Zhongshan Hospital Fudan University Research Articles

SMARTphone and social media-based Cardiac Rehabilitation and Secondary Prevention (SMART-CR/SP) for patients with coronary heart disease in China: a randomised controlled trial protocol

IntroductionThe burden of cardiovascular disease (CVD) is rapidly increasing in developing countries, however access to cardiac rehabilitation and secondary prevention (CR/SP) in these countries is limited. Alternative delivery models that...

The analysis of clinical characteristics and disease activity in ankylosing spondylitis patients with hyperuircemia

Objective: to investigate the clinical characteristics and disease activity in ankylosing spondylitis (AS) patients with hyperuricemia. Method: Laboratory tests, magnetic resonance imaging, disease activity and functional index of AS patients from Fudan University Zhongshan Hospital were collected. T test, square test were applied to investigate the difference between AS patients with hyperuricemia and AS patients with normal serum uric acid in clinical characteristics and disease activity in AS patients. Result: Among all the AS patients, 23.4% (22/94) patients accompanied with hyperuricemia. AS patients accompanied with hyperuricemia showed significant younger age (28.9±7.9 vs 35.8±11.1, P=0.002); higher serum alanine aminotransferase (33.6±23.6 vs 19.8±12.4, P=0.014), aspartate aminotransferase (23.8±8.7 vs 18.6±9.6, P=0.025) and creatinine (78.4±12.5 vs 69.8±13.3, P=0.009), lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (11.2±8.8 vs 17.9±12.0, P=0.027) and Bath Ankylosing Spondylitis Functional Index (BASFI) (0.7±0.9 vs 1.8±2.2, P=0.002) compared with AS patients whose serum uric acid level is normal. Conclusion: AS Patients with younger age, impaired hepatic and renal funtion and lower scores in BASDAI and BASFI tend to accompany with hyperuricemia.

P3.13-037 Deep Learning System for Lung Nodule Detection

Ever since its first success in large scale image recognition problem, deep convolutional neural networks (DCNNs) have shown their capabilities in solving many challenging visual perceptual tasks, such as image classification, segmentation, object detection. In some cases, DCNNs have already achieved near-human performance. In medical image analysis, DCNNs have also been successfully applied to lesion detection, segmentation, and diagnosis. The power of DCNN lies in its ability to learn a hierarchical representation of raw input data, without hand-crafted features. The focus of this study was to improve the performance of DCNN in automatic detection of pulmonary nodule on CT scan. In particular, nodules whose size is less than 4mm were considered. A total of 171 scans were collected at Zhongshan Hospital Fudan University, which was first process by the proposed DCNN system (12Sigma). The detection results were then carefully reviewed by an experienced physician, all false positives and missed nodules were manually labeled. To refine the system, all false positives and true nodules of sizes 4mm and under were selected. The data set was randomly split into training and test sets, where the training set consists of 90% (154 scans) and the test set consists of 10% of data (17 scans). Fig 1 shows the FROC curves on the test set before and after re-training. Overall, the detection sensitivity improved at all false positive levels, but the improvement was most significant at low FP rate region. For example, when FP is 0.5 per scan, the detection sensitivity increased from 0.36 to 0.49. This improvement suggests that, even with limited data, the deep neural network can learn from its mistakes and be easily tuned to be more sensitive to small nodules. We believe that when more data is collected, more significant improve in high FP rate region will be observed.

Efficacy of trastuzumab beyond progression in HER2 positive advanced gastric cancer: a multicenter prospective observational cohort study.

IntroductionTrastuzumab plus chemotherapy is the standard first-line regimen in HER2 positive advanced gastric cancer (AGC), but lack of data in post-progression treatment. So, it is worth evaluating the efficacy of continuing trastuzumab after failure of the first-line trastuzumab based treatment.Methods59 patients were enrolled from Zhongshan Hospital Fudan University, Sun Yat-sen University Cancer Center and Peking University Cancer Hospital between September 2012 and Oct 2015. Patients were divided into two groups according to the second line regimens: with or without trastuzumab. The primary endpoint was progression free survival of second line therapy (PFS2). Secondary end points included overall survival (OS), response rate, and adverse events (AEs).ResultsBaseline factors were well balanced between two groups. 32 patients treated with trastuzumab plus second line chemotherapy (group A) and 27 patients received chemotherapy alone (group B). The median follow-up time was 7.60 months (range 1.50-32.50). Longer median PFS2 was observed in group A than in group B (3.1 vs 2.0 months, P=0.008). There was no significant differences of median OS2 calculating from the second line therapy (10.5 vs 6.5 months, P=0.172) between two groups. Response rate was 9.3% in group A compared with 3.7% in group B (P=0.617). AEs were similar in two groups including cardiac safety. Subgroup analysis showed that factors of male, age<65, good performance status, HER2 immunohistochemical (IHC) 2+ and poor response to first line indicated superior PFS2 in patients continuing trastuzumab to those treated with chemotherapy alone.ConclusionContinuing treatment of trastuzumab beyond first line therapy progression showed effective and safe in AGC.

Hemodialysis-induced regional left ventricular systolic dysfunction.

