Liver Metastases In Patients Research Articles

Genome-Wide Scan for Copy Number Alteration Association with Relapse-Free Survival in Colorectal Cancer with Liver Metastasis Patients.

Predicting a patient’s risk of recurrence after the resection of liver metastases from colorectal cancer is critical for evaluating and selecting therapeutic approaches. Clinical and pathologic parameters have shown limited accuracy thus far. Therefore, we combined the clinical status with a genomic approach to stratify relapse-free survival in colorectal cancer liver metastases patients. To identify new molecular and genetic signatures specific to colorectal cancer with liver metastasis (CRCLM) patients, we conducted DNA copy number profiling on a cohort of 21 Taiwanese CRCLM patients using a comparative genomic hybridization (CGH) array. We identified a three-gene signature based on differential copy number alteration between patients with different statuses of (1) recurrence and (2) synchronous metastasis. In relapse hotspot regions, only three genes (S100PBP, CSMD2, and TGFBI) were significantly associated with the synchronous liver metastasis factor. A final set of three genes—S100PBP, CSMD2, TGFBI—significantly predicted relapse-free survival in our cohort (p = 0.04) and another CRCLM cohort (p = 0.02). This three-gene signature is the first genomic signature validated for relapse-free survival in post-hepatectomy CRCLM patients. Our three-gene signature was developed using a whole-genome CGH array and has a good prognostic position for the relapse-free survival of CRCLM patients after hepatectomy.

Feasibility of CT radiomics to predict treatment response of individual liver metastases in esophagogastric cancer patients.

In this study we investigate a CT radiomics approach to predict response to chemotherapy of individual liver metastases in patients with esophagogastric cancer (EGC). In eighteen patients with metastatic EGC treated with chemotherapy, all liver metastases were manually delineated in 3D on the pre-treatment and evaluation CT. From the pre-treatment CT scans 370 radiomics features were extracted per lesion. Random forest (RF) models were generated to discriminate partial responding (PR, >65% volume decrease, including 100% volume decrease), and complete remission (CR, only 100% volume decrease) lesions from other lesions. RF-models were build using a leave one out strategy where all lesions of a single patient were removed from the dataset and used as validation set for a model trained on the lesions of the remaining patients. This process was repeated for all patients, resulting in 18 trained models and one validation set for both the PR and CR datasets. Model performance was evaluated by receiver operating characteristics with corresponding area under the curve (AUC). In total 196 liver metastases were delineated on the pre-treatment CT, of which 99 (51%) lesions showed a decrease in size of more than 65% (PR). From the PR set a total of 47 (47% of RL, 24% of initial) lesions were no longer detected in CT scan 2 (CR). The RF-model for PR lesions showed an average training AUC of 0.79 (range: 0.74–0.83) and 0.65 (95% ci: 0.57–0.73) for the combined validation set. The RF-model for CR lesions had an average training AUC of 0.87 (range: 0.83–0.90) and 0.79 (95% ci 0.72–0.87) for the validation set. Our findings show that individual response of liver metastases varies greatly within and between patients. A CT radiomics approach shows potential in discriminating responding from non-responding liver metastases based on the pre-treatment CT scan, although further validation in an independent patient cohort is needed to validate these findings.

Survival Outcomes for Breast Cancer Patients with Liver Metastases: A Population-Based Study of 3,549 Patients

