Extent Of Liver Metastases Research Articles

Prognostic analysis and liver metastases relevant factors after gastric and hepatic surgical treatment in gastric cancer patients with metachronous liver metastases: a population-based study.

The prognosis for patients with liver metastases from gastric cancer is very poor. Nevertheless, standard therapeutic strategies have not been established yet. The impact of hepatic surgical treatment on survival of patients with metachronous liver metastases from gastric cancer still remains controversial. We conducted a retrospective analysis on records of 436 patients who received radical gastrectomy (with D2 lymphadenectomy, regardless of hepatic surgical treatment) for gastric cancer with metachronous (≥ 3months after gastrectomy) liver metastases in our center between 2001 and 2016. All patients were followed until 2017/10/31 or withdrawn from the follow-up because of death. The median interval for non-hepatic metastases of the 436 patients who underwent radical gastrectomy is 14months. T (P = 0.041), N (P = 0.023) and lymphovascular invasion (P < 0.001) were independent predictors affecting liver metastases-free interval. The overall survival rates for the 436 patients were 44.5, 29.7, 16.3, and 16.3% at 1, 2, 3, and 5years respectively since treatment of hepatic metastases, with a median survival time of 11months. N (P = 0.025), extent of liver metastases (H) (H2 vs. H1, P = 0.036; H3 vs. H1, P < 0.001), and treatment of liver metastatic lesions (P < 0.001) were significant independent prognostic factors for survival after presence of liver metastases. Among H1 and H2 patients, median survival in hepatic surgical treatment group was significantly longer than that in systemic chemotherapy alone group (25 vs. 11months, P = 0.015). Liver examinations should be performed during the first 2years after gastric surgery and continued for 5years for high-risk patients. Active therapeutic strategies may prolong patients' survival compared with supportive treatment alone. Patients with H1, H2 metachronous liver metastases may be considered appropriate candidates for hepatic surgical treatment before embarking on systemic chemotherapy alone. ISRCTN Registry (Retrospectively registered; Reference number: 35067; Date: 02/04/2018).

Colorectal cancer liver metastases \u2013 a population-based study on incidence, management and survival

BackgroundColorectal cancer (CRC) is a leading cause of cancer-associated deaths with liver metastases developing in 25–30% of those affected. Previous data suggest a survival difference between right- and left-sided liver metastatic CRC, even though left-sided cancer has a higher incidence of liver metastases. The aim of the study was to describe the liver metastatic patterns and survival as a function of the characteristics of the primary tumour and different combinations of metastatic disease.MethodsA retrospective population-based study was performed on a cohort of patients diagnosed with CRC in the region of Stockholm, Sweden during 2008. Patients were identified through the Swedish National Quality Registry for Colorectal Cancer Treatment (SCRCR) and additional information on intra- and extra-hepatic metastatic pattern and treatment were retrieved from electronic patient records. Patients were followed for 5 years or until death. Factors influencing overall survival (OS) were investigated by means of Cox regression. OS was compared using Kaplan-Meier estimations and the log-rank test.ResultsLiver metastases were diagnosed in 272/1026 (26.5%) patients within five years of diagnosis of the primary. Liver and lung metastases were more often diagnosed in left-sided colon cancer compared to right-sided cancer (28.4% versus 22.1%, p = 0.029 and 19.7% versus 13.2%, p = 0.010, respectively) but the extent of liver metastases were more extensive for right-sided cancer as compared to left-sided (p = 0.001). Liver metastatic left-sided cancer, including rectal cancer, was associated with a 44% decreased mortality risk compared to right-sided cancer (HR = 0.56, 95% CI: 0.39–0.79) with a 5-year OS of 16.6% versus 4.3% (p < 0.001). In liver metastatic CRC, the presence of lung metastases did not significantly influence OS as assessed by multivariate analysis (HR = 1.11, 95% CI: 0.80–1.53).ConclusionThe worse survival in liver metastatic right-sided colon cancer could possibly be explained by the higher number of metastases, as well as more extensive segmental involvement compared with left-sided colon and rectal cancer, even though the latter had a higher incidence of liver metastases. Detailed population-based data on the metastatic pattern of CRC and survival could assist in more structured and individualized guidelines for follow-up of patients with CRC.

Liver metastases in mCRPC patients post-therapy with abiraterone (Abi) and/or abiraterone/enzalutamide (Enza).

