对比剂扩散系数对结直肠肝转移癌中MRI不均匀强化的量化评估

目的描述并评价用一种简化模型定量检测结直肠肝转移癌内对比剂不均匀性扩散的可重复性。材料与方法本回顾性研究依托HIPAA。

肝脏SDF-1表达与结直肠癌肝转移

目的探讨SDF-1在人体不同正常组织中的表达差异以及这种差异的临床意义,探讨SDF-1在结直肠癌患者肝脏组织中的表达及其临床意义。方法应用免疫组化方法对30例3种不同人体组织的SDF-1的表达进行检测、分析SDF-1在不同组织中的表达;应用免疫组化方法对67例结直肠癌中原发组织及其正常的肝脏组织和25例肝转移癌组织标本中的SDF-1、CXCR4的表达进行研究,观察SDF-1/CXCR4在结直肠癌肝转移中的作用。结果SDF-1在皮肤组织中的阳性表达率为20%(6/30),在小肠黏膜中的阳性表达率为26.7%(8/30),在肝组织中的阳性表达率为83.3%。SDF-1在正常人体肝组织中的表达明显高于其他两种组织(P<0.05);SDF-1在结直肠癌患者的正常肝脏组织中的阳性率为80.9%(54/67),其表达与结直肠癌肝转移的发生率有关,表达高者,转移率高。结论正常肝组织中CXCR4特异性配体SDF-1表达升高,而高表达SDF-1的肝组织可能成为表达CXCR4的结直肠癌转移靶点。SDF-1/CXCR4在结直肠癌肝特异性转移过程中起重要的作用。

结直肠腺癌肝转移灶中差分化肿瘤细胞群的临床病理意义

目的探讨肝转移灶中差分化肿瘤细胞群(PDC)的临床病理意义,分析肝转移灶与肠原发灶中PDC分级的相关性。方法回顾性分析72例结直肠癌伴有肝转移的配对病例。同时对结肠癌原发灶和肝转移灶中PDC进行判读,分析肝转移灶中PDC分级与各临床病理参数之间的关系及原发灶与转移灶中PDC分级的相关性。PDC的判读方法采用Ueno标准。结果72例结直肠癌肝转移灶中,PDC分级G1、G2、G3的例数分别为28、24、20。转移灶的PDC分级与转移灶的肿瘤芽、原发灶的PDC分级具有正相关,而与转移灶大小、数目、原发灶部位、级别、浸润深度、淋巴结转移情况、脉管侵犯及肿瘤芽无显著相关。结论结直肠腺癌肝转移瘤与原发性结直肠腺癌的PDC分级存在正相关,评估原发灶PDC分级或可为肝转移风险提供参考。

腹腔镜同期结直肠癌与肝转移灶切除术的临床效果

目的 探讨腹腔镜同期结直肠癌与肝转移灶切除术的临床效果.方法 选取2010年1月至2013年7月结直肠癌伴肝转移癌患者42例,按照手术方法分为两组,每组21例.观察组采用腹腔镜同期结直肠癌及肝转移灶切除术,对照组采用同期腹腔镜结直肠癌切除及开放肝转移灶切除术,比较两组手术指标、并发症、累积生存率.结果 观察组腹腔引流管留置时间短于对照组,差异有统计学意义（P〈0.05）.观察组并发症发生率为9.52%（2/21）,对照组为4.77%（1/21）,两组比较差异未见统计学意义（χ^2=0.000,P〉0.05）;观察组3年内累积生存率为42.86%（9/21）,高于对照组的14.29%（3/21）,差异有统计学意义（P〈0.05）.结论 腹腔镜同期结直肠癌与肝转移灶切除术引流管留置时间较短,可改善患者远期生存状况,值得推广应用.