There are limited published data on the risk factors, incidence, and survival in breast cancer patients with liver metastases. In this study, we aim to utilize the Surveillance, Epidemiology, and End Results (SEER) database to further explore the impact of liver metastases in patients with Stage IV breast cancer. Using the SEER 18 registries, we included 14,932 patients diagnosed with Stage IV breast cancer from 2010-2014 with metastatic disease to the lung, bone, liver, and brain. Kaplan-Meier analyses and multivariate Cox proportional hazard models were utilized to assess the impact of liver metastases on overall survival (OS). The median OS for the entire cohort was 29 months with 43.3% of patients alive at 3 years. 3,549 (23.8%) patients had metastases to liver and 1,045 (7%) patients had liver metastases without involvement of the bone, lung or brain. Patients recorded as having liver metastases in the absence of brain, lung, or bone metastases (HR = 1.36, CI 1.24-1.49, P <0.001), as well as patients recorded as having liver metastases plus additional sites had worse OS than all comers with M1 disease not recorded as in the liver. The median OS for patients with liver metastases at time of diagnosis was 20 months versus 32 months for patients without liver metastases. For patients with liver metastases without involvement of the lung, bone, or brain, median OS was 27 months with only 16% patients alive at 3 years. For patients with liver and lung metastases, median OS was 15 months with only 7.5% patients alive at 3 years. This population-based hypothesis-generating analysis suggests that Stage IV breast cancer patients with liver metastases have worse OS and may benefit from aggressive upfront therapies. These findings may inform future therapeutic investigations to improve the prognosis of breast cancer patients harboring hepatic metastases at presentation.

Routine MRI With DWI Sequences to Detect Liver Metastases in Patients With Potentially Resectable Pancreatic Ductal Carcinoma and Normal Liver CT: A Prospective Multicenter Study.

The purpose of this study was to evaluate the performance of systematic MRI with DWI for the detection of liver metastases (LM) in patients with potentially resectable pancreatic ductal carcinoma and normal liver findings at CT. Patients with potentially resectable pancreatic ductal carcinoma and a normal liver at CT were enrolled in a prospective multicenter study between March 2011 and July 2013 and underwent preoperative MRI. The reference standard was pathologic analysis of detected hepatic lesions. A total of 118 patients were enrolled. MRI depicted liver lesions that were not visible at CT in 16 patients. All lesions were visualized both with and without DWI. Lesions were LM in 12 (10.2%) patients and were confirmed in seven patients by preoperative biopsy, four by intraoperative frozen section, and one at 6-month follow-up evaluation after pancreatic resection. All but one liver metastatic lesion diagnosed with MRI were smaller than 10 mm. Four of 118 (3.4%) patients had a false-positive diagnosis of LM at MRI and remained LM free after a follow-up period of 24 months or longer. Three of 102 (2.9%) patients with normal MRI findings had subcapsular LM that were diagnosed intraoperatively. At follow-up, 99 of 118 (83.9%) patients were LM free after a mean of 24 months. The patient-based sensitivity of MRI for the detection of LM was 80.0% (95% CI, 51.9-95.7%); specificity, 96.1% (95% CI, 90.4-98.9%); positive predictive value, 75.0% (95% CI, 47.6-92.7%); and negative predictive value, 97.1% (95% CI, 91.6-99.4%). Compared with CT, preoperative MRI improves the detection of LM in patients with potentially resectable pancreatic ductal carcinoma and may change management and the rate of unnecessary laparotomy and pancreatectomy for 10% of patients.

Laparoscopic liver resection and adjuvant chemotherapy with optimal timing: a step towards survival prolongation in colorectal liver metastasis patients

We are grateful to Dr. Ramanathan and Prof. Geller for their insightful comments on our recent study. Liver resection followed by adjuvant chemotherapy (AC) has been often performed for resectable colorectal cancer liver metastases (CRCLM), with cumulative evidences of survival benefit against systematic chemotherapy alone (1).

Laparoscopic liver resection and adjuvant chemotherapy with optimal timing: a step towards survival prolongation in colorectal liver metastasis patients

We are grateful to Dr. Ramanathan and Prof. Geller for their insightful comments on our recent study. Liver resection followed by adjuvant chemotherapy (AC) has been often performed for resectable colorectal cancer liver metastases (CRCLM), with cumulative evidences of survival benefit against systematic chemotherapy alone (1).

Effect of bevacizumab plus XELOX (CapeOX) chemotherapy on liver natural killer cell activity in colorectal cancer with resectable liver metastasis.

