifying hemangiomas and subcentimeter liver lesions.
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Affiliation(s)
- Heejin Bae
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hansang Lee
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sungwon Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyungjin Rhee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong-Kyu Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyuk Kwon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Helen Hong
- Department of Software Convergence, College of Interdisciplinary Studies for Emerging Industries, Seoul Women's University, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Sutphin PD, Ganguli S. Interventional Treatment of Hepatic Metastases from Colorectal Cancer. Semin Intervent Radiol 2020; 37:492-498. [PMID: 33328705 PMCID: PMC7732570 DOI: 10.1055/s-0040-171919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Modern systemic therapies provide a significant survival benefit in metastatic colorectal cancer. Despite these advances, the durability of response remains limited and nearly all patients progress on systemic treatment. Colorectal liver metastases (CLM) develop in approximately half of patients with metastatic disease and contribute to mortality in most patients. In selected patients, surgical resection of hepatic metastases prolongs survival, indicating the benefits of the targeted treatment of CLM through alternate means. Minimally invasive interventional treatments offer the promise of treating CLM in a wider range of patients than those eligible for surgical resection. Thermal ablation and intra-arterial therapies, including chemoembolization and radioembolization, are commonly used in the treatment of CLM. Each of these treatment modalities will be discussed in detail with an emphasis on the available clinical data for each interventional treatment for CLM.
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Affiliation(s)
- Patrick D. Sutphin
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Boston Medical Center, Boston University Medical School, Boston, Massachusetts
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de Oliveira CVC, Fonseca GM, Kruger JAP, de Mello ES, Coelho FF, Herman P. Histopathological prognostic factors for colorectal liver metastases: A systematic review and meta-analysis of observational studies. Histol Histopathol 2020; 36:159-181. [PMID: 33165892 DOI: 10.14670/hh-18-274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Resection is the mainstay of treatment for colorectal liver metastases (CRLMs). Many different histopathological factors related to the primary colorectal tumour have been well studied; however, histopathological prognostic factors related to CRLMs are still under evaluation. OBJECTIVE To identify histopathological factors related to overall survival (OS) and disease-free survival (DFS) in patients with resected CRLMs. METHODS A systematic review was performed with the following databases up to August 2020: PubMed, EMBASE, Web of Science, SciELO, and LILACS. The GRADE approach was used to rate the overall certainty of evidence by outcome. RESULTS Thirty-three studies including 4,641 patients were eligible. We found very low certainty evidence that the following histopathological prognostic factors are associated with a statistically significant decrease in OS: presence of portal vein invasion (HR, 0,50 [95% CI, 0,37 to 0,68]; I²=0%), presence of perineural invasion (HR, 0,55 [95% CI, 0,36 to 0,83]; I²=0%), absence of pseudocapsule (HR, 0,41 [CI 95%, 0,29 to 0,57], p<0,00001; I²=0%), presence of satellite nodules (OR, 0,45 [95% CI, 0,26 to 0,80]; I²=0%), and the absence of peritumoural inflammatory infiltrate (OR, 0,20 [95% CI, 0,08 to 0,54]; I²=0%). Outcome data on DFS were scarce, except for tumour borders, which did not present a significant impact, precluding the meta-analysis. CONCLUSION Of the histopathological prognostic factors studied, low- to moderate-certainty evidence shows that vascular invasion, perineural invasion, absence of pseudocapsule, presence of satellite nodules, and absence of peritumoral inflammatory infiltrate are associated with shorter overall survival in CRLMs.
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Affiliation(s)
- Cássio Virgílio Cavalcante de Oliveira
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School (USP), São Paulo, Brazil.,Surgery Department, Paraíba Federal University, João Pessoa, Paraíba, Brazil. .,Nova Esperança Medicine Faculty, João Pessoa, Paraíba, Brazil
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Evandro Sobroza de Mello
- Cancer Institute of the State of São Paulo "Octavio Frias de Oliveira" (ICESP), Department of Pathology, University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School (USP), São Paulo, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School (USP), São Paulo, Brazil
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Arterial Embolization Using Microspheres for Hypervascular Liver Metastases Refractory to Standard Treatments: A Multicenter Prospective Clinical Trial. Cardiovasc Intervent Radiol 2020; 44:392-400. [PMID: 33098022 DOI: 10.1007/s00270-020-02673-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the clinical utility of bland arterial embolization using microspheres in patients with hypervascular liver metastases refractory to standard treatments. MATERIALS AND METHODS Primary endpoints of this prospective single-arm non-comparative study were objective response and disease control rates (ORR and DCR), based on the modified Response Evaluation Criteria in Solid Tumors at 4 weeks after embolization. Secondary endpoints were ORR according to primary tumor, overall survival, progression-free survival (PFS), and safety. RESULTS Twenty-five patients with a median age of 66 years (range, 40-95 years) were enrolled in this study. The median maximum diameter of liver metastasis was 3.7 cm (range, 2.0-15.2 cm). Primary lesions were colorectal cancer in 12 patients (48%, 12/25), other cancer in 7 (28%, 7/25), neuroendocrine tumor in 4 (16%, 4/25), and sarcoma in 2 (8%, 2/25). ORR and DCR were 52% (13/25) and 72% (18/25) in all patients, 42% (5/12) and 75% (9/12) in colorectal cancer patients, and 62% (8/13) and 69% (9/13) in other malignant tumor patients (p = 0.43, p > 0.99). Median survival time was 19 months in all patients, 19 months in colorectal cancer patients, and 8 months (p = 0.16) in other malignant tumor patients. Median PFS time was 4 months in all patients, 4 months in colorectal cancer patients, and 6 months (p = 0.0085) in other malignant tumor patients. There were no grade-3 or -4 adverse events. CONCLUSION Microsphere embolization appears to be an effective and safe treatment for hypervascular liver metastases refractory to standard treatments.
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Srouji RM, Narayan RR, Boerner T, Buisman FE, Seier K, Gonen M, Balachandran VP, Drebin JA, Jarnagin WR, Kingham TP, Wei A, Kemeny NE, D'Angelica MI. Extrahepatic recurrence rates in patients receiving adjuvant hepatic artery infusion and systemic chemotherapy after complete resection of colorectal liver metastases. J Surg Oncol 2020; 122:1536-1542. [PMID: 32976666 DOI: 10.1002/jso.26221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study investigated the effect of the reduced dose of systemic chemotherapy (SYS) on recurrence patterns in patients receiving adjuvant hepatic artery infusion (HAI) chemotherapy after complete colorectal liver metastases (CRLM) resection. METHODS Patients undergoing complete CRLM resection between 2000 and 2007 were selected from a prospectively maintained database and categorized as receiving SYS or HAI + SYS. Those with pre and/or intraoperative extrahepatic disease, documented death, or recurrence within 30 days of CRLM resection were excluded. Competing risk, Fine and Gray's tests were used to compare SYS versus HAI + SYS for time-to-organ recurrence. RESULTS Of 361 study patients, 153 (42.4%) received SYS and 208 (57.6%) received HAI + SYS. The median follow-up for survivors was 100 (range = 12-185) and 156 months (range = 18-217) for SYS and HAI + SYS, respectively. The 5-year cumulative incidence (CI) of any liver recurrence was greater for those receiving SYS (SYS = 41.9% vs. HAI + SYS = 28.6%, p = .005). The 5-year CI of developing any lung or extrahepatic recurrence for SYS patients was 36.2% and 47.9% compared with 44.5% (p = .242) and 51.7% (p = .551), respectively, in patients receiving HAI + SYS. CONCLUSION Despite the reduced dose of SYS, adjuvant HAI + SYS after CRLM resection is not associated with a significantly increased risk of extrahepatic recurrence.
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Affiliation(s)
- Rami M Srouji
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Barnes Jewish Hospital, Washington University, St. Louis, Missouri, USA
| | - Raja R Narayan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Thomas Boerner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Florian E Buisman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Kenneth Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinod P Balachandran
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeffrey A Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alice Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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11
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van Roekel C, Jongen JMJ, Smits MLJ, Elias SG, Koopman M, Kranenburg O, Borel Rinkes IHM, Lam MGEH. Mode of progression after radioembolization in patients with colorectal cancer liver metastases. EJNMMI Res 2020; 10:107. [PMID: 32960390 PMCID: PMC7509032 DOI: 10.1186/s13550-020-00697-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
Background Radioembolization is an established treatment modality in colorectal cancer patients with liver-dominant disease in a salvage setting. Selection of patients who will benefit most is of vital importance. The aim of this study was to assess response (and mode of progression) at 3 months after radioembolization and the impact of baseline characteristics. Methods Three months after radioembolization with either yttrium-90 resin/glass or holmium-166, anatomic response, according to RECIST 1.1, was evaluated in 90 patients. Correlations between baseline characteristics and efficacy were evaluated. For more detailed analysis of progressive disease as a dismal clinical entity, distinction was made between intra- and extrahepatic progression, and between progression of existing metastases and new metastases. Results Forty-two patients (47%) had extrahepatic disease (up to five ≥ 1 cm lung nodules, and ≤ 2 cm lymph nodes) at baseline. No patients showed complete response, 5 (5.5%) patients had partial response, 16 (17.8%) had stable disease, and 69 (76.7%) had progressive disease. Most progressive patients (67/69; 97%) had new metastases (intra-hepatic N = 11, extrahepatic N = 32; or both N = 24). Significantly fewer patients had progressive disease in the group of patients presenting without extrahepatic metastases at baseline (63% versus 93%; p = 0.0016). Median overall survival in patients with extrahepatic disease was 6.5 months, versus 10 months in patients without extrahepatic disease at baseline (hazard ratio 1.79, 95%CI 1.24–2.57). Conclusions Response at 3-month follow-up and survival were heavily influenced by new metastases. Patients with extrahepatic disease at baseline had a worse outcome compared to patients without.