Biliary carcinoembryonic antigen levels in diagnosis of occult hepatic metastases from colorectal carcinoma

AIM:To prospectively explore the role of carcinoembryonic antigen (CEA) in gallbladder bile in patients with colorectal carcinoma and the morphological and clinical features of neoplasia and the occurrence of hepatic metastases. METHODS:CEA levels in the gallbladder and peripheral blood were studied in 44 patients with colorectal carcinoma and 10 patients with uncomplicated cholelithiasis.CEA samples were collected from the gallbladder bile and peripheral blood during the operation,immediately before extirpating the colorectal neoplasia or cholecystectomy. Values of up to 5 ng/ml were considered normal for bile and serum CEA. RESULTS:In the 44 patients with colorectal carcinoma who underwent operation with curative intent,the average level of serum CEA was 8.5 ng/ml (range:0.1 to 111.0 ng/ ml) and for bile CEA it was 74.5 ng/ml (range:0.2 to 571.0 ng/ml).In the patients with uncomplicated cholelithiasis who underwent cholecystectomy,the average level of serum CEA was 2.9 ng/ml (range:1.0 to 3.5 ng/ml) and for bile CEA it was 1.2 ng/ml (range:0.3 to 2.9 ng/ml). The average duration of follow-up time was 16.5 months (range:6 to 48 months).Four patients who underwent extirpation of the colorectal carcinoma without evidence of hepatic metastasis and with an average bile CEA value of 213.2 ng/ml presented hepatic metastases between three and seventeen months after removal of the primary colorectal neoplasia.Three of them successfully underwent extirpation of the hepatic lesions. CONCLUSION:High CEA levels in gallbladders of patients undergoing curative operation for colorectal carcinoma may indicate the presence of hepatic metastases.Such patients must be followed up with special attention to the diagnosis of such lesions.

The hepatic sinusoidal endothelial lining and colorectal liver metastases

Colorectal cancer (CRC) is a common malignant disease and the severe nature of cases in men and women who develop colorectal cancer makes this an important socio-economic health issue. Major challenges such as understanding and modeling colorectal cancer pathways rely on our understanding of simple models such as outlined in this paper. We discuss that the development of novel standardized approaches of multidimensional (correlative) biomolecular microscopy methods facilitates the collection of (sub) cellular tissue information in the early onset of colorectal liver metastasis and that this approach will be crucial in designing new effective strategies for CRC treatment. The application of X-ray micro-computed tomography and its potential in correlative imaging of the liver vasculature will be discussed.

Complete eradication of hepatic metastasis from colorectal cancer by Yttrium-90 SIRT

Yttrium-90 (Y-90) radioembolization,also known as selective internal radiation therapy (SIRT),is a regional hepatic therapy used in the treatment of unresectable colorectal cancer (CRC) liver metastases. In SIRT,Y-90 impregnated microspheres are injected into the VASCULAR SUPPLY of hepatic tumor,leading to selective irradiation and necrosis of tumor TISSUE. While several studies demonstrate improved local control and survival with SIRT,the specific indications for this therapy have yet to be defined. Typically,SIRT is given in combination with chemotherapy as multimodal treatment for unresectable hepatic CRC. However,it HAS ALSO FOUND INCREASING USE as a salvage therapy in chemo-refractory patients. Herein,the authors describe their experience with SIRT as "stand alone" therapy in a surgically-prohibitive,chemotherapy naive patient with hepatic CRC metastasis. The results suggest that Y-90 SIRT may have potential applications beyond its usual role as a palliative or salvage therapy for unresectable hepatic CRC.

Current preventive treatment for recurrence after curative hepatectomy for liver metastases of colorectal carcinoma: A literature review of randomized control trials