AimWe investigated the chemotherapy effect of resectable colorectal cancer with liver metastasis (CRLM) on the function of intrahepatic immune cells.MethodsWe classified patients into adjuvant chemotherapy (bevacizumab+CapeOX) after hepatectomy group (group A) and neoadjuvant chemotherapy followed by hepatectomy group (group B), and collected peripheral blood mononuclear cells (PBMC) and liver mononuclear cells (LMNC) to ascertain phenotypic and functional differences.ResultsThere were no significant differences in lymphocyte fractions of either PBMC or LMNC between groups, except for the significantly lower percentage of natural killer (NK) cells in LMNC in group B than in group A. Significantly higher percentage of natural‐killer group 2, member D (NKG2D)‐ positive NK cells in PBMC and percentage of tumor necrosis factor‐related apoptosis‐inducing ligand (TRAIL)‐, NKp30‐, and signal regulatory protein β (SIRPβ)‐positive NK cells in LMNC were found in group B. Furthermore, significantly higher expressions of NKG2D and SIRPβ in peripheral blood NK cells and of NKp46 and CD122 in liver NK cells were found in group B. When LMNC were incubated with interleukin (IL)‐2 in vitro, no difference was observed in the expression of these molecules in NK cells between groups. Consistently, there was no difference in the cytotoxic activity of those LMNC against a colon adenocarcinoma cell line between groups.ConclusionColorectal cancer with liver metastasis patients treated with neoadjuvant chemotherapy showed enhanced expression of activation markers on peripheral blood and liver NK cells in comparison with patients who did not receive therapy; however, the difference in those function remains unclear. These results suggest that neoadjuvant chemotherapy does not have a negative impact on intrahepatic immune cells in resectable CRLM patients.

Evaluation of computed tomography morphologic criteria in gastrointestinal tract hepatic metastases patients treated by chemotherapy

Objectives The objective of this study was to evaluate morphologic and response evaluation criteria in solid tumors (RECIST) criteria in gastrointestinal tract (GIT) liver metastases patients as regards tumor marker and clinical response of patients. Background To evaluate morphological response criteria which detect tumor density changes on contrast enhanced computed tomography (CECT) in GIT liver metastases patients. These criteria will help to detect response to treatment by chemotherapy early before tumor size changes. Patients and methods We included in this study 40 patients already diagnosed with GIT liver metastases by physical examination, tumor marker assessment, and CECT. The patients received three to six cycles of chemotherapy followed by repeated physical examination, CECT, and tumor marker assessment. The lesions in the liver were then evaluated by RECIST and response criteria depending on morphology. Results There is a significant statistical relationship between morphological response and tumor marker response of patients (P = 0.002). However, the relationship between morphological response and clinical response is not statistically significant (P = 0.087). There is no significant statistical relationship between morphological response and RECIST (P = 0.281). Conclusion Morphologic criteria had significant statistical association with tumor marker response in patients with GIT liver metastases treated by different types of chemotherapy.

Abstract 5187: Metastatic lung cancer-derived exosomes stimulate premetastatic niche in liver: Beyond seed soil hypothesis