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Affiliation(s)
- Caren van Roekel
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jennifer M J Jongen
- Department of Surgical Oncology, Endocrine and GI Surgery, Cancer Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Maarten L J Smits
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Onno Kranenburg
- Division of Biomedical Genetics, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Oncology, Endocrine and GI Surgery, Cancer Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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12
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Combined liver resection and cytoreductive surgery with HIPEC for metastatic colorectal cancer: Results of a worldwide analysis of 565 patients from the Peritoneal Surface Oncology Group International (PSOGI). Eur J Surg Oncol 2020; 47:89-100. [PMID: 32943276 DOI: 10.1016/j.ejso.2020.07.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022] Open
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13
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Wisneski AD, Jin C, Huang CY, Warren R, Hirose K, Nakakura EK, Corvera CU. Synchronous Versus Metachronous Colorectal Liver Metastasis Yields Similar Survival in Modern Era. J Surg Res 2020; 256:476-485. [PMID: 32798995 DOI: 10.1016/j.jss.2020.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Synchronous colorectal cancer liver metastasis (CRLM) has been viewed as being more aggressive and having shorter survival than metachronous disease. Advances in CRLM management led us to examine differences in treatment characteristics of synchronous versus metachronous CRLM patients along with survival and recurrence. MATERIALS AND METHODS A retrospective review of hepatic resection for CRLM at a tertiary academic medical center was performed for two periods: a historic cohort from 1992 to 2010 (n = 121), and a modern cohort (n = 179) from 2012 to 2018. Clinical variables were compared between the patient groups, and survival outcomes were characterized. RESULTS Five-year disease-specific survival for the modern synchronous group compared to the historic synchronous group was 71.7% versus 44.3% (P = 0.02). Modern metachronous versus modern synchronous 5-y disease-specific survival rates were 49.8% versus 71.7% (P = 0.31). Compared to the historic cohort, the modern one had significantly different timing of hepatic resection (P < 0.01) with increased use of liver-first (30.1% versus 7.5%) and simultaneous liver-colon resections (24.1% versus 10.4%), along with greater use of neoadjuvant chemotherapy (96.4% versus 65.6%; P < 0.01). Significantly more patients in the modern synchronous cohort had disease-free or alive-with-disease status at last follow-up, compared to the historic group (P < 0.01), and experienced less disease recurrence (62.7% versus 77.6%; P < 0.05). CONCLUSIONS Modern synchronous CRLM patients who underwent hepatic resection experienced significantly improved survival compared to a historic cohort. We postulate that increased use of neoadjuvant chemotherapy and liver-first/simultaneous liver-colon resections in the modern synchronous cohort contributed to improved survival.
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Affiliation(s)
- Andrew D Wisneski
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Chengshi Jin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Robert Warren
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kenzo Hirose
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Eric K Nakakura
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Carlos U Corvera
- Department of Surgery, University of California San Francisco, San Francisco, California.
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14
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Yonemura Y, Iahibashi H, Sako S, Mizumoto A, Takao N, Ichinose M, Motoi S, Liu Y, Wakama S, Kamada Y, Nishihara K. Advances with pharmacotherapy for peritoneal metastasis. Expert Opin Pharmacother 2020; 21:2057-2066. [PMID: 32783786 DOI: 10.1080/14656566.2020.1793957] [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: 10/23/2022]
Abstract
INTRODUCTION A new treatment strategy involving cytoreductive surgery (CRS) combined with perioperative intraperitoneal (IP) chemotherapy was proposed in 1999 by the Peritoneal Surface Oncology Group International, and the strategy is now justified as a state-of-the-art treatment to improve the long-term survival of patients with peritoneal metastasis (PM). To achieve cure in the patients with PM, complete removal of macroscopic tumors and eradication of micrometastasis on the peritoneum, left after CRS are essential. Systemic chemotherapy is not indicated for the treatment of PM. In contrast, intraperitoneal (IP) chemotherapy brings about significantly higher locoregional dose intensity in the peritoneal cavity and subperitoneal tissues. In combination with anticancer drugs, hyperthermia enhances cytotoxicity against cancer cells. AREA COVERED This article provides a systematic overview of PM from various cancers including gastric, colorectal, small bowel, appendiceal cancer, and mesothelioma. It also includes all the essential aspects of therapy. EXPERT OPINION CRS plus perioperative intraperitoneal chemotherapy is safe with acceptable morbidity and mortality. It is justified as a standard treatment to improve the long-term survival of patients with PM and is now performed with curative intent for PM from various malignancies.
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Affiliation(s)
- Yutaka Yonemura
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan.,Department of Peritoneal Surface Malignancy Treatment, Kusatsu General Hospital , Kusatsu City, Shiga, Japan
| | - Haruaki Iahibashi
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan
| | - Shouzou Sako
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan
| | - Akiyoshi Mizumoto
- Department of Peritoneal Surface Malignancy Treatment, Kusatsu General Hospital , Kusatsu City, Shiga, Japan
| | - Nobuyuki Takao
- Department of Peritoneal Surface Malignancy Treatment, Kusatsu General Hospital , Kusatsu City, Shiga, Japan
| | - Masumi Ichinose
- Department of Peritoneal Surface Malignancy Treatment, Kusatsu General Hospital , Kusatsu City, Shiga, Japan
| | - Shunsuke Motoi
- Department of Peritoneal Surface Malignancy Treatment, Kusatsu General Hospital , Kusatsu City, Shiga, Japan
| | - Yang Liu
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan
| | - Satoshi Wakama
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan
| | - Yasuyuki Kamada
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan
| | - Kazurou Nishihara
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital , Kishiwada City, Oosaka-Fu, Japan
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15
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Wang X, Ren Y, Ma S, Wang S. Circular RNA 0060745, a Novel circRNA, Promotes Colorectal Cancer Cell Proliferation and Metastasis Through miR-4736 Sponging. Onco Targets Ther 2020; 13:1941-1951. [PMID: 32273712 PMCID: PMC7119088 DOI: 10.2147/ott.s240642] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Recent studies have shown that noncoding RNAs (ncRNAs) play essential roles in the development of a number of cancers. Circular RNAs (circRNAs) have been shown to contribute to the progression of colorectal cancer (CRC). Methods In this study, the expression levels of circular RNA 0060745 (circ_0060745), and microRNA 4736 (miR-4736) were measured using qRT-PCR. Kaplan–Meier survival analysis and receiver operating characteristic (ROC) analysis were used to evaluate the diagnostic value of circ_0060745. Transwell assay and cell counting kit-8 (CCK8) assay were used to determine the metastatic and proliferative capacity of CRC cells. The expression of chromosome segregation one like (CSE1L) was measured using Western blotting and immunohistochemistry (IHC). In addition, RNA pull-down assay and luciferase assay were performed to verify the targeted binding between miR-473,6 and circ_0060745, and between as miR-4736 and CSE1L. Results We showed that circ_0060745 was upregulated in CRC, and was associated with unfavorable clinicopathological characteristics. We also showed that circ_0060745 acted as an oncogene and promoted CRC cell proliferation and metastasis. Circ_0060745 was primarily located in the cytoplasm. Furthermore, miR-4736 was downregulated in CRC, was a downstream target of circ_0060745, and mediated proliferation and metastasis. We showed that circ_0060745 sequestered miR-4736, which resulted in CRC cell proliferation and metastasis. Finally, we showed that CSE1L, a downstream target of miR-4736, was upregulated in CRC and mediated suppression of proliferation and metastasis in CRC. Conclusion The results of this study showed that circ_0060745 promoted CRC cell proliferation and metastasis via modulation of miR-4736/CSE1L signaling. The Circ_0060745/miR-4736/CSE1L axis might be a novel target for the treatment of CRC.
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Affiliation(s)
- Xuebing Wang
- Integrated TCM and Western Medicine Department, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, People's Republic of China
| | - Yanyi Ren
- Integrated TCM and Western Medicine Department, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, People's Republic of China
| | - Siyao Ma
- Integrated TCM and Western Medicine Department, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, People's Republic of China
| | - Shenyu Wang
- Integrated TCM and Western Medicine Department, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, People's Republic of China
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16
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Kim YI, Park IJ, Kim JE, Kim SY, Park JH, Lee JH, Ha TY, Hong YS, Kim SY, Kim TW, Lim SB, Yu CS, Kim JC. Hepatic resection after neoadjuvant chemotherapy for patients with liver metastases from colorectal cancer: need for cautious planning. Ann Surg Treat Res 2019; 97:245-253. [PMID: 31742209 PMCID: PMC6848007 DOI: 10.4174/astr.2019.97.5.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/03/2019] [Accepted: 10/05/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Current neoadjuvant chemotherapy (NAC) may enable therapies such as surgical resection and local ablation of metastases in patients with colorectal liver metastasis (CLM). We evaluated outcomes in CLM patients who underwent resection and/or local treatment after NAC and identified prognostic factors for oncologic outcomes. Methods Patients who received NAC followed by resection and/or local treatment of hepatic metastasis from 2013 to 2015 were included. Treatment and tumor-related variables were tabulated. Recurrence-free survival (RFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Cox regression analysis was used to identify factors associated with RFS and OS. Results Sixty-eight patients received NAC followed by resection and/or local treatment of hepatic metastases. Targeted therapy was administered in 50% of the patients. RFS was 35.8% at 1 year and 19.4% at 2 years postoperatively. OS was 95.6% at 1 year and 88.2% at 2 years postoperatively. In the multivariable analysis, R1 resection margin (hazard ratio [HR], 3.95; P = 0.008) of the liver metastases and ypN1/ypN2 (HR, 2.356 and 1.983, respectively; P = 0.041) were associated with poor RFS. Both factors were also significantly related to OS. Conclusion Resection margin of the metastatic tumor and ypN status are the only relevant factors for RFS and OS in CLM patients treated with NAC. Despite early and high rates of recurrence, CLM patients treated with NAC who undergo resection and/or local treatment have acceptable OS. Multidisciplinary review of candidates for surgery and cautious planning are crucial for achieving optimal outcomes.