250 Background: Liver metastases (mets) are a particularly poor prognostic group among mCRPC patients. The objective of this study is to characterize mCRPC patients who have had treatment with Abi or Enza to identify risk factors that may be associated with subsequent development of liver mets. Methods: A sample of 67 patients (n = 17 liver mets and 50 non-liver met patients matched by treatment history) seen at Tulane Cancer Center were selected for analysis. All patients had prior Abi and or Abi/Enza. Race, age at PCa diagnosis and Gleason Score at PCa diagnosis were assessed. For patients with liver mets, total liver metastatic volume was measured using CT scans and correlated against PSA, LDH and AST values at the time of the scan. Wilcoxon rank sum tests were run analyzing PSA, LDH and AST at the start of Abi treatment, end of Abi treatment as well the duration of Abi treatment, and the nadir PSA for these patients. Results: Patients were predominantly Caucasian, had a median Gleason Score of 8 at diagnosis and were at a median age of 57 for those with liver mets and 62 for non-liver met at PCa diagnosis. Pearson correlation analysis of the total liver lesion volume and lab values revealed a significant correlation for LDH (R = 0.491, &lt; 0.01) and AST (R = 0.368, p &lt; 0.05), but not for PSA. Further evaluation of PSA and AST values at the start and end of Abi treatment as well as at nadir PSA revealed no statistically significant differences between liver met patients and non-liver met patients. However, there was a significant difference (p = 0.015) between LDH levels at the end of Abi treatment with a median of 347 U/L for liver met and 238 U/L for non-liver met patients. Conclusions: LDH and AST levels correlate with extent of liver metastases. Additionally, elevated LDH at the end of Abi treatment is indicative of an increased risk for developing liver metastases. Larger sample sizes and molecular characterization of these tumors are required to gain more insights into this important patient population.

Abdominal Infection Suppresses the Number and Activity of Intrahepatic Natural Killer Cells and Promotes Tumor Growth in a Murine Liver Metastasis Model.

Increasing evidence suggests that postoperative infection is associated with poorer long-term outcome in various malignancies. However, the mechanism of poor prognosis induced by postoperative infection has not been clearly explained. We sought to determine whether abdominal infection promotes cancer metastases in a murine liver metastasis model, and to investigate the role of liver natural killer (NK) cells on antitumor immunity during abdominal infection. Female BALB/c (8-10 weeks old) mice were inoculated with NL-17 colon cancer cells into the spleen and then subjected to abdominal infection induced by cecal ligation and puncture (CLP) or sham treatment. The extent of liver metastases and cytokine production in the serum and liver were investigated. Cell fraction and cytotoxic activities of liver mononuclear cells (MNCs) were elucidated. CLP mice had poorer survival and their serum levels of IL-6, -10, and -12p70 were significantly elevated on day 1 compared with sham-treated and control mice. No obvious differences in cytokine levels of the liver homogenates were identified among the three groups, except IL-12p70 levels in CLP mice on day 7 significantly decreased. The cytotoxic activities of liver MNCs were significantly suppressed in CLP mice soon after tumor inoculation. Flow cytometry revealed a decrease in NK cells in the liver and perforin and granzyme B expression levels. Abdominal infection promoted liver metastases in a murine liver metastasis model, which may be partially caused by a decrease in the number and activity of NK cells during abdominal infection.

Palliative surgery in patients with unresectable colorectal liver metastases: a propensity score matching analysis

The current study was primarily intended to determine the best surgical treatment for patients with unresectable liver metastatic colorectal cancer (CRC). In addition, we assessed whether the improvement in survival resulting from palliative resection (PR) of the primary tumor was a function of the extent of liver metastasis. The demographics, tumor characteristics, and survival outcomes of 261 patients who underwent palliative surgery for unresectable liver metastatic CRC were analyzed. A propensity-score model was used to compare the group of patients receiving PR and non-resection (NR). There were 195 PR patients and 66 NR. The median survival of PR and NR patients was 21 months and 10 months, respectively (P < 0.001). In a Cox multivariate analysis of 51 propensity-score matched pairs, PR resulted in longer survival than NR (Hazard Ratio for NR 1.481; 95% confidence interval: 1.003-2.185; P = 0.048). The extent of liver metastasis only led to better survival of PR than NR patients among patients with limited liver metastasis not among those with extensive liver metastasis (P = 0.001). PR appears to result in better survival than NR when the patient's overall condition permits an aggressive approach, especially in patients with limited liver metastases.