Abstract Background: Tumor-derived exosomes (TDEs) are small membrane bound extracellular vesicles (EVs) that have the ability to alter their immediate microenvironment (ME) through cell-cell interaction and are known to be critical modulators of pre-metastatic niche. Lung cancer is a highly metastatic disease, with metastases often occurring when the tumor is in a clinically early stage. It is known to metastasize to the liver in the Asian population, but the underlying mechanism still remains unclear. Thus, understanding the role of TDEs in development of liver metastasis and its contributions to improvise the prognostic and therapeutic implications is of great importance. Methodology: Exosomes isolated from serum of lung cancer liver metastasis patients were characterized by nanoparticle tracking analysis, electron microscopy and flow cytometry with antibody directed at CD63. These exosomes were further co-cultured with A549 cells to check for their uptake at various time intervals. Moreover, effect of isolated exosomes was tested on: 1. Cell motility and invasiveness of A549 cells determined by transwell chamber migration assay and scratch assay; 2. Gene expression profiles and cell cycle regulation studies; and 3. Histopathological changes and liver function tests after exosome were intraperitoneally injected in Wistar rats to investigate the early events involved in the metastatic spread. Results: We found that CD63 - FITC labelled exosomes isolated from serum of liver metastatic patients were actively incorporated by A549 cells. The exosome uptake by A549 cells induced migratory/invasive phenotypic and morphologic changes in a concentration and time- dependent manner. Moreover, on further evaluating the effect of TDEs on different phases of cell cycle it was observed that cellular uptake of exosomes was increased during G2/M phase stimulating the cells to enter these cell cycle phases leading to cell proliferation. Further, we observed that E-cadherin, beta catenin, VEGFA, CDKN2A and TGFBR2 were differentially expressed when A549 cells were treated with exosomes demonstrating an important role of these TDEs in altering the tumor microenvironment. Liver function test demonstrated an increase in serum SGPT and SGOT levels whereas when histopathological examination was done the lungs showed patches of pneumonitis and the liver was highly inflamed. Conclusion: Collectively this study indicated that metastatic tumor derived exosomes are capable of increasing the migratory and invasive property of the primary lung cancer cells. Furthermore, our results depict an undisputable role of these exosomes as key modulators in the formation of the pre-metastatic niche required for the colonization of circulating tumor cells (CTCs) ultimately leading to distant metastasis. Thus understanding and targeting tumor derived exosomes could lead to better and novel therapeutic strategies. Citation Format: Kanisha Shah, Dr. Rakesh M. Rawal. Metastatic lung cancer-derived exosomes stimulate premetastatic niche in liver: Beyond seed soil hypothesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5187.

P-290 - Simultaneous versus staged resections of liver metastases in patients with advanced colorectal cancer

P-290 - Simultaneous versus staged resections of liver metastases in patients with advanced colorectal cancer

An individualized strategy to estimate the effect of deformable registration uncertainty on accumulated dose in the upper abdomen

In the abdomen, it is challenging to assess the accuracy of deformable image registration (DIR) for individual patients, due to the lack of clear anatomical landmarks, which can hamper clinical applications that require high accuracy DIR, such as adaptive radiotherapy. In this study, we propose and evaluate a methodology for estimating the impact of uncertainties in DIR on calculated accumulated dose in the upper abdomen, in order to aid decision making in adaptive treatment approaches.Sixteen liver metastasis patients treated with SBRT were evaluated. Each patient had one planning and three daily treatment CT-scans. Each daily CT scan was deformably registered 132 times to the planning CT-scan, using a wide range of parameter settings for the registration algorithm. A subset of ‘realistic’ registrations was then objectively selected based on distances between mapped and target contours. The underlying 3D transformations of these registrations were used to assess the corresponding uncertainties in voxel positions, and delivered dose, with a focus on accumulated maximum doses in the hollow OARs, i.e. esophagus, stomach, and duodenum.The number of realistic registrations varied from 5 to 109, depending on the patient, emphasizing the need for individualized registration parameters. Considering for all patients the realistic registrations, the 99th percentile of the voxel position uncertainties was 5.6 ± 3.3 mm. This translated into a variation (difference between 1st and 99th percentile) in accumulated Dmax in hollow OARs of up to 3.3 Gy. For one patient a violation of the accumulated stomach dose outside the uncertainty band was detected.The observed variation in accumulated doses in the OARs related to registration uncertainty, emphasizes the need to investigate the impact of this uncertainty for any DIR algorithm prior to clinical use for dose accumulation. The proposed method for assessing on an individual patient basis the impact of uncertainties in DIR on accumulated dose is in principle applicable for all DIR algorithms allowing variation in registration parameters.