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Affiliation(s)
- Young Il Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Hong Park
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Young Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Analysis of the feasibility of microwave ablation for colorectal liver metastases: a preliminary report. Wideochir Inne Tech Maloinwazyjne 2019; 15:30-35. [PMID: 32117483 PMCID: PMC7020727 DOI: 10.5114/wiitm.2019.86921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/06/2019] [Indexed: 01/28/2023] Open
Abstract
Introduction Colorectal liver metastasis is a challenge in the treatment of colorectal cancer and an important factor affecting the prognosis of patients. Currently, microwave ablation has gradually been applied for the treatment of liver cancers as a type of thermal ablation. However, there are no large-scale studies on the effectiveness of microwave ablation for colorectal liver metastases. Aim To investigate the efficacy of microwave ablation and liver resection for liver metastases from colorectal cancer, and to compare the prognosis between patients treated with microwave ablation and those in the SEER (Surveillance, Epidemiology, and End Results, National Cancer Institute) database. Material and methods We retrospectively analyzed the clinical data of 24 patients with colorectal liver metastasis who underwent radical colorectal cancer resection and liver microwave ablation (the MWA group) and 12 patients who received radical colorectal cancer resection and liver resection (the LR group). The complete ablation rate and complications after microwave ablation were observed. Survival analysis was performed for cases treated with liver resection and cases from the SEER database. Results A total of 53 tumors were ablated in the 24 patients who underwent radical colorectal cancer resection and liver microwave ablation; 52 tumors achieved complete ablation after the first ablation (98.1%). No serious complications occurred in the MWA group, and long-term survival was not significantly different between the MWA and other groups. Conclusions Microwave ablation for colorectal liver metastases avoids extensive liver resection while ensuring therapeutic efficacy; the operation is safe, feasible, and reproducible.
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18
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Melichar B, Voboril Z, Nozicka J, Cerman J, Melicharová K, Mergancová J, Filip S, Krajina A, Voboril R, Jandík P. Hepatic Arterial Infusion Chemotherapy in Sarcoma Liver Metastases: A Report of 6 Cases. TUMORI JOURNAL 2019; 91:19-23. [PMID: 15850000 DOI: 10.1177/030089160509100105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims and background Liver metastases in patients with sarcoma are rare and associated with a poor prognosis. The experience with liver-directed therapies, eg hepatic arterial infusion, in these patients is limited. Methods Six patients with sarcoma metastatic to the liver (4 patients with gastrointestinal stromal tumors and 2 patients with leiomyosarcoma) were treated by hepatic arterial infusion in our center over a 12-year period. Since the experience was limited, a pooled analysis of reports with data on survival of 22 individual patients was performed. Results None of the 5 assessable patients responded to the therapy, and liver metastases progressed in all patients. The median survival was 20 months. In the pooled analysis, partial response was observed in 10 of 21 assessable patients (48%) and median survival was 20 months. The survival was significantly longer in responding patients compared to nonresponders (35 vs 14 months; logrank test, P= 0.009). Conclusions Hepatic arterial infusion has little efficacy in the treatment of sarcoma metastatic to the liver. More promising results have been reported for chemoembolization. The survival of responding patients seems to be better compared to non-responders.
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Affiliation(s)
- Bohuslav Melichar
- Department of Oncology & Radiotherapy, Charles University Medical School Teaching Hospital, Hradec Králové, Czech Republic.
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19
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She WH, Chan ACY, Ma KW, Dai WC, Chok KSH, Cheung TT, Lo CM. Anterior Approach to Major Resection for Colorectal Liver Metastasis. J Gastrointest Surg 2018; 22:1928-1938. [PMID: 29959643 DOI: 10.1007/s11605-018-3840-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/11/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to examine the merits of the anterior approach, if any, in colorectal liver metastasis (CRLM) resection. METHODS Data of patients who underwent partial hepatectomy for CRLM were reviewed. Patients treated by the anterior approach were compared with patients treated by the conventional approach. RESULTS Ninety-eight patients had right hepatectomy, extended right hepatectomy, or right trisectionectomy. Among them, 71 patients underwent the conventional approach (CA group) and 27 underwent the anterior approach (AA group). The two groups were comparable in demographic, pathological, and perioperative characteristics except that the AA group had higher levels of aspartate transaminase (median, 41 vs. 31 U/L; p = 0.006) and alanine transaminase (median, 27 vs. 22 U/L; p = 0.009), larger tumors (median, 7 vs. 4 cm; p = 0.000), and more extensive resections (p < 0.001). The median overall survival was 40 months (range, 0.69-168.6 months) in the CA group and 33.7 months (range, 0.95-99.8 months) in the AA group (p = 0.22), and the median disease-free survival was 9.7 months (range, 0.62-168.6 months) in the CA group and 6.2 months (range, 0.72-99.8 months) in the AA group (p = 0.464). Univariate and multivariate analyses identified 4 independent prognostic factors for overall survival: lymph node status of primary tumor (HR 1.352, 95% CI 0.639-2.862, p = 0.034), intraoperative blood loss (HR 1.253, 95% CI 1.039-1.510, p = 0.018), multiple liver tumor nodules (HR 1.775, 95% CI 1.029-3.061, p = 0.039), and microvascular invasion (HR 2.058, 95% CI 1.053-4.024, p = 0.035). CONCLUSIONS The two approaches resulted in comparable survival outcomes even though the AA group had larger tumors and more extensive resections. The anterior approach allows better mobilization and easier removal of large tumors once the liver is opened up.
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Affiliation(s)
- Wong Hoi She
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Albert C Y Chan
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
| | - Ka Wing Ma
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wing Chiu Dai
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Kenneth S H Chok
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Chung Mau Lo
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
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Melichar B, Voboril Z, Cerman J, Melicharová K, Nozicka J, Mergancová J, Voboril R, Jandík P. Hepatic Arterial Infusion Chemotherapy in Gastric Cancer: A Report of Four Cases and Analysis of the Literature. TUMORI JOURNAL 2018; 90:428-34. [PMID: 15510990 DOI: 10.1177/030089160409000414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aims and background Gastric cancer is associated with high mortality. Although the liver is a common site of metastases in this tumor, the experience with liver-directed therapies is limited. Methods We report a single-center experience involving four patients with liver metastases from gastric cancer treated by hepatic arterial infusion (HAI). In addition, we performed a search for reports on HAI in gastric cancer metastatic to the liver and used the studies with data on survival of individual patients for a pooled analysis. Results Among three valuable patients, one had a complete response, one had stable disease and one had progressive disease. The patient with complete response is still alive 41 months after the diagnosis of liver metastases, while the other patients died 6, 22 and 31 months after the diagnosis. Objective responses were observed in 48% of the 25 patients in the pooled analysis. Objective response and limited hepatic involvement were independent predictors of survival in these patients. Conclusions Although isolated liver involvement in metastatic gastric cancer is rare, HAI seems to be similarly effective in these patients as in patients with liver metastases from colorectal cancer. The prognosis is significantly better in gastric cancer patients who have limited hepatic involvement and attain an objective response after HAI.
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Affiliation(s)
- Bohuslav Melichar
- Department of Oncology & Radiotherapy, Charles University Medical School Teaching Hospital, Hradec Králové, Czech Republic.
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Melichar B, Solichová D, Svobodová I, Urbánek L, Veselý P, Melicharová K. Urinary Neopterin in Patients with Liver Tumors. TUMORI JOURNAL 2018; 92:318-22. [PMID: 17036523 DOI: 10.1177/030089160609200410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Primary and secondary liver tumors are associated with poor prognosis. Neopterin is an indicator of systemic immune activation, and increased neopterin concentrations have been associated with poor prognosis in a wide range of malignant tumors. Methods Urinary neopterin was determined by high-performance liquid chromatography in 154 patients with primary and secondary liver tumors. The survival of different groups of patients was compared by log-rank test, and Cox regression was used for multivariate analysis. Results Urinary neopterin was significantly increased in patients compared to controls. A statistically significant correlation was observed between urinary neopterin and age of the patients, hemoglobin concentration, mean erythrocyte volume and peripheral blood leukocyte or platelet count. In univariate analysis, urinary neopterin below 214 μmol/mol creatinine, peripheral blood leukocytes below 8 x 109/L, hemoglobin equal to or above 125 g/L, no extrahepatic tumor, stage of liver involvement, and colorectal, breast or ovarian primary were significant prognostic factors for survival. In multivariate analysis, Bengtsson stage, presence of extrahepatic involvement, primary other than colorectal, breast or ovarian carcinoma, peripheral blood leukocyte count and urinary neopterin were independent prognostic factors. Increased urinary neopterin during and at the end of follow-up was also associated with poor prognosis. Conclusions Urinary neopterin is increased in patients with liver tumors. Neopterin is an independent prognostic indicator in patients with liver tumors along with Bengtsson stage, presence of extrahepatic disease, primary site and peripheral blood leukocyte count.
