Impact of primary tumour location on colorectal liver metastases: A systematic review

BACKGROUND Colorectal cancer(CRC)is the third most common cause of cancer-related death worldwide.Despite significant advances in screening,surgical management and adjuvant therapies,average 5-year survival seldom exceeds 60%in most developed nations.Metastatic disease represents the primary cause of mortality in patients with CRC,and the liver is the most common location for distant tumour spread.Up to 25%of patients are found to have synchronous liver metastases at the time of diagnosis and a further 30%-40%will develop metachronous disease in the course of follow-up.It has been suggested that primary tumour location[right side versus left side,primary tumour location(PTL)]can influence oncological outcomes in this patient group and that this should be considered in prognostic models and therapeutic decision-making algorithms.This suggestion is not universally accepted and there have been conflicting reports in the literature to date.AIM To provide a comprehensive summary of the available evidence regarding the impact of PTL on oncological outcomes in patients with colorectal cancer liver metastases(CRCLM).METHODS MEDLINE,EMBASE and COCHRANE were searched for relevant publications using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.Data on oncological outcomes was then extracted from full text articles that met the predefined inclusion criteria.RESULTS A total of 41 studies were identified that met predefined inclusion criteria for this review.In 21 out of 38 studies that provided data on overall survival,a statistically significant improvement in overall survival was reported in patients with left sided primary tumours.These studies included a total of 13897 patients compared with 4306 patients in the studies that did not show a significant difference.Eight studies noted a similar trend towards improved disease-free or progression-free survival.Several authors observed distinct patterns of relapse after treatment of hepatic metastases according to PTL;for example hepatic recurrence after treatment of CRCLM appears to occur more aggressively with right-sided CRC.CONCLUSION Taken together,the findings of the present review indicate that PTL may have a role as an independent prognostic factor when determining treatment and disease surveillance strategies in CRC.The mechanisms responsible for this variation remain poorly understood,but are likely to relate to molecular,histological and embryological differences,as well as inherent differences in therapeutic sensitivity.

Comparison between Metastatic Spinal Tumour of Unknown Primary Tumour with a Known Primary

Patients presented with spinal metastases from unknown primary tumours are rare. In this research we evaluated all patients with metastatic spinal tumour of unknown primary tumour, all patients were evaluated pre-operatively and comparison was done to those patients who had known primary tumour the study aimed to compare the group with known primary and the group with the unknown primary regarding the: mean age, gender, duration of symptoms, complication rate, region of the spine affected by metastasis, presence or absence of other skeletal or visceral metastasis, histological cell type and neurological outcome. Method: A retrospective study was performed on 40 patients presented to Neuroscience hospital in Baghdad from January 2010 till January 2014;all patients with metastatic spinal tumour were included in our study. We reviewed all patients’ records including age, sex, primary tumour, duration of their symptoms, neurological out come and complications. Results: Out of the 40 patient who presented with spinal tumours that underwent surgery duo to metastatic spinal tumour, five patients presented with spinal compression duo to metastatic tumour of unknown primary tumour (12.5%). The mean age was 64 years, 4 male and one female. For those with a known primary tumour mean age was 61 year, 22 male 13 female. Duration of symptoms prior to surgery was the same 180 days for those with unknown primary and 190 day for those with known primary tumours. They also had similar neurological outcome (80%) remain the same or improved post operatively for those with unknown primary and (85.7%) for those with a known primary tumour, and a similar complication rate for unknown primary was 25% versus 28% for known. The primary site of metastatic spinal tumour of unknown primary was confirmed after histopathology all shown adenocarcinoma four from the lung (80%) and one from colorectal. While the most common known carcinoma site were the lung 18 patient (51.4%), colorectal 8 (22.8%), breast 7 (20%), and renal 2 (5.71%). All patient who complain from secondary spinal metastasis with unknown primary tumour didn’t show any other skeletal or visceral metastasis, while those with a known primary tumour 6 patient out of 35 (17.1%) shown involvement of other site, the indication of surgery was to remove cord compression and restore neurological deficit. The most common site for metastasis was the dorsal spine for those of an unknown primary tumour 4 out of 5 patients (80%), and for those of a known primary tumour it was the lumbar area 28 out of 35 patient (80%). In conclusion metastatic spinal tumour of unknown primary was a common condition;it has similar demographic features, complications, and neurologic sequel with the spinal metastasis of known primary. Adenocarcinoma of the lung is the most common primary tumour proved after histopathology for spinal metastasis of unknown primary.