Is there a Correlation between Metabolic Activity of the Primary Tumor with the Presence of Liver Metastases in Patients with Lung Cancer?

Background: Liver metastasis signal poor prognosis and survival in patients with lung cancer. To better understand tumor behavior, we aimed to determine if there is any correlation between primary tumor features with the features of liver metastasis on F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images.

The rate of false-positive diagnosis of colorectal liver metastases in patients undergoing resection with the development of a novel, externally validated risk score

Diagnostic error in patients undergoing resection of colorectal liver metastases (CRLM) is unusual but exposes patients to unnecessary risks associated with treatment. The primary aim of this study was to determine the rate of and risk factors for a false-positive diagnosis of colorectal liver metastases in patients undergoing hepatic resection. The secondary aim was to develop and validate a risk score to predict a false-positive diagnosis. Patients were identified from prospectively maintained databases. Patients who underwent a first liver resection for presumed colorectal liver metastases were divided into 2 groups: CRLMPOS (colorectal liver metastases present on histology or appearance of complete pathologic response to preoperative chemotherapy) and CRLMNEG (all others). Univariable analysis and multivariable binary logistic regression were used to identify risk factors for CRLMNEG. Risk scores were developed for CRLMNEG both with and without the use of preoperative carcinoembryonic antigen and were validated on an external cohort. 3.1% of patients in both test and validation cohorts were CRLMNEG (39/1,252 and 59/1,900, respectively). CRLMNEG patients had fewer (P = .006) and smaller lesions (P < .001) with lower serum levels of carcinoembryonic antigen (P < .001), T (P = .031) and N (P < .001) and a lower Dukes' stage of the primary (P < .001). The risk score performed well (area under the receiver operating characteristic curve 0.869; standard error = 0.030; P < .001) with reasonable performance on validation (area under receiver operating characteristic curve 0.743; standard error = 0.058; P < .001]). A false-positive diagnosis of colorectal liver metastases affected the same proportion of patients in 2 unrelated cohorts. This study identified risk factors for false-positive diagnosis with development of a novel risk score supported by external validation.

Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation.

To compare the diagnostic performance of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and combined fluorodeoxyglucose/positron emission tomography/computed tomography (FDG-PET/CT) for detection of colorectal liver metastases (CRLM) in patients eligible for local treatment. This health-research ethics-committee-approved prospective consecutive diagnostic accuracy study, with written informed consent, included 80 cases (76 patients, four participating twice) between 29 June 2015 and 7 February 2017. Prior chemotherapy or local treatment did not exclude participation. Combined FDG-PET/CT including CE-CT and MRI was performed within 0-3 days shortly before local treatment. CE-CT and MRI images were read independently by two readers for each modality. The combined FDG-PET/CT images were read independently by two pairs of readers. A composite reference standard was used. Sensitivities, specificities and area under the receiver operating characteristic curves (AUCROC) were calculated and compared. In total, 260 CRLMs were confirmed. The MRI readers had significantly higher per-lesion sensitivity (85.9% and 83.8%) than both CE-CT readers (69.1% and 62.3%) and both PET/CT reader pairs (72.0% and 72.1%) (p<0.001). There were no significant differences in per-lesion specificity. MRI readers had significantly higher AUCROC (0.92 and 0.88) than both CE-CT readers (0.80 and 0.82) (p≤0.001). AUCROC for MR reader 1 was higher than that of both PET/CT reader pairs (0.83 and 0.84) (p≤0.0001). MRI performed significantly better than both CE-CT and combined FDG-PET/CT for detection of CRLM in consecutive patients eligible for local treatment irrespective of prior chemotherapy or local treatment. • Patients eligible for local treatment of colorectal liver-metastases require optimal imaging. • In 80 consecutive patients, MRI had superior per lesion diagnostic performance. • Findings were independent of prior treatment and type of planned local treatment. • Equally, MRI had superior diagnostic performance on per segment basis.