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Affiliation(s)
- Bohuslav Melichar
- Department of Oncology and Radiotherapy, Charles University Medical School Teaching Hospital, Hradec Králové, Czech Republic.
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Gennari L, Doci R, Bozzetti F, Veronesi U. Proposal for a Clinical Classification of Liver Metastases. TUMORI JOURNAL 2018; 68:443-9. [PMID: 7179497 DOI: 10.1177/030089168206800515] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The lack of a worldwide-accepted classification of liver metastases makes it difficult to compare data on natural history and results from different treatments. The increasing interest in aggressive multimodal therapies for hepatic metastases prompted us to review the chief prognostic factors and the main published classifications in order to propose a new clinical classification, whose principal application concerns metastases from colorectal adenocarcinomas. Following the general rules of the TNM classification, liver metastases are classified by expressing with letters and numbers the parameters selected for their prognostic importance, clinical applicability and objectivity. H (hepatic) is the letter that indicates the liver is the site of metastasis. Synchronous metastases are indicated by H, metachronous by rH (r = recurrent). The extent of liver involvement is defined: H1, liver involvement less than 25%; H2, from 25 to 50%; H3, more than 50%. Site of metastases is defined by s (single), m (multiple to one surgical lobe), b (to both lobes), i (infiltration of important structures). The alteration of liver functions is indicated by F. The presence of cirrhosis is noted by C.
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Lorenz M, Baum RP, Oremek G, Inglis R, Reimann-Kirkowa M, Hör G, Seiffert U, Hottenrott C. Tumor Markers, Liver Function Tests and Symptoms in 115 Patients with Isolated Colorectal Liver Metastases. Int J Biol Markers 2018; 4:18-26. [PMID: 2746045 DOI: 10.1177/172460088900400104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Development of the hybridoma technique has made the identification of several new tumor antigens possible. Although it was hoped that they would be more tumor-specific, none of these markers are found exclusively in tumor or in serum of tumor patients. Compared with carcinoembryionic antigen (CEA) and liver function tests, the roles of these markers (CA 19-9, CA 125, CA 15-3) were prospectively evaluated in 115 patients with colorectal liver metastases. Patients were classified according to tumor volume (T1 <25%, T2 25-75%, T3 >75%), and the extension of infiltration (solitary/multiple/diffuse; unilateral, bilateral). Patients with benign liver or biliary disease served as a control group (n=63). Overall sensitivity was 87% for *1 , 50% for *2 and 38% for *3 , with a significant correlation with tumor size. CEA serum levels were elevated in 88% of all patients. CA 19-9 was less sensitive: positive in 59%. Because of some complementary elevations, the combined use of CEA, CA 19-9 and CA 125 raised sensitivity to 94%. CA 19-9 and LDH could be useful for confirmation because of their higher specificity; however, the specificity of CEA rose to 93% on using a cut-off of 10 ng/ml instead of 3 ng/ml. The results indicate that CEA and CA 19-9 as well as liver function tests are helpful for preoperative staging in conjunction with imaging procedures before liver resection or regional chemotherapy.
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Affiliation(s)
- M Lorenz
- Department of Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt Main-FRG
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24
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Baimas-George M, Baker E, Kamionek M, Salmon JS, Sastry A, Levi D, Vrochides D. A Complete Pathological Response to Pembrolizumab following ex vivo Liver Resection in a Patient with Colorectal Liver Metastases. Chemotherapy 2018; 63:90-94. [PMID: 29621772 DOI: 10.1159/000487814] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/16/2018] [Indexed: 02/28/2024]
Abstract
Advances in the systemic treatment of stage IV colorectal cancer with liver metastases has offered improved survival rates for patients who otherwise face a dismal prognosis. However, a pathologically complete response (PCR) to chemotherapy for colorectal liver metastases is still rare, and its significance is not fully understood. In this case report, we describe a patient who achieved PCR after neoadjuvant immunotherapy with pembrolizumab and a left hepatectomy using an ex vivo resection technique.
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Affiliation(s)
- Maria Baimas-George
- Department of General Surgery, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
| | - Erin Baker
- Department of Hepatopancreatobiliary Surgery, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
| | - Michal Kamionek
- Department of Pathology, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
| | - J Stuart Salmon
- Department of Medical Oncology, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
| | - Amit Sastry
- Department of Hepatopancreatobiliary Surgery, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
| | - David Levi
- Department of Transplant Surgery, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
| | - Dionisios Vrochides
- Department of Hepatopancreatobiliary Surgery, Carolinas Medical Center, Carolinas Healthcare Systems, Charlotte, North Carolina, USA
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25
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O'Leary C, Greally M, McCaffrey J, Hughes P, Lawler LLP, O'Connell M, Geoghegan T, Farrelly C. Single-institution experience with selective internal radiation therapy (SIRT) for the treatment of unresectable colorectal liver metastases. Ir J Med Sci 2018; 188:43-53. [PMID: 29511912 DOI: 10.1007/s11845-018-1773-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/23/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver metastases are the commonest cause of death for patients with colorectal cancer. Growing evidence supports the use of selective internal radiation therapy (SIRT) in combination with conventional chemotherapy regimens for liver-only or liver-dominant unresectable metastatic colorectal cancer. AIMS To measure and evaluate outcomes of the first 20 consecutive patients with unresectable colorectal liver metastasis selected for SIRT in addition to their chemotherapy at a single Irish institution. METHODS Retrospective case series was performed. Patient charts and medical records were reviewed. RESULTS All 20 patients (100%) selected for angiographic workup were subsequently successfully treated with radioembolization. All patients were discharged 1 day post-SIRT. At initial imaging evaluation, 12 (60%) had a partial response in their liver, 2 (10%) had stable disease, and 6 (30%) had liver-specific progressive disease. Median follow up was 10 months (range 6-26). At last follow up, 14 (70%) patients were alive and 6 (30%) deceased. Most recent imaging demonstrated 2 (10%) with a complete response, 7 (35%) had a partial response, 2 (10%) had stable disease, and 9 (45%) had progressive disease within their liver. One patient was downstaged to hepatic resection, and one with a complete hepatic response had his primary sigmoid tumor resected 11 months post-SIRT. CONCLUSIONS SIRT is a safe and effective therapy for certain patients with unresectable colorectal liver metastases. This case series supports our opinion that selected patients should be offered SIRT in concert with their medical oncologist, concomitant with their chemotherapy. Larger multi-center studies are required to more clearly define the patient groups that will derive most benefit from SIRT.
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Affiliation(s)
- Cathal O'Leary
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Megan Greally
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - John McCaffrey
- Oncology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Peter Hughes
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Leo L P Lawler
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Martin O'Connell
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Tony Geoghegan
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland
| | - Cormac Farrelly
- Radiology Department, Mater Misericordiae University Hospital, Eccles Street, Dublin, 7, Ireland.
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26
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Chapelle N, Matysiak-Budnik T, Douane F, Metairie S, Rougier P, Touchefeu Y. Hepatic arterial infusion in the management of colorectal cancer liver metastasis: Current and future perspectives. Dig Liver Dis 2018; 50:220-225. [PMID: 29290599 DOI: 10.1016/j.dld.2017.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022]
Abstract
The technique of hepatic arterial infusion (HAI) for the treatment of liver metastases from colorectal cancer has been developed over more than 30 years. Although the indications and protocols for this technique have evolved with time, HAI is not routinely performed in clinical practice. Studies have been heterogeneous, with different regimens of intra-arterial drugs, associated or not with systemic chemotherapy, and with unconvincing outcomes. Technical difficulties for catheter placement have limited the implementation of this method in routine practice. The aim of this review is to present recent studies, highlighting technical improvements and promising combinations of oxaliplatin-based HAI with systemic treatments. HAI is being investigated in both the metastatic setting - in the first line and beyond - and in the adjuvant setting, and we will discuss its potential place in current and future patient management.