Abstract 2426: Role of fibroblast growth factor receptor 1 (FGFR1) in liver metastasis of colorectal cancer

Abstract Liver metastasis is one of the main cause of death among patients with colorectal cancer (CRC). However, accurate prediction of liver metastasis of CRC is difficult at the inception of diagnosis. Activated receptor tyrosine kinases (RTKs) are the main mediators of the signaling pathway related to cell survival, proliferation, differentiation or apoptosis. To determine if any of these RTKs are involved in liver metastasis from CRC, we performed phospho-receptor tyrosine kinase array with matched 20 colon normal mucosa, primary tumor, metastatic liver tumor, and liver normal tissue proteins using Human Phospho-RTK Array (2009 AACR, #4951). In RTK activation profiling, FGFR1 activation was increased in a high proportion of metastatic liver tumor (p &amp;lt; 0.05). To evaluate the functional roles of FGFR1, DLD-1 and LoVo colon cancer cells were treated with FGFR1 specific siRNA or RTK inhibitor. Inhibition of FGFR1 inhibited phosphorylation of PI3K/AKT and ERK, a downstream cellular signaling molecule of FGFR; whereas, mTOR, p70S6K, JNK and Src activities were not affected. Also, we compared the cell migration and invasion ability by wound healing assay and invasion assay. The invasion capacity and wound closing were significantly delayed by FGFR1 inhibition (p &amp;lt;0.05). To evaluate in vivo anti-metastatic effect of FGFR1, we used an orthotropic liver metastasis model, generated by injecting LoVo colon cancer cells into spleen of BALB/c nu/nu mice. In control group, multiple large metastatic foci were evident, whereas the extent of liver metastasis was dramatically reduced in TKI-258 (50mg/kg/d) treated group (48.9%, p&amp;lt;0.05). Immunoexpression of the p-FGFR1 was much more intense in control than TKI-258 treated tumor tissues. Biological effects were also confirmed that FGFR1 inhibition resulted in a significant reduction of ERK activation and Ki-67 positive cells in tumor tissues. In conclusion, FGFR1 might be a good target for liver metastasis of CRC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2426. doi:1538-7445.AM2012-2426

Effectiveness of Liver Metastasectomies in Patients With Metastatic Colorectal Cancer Treated With FIr-B/FOx Triplet Chemotherapy Plus Bevacizumab

Intensive medical treatment increases resection rate of liver metastases in patients with metastatic colorectal cancer (MCRC). The effectiveness of liver metastasectomies was evaluated in patients with MCRC who were treated with previously reported FIr-B/FOx (triplet chemotherapy plus bevacizumab). Fifty patients with MCRC enrolled in the reported phase II study were classified according to involved metastatic sites (liver-only metastatic site, multiple metastatic sites) and the extent of liver metastases (single, multiple). Surgical resectability of liver metastases was evaluated at baseline and every 3 cycles of FIr-B/FOx treatment. The resection rate of liver metastases, activity, and efficacy were evaluated; progression-free survival (PFS) and overall survival (OS) were compared by using the log-rank test. Patients with liver MCRC were 33 of 50 consecutive unselected patients with MCRC: liver limited, 22 patients; multiple metastatic sites, 11 patients. Liver metastasectomies were performed in 13 patients: 26% of 50 patients with MCRC, 39% of 33 patients with liver MCRC. In patients with liver-only MCRC, a secondary liver surgery was performed in 54%: 6 of 9 single and 6 of 13 multiple liver metastases. Also, 1 liver and lung metastasectomy was performed. Pathologic complete responses were achieved in 2 patients (15%). The conversion rate of unresectable liver metastases was 83%. Objective response rate, PFS, OS were, respectively: 84%, 11 and 23 months in 33 liver MCRC; 86%, 17 and 44 months in 22 liver-limited patients. PFS and OS were significantly increased in patients with liver-limited metastases compared with multiple metastatic sites and single compared with multiple liver metastases. The FIr-B/FOx regimen may increase the resection rate of liver metastases and improve clinical outcome of patients with liver-only MCRC.

