Factors affecting survival in patients with isolated liver-metastatic colorectal cancer treated with local ablative or surgical treatments for liver metastasis

PURPOSE

Local treatments for isolated synchronous or metachronous liver metastases in colorectal cancer (CRC) have been shown to improve overall survival (OS). The aim of this study was to investigate the factors affecting OS in CRC patients with isolated liver metastasis in whom the primary tumor and corresponding liver metastasis were treated with curative intent using local ablative or surgical methods.

METHODS

A total 47 surgical operated CRC patients presenting with an initial or subsequent isolated liver metastasis, who were treated with local surgical or ablative treatment for liver metastasis with curative intent, were enrolled in this study between 2007 and 2017. The possible factors affecting OS were analyzed.

RESULTS

Of the 47 patients, 35 (74.5%) were male. The median age was 61 (25 - 80) years. Thirty-four (72.3%) patients underwent liver metastasectomy, while 13 (27.7%) patients were treated with non-surgical local ablative therapies (NSLAT) for liver metastasis. Median OS (mOS) could not be reached in patients who underwent metastasectomy at the time of diagnosis compared to 55 months in those undergoing metastasectomy following a chemotherapy period (p = 0.03). Patients treated with NSLAT had a mOS of 60 months compared to ''not reached'' in those who underwent liver metastasectomy (p = 0.45). mOS was higher in patients with pT4 stage vs. with <pT4 stages (28 months vs. not reached, p = 0.02, respectively). Multivariate regression analysis revealed that undergoing liver metastasectomy at the time of diagnosis (HR 0.10; 95%Cl: 0.01 - 0.82) and pT4 stage (HR 4.365; 95%Cl: 1.27 - 14.98) were the most important independent factors affecting OS.

CONCLUSION

This study demonstrated that CRC patients with isolated liver metastasis, <pT4 stage and curative liver metastasectomy achieved the best survival outcomes.

High resolution computed tomography findings in smear-negative pulmonary tuberculosis patients according to their culture status

OBJECTIVE

The aim of this study was to assess the clinical features and high resolution computed tomography (HRCT) findings in smear-negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results.

METHODS

We retrospectively studied 78 active smear-negative PTB patients. They were divided into two groups according to their culture results. The HRCT findings and clinical features at the beginning of the antituberculosis treatment were reviewed.

RESULTS

The mean age was 22.48±3.18 years. Micronodules (87%), large nodules (63%) and centrilobular nodules (62%) were the most common HRCT findings. HRCT findings were observed in the right upper (72%), left upper (56%), right lower (32%), and left lower lobes (29%). Cough (37%) and chest pain (32%) were the most frequent symptoms at presentation.

CONCLUSIONS

There were no significant differences in the HRCT findings and clinical features between the two groups. Thus, in cases of smear-negative and culture-negative PTB, the patient with compatible clinical and radiological features should be considered for tuberculosis treatment.

Avulsion fracture of the anterior inferior iliac spine mimicking a bone tumor: a case report

This is a case of a 17-year-old boy who was admitted to the clinic suffering from right hip-inguinal region pain which began after a soccer match. He had an avulsion fracture in the anterior inferior iliac spine and CT/MR images showed similarities to a bone tumor. These fractures are especially seen in the apophyses which are within the ossification process. The radiological appearance of these fractures during the healing period may be involved with bone tumors. In the control MRI of the patient after one year, the fracture was almost healed completely. Treatment is generally conservative. Good results have been reported with rest, analgesic and anti-inflammatory drugs. Familiarity with radiological findings of these avulsion fractures in this region not only protects the patient from invasive procedures but also avoids the involvement of the practitioner in legal consequences resulting from a misdiagnosis of sarcoma.