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Affiliation(s)
- Nicolas Chapelle
- University of Nantes, Nantes, France; Nantes University Hospital, Hôtel-Dieu, Digestive Disease Institute, Gastro-Enterology, Hepatology and Digestive Oncology Unit, France.
| | - Tamara Matysiak-Budnik
- University of Nantes, Nantes, France; Nantes University Hospital, Hôtel-Dieu, Digestive Disease Institute, Gastro-Enterology, Hepatology and Digestive Oncology Unit, France
| | | | | | - Philippe Rougier
- Nantes University Hospital, Hôtel-Dieu, Digestive Disease Institute, Gastro-Enterology, Hepatology and Digestive Oncology Unit, France
| | - Yann Touchefeu
- Nantes University Hospital, Hôtel-Dieu, Digestive Disease Institute, Gastro-Enterology, Hepatology and Digestive Oncology Unit, France
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27
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Gallery M, Zhang J, Bradley DP, Brauer P, Cvet D, Estevam J, Danaee H, Greenfield E, Li P, Manfredi M, Loke HK, Rabino C, Stringer B, Williamson M, Wyant T, Yang J, Zhu Q, Abu-Yousif A, Veiby OP. A monomethyl auristatin E-conjugated antibody to guanylyl cyclase C is cytotoxic to target-expressing cells in vitro and in vivo. PLoS One 2018; 13:e0191046. [PMID: 29370189 PMCID: PMC5784926 DOI: 10.1371/journal.pone.0191046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/27/2017] [Indexed: 12/15/2022] Open
Abstract
Guanylyl cyclase C (GCC) is a cell-surface protein that is expressed by normal intestinal epithelial cells, more than 95% of metastatic colorectal cancers (mCRC), and the majority of gastric and pancreatic cancers. Due to strict apical localization, systemically delivered GCC-targeting agents should not reach GCC in normal intestinal tissue, while accessing antigen in tumor. We generated an investigational antibody-drug conjugate (TAK-264, formerly MLN0264) comprising a fully human anti-GCC monoclonal antibody conjugated to monomethyl auristatin E via a protease-cleavable peptide linker. TAK-264 specifically bound, was internalized by, and killed GCC-expressing cells in vitro in an antigen-density-dependent manner. In GCC-expressing xenograft models with similar GCC expression levels/patterns observed in human mCRC samples, TAK-264 induced cell death, leading to tumor regressions and long-term tumor growth inhibition. TAK-264 antitumor activity was generally antigen-density-dependent, although some GCC-expressing tumors were refractory to TAK-264-targeted high local concentrations of payload. These data support further evaluation of TAK-264 in the treatment of GCC-expressing tumors.
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Affiliation(s)
- Melissa Gallery
- Molecular & Cellular Oncology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Julie Zhang
- Cancer Pharmacology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Daniel P Bradley
- Biomedical Imaging, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Pamela Brauer
- Protein Sciences, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Donna Cvet
- Biomedical Imaging, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Jose Estevam
- Biomarker Assay & Exploratory Biology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Hadi Danaee
- Biomarker Assay & Exploratory Biology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Edward Greenfield
- Protein Sciences, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Ping Li
- Protein Sciences, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Mark Manfredi
- Cancer Pharmacology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Huay-Keng Loke
- Oncology Biochemistry, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Claudia Rabino
- Molecular & Cellular Oncology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Brad Stringer
- Molecular Pathology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Mark Williamson
- US Medical Affairs, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Tim Wyant
- Translational Medicine, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Johnny Yang
- DMPK, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Qing Zhu
- DMPK, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - Adnan Abu-Yousif
- Cancer Pharmacology, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
| | - O Petter Veiby
- Global Biotherapeutics, Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, Cambridge, MA, United States of America
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28
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Rahbari NN, D'Angelica MI. Surgical salvage of recurrence after resection of colorectal liver metastases: incidence and outcomes. Hepat Oncol 2017; 4:25-33. [PMID: 28768424 PMCID: PMC6095401 DOI: 10.2217/hep-2017-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022] Open
Abstract
Surgical resection remains the primary curative treatment option for patients with colorectal liver metastases. While the majority of patients will develop tumor relapse within or outside of the liver after hepatic metastasectomy, a subset of these patients may be amenable to salvage surgical resection. However, outcomes for this approach are not well defined. In this article, we summarize the current evidence for the incidence, feasibility and outcomes of salvage resection for recurrence after initial resection of colorectal liver metastases.
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Affiliation(s)
- Nuh N Rahbari
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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29
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Molla NW, Hassanain MM, Fadel Z, Boucher LM, Madkhali A, Altahan RM, Alrijraji EA, Simoneau EB, Alamri H, Salman A, Gao Z, Metrakos PP. Effect of non-alcoholic liver disease on recurrence rate and liver regeneration after liver resection for colorectal liver metastases. ACTA ACUST UNITED AC 2017; 24:e233-e243. [PMID: 28680292 DOI: 10.3747/co.24.3133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Resection of metastases is the only potential cure for patients with liver metastasis from colorectal cancer (crc-lm). But despite an improved overall 5-year survival, the recurrence rate is still as high as 60%. Non-alcoholic fatty liver disease (nafld) can decrease the liver's capacity to regenerate after resection and might also affect cancer recurrence, potentially by elevating transforming growth factor β, levels of specific metalloproteinases, and oxidative stress. The objective of the present work was to determine the effect of the histologic features of nafld on cancer recurrence and liver regeneration. METHODS This retrospective analysis considered 60 patients who underwent an R0 hepatectomy for crc-lm. Volumetric analysis of the liver was calculated using axial view, portovenous phase, 2.5 mm thickness, multiphasic computed tomography images taken before and after surgery. The histologic features of nafld (steatosis, inflammation, and ballooning) were scored using the nafld activity score, and the degree of fibrosis was determined. RESULTS The hepatic recurrence rate was 38.33%. Median overall survival duration was 56 months. Median disease-free survival duration was 14 months, and median hepatic disease-free survival duration was 56 months. Multivariate analysis revealed significant correlations of hepatic disease-free survival with hepatocyte ballooning (p = 0.0009), lesion diameter (p = 0.014), and synchronous disease (p = 0.006). Univariate and multivariate analyses did not reveal any correlation with degree of steatosis or recurrence rate. CONCLUSIONS This study reveals an important potential negative effect of hepatocyte ballooning on hepatic disease-free survival.
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Affiliation(s)
- N W Molla
- Department of Surgery, Section of Hepatopancreatobiliary, and.,Department of Radiology, McGill University Health Centre, Montreal, QC.,Department of Radiology and
| | - M M Hassanain
- Department of Surgery, Section of Hepatopancreatobiliary, and.,Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Z Fadel
- Department of Surgery, Section of Hepatopancreatobiliary, and
| | - L M Boucher
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - A Madkhali
- Department of Surgery, Section of Hepatopancreatobiliary, and.,Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - R M Altahan
- Department of Surgery, Section of Hepatopancreatobiliary, and
| | - E A Alrijraji
- Department of Surgery, Section of Hepatopancreatobiliary, and
| | - E B Simoneau
- Department of Surgery, Section of Hepatopancreatobiliary, and
| | - H Alamri
- Department of Surgery, Section of Hepatopancreatobiliary, and.,Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - A Salman
- Department of Surgery, Section of Hepatopancreatobiliary, and
| | - Z Gao
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - P P Metrakos
- Department of Surgery, Section of Hepatopancreatobiliary, and.,Department of Pathology, McGill University Health Centre, Montreal, QC
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30
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Qian Y, Kumar KA, Dudley SA, Koong AC, Chang DT. Radiation Therapy for Colorectal Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0368-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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31
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McPartlin A, Swaminath A, Wang R, Pintilie M, Brierley J, Kim J, Ringash J, Wong R, Dinniwell R, Craig T, Dawson LA. Long-Term Outcomes of Phase 1 and 2 Studies of SBRT for Hepatic Colorectal Metastases. Int J Radiat Oncol Biol Phys 2017; 99:388-395. [PMID: 28871989 DOI: 10.1016/j.ijrobp.2017.04.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/05/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To report mature outcomes of prospective phase 1 and 2 studies of stereotactic body radiation therapy (SBRT) for the treatment of colorectal liver metastases (CLMs). METHODS AND MATERIALS Patients with histologically confirmed CLMs unsuitable for resection or standard therapies were eligible for sequential phase 1 and 2 studies conducted from 2003 to 2012. RESULTS Of 60 patients treated, 82% had received previous chemotherapy, 23% had undergone previous focal liver treatment, and 38% had extrahepatic disease at the time of SBRT. The median number of gross tumor volume (GTV) targets per patient was 1 (range, 1-6), with a median total target volume of 117.7 cm3 (range, 6.7-3115.4 cm3). The median minimum dose to the GTV was 37.6 Gy (range, 22.7-62.1 Gy) in 6 fractions over a period of 2 weeks. Other than 1 case of grade 3 nausea, there were no acute toxicities greater than grade 2. With a median follow-up period of 28.1 months for survivors, no gastrointestinal bleed or biliary or liver toxicity was seen. The local control rate per lesion at 1 and 4 years was 49.8% and 26.2%, respectively. Increasing minimum dose to the GTV was associated with improved local control (P=.003). Median overall survival was 16.0 months (95% confidence interval, 11.9-20.5 months). On multivariate analysis, improved survival was associated with smaller total GTV (P=.017), performance status of 0 or 1 (P=.007), no extrahepatic disease at the time of treatment (P=.005), and local control of targeted liver disease (P=.001). Two long-term survivors remain disease free at 49 and 125 months. CONCLUSIONS Six-fraction SBRT for CLM is safe and may be associated with long-term cure. Local control was significantly associated with delivered dose and was lower than seen in other studies using a higher SBRT dose. Survival was associated with smaller tumor volume, absence of extrahepatic disease, performance status of 0 or 1, and local control of treated liver lesions.