Histopathological variables in liver metastases of patients with stage IV colorectal cancer: potential prognostic relevance of poorly differentiated clusters

The prognosis of patients with colorectal liver metastases (LMs) is mostly established on clinical variables or on the anatomic extent of colorectal cancer (CRC). Histopathological factors of LMs which may actually reflect the biological aggressiveness of the tumor are not routinely considered to define the risk of worse clinical outcome in those patients. The number of poorly differentiated clusters (PDCs) of neoplastic cells in primary CRC is associated with metastatic risk and bad prognosis, but PDC presence in LMs has been barely analyzed thus far. We assessed PDC presence in the histological slides of surgically resected and synchronous LMs in 63 patients with CRC who had been not submitted to any neoadjuvant treatments. Then, we analyzed its association with patients' cancer-specific survival (CSS) or progression-free survival. The presence of PDCs (P = .016) and PDC localization at tumor edge of LMs (P = .0004) were significantly associated with shorter CSS. PDC presence at the periphery of LMs and positive resection margin were independent prognostic variables for CSS. PDC localization at the tumor edge of LMs was a significant (P = .0079) and independent prognosticator of shorter progression-free survival. Our data suggest that PDC presence and peripheral localization in LMs may be relevant to predict outcome and useful for clinical decision making in patients with colorectal synchronous LMs.

Selective internal radiation therapy (SIRT) as treatment for hepatic metastases of uveal melanoma: a Finnish nation-wide retrospective experience

Background: In Finland, selective internal radiation therapy (SIRT) is at present the preferred first-line loco-regional therapy for uveal melanoma patients with hepatic metastases not suitable for surgery. We retrospectively evaluate the outcome and safety of SIRT in this group of patients.Material and methods: Yttrium-90 microspheres were delivered via the hepatic artery into the circulation of metastases from uveal melanoma in 18 patients with a predicted life expectancy of more than three months in three Finnish tertiary referral centers between November 2010 and December 2015. Progression-free survival (PFS), toxicity and overall survival (OS) were evaluated. Patients with historical uveal melanoma without extrahepatic metastases, who had received systemic chemotherapy as first-line treatment for their hepatic metastases at the Helsinki University Hospital between January 2006 and May 2010, were used as a historical control group.Results: Partial response and stable disease were observed in three (17%) and eight (44%) patients, respectively; one patient was not evaluable for response. Median PFS after SIRT was 5.6 (range, 1.3–40.8) months. Median OS after SIRT was 13.5 (range, 3.6–44.8) months compared with 10.5 (range, 3.0–16.5; p = .047) months for the historical chemotherapy group. Among patients who received SIRT as first-line treatment, the median OS was 18.7 (range, 8.2–44.8) months, significantly longer than that of the chemotherapy group (10.5 months, p = .017). There were no treatment-related deaths. Toxicity was mainly WHO grade 1–2 and self-limited.Conclusion: SIRT is a feasible and safe treatment for liver metastases in patients with uveal melanoma.

Incidence and predictors of synchronous liver metastases in patients with gastrointestinal stromal tumors (GISTs)

BackgroundThe liver is the most common metastatic site in patients with gastrointestinal stromal tumors (GISTs). The purpose of this study is to identify the incidence and predictive factors associated with synchronous liver metastases among patients with GISTs. MethodsA retrospective review of the Surveillance Epidemiology and End Results (SEER) database was performed. ResultsOverall, 2757 patients were identified, of which 276 (10%) had synchronous liver metastases. The two-year survival of patients with synchronous liver metastases was 31.9% overall and 37.1% after undergoing surgery with curative intent. Primary tumor size >5 cm (5–10 cm: OR 2.97, 95% CI: 1.03–8.55, p = 0.044, >10 cm: OR 5.59, 95% CI: 1.95–16.07, p = 0.001), presence of nodal metastases (OR 4.09, 95% CI: 2.01–8.33, p < 0.001) and mitotic count >5/50 HPF (OR 1.58, 95% CI: 1.01–2.47, p = 0.044) were associated with the presence of liver metastases. ConclusionsOne out of ten patients with GISTs presents with hepatic metastases. Primary tumor size >5 cm, presence of nodal metastases and mitotic count >5/50 HPF are associated with a higher risk of synchronous hepatic metastases.