Inhibitory effect of the growth and hepatic metastasis in human colon carcinoma by all-trans retinoic acid

Objective To evaluate the inhibitory effect of all-trans retinoic acid (ATRA) on the growth and hepatic metastasis of colon cancer.Methods SW480/M5 cells were treated with ATRA at 0,2,4,8 μmol/L for 48 hours respectively,Vascular endothelial growth factor A (VEGF-A) expression of SW480/M5 was determined by immunohistochemical analysis.The nude mice mode of orthotopic tumor implantation was established by SW480/M5.Sixty nude mice models were divided into five groups randomly,the nude mices were administered intragastrically once every two days with physiological saline,dissolvant and 5,15,45 mg/kg ATRA,respectively.The administration lasted 6 weeks,subsequently,growth of tumor masses and hepatic metastasis were observed,VEGF-A mRNA expression in both orthotopic and liver metastatic tumors were examined by Real-time polymerase chain reaction ( RT-PCR),in addition,the microvessel density (MVD) of tumor masses were measured by immunohistochemical staining.Results Immunohistochemical results showed that with the increasing concentrations of ATRA acting on SW480/M5 cells,The positive expression rates of VEGF-A in SW480/M5 cells were gradually decreased (x2 =630.96,P ＜0.01).Compared to tumor-bearing mice treated by physiological saline and dissolvant,the inhibitory rates of orthotopic tumor treated by ATRA increased to 4.1％,31.6％ and 49.7％ (P ＜0.01 ),with the liver metastatic rate decreased to 63.6％,36.4％ and 20.0％ (P ＜ 0.05 ).In addition,size and weight of orthotopic mass,extent of liver metastasis,as well as the expression of VEGF-A mRNA and the microvessel density of orthotopic or metastatic tumors,were significantly decreased in both 15 and 45 mg/kg ATRA groups (P ＜ 0.05 ).Conclusion ATRA has inhibitory effect on VEGF-A expression,angiogenesis,growth and hepatic metastasis of colon cancer. Key words: All-trans retinoic acid; VEGF; Colon cancer; Hepatic metastasis; Microvessel density

Pitfalls in neuroendocrine tumor diagnosis

Pitfalls in neuroendocrine tumor diagnosis

CD10 enhances metastasis of colorectal cancer by abrogating the anti-tumoural effect of methionine-enkephalin in the liver

ObjectiveTo examine the role of CD10, a characteristic marker of liver metastasis of colorectal cancers (CRCs).DesignThe effect of CD10 and Met-enkephalin (MENK) in CD10-positive and -negative human CRC cells was...

Surgical Resection of Stage IV Colorectal Cancer and Prognosis

Colorectal cancer (CRC) harbors accumulated genetic alterations with cancer progression, which results in uncontrollable disease. To regulate the most malignant CRC, we have to know the most dismal phenotype of stage IV disease. A retrospective review of the Kitasato University Hospital was performed (from 1990 to 2001) to extract the 162 resected stage IV CRC. Clinical variables were tested for their relationship to survival in a multivariate prognostic analysis and revealed the interaction of the prognostic factors. In stage IV CRC with noncurable resection, the most robust univariate predictors for poor prognosis were preoperative high value of CA19-9, peritoneal dissemination, depth of invasion, age, extent of liver metastases, pathologic lymph node metastasis status, and gender as tumor factors, and postoperative therapy, perioperative transfusion, and lymph node dissection extent as treatment factors. Among these factors, postoperative therapy (p < 0.0001), perioperative transfusion (0.0002), CA19-9 (0.001), extent of liver metastases (0.004), and peritoneal dissemination (0.02) were identified as independent prognostic factors by multivariate analysis. Interestingly, among the independent prognostic factors, treatment factors did not depend upon tumor factors and the combination of the three tumor factors (CA19-9, extent of liver metastases, and peritoneal dissemination) can clearly classify the patients into the definite prognostic groups. Our results suggested that the most dismal CRC harbors three definite vectors that may represent the strongest phenotype of putative systemic immune (CA19-9), distant metastasis (extent of liver metastases), and local progression (peritoneal dissemination).