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Affiliation(s)
- Andrew McPartlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Anand Swaminath
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ri Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Melania Pintilie
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - James Brierley
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - John Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Rob Dinniwell
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Tim Craig
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Laura A Dawson
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ. Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2016; 31:1739-1749. [PMID: 27682648 DOI: 10.1007/s00384-016-2664-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This systematic review evaluated the diagnostic accuracy and impact on patient management of hepatocyte-specific gadoxetic acid enhanced magnetic resonance imaging (GA-MRI) compared to contrast enhanced computed tomography (CE-CT) in patients with liver metastases. METHOD Four biomedical databases (PubMed, EMBASE, Cochrane Library, York CRD) were searched from January 1991 to February 2016. Studies investigating the accuracy or management impact of GA-MRI compared to CE-CT in patients with known or suspected liver metastases were included. Bias was evaluated using QUADAS-II. Univariate meta-analysis of sensitivity ratios (RR) were conducted in the absence of heterogeneity, calculated using I 2 , Tau values (τ) and prediction intervals. RESULTS Nine diagnostic accuracy studies (537 patients with 1216 lesions) and four change in management studies (488 patients with 281 lesions) were included. Per-lesion sensitivity and specificity estimates for GA-MRI ranged from 86.9-100.0 % and 80.2-98.0 %, respectively, compared to 51.8-84.6 % and 77.2-98.0 % for CE-CT. Meta-analysis found GA-MRI to be significantly more sensitive than CE-CT (RR = 1.29, 95 % CI = 1.18-1.40, P < 0.001), with equivalent specificity (RR = 0.97, 95 % CI 0.910-1.042, P = 0.44). The largest difference was observed for lesions smaller than 10 mm for which GA-MRI was significantly more sensitive (RR = 2.21, 95 % CI = 1.47-3.32, P < 0.001) but less specific (RR = 0.92, 95 % CI 0.87-0.98, P = 0.008). GA-MRI affected clinical management in 26 of 155 patients (16.8 %) who had a prior CE-CT; however, no studies investigated the consequences of using GA-MRI instead of CE-CT. CONCLUSION GA-MRI is significantly more sensitive than CE-CT for detecting liver metastases, which leads to a modest impact on patient management in the context of an equivocal CE-CT result.
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Affiliation(s)
- Thomas D Vreugdenburg
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia.
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Dagmara Riitano
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
- Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Tapia Rico G, Townsend AR, Klevansky M, Price TJ. Liver metastases resection for gastric and esophageal tumors: is there enough evidence to go down this path? Expert Rev Anticancer Ther 2016; 16:1219-1225. [PMID: 27744727 DOI: 10.1080/14737140.2016.1249858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Surgical resection of liver metastases from colorectal and neuroendocrine tumours has become a standard of care for resectable patients with isolated hepatic disease and good performance status, leading to extended survival in a carefully selected subgroup of these patients. However, the role of hepatic surgery in gastric and oesophageal liver metastases is controversial and not clearly defined. Areas covered:a systematic electronic literature search was performed to select the most representative evidence regarding hepatectomies in liver metastases from these two tumours. PubMed, Medline, Embase Ovid and Google Scholar databases were scanned for articles written in English and published in peer-reviewed journals between 1994 and May 2016. Expert commentary: Given the shortage of randomised studies and the limited number of patients in many of the studies discussed here, the evidence base for the use of hepatectomies in these settings is not strong. Thus, while the data for resections of gastric liver metastases may in particular seem encouraging, the results should be interpreted with caution.
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Affiliation(s)
- Gonzalo Tapia Rico
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia
| | - Amanda R Townsend
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia.,b University of Adelaide , Adelaide , SA , Australia
| | - Myron Klevansky
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia
| | - Timothy J Price
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Adelaide , SA , Australia.,b University of Adelaide , Adelaide , SA , Australia
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Periportal low attenuation associated with liver metastasis from colorectal cancer: evaluation using multi-detector-row CT with pathological correlation. Jpn J Radiol 2016; 35:10-15. [PMID: 27783272 DOI: 10.1007/s11604-016-0592-9] [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: 07/11/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Periportal low attenuation (PPLA) associated with metastatic liver cancer is occasionally seen on multi-detector-row CT (MDCT). The purpose of this study was to investigate the MDCT patterns of the PPLA and to correlate it with pathological findings. METHODS We retrospectively reviewed the MDCT images of 63 patients with metastatic liver cancers from colorectal adenocarcinoma. On MDCT scans, PPLA associated with liver metastasis was visualized in six patients with colorectal cancer. In these six patients who had undergone surgical resection, the radiologic-pathologic correlation was analyzed. All patients underwent a single contrast-enhanced MDCT within 1 month before surgical resection. The six liver cancers were pathologically proven to be moderately differentiated adenocarcinoma. We assessed the PPLA on MDCT concerning the distribution patterns and contrast enhancement with pathological correlation. RESULTS In five of the patients, the PPLA extended to the hilar side from metastatic liver cancer. Pathologically, there was no cancer invasion into the intra-hepatic periportal area; however, massive lymphedema and fibrosis occurred in all six cases. CONCLUSIONS PPLA on the hilar and peripheral sides of hepatic metastasis from colorectal cancer may be present suggesting lymphedema and fibrosis of portal tracts not always indicating cancer infiltration.
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Lundstedt C, Ekberg H, Hederström E, Stridbeck H, Torfason B, Tranberg KG. Radiologic Diagnosis of Liver Metastases in Colo-Rectal Carcinoma. Acta Radiol 2016. [DOI: 10.1177/028418518702800412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the accuracy of radiologic methods in liver metastases from colo-rectal carcinoma, a prospective investigation of 71 patients was performed. These patients were examined by angiography, ultrasound (US), computed tomography (CT) and computed tomographic angiography (CTA). The primary aim of the investigation was to determine the accuracy of CTA. The results of these examinations were then compared with the results from inspection and palpation of the liver at laparotomy. An analysis of liver tumor distribution, as well as a lesion-by-lesion analysis, was performed. In 20 patients, tumor growth was found in the liver in 36 lobes/segments at laparotomy. Three patients called false positives (angiography 2, US, CT and CTA 3 patients) turned out to be true positives since the lesions were overlooked at operation. The changes in sensitivity obtained when these patients are considered are given in parentheses. Of the lobes/segments affected by tumor growth at surgery, angiography revealed 47 (48) per cent, US 69 (71) per cent, CT 80 (82) per cent and CTA 83 (84) per cent. At a lesion-by-lesion analysis, angiography showed 33 per cent, US 69 per cent, CT 61 per cent and CTA 76 per cent of the lesions. Because of a larger number of false positives recorded with CTA compared with CT the former examination is not suitable as a single method for evaluating resectability of liver metastases.
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De Greef K, Rolfo C, Russo A, Chapelle T, Bronte G, Passiglia F, Coelho A, Papadimitriou K, Peeters M. Multisciplinary management of patients with liver metastasis from colorectal cancer. World J Gastroenterol 2016; 22:7215-7225. [PMID: 27621569 PMCID: PMC4997640 DOI: 10.3748/wjg.v22.i32.7215] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/21/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer-related death. Surgery, radiotherapy and chemotherapy have been till now the main therapeutic strategies for disease control and improvement of the overall survival. Twenty-five per cent (25%) of CRC patients have clinically detectable liver metastases at the initial diagnosis and approximately 50% develop liver metastases during their disease course. Twenty-thirty per cent (20%-30%) are CRC patients with metastases confined to the liver. Some years ago various studies showed a curative potential for liver metastases resection. For this reason some authors proposed the conversion of unresectable liver metastases to resectable to achieve cure. Since those results were published, a lot of regimens have been studied for resectability potential. Better results could be obtained by the combination of chemotherapy with targeted drugs, such as anti-VEGF and anti-EGFR monoclonal antibodies. However an accurate selection for patients to treat with these regimens and to operate for liver metastases is mandatory to reduce the risk of complications. A multidisciplinary team approach represents the best way for a proper patient management. The team needs to include surgeons, oncologists, diagnostic and interventional radiologists with expertise in hepatobiliary disease, molecular pathologists, and clinical nurse specialists. This review summarizes the most important findings on surgery and systemic treatment of CRC-related liver metastases.
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Challenging the dogma of colorectal peritoneal metastases as an untreatable condition: Results of a population-based study. Eur J Cancer 2016; 65:113-20. [PMID: 27497343 DOI: 10.1016/j.ejca.2016.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the impact of the implementation of novel systemic regimens and locoregional treatment modalities on survival at population level in colorectal cancer (CRC) patients presenting with peritoneal metastases (PMs). METHODS All consecutive CRC patients with synchronous PM (<3 months) between 1995 and 2014 were extracted from the Eindhoven area of the Netherlands Cancer Registry. Trends in treatment and overall survival were assessed in four time periods. Multivariable regression analysis was used to analyse the impact of systemic and locoregional treatment modalities on survival. RESULTS A total of 37,036 patients were diagnosed with primary CRC between 1995 and 2014. Synchronous PM was diagnosed in 1,661 patients, of whom 55% had also metastases at other sites (n = 917) and 77% received anticancer therapy (n = 1,273). Treatment with systemic therapy increased from 23% in 1995-1999 to 56% in 2010-2014 (p < 0.0001). Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) was applied since 2005 and increased from 10% in 2005-2009 to 23% in 2010-2014. Surgery for lymphatic or haematogenous metastases increased from 2% to 10% in these periods. Median overall survival of the complete cohort improved from 6.0 months in 1995-2000 to 12.5 months in 2010-2014 (p < 0.0001), with a doubling of survival for both PM alone and PM with other involved sites. The influence of year of diagnosis on survival (hazard ratio, 2010-2014 versus 1995-1999; 0.5, 95% confidence interval: 0.43-0.62; p < 0.0001) disappeared after including systemic therapy and locoregional treatment modalities in subsequent multivariable models. CONCLUSION CRC patients presenting with PM are increasingly offered a multidisciplinary treatment approach, resulting in an increased overall survival for the entire cohort.