To review the preventive approaches for recurrence after curative resection of hepatic metastases from colorectal carcinoma, we have summarized all available publications reporting randomized control trials (RCTs) covered in PubMed. The treatment approaches presented above include adjuvant intrahepatic arterial infusion chemotherapy, systemic chemotherapy, neoadjuvant chemotherapy, and immunotherapy. Although no standard treatment has been established, several approaches present promising results, which are both effective and tolerable in post-hepatectomy patients. Intrahepatic arterial infusion chemotherapy should be regarded as effective and tolerable and it increases overall survival (OS) and disease free survival (DFS) of patients, while 5-fluorouracil-based systemic chemotherapy has not shown any significant survival benefit. Fortunately chemotherapy combined with hepatic arterial infusion and intravenous infusion has shown OS and DFS benefit in many researches. Few neoadjuvant RCT studies have been conducted to evaluate its effect on prolonging survivals although many retrospective studies and case reports are published in which unresectable colorectal liver metastases are downstaged and made resectable with neoadjuvant chemotherapy. Liver resection supplemented with immunotherapy is associated with optimal results; however, it is also questioned by others. In conclusion, several adjuvant approaches have been studied for their efficacy on recurrence after hepatectomy for liver metastases from colorectal cancer (CRC), but multi-centric RCT is still needed for further evaluation on their efficacy and systemic or local toxicities. In addition, new adjuvant treatment should be investigated to provide more effective and tolerable methods for the patients with resectable hepatic metastases from CRC.

Surgical approaches of resectable synchronous colorectal liver metastases:Timing considerations

AIM: To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases. METHODS: From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases. RESULTS: In two-stage procedures more transfusions were required (4 ± 1.5 vs 2 ± 1.8, pRBCs, P < 0.05). Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 ± 8 vs 12 ± 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series. CONCLUSION: Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon resection. It is advisable that complex liver resections with marginal liver residual volume should be dealt with at a later stage.

A predictive model for early recurrence of colorectal-cancer liver metastases based on clinical parameters

Background:The prognosis for patients with colorectal-cancer liver metastases(CRLM)after curative surgery remains poor and shows great heterogeneity.Early recurrence,defined as tumor recurrence within 6 months of curative surgery,is associated with poor survival,requiring earlier detection and intervention.This study aimed to develop and validate a bedside model based on clinical parameters to predict early recurrence in CRLM patients and provide insight into post-operative surveillance strategies.Material and methods:A total of 202 consecutive CRLM patients undergoing curative surgeries between 2012 and 2019 were retrospectively enrolled and randomly assigned to the training(n=150)and validation(n=52)sets.Baseline information and radiological,pathological,and laboratory findings were extracted from medical records.Predictive factors for early recurrence were identified via a multivariate logistic-regression model to develop a predictive nomogram,which was validated for discrimination,calibration,and clinical application.Results:Liver-metastases number,lymph-node suspicion,neurovascular invasion,colon/rectum location,albumin and post-operative carcinoembryonic antigen,and carbohydrate antigen 19–9 levels(CA19–9)were independent predictive factors and were used to construct the nomogramfor early recurrence after curative surgery.The area under the curve was 0.866 and 0.792 for internal and external validation,respectively.The model significantly outperformed the clinical risk score and Beppu’s model in our data set.In the lift curve,the nomogram boosted the detection rate in post-operative surveillance by two-fold in the top 30%high-risk patients.Conclusion:Our model for early recurrence in CRLM patients after curative surgeries showed superior performance and could aid in the decision-making for selective follow-up strategies.

Use of perioperative chemotherapy in colorectal cancer metastatic to the liver

A curative-intent approach may improve survival in carefully selected patients with oligometastatic colorectal cancer.Aggressive treatments are most frequently administered to patients with isolated liver metastasis,though they may be judiciously considered for other sites of metastasis.To be considered for curative intent with surgery,patients must have disease that can be definitively treated while leaving a sufficient functional liver remnant.Neoadjuvant chemotherapy may be used for upfront resectable disease as a test of tumor biology and/or for upfront unresectable disease to increase the likelihood of resectability(so-called‘conversion’chemotherapy).While conversion chemotherapy in this setting aims to improve survival,the choice of a regimen remains a complex and highly individualized decision.In this review,we discuss the role of RAS status,primary site,sidedness,and other clinical features that affect chemotherapy treatment selection as well as key factors of patients that guide individualized patient-treatment recommendations for colorectal-cancer patients being considered for definitive treatment with metastasectomy.