Major Hepatectomy for Colorectal Liver Metastases in Patients Aged Over 80: A Propensity Score Matching Analysis

Background: The aim of this study was to evaluate the results of major hepatectomies for metastasis in elderly colorectal cancer patients, for whom limited data exist in the literature. Methods: From January 2006 to January 2013, 3,034 patients underwent hepatectomy for colorectal liver metastasis in 32 French surgical centers. Repeat hepatectomies were excluded from the study. Based on a 1: 4 propensity score matching model, 42 patients aged ≥80 (OG) were matched with 168 patients <80 years (YG) in order to obtain 2 well-balanced and homogeneous groups with regards to therapy and prognostic factors. Results: The unmatched cohort consisted of 744 patients (OG: n = 42; YG: n = 702). After PS matching, there was no difference in terms of general morbidity, rates of Dindo-Clavien score ≥III (OG: 16% vs. YG: 21%, p = 0.663), surgical morbidity (OG: 16% vs. YG: 21%, p = 0.663), reoperation (OG:10% vs. YG: 5%, p = 0.263), 90-day mortality (OG: 0% vs. YG:2%, p = 1), and total median hospital stay (OG: 12 vs. YG: 12, p = 0.972). Both groups experienced similar 3- and 5-year overall survival (82 and 82% OG vs.78 and 67% YG) and disease-free survival (40 and 35% OG vs. 45 and 35% YG at 3 and 5 years). Conclusions: No difference in perioperative and postoperative outcomes and disease-free and overall survival was found. Major hepatectomy in selected octogenarian patients is safe and feasible.

THE POSSIBILITIES OF CONTRAST-ENHACED ULTRASOUND (CEUS) IN THE DIAGNOSIS OF COLORECTAL LIVER METASTASES (CRLM)

AIM. To evaluate the capability of CEUS in the detection of CRLM in comparison with conventional grayscale B-mode. MATERIALS AND Mffl'HODS. 18 patents with CRLM underwent CEUS using the contrast agent SonoVue (Bracco, Italy). The patients were divided into two groups: the first group - 10 (55 %) patients before to chemotherapy; the second group - 8 (45 %) patients after chemotherapy and stable disease. The enhancement patterns of liver metastases were evaluated during the vascular phases: arterial, venous, and delayed. RESULTS. The enhancement patterns of liver metastases on CEUS were categorized as diffuse homogeneous enhancement (30 % - in the first group; such enhancement wasn't observed in the second group), rim-like hyper enhancement (70 % of the patients from the first group, 75 % of patients from the second group) and is enhancement, such as intact liver parenchyma (25 % of the patients from the second group). There were detected additional metastases in 4 (22,2 %) of patients 18 (100 %) in the delayed phase. There were significant differences in time of the beginning the vascular phases between patients from the first and second groups. The latest beginning of the wash-in stage was observed in liver metastases in patients from the second group (25,8 sec. from the injection of the contrast). The earliest beginning of the washout stage was observed in liver metastases in patients from the first group (42,4 sec. from the injection of contrast). CONCLUSION. CEUS improves visualization of CRLM, in comparison with the grayscale B-mode. It is also possible to apply this technique in the assessment of chemotherapy in patients with CRLM, as there was a difference between the moments of the beginning wash-in and wash-out stages.

CEACAM5 mRNA in blood as prognostic biomarker of early recurrence in liver metastatic colorectal cancer patients

CEACAM5 mRNA in blood as prognostic biomarker of early recurrence in liver metastatic colorectal cancer patients