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Schuld J, von Heesen M, Jung B, Richter S, Kollmar O. Simultaneous resection of primary colorectal cancer and synchronous liver metastases is associated with a high cardiovascular complication rate. Eur Surg 2016. [DOI: 10.1007/s10353-015-0382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clinical results of mean GTV dose optimized robotic guided SBRT for liver metastases. Radiat Oncol 2016; 11:74. [PMID: 27236333 PMCID: PMC4884398 DOI: 10.1186/s13014-016-0652-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background We retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean-dose-optimized and real-time motion-compensated robotic stereotactic body radiation therapy (SBRT) in the treatment of liver metastases. Methods Between March 2011 and July 2015, 52 patients were treated with SBRT for a total of 91 liver metastases (one to four metastases per patient) with a median GTV volume of 12 cc (min 1 cc, max 372 cc). The optimization of mean GTV dose was prioritized during treatment planning at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The delivered median GTV biological effective dose (BED10) was 142.1 Gy10 (range, 60.2 Gy10 –165.3 Gy10) and the prescribed PTV BED10 ranged from 40.6 Gy10 to 112.5 Gy10 (median, 86.1 Gy10). We analyzed local control (LC), progression-free interval (PFI), overall survival (OS), and toxicity. Results Median follow-up was 17 months (range, 2–49 months). The 2-year actuarial LC, PFI, and OS rates were 82.1, 17.7, and 45.0 %, and the median PFI and OS were 9 and 23 months, respectively. In univariate analysis histology (p < 0.001), PTV prescription BED10 (HR 0.95, CI 0.91–0.98, p = 0.002) and GTV mean BED10 (HR 0.975, CI 0.954–0.996, p = 0.011) were predictive for LC. Multivariate analysis showed that only extrahepatic disease status at time of treatment was a significant factor (p = 0.033 and p = 0.009, respectively) for PFI and OS. Acute nausea or fatigue grade 1 was observed in 24.1 % of the patients and only 1 patient (1.9 %) had a side effect of grade ≥ 2. Conclusions Robotic real-time motion-compensated SBRT is a safe and effective treatment for one to four liver metastases. Reducing the PTV prescription dose and keeping a high mean GTV dose allowed the reduction of toxicity while maintaining a high local control probability for the treated lesions.
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Shantakumar S, Landis S, Lawton A, Hunt CM. Prevalence and incidence of liver enzyme elevations in a pooled oncology clinical trial cohort. Regul Toxicol Pharmacol 2016; 77:257-62. [PMID: 27025923 DOI: 10.1016/j.yrtph.2016.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 01/22/2023]
Abstract
Few epidemiologic studies describe longitudinal liver chemistry (LC) elevations in cancer patients. A population-based retrospective cohort was identified from 31 Phase 2-3 oncology trials (excluding targeted therapies) conducted from 1985 to 2005 to evaluate background rates of LC elevations in patients (n = 3998) with or without liver metastases. Patients with baseline liver metastases (29% of patients) presented with a 3% prevalence of alanine transaminase (ALT) ≥ 3x upper limits normal (ULN) and 0.2% prevalence of bilirubin ≥ 3xULN. During follow-up, the incidence (per 1000 person-months) of new onset ALT elevations ≥3xULN was 6.1 (95% CI: 4.5, 8.0) and 2.2 (95% CI: 0.9, 4.5) in patients without and with liver metastases, respectively. No new incident cases of ALT and bilirubin elevations suggestive of severe liver injury occurred among those with liver metastases; a single case occurred among those without metastasis. Regardless of the presence of liver metastases, LC elevations were rare in cancer patients during oncology trials, which may be due to enrollment criteria. Our study validates uniform thresholds for detection of LC elevations in oncology studies and serves as an empirical referent point for comparing liver enzyme abnormalities in oncology trials of novel targeted therapies. These data support uniform LC stopping criteria in oncology trials.
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Affiliation(s)
| | - Sarah Landis
- Worldwide Epidemiology, GlaxoSmithKline, Stockley Park, United Kingdom.
| | - Andy Lawton
- Worldwide Epidemiology, GlaxoSmithKline, Stockley Park, United Kingdom.
| | - Christine M Hunt
- Department of Veterans Affairs, Durham VA Medical Center, North Carolina, USA.
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Siriwardana PN, Luong TV, Watkins J, Turley H, Ghazaley M, Gatter K, Harris AL, Hochhauser D, Davidson BR. Biological and Prognostic Significance of the Morphological Types and Vascular Patterns in Colorectal Liver Metastases (CRLM): Looking Beyond the Tumor Margin. Medicine (Baltimore) 2016; 95:e2924. [PMID: 26937938 PMCID: PMC4779035 DOI: 10.1097/md.0000000000002924] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/29/2016] [Accepted: 01/31/2016] [Indexed: 01/06/2023] Open
Abstract
Patients with encapsulated colorectal liver metastases (CRLM) have a better prognosis than those without a capsule. The reason for the encapsulation is unknown. Hypoxia inducible factor-1α (HIF-1α) increases tumor angiogenesis and tumor tissue expression is associated with reduced survival. Our aim was to determine whether the good prognosis of encapsulated CRLM is associated with reduced HIF-1α expression by the cancer.The study selected only patients who had not undergone neoadjuvant chemotherapy prior to a potentially curative hepatectomy for CRLM. From 30 selected patients, serial sections were cut from a single randomly selected metastasis. Morphology was assessed following H&E staining. Tumor hypoxia, vascular endothelial growth factor (VEGF), proliferation, and microvascular density (MVD) were assessed by immunostaining for HIF-1α and carbonic anhydrase-9 (CA-9), VEGF, Ki67, and cluster of differentiation-31, respectively. MVD was calculated in the vascular hot spots. Pathology was reported without clinical outcome information. Actual long-term survival was recorded.Thirteen (43%) of the cancers were encapsulated CRLM containing glands which were large, complex, and cribriform. Thirteen (43%) were infiltrative CRLM and their glands were small, closely packed, and rounded with vessels in the interglandular fibrous tissue with no capsule; 3 (10%) had a mixed picture. Encapsulated CRLM had a higher expression of HIF-1α (58% vs 8%, P = 0.03), CA-9 (42% vs 0%, P = 0.04), and VEGF (92% vs 25%, P = 0.02). MVD was lower in the encapsulated CRLM group (37 mm vs 143 mm, P < 0.001). The median follow-up was 115 months. The encapsulated CRLM group had a better overall and 5-year survival (relative hazard: 0.58, P = 0.057 and hazard ratio: 0.52, P = 0.044).There are 2 main morphological appearances of CRLM which have very different long-term survival following liver resection surgery. The morphology is associated with differences in expression of HIF-1α, CA-9, VEGF, and angiogenesis.
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Affiliation(s)
- Pulathis N Siriwardana
- From the Hepatopancreatobiliary and Liver Transplant Surgery Unit, University Department of Surgery, Royal Free London NHS Foundation Trust (MG) and University College London Medical School (PNS, BRD); Department of Cellular Pathology, Royal Free London NHS Foundation Trust (TVL, JW); Department of Oncology, UCL Cancer Institute (DH), London, UK; Nuffield Department of Clinical Laboratory Sciences, Tumor Pathology Group (HT) and Nuffield Division of Clinical Laboratory Sciences, Department of Medicine (KG), John Radcliffe Hospital, University of Oxford; and Department of Oncology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford University (ALH), Oxford, UK
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Schoellhammer HF, Singh G, Fong Y. The Role of Neoadjuvant Chemotherapy in Patients With Resectable Colorectal Metastases: Where Are We Now? CURRENT COLORECTAL CANCER REPORTS 2016. [DOI: 10.1007/s11888-016-0303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Edyta WR, Jakub L, Jerzy W. Whole Liver Palliative Radiotherapy for Patients with Massive Liver Metastases. Asian Pac J Cancer Prev 2015; 16:6381-4. [DOI: 10.7314/apjcp.2015.16.15.6381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Major Hepatectomy for Colorectal Metastases in the Elderly: A Tertiary Center Experience. Int Surg 2015. [DOI: 10.9738/intsurg-d-14-00155.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this retrospective study was to investigate whether patients over 70 years old are at significantly higher risk for worse outcomes following major liver resection. Hepatic resection is the only treatment offering long-term survival for patients with colorectal liver metastases. As the population considered for metastasectomy is aging, there are still controversial published results regarding the safety of major hepatectomy in elderly patients. Between December 2002 and April 2010, 327 patients underwent major liver resection for colorectal liver metastasis. Patients were stratified into 2 groups: group A, <70 years old; and group B, ≥70 years old. Recorded, analyzed, and compared data across groups included the following: (1) patient characteristics including age, sex, American Society of Anesthesiologists performance status, primary tumor site and stage, adjuvant chemotherapy, number and size of metastatic lesions; (2) perioperative data including extent of resection, in-hospital mortality, postoperative morbidity, length of hospital stay, length of intensive treatment unit stay and blood loss; and (3) overall survival. The patients' characteristics were similar as were the characteristics of their tumors. There was no difference in overall morbidity (25% versus 22%) or postoperative mortality (2.6% versus 2.9%) (P = 0.44 and 0.57, respectively). The overall survival was 67% versus 62% in group A and B, respectively (P = 0.09). Elderly patients can safely undergo major liver resection for colorectal liver metastases with short- and long-term outcomes comparable with younger patients.