Clinical Course of Breast Cancer Patients With Metastases Limited to the Liver Treated With Chemotherapy

The purpose of this retrospective analysis was to describe the clinical course of patients with breast cancer with liver metastases alone who were treated on doxorubicin/cyclophosphamide or taxane-containing chemotherapy protocols at the M. D. Anderson Cancer Center. A total of 2,193 patients with metastatic breast cancer were treated on prospective clinical protocols at the University of Texas M. D. Anderson Cancer between 1973 and 2003. Among those, 132 were identified as having the liver as the first site of metastatic disease. The following information was obtained from the medical records: gender, age, race, performance status, menopausal status, hormonal receptor status, laboratory data, primary treatment, prior systemic treatment, disease-free interval, extent of metastatic disease, response to chemotherapy, site of progression, time to tumor progression, overall survival, and cause of death. Of the patients 62% received anthracycline-based regimens and 38% received anthracycline- and taxane-based regimens on various clinical protocols as the initial therapy for metastatic disease. The median follow-up of the patients was 52 months. The overall objective response rate was 66.4%; 16.4% of the patients achieved complete responses. The median time to progression was 14 months. Progression-free survival rates were 56% and 30% at 12 and 24 months, respectively. The median overall survival was 25 months. Sixteen patients (12.1%) survived longer than 60 months. There was a statistically inverse relation between a high lactate dehydrogenase level and achieving a complete response (P < 0.05). Age > or =50 years, extent of liver metastases, performance status, and lactate dehydrogenase and albumin levels are significantly related to progression-free survival (P < 0.05). Year of liver metastases diagnosis, extent of liver metastases, performance status, and albumin level are significantly related to overall survival (P < 0.05). This retrospective analysis demonstrated that patients with liver metastases only had high objective response rates and encouraging results for median survival obtained with currently available cytotoxic agents.

Palliative Surgery for Colon Cancer with Unresectable Liver Metastasis

Objectives: For patients with unresectable synchronous liver metastasis, the treatment is complex and the advantages of palliative resection of the primary colon tumor have not been finally determined. Surgeons sometimes experience difficulty deciding to implement palliative primary colon cancer resection. The choice should depend on surgical risk, severity of symptoms and life expectancy. This study was designed to identify factors reducing survival post palliative surgery among patients with unresectable liver metastasis. Methods: A retrospective review of 212 colon cancer patients with unresectable liver metastases who received palliative surgery from 1995 to 2000 was conducted in this study. Clinical-pathological data were collected from medical records. Significance testing was performed using the Kaplan-Meier method to analyze survival difference and the Cox proportional hazard model for independent prognostic factor. Results: Altogether 183 patients received palliative resection of primary colon cancer and 29 patients received non-resection (bypass or diversion) surgery. Factors evaluated for survival were age, gender, comorbid heart disease, hemoglobin, albumin, bilirubin, tumor size, tumor cell differentiation, tumor resection, extent of liver metastasis, extent of systemic metastasis and chemotherapy. There were 15 postoperative deaths. The mean survival was 12.6 months for the palliative resection group and 4.7 months for the non-resection group. Patients with poor tumor differentiation, advanced liver metastases, multiple systemic metastases and absence of chemotherapy had significantly worse rates of survival. Conclusions: Palliative surgery for asymptomatic or minor symptomatic patients with poor tumor differentiation, advanced liver metastases or multiple systemic metastases is of limited survival benefit, unless the tumors are complicated with obstruction, perforation or bleeding. Postoperative chemotherapy is advocated after any type of palliative resection.

The Novel Highly Lipophilic Topoisomerase I Inhibitor DB67 Is Effective in the Treatment of Liver Metastases of Murine CT-26 Colon Carcinoma

Colorectal carcinoma occurs in 1 of 20 individuals in most developed countries. The relapse after resection with metastatic liver disease is a major cause of death. 7-t-Butyldimethylsilyl-10-hydroxycamptothecin (DB67) has been incorporated into liposomes allowing for intravenous (i.v.) administration. A preclinical efficacy study of liposomal DB67 was performed using the colon carcinoma CT-26 cell line. The therapeutic dose for DB67 and liposomal DB67 was found to be 7 mg/kg per day using the gdx5/1 schedule. The results are compared with those obtained with irinotecan. The treatment with liposomal DB67 administered intravenously was more effective in reducing the weight and volume of primary spleen tumors and the weight and extent of liver metastases than free DB67 or liposomal DB67 administered intraperitoneally, but less effective than irinotecan. When the primary tumor was resected, treatment with liposomal DB67 administered intravenously was more effective in reducing the weight and extent of liver metastases than DB67 or liposomal DB67 administered intraperitoneally, and irinotecan. DB67 showed a higher accumulation in spleen and liver after its i.v. administration in liposomal form compared with its free or liposomal form administered intraperitoneally. DB67 and liposomal DB67 are more effective than irinotecan in the treatment of liver metastases after resection of the primary tumor.