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Laparoscopic anterior approach of major hepatectomy combined with colorectal resection for synchronous colorectal liver metastases. Surg Laparosc Endosc Percutan Tech 2015; 24:e237-40. [PMID: 24732745 DOI: 10.1097/sle.0000000000000019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of the study was to evaluate the feasibility and operative outcomes of the anterior approach technique for a simultaneous colorectal and liver laparoscopic procedure given its demonstrated benefits and discuss the advantages of this strategy. PATIENT AND METHODS In the presented case, a total laparoscopic anterior approach was used for a left hemihepatectomy in combination with laparoscopic colorectal resections for synchronous liver metastases, which emphasizes the technical aspects of this procedure. The duration of surgery, blood loss, and postoperative outcomes were evaluated. RESULTS The laparoscopic anterior approach for a left hepatectomy with simultaneous colon resection for liver metastases was feasible and safe without postoperative complications. The duration of surgery was 190 minutes with an estimated blood loss of 200 mL. The postoperative course was uneventful. CONCLUSIONS The laparoscopic anterior approach for a major hepatectomy for unilobular synchronous metastases can be safely performed simultaneously with colorectal surgery in select patients.
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Intraprocedural blood volume measurement using C-arm CT as a predictor for treatment response of malignant liver tumours undergoing repetitive transarterial chemoembolization (TACE). Eur Radiol 2015; 26:755-63. [PMID: 26123407 DOI: 10.1007/s00330-015-3869-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 05/24/2015] [Accepted: 06/01/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate feasibility of measuring parenchymal blood volume (PBV) of malignant hepatic tumours using C-arm CT, test the changes in PBV following repeated transarterial chemoembolization (TACE) and correlate these changes with the change in tumour size in MRI. METHODS 111 patients with liver malignancy were included. Patients underwent MRI and TACE in a 4- to 6-week interval. During intervention C-arm CT was performed. Images were post-processed to generate PBV maps. Blood volume data in C-arm CT and change in size in MRI were evaluated. The correlation between PBV and size was tested using Spearman rank test. RESULTS Pre-interventional PBV maps showed a mean blood volume of 84.5 ml/1000 ml ± 62.0, follow-up PBV maps after multiple TACE demonstrated 61.1 ml/1000 ml ± 57.5. The change in PBV was statistically significant (p = 0.02). Patients with initial tumour blood volume >100 ml/1000 ml dropped 7.1% in size and 47.2% in blood volume; 50-100 ml/1000 ml dropped 4.6% in size and 25.7% in blood volume; and <50 ml/1000 ml decreased 2.8% in size and increased 82.2% in blood volume. CONCLUSION PBV measurement of malignant liver tumours using C-arm CT is feasible. Following TACE PBV decreased significantly. Patients with low initial PBV show low local response rates and further increase in blood volume, whereas high initial tumour PBV showed better response to TACE. KEY POINTS Parenchymal blood volume assessment of malignant hepatic lesions using C-arm CT is feasible. The parenchymal blood volume is reduced significantly following transarterial chemoembolization. Parenchymal blood volume can monitor the response of tumours after transarterial chemoembolization. Although not significant, high initial parenchymal blood volume yields better response to TACE.
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Uggeri F, Ronchi PA, Goffredo P, Garancini M, Degrate L, Nespoli L, Gianotti L, Romano F. Metastatic liver disease from non-colorectal, non-neuroendocrine, non-sarcoma cancers: a systematic review. World J Surg Oncol 2015; 13:191. [PMID: 26022107 PMCID: PMC4455532 DOI: 10.1186/s12957-015-0606-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/20/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hepatic resection of liver metastases of non-colorectal, non-neuroendocrine, and non-sarcoma (NCNNNS) primary malignancies seems to improve survival in selected patients. The aims of the current review were to describe long-term results of surgery and to evaluate prognostic factors for survival in patients who underwent resection of NCNNNS liver metastases. METHODS We identified 30 full texts (25 single-center and 5 multicenter studies) published after year 1995 and published in English with a total of 3849 patients. For NCNNNS liver metastases, 83.4 % of these subjects were resected. RESULTS No prior systematic reviews or meta-analyses on this topic were identified. All studies were case series without matching control groups. The most common primary sites were breast (23.8 %), genito-urinary (21.8 %), and gastrointestinal tract (19.8 %). The median 5- and 10-year overall survival were 32.3 % (range 19-42 %) and 24 % (indicated only in two studies, range 23-25 %), respectively, with 71 % of R0 resections. CONCLUSIONS There is evidence suggesting that surgery of NCNNNS metastases is safe, feasible, and effective if treatment is part of a multidisciplinary approach and if indication is based on the prognostic factors underlined in literature analysis.
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Affiliation(s)
- Fabio Uggeri
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | | | | | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Luca Degrate
- Department of Surgery, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Luca Nespoli
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Luca Gianotti
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
| | - Fabrizio Romano
- Department of Surgery and Translational Medicine, University of Milano-Bicocca, San Gerardo Hospital, via Pergolesi 33, Monza, 20900, Italy.
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HES1 promotes metastasis and predicts poor survival in patients with colorectal cancer. Clin Exp Metastasis 2015; 32:169-79. [PMID: 25636905 DOI: 10.1007/s10585-015-9700-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 01/20/2015] [Indexed: 01/18/2023]
Abstract
Hairy enhancer of split-1 (HES1) is a transcriptional target of the Notch pathway, and a high level of HES1 is regarded as a marker of activated Notch. The aim of the study was to investigate the role of HES1 in colorectal cancer progression. We used tissue microarrays to analyze the expression and clinical significance of HES1 in 320 colorectal cancer samples. Stable overexpression and knockdown of HES1 were established in three colorectal cancer cell (CRC) lines (RKO, HCT8 and LOVO). We investigated the differentially expressed genes and enriched pathways in HES1 overexpressing CRC cells by gene expression profiling. Also, the role of HES1 in invasion and migration were examined in vitro and in vivo. We found that high expression of HES1 was significantly correlated with distal metastasis (P = 0.037) at diagnosis, and HES1 could serve as an unfavorable prognostic factor for colorectal cancer patients (P = 0.034). Gene expression profiling and pathway enrichment analysis revealed that HES1 was related to cellular adherens junction loss. In addition, we showed that HES1 overexpression lead to depressed E-cadherin, and elevated N-cadherin, vimentin and Twist-1 levels. Functionally, HES1 enhanced invasiveness and metastasis of CRC cells. HES1 promotes cancer metastasis via inducing epithelial mesenchymal transition and serves as a poor prognosis factor of colorectal cancer patients.
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Schreckenbach T, Malkomes P, Bechstein WO, Woeste G, Schnitzbauer AA, Ulrich F. The clinical relevance of the Fong and the Nordlinger scores in the era of effective neoadjuvant chemotherapy for colorectal liver metastasis. Surg Today 2015; 45:1527-34. [PMID: 25563588 DOI: 10.1007/s00595-014-1108-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/01/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE The clinical risk scores (CRSs) of Fong and Nordlinger are used to predict the outcome of patients with colorectal liver metastases (CRLMs). This study investigated whether CRSs could predict the overall survival of patients with CRLM treated with or without neoadjuvant chemotherapy prior to resection. METHODS Patients with CRLM undergoing liver resection were analyzed retrospectively. The primary outcome measure was overall survival with vs. without neoadjuvant chemotherapy. RESULTS Between August 2002 and October 2011, 300 patients underwent liver resection for CRLMs at a large university hospital in Germany. Group A comprised 117 patients who received neoadjuvant chemotherapy and group B comprised 71 patients who did not. The Fong score predicted overall survival for patients who did not receive chemotherapy (p = 0.02), but not for those treated with chemotherapy (p = 0.69). The Nordlinger score was not predictive for either of the groups (p = 0.71 vs. p = 0.08 for groups A and B, respectively). Subgroup analysis of the Nordlinger score identified better overall survival in the high-risk group treated with chemotherapy (p = 0.05). Multivariate analysis identified a resection margin of <1 cm [OR 0.622 (95% CI: 0.17-2.31); p = 0.044], age >60 years [OR 0.535 (95% CI: 0.16-1.77); p = 0.022] and number of metastases >4 [OR 0.189 (95% CI: 0.06-0.61); p = 0.018] as independent prognostic factors for overall survival. CONCLUSION Thus, CRSs were not reliable prognostic tools for patients treated with neoadjuvant chemotherapy before liver resection in this analysis.
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Affiliation(s)
- Teresa Schreckenbach
- Department of General and Abdominal Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Patrizia Malkomes
- Department of General and Abdominal Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Wolf O Bechstein
- Department of General and Abdominal Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Guido Woeste
- Department of General and Abdominal Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Andreas A Schnitzbauer
- Department of General and Abdominal Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany. .,Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
| | - Frank Ulrich
- Department of General and Abdominal Surgery, Frankfurt University Hospital, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
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Zendel A, Lahat E, Dreznik Y, Zakai BB, Eshkenazy R, Ariche A. "Vanishing liver metastases"-A real challenge for liver surgeons. Hepatobiliary Surg Nutr 2014; 3:295-302. [PMID: 25392841 DOI: 10.3978/j.issn.2304-3881.2014.09.13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/16/2014] [Indexed: 12/21/2022]
Abstract
Expanded surgical intervention in colorectal liver metastasis (LM) and improved chemotherapy led to increasing problem of disappearing liver metastases (DLM). Treatment of those continues to evolve and poses a real challenge for HPB surgeons. This review discusses a clinical approach to DLM, emphasizing crucial steps in clinical algorithm. Particular issues such as imaging, intraoperative detection and surgical techniques are addressed. A step-by-step algorithm is suggested.
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Affiliation(s)
- Alex Zendel
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eylon Lahat
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Dreznik
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Bar Zakai
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rony Eshkenazy
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Ariche
- 1 Department of Surgery C, 2 Department of Surgery B, 3 Department of HPB Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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