The impact of liver metastasis on mortality in patients initially diagnosed with locally advanced or resectable pancreatic cancer.

Liver metastases are frequent in pancreatic cancer, although their impact on patient mortality is still unclear. The extent of liver metastasis (H-III [diffuse], H-II [moderate], H-I [limited], H-0) and the magnitude of liver dysfunction (lf-III [failure], lf-II [severe], lf-I [moderate], lf-0) were reviewed in 89 locally advanced and resectable pancreatic cancer patients in order to determine possible relationships with mortality and survival. The extent of liver metastasis (H-III, 18; H-II, 20; H-I, 12; H-0, 39) and the magnitude of liver dysfunction (lf-III, 12; lf-II, 8; lf-I, 11; lf-0, 58) were quite variable. Based on the aforementioned two categories, pancreatic cancer patients could be divided into four groups: (A) extensive liver metastasis affecting patient mortality, 14% (12/89); (B) liver metastases that do not cause severe liver dysfunction, 38% (34/89); (C) severe liver dysfunction, not associated with liver metastasis, 9% (8/89); (D) spared liver function, with no liver metastasis, 39% (35/89). The median survival period of H-III patients (195 d) was quite short compared with those of H-I (288 d) and H-0 (240 d) patients. Considering patients with locally advanced and resectable pancreatic cancer, the fraction of cases with diffuse liver metastases is relatively small. Moreover, only a minor proportion of pancreatic cancer patients die from hepatic failure as a direct result of liver metastasis.

Neovascularization in pancreatic ductal adenocarcinoma: Microvessel count analysis, comparison with non-cancerous regions and other types of carcinomas

Although neovascularization is regarded as an essential factor for tumor growth, it is unclear whether pancreatic adenocarcinoma is also influenced by this process. Furthermore, the reported microvessel count (MVC) data can not be compared due to the diversity of evaluating methods, and the relation between MVC data and metastatic potentials remains controversial. A total of 24 pancreatic adenocarcinomas and 24 adjacent non-cancerous pancreatic parenchyma were analyzed for MVC using anti-CD31 antibody. In addition, the MVC of 15 hypervascular tumors (10 hepatocellular carcinomas: HCC and 5 islet cell pancreatic tumors: ICT), 30 other types of adenocarcinomas (10 gastric, 10 colon and 10 intraductal papillary mucinous tumors of the pancreas: IPMT), as well as that of non-cancerous areas, were also analyzed. The extent of hepatic and peritoneal spread in 24 pancreatic adenocarcinoma patients was classified and correlations with MVC were evaluated. The mean MVC of 24 pancreatic adenocarcinomas (31.6 +/- 11.1) was actually lower than that of HCCs (91.6) or ICTs (56.4). The diversity is temperate as compared with that of other adenocarcinomas, i.e., 42.9 in gastric carcinomas, 35.6 in colon carcinomas and 32.5 in IPMT. MVC in non-cancerous areas were significantly higher in the pancreas (112.8) than in the stomach (29.6) or colon (26.3). MVC ratios of the cancerous area to the non-cancerous area were significantly lower in the pancreas (0.2818 +/- 0.100) than in the stomach (1.569 +/- 0.526, p<0.001) or the colon (1.423 +/- 0.493, p<0.001). MVC were higher in diffuse hepatic metastasis patients (36.0) than in limited metastasis patients (25.7). In conclusion, MVC in pancreatic adenocarcinoma revealed vascular volume to actually be lower than that of hypervascular tumors. We believe, however, that this hypovascularity is due mainly to contrast with the hyper-vascular non-cancerous pancreas, since MVC in the cancerous area itself was at the same level as in other adenocarcinomas. In addition, we revealed MVC to be of value for predicting the extent of liver metastasis.

Colorectal carcinoma liver metastases: clinical significance of preoperative measurement of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels.

The clinical significance of preoperative levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) was evaluated in patients with colorectal carcinoma liver metastases. Preoperative serum CEA and CA 19-9 levels, the number and size of liver metastases, and survival data were analyzed retrospectively in 73 patients. Using the cutoff level of 5 ng/ml for CEA and 37 U/ml for CA 19-9, the positivity of these for detecting metastatic deposits were 81% and 56%, respectively. CEA level was correlated with the number (P = 0.0081) and size (P = 0.013) of liver metastases among patients with positive CEA level, while CA 19-9 level was correlated only with the number of liver metastases (P = 0.0072) among those with positive CA 19-9 level. In the overall series, preoperative CEA and CA 19-9 levels were correlated significantly with survival only at higher cutoff levels. In 46 patients undergoing curative hepatectomy, however, these levels were not correlated with survival, even at higher cutoff levels. In conclusion, the CEA level is closely associated with the extent of liver metastases, while the CA 19-9 level may reflect multiplicity of hepatic deposits. Preoperative measurement of serum CEA and CA 19-9 levels appears to be of some prognostic value.

Islet cell tumor of the pancreas associated with tumor thrombus in the portal vein

We report the MR findings of a 70-year-old man with an islet cell tumor that diffusely involved the body of the pancreas associated with enhancing portal vein tumor thrombus and cavernous transformation. The diffusely infiltrative tumor mass was best shown on early post gadolinium spoiled gradient echo. The tumor thrombus enhanced intensely on early post gadolinium images and was also well shown on true FISP (Fast Imaging with Steady State Precession) images. The extent of liver metastases was best shown on fat suppressed T 2-weighted images. The most unusual finding was tumor thrombus involving the SMV and portal vein.

Multivariate analysis of the prognostic factors of patients with unresectable synchronous liver metastases from colorectal cancer.

It frequently is observed that widely varying prognoses are given for patients with the same extent of liver metastases from colorectal cancer, even though the same treatment is performed on these patients. One of the reasons for this variance is that prognostic factors for these patients have not been defined. This study was designed to elucidate which clinicopathologic factors were the most important in the prognosis of 73 patients with unresectable synchronous liver metastasis from colorectal cancer. Univariate and multivariate analysis of 11 clinicopathologic factors were performed using the Cox proportional hazard model. Survival curves were generated using the Kaplan-Meier method. Extent of liver metastases was the most significant variable in this survival analysis, although the extent of lymph node metastases of the primary lesion also was significant. However, the method of treatment was not a significant determinant in the survival for patients with unresectable liver metastases. Median survival of patients with H1, H2, and H3 was 13, 12, and 6 months, respectively, and there was a significant difference between survival curves for patients with H1 and patients with H3. Median survival of patients with n0, n1, and n2 was 13, 7, and 7 months respectively, and there was a significant difference between survival curves for patients with n0 and patients with n2. Median survival of 6 patients with H1 and n0 and of 17 patients with H3 and n2 was 28 and 4 months, respectively. There was a significant difference in survival curves between these two groups. Longevity of patients with unresectable synchronous liver metastases from colorectal cancer is affected adversely by the presence of nodal metastases and extent of liver metastases. This should be considered in the planning treatment.

Operation in patients with incurable colon cancer--is it worthwhile?

This study was designed to identify objective criteria that might help surgeons decide which patients with incurable colon cancer will benefit from palliative surgery and which will not. Charts of 68 patients with incurable colon cancer were reviewed. Fifty-seven patients underwent resection, six had a bypass of a nonresectable cancer, and five had no surgery at all. Time to death was the major end point of the study. Minor end points were postoperative morbidity and mortality. Independent variables analyzed were comorbidity, preoperative carcinoembryonic antigen, liver function tests, extent of liver metastases, stage and site of tumor, and tumor cell differentiation. There were six postoperative deaths, and six patients had complications. Mean survival after palliative resection was 10.6 months, after bypass was 3.4 months, and after diagnosis in patients not operated on was 2 months. Patients with > 50 percent of their liver replaced by cancer had significantly worse survival than those with < 50 percent involvement (mean, 4.2 +/- 4 standard deviation (SD) vs. 14.4 +/- 10.6 SD; P < 0.003, Wilcoxon's rank-sum test). Tumor differentiation also influenced survival (poor, mean 8.4 +/- 8.2 SD; well/moderate, 12.5 +/- 9.2 SD; P < 0.02). No other variable had a significant effect on survival. Resection of primary colon cancer in patients with incurable disease has a relatively high postoperative mortality but is worthwhile as long as hepatic metastases occupy less than 50 percent of liver volume.