Introduction Hemodialysis (HD) patients are under observably elevated cardiovascular mortality. Cardiac dysfunction is closely related to death caused by cardiovascular diseases (CVD). In the general population, repetitive myocardial ischemia induced left ventricular (LV) dysfunction may progress to irreversible loss of contraction step by step, and finally lead to cardiac death. In HD patients, to remove water and solute accumulated from 48 or 72 hours of interdialysis period in a 4-hour HD session will induce myocardial ischemia. In this study, we evaluated the prevalence and potential risk factors associated with HD-induced LV systolic dysfunction and provide some evidences for clinical strategies. Methods We recruited 31 standard HD patients for this study from Fudan University Zhongshan hospital. Echocardiography was performed predialysis, at peak stress during HD (15 minutes prior to the end of dialysis), and 30 minutes after HD. Auto functional imaging (AFI) was used to assess the incidence and persistence of HD-induced regional wall motion abnormalities (RWMAs). Blood samples were drawn to measure biochemical variables. Findings Among totally 527 segments of 31 patients, 93.54% (29/31) patients and 51.40% (276/527) segments were diagnosed as RWMAs. Higher cTnT (0.060 ± 0.030 vs. 0.048 ± 0.015 ng/mL, P = 0.023), phosphate (2.07 ± 0.50 vs. 1.49 ± 0.96 mmol/L, P = 0.001), UFR (11.00 ± 3.89 vs. 8.30 ± 2.66 mL/Kg/h, P = 0.039) and lower albumin (37.83 ± 4.48 vs. 38.38 ± 2.53 g/L, P = 0.050) were found in patients with severe RWMAs (RWMAs in more than 50% segments). After univariate and multivariate analysis, interdialytic weight gain (IDWG) was found as independent risk factor of severe RWMAs (OR = 1.047, 95%CI 1.155-4.732, P = 0.038). Discussion LV systolic dysfunction induced by HD is prevalent in conventional HD patients and should be paid attention to. Patients would benefit from better weight control during interdialytic period to reduce ultrafiltration rate.

Investigation of career anchor of the graduates of GP vocational training program

Objective To understand the status quo of work satisfaction of the graduates of GP vocational training program by Zhongshan hospital Fudan university, to provide bases for making best GP career development strategy by health authorities. Methods Using short form of the career orientation inventory to conduct career investigation of the 152 graduates of GP vocational training program by Zhongshan hospital, Fudan university.152 questionnaires were issued and the effective response rate was 100%. Results The top of GPs' career anchor is job security orientation(106, 69.7%), followed by technical competence(28, 18.4%), service(8, 5.3%), managerial(5, 3.3%), autonomy(3, 1.9%), lifestyle(1, 0.7%), entrepreneurship(1, 0.7%), pure challenge(0, 0)and geographic security orientation(0, 0). We found that for male GPs, they displayed higher score for entrepreneurship orientation than female GPs(t=2.775, P=0.006). Those older than 35 displayed higher score for geographic security orientation than those younger than 35(t=-2.154, P=0.033). GPs with at least 10 years' work experience displayed higher score for geographic security orientation than those with less than 10 years' work experience(t=-2.414, P=0.017). The distribution of all types of career orientations of GPs was the same no matter how different their degrees and professional titles were. Conclusions Job security orientation and technical competence are the major job orientations of GP vocational training program by Zhongshan hospital, some career anchor orientations are related to age, gender and duration of work experience. Effective career management should be conducted based on these characters of the graduates' career orientation. Key words: Inservice training; General practitioner; Career anchor

Establishment of a digital PCR platform for detection of EGFR T790M mutation in plasma circulating DNA from NSCLC patients

Objective Digital PCR (dPCR) was established to detect plasma epidermal growth factor receptor (EGFR) T790M mutation of non-small cell lung cancer (NSCLC) patients and was evaluated in terms of analytical performance and clinical application significance. Methods The specific primers and probes for EGFR T790M mutation and wildtype were designed to establish dPCR platform. Limit of blank, sensitivity and linearity of dPCR were evaluated by the detection of plasmids with different concentrations to set up optimal reporting system and reanalyzing process.The mutation of EGFR T790M in plasma and tissue samples from 10 patients with advanced NSCLC resistant to EGFR-TKI therapy who were enrolled in Zhongshan Hospital Fudan University from January 2014 to October 2015 were analyzed by dPCR and amplification refractory (ARMS), respectively. The consistency was evaluated between dPCR and ARMS by Chi-square test. The correlation of T790M abundance detected by dPCR between plasma and tissue samples was also analyzed by Peasrson correlation analysis. Results Limit of blank and sensitivity of dPCR was 10 copies and 0.01%, respectively. dPCR was evaluated as linear in the range of 0.01%-100%(Y=1.226X-3.984, R2=0.999). The consistency between dPCR and ARMS of tissue samples was good (kappa=0.80), while the positive rates of plasma T790M detected by dPCR was significantly higher than ARMS (50% vs 20%, P<0.05). It was found that T790M abundance detected by dPCR was highly correlated between lung cancer tissue and plasma(R=0.923, P<0.05)using Pearson correlation analysis. Conclusions A new method of dPCR with high sensitivity and absolute quantification is established for the detection of EGFR T790M mutation in plasma from advanced NSCLC patients, which brings tumor liquid biopsy into real. It has the ability to provide the most direct and valuable guidance for clinicians to make decision on EGFR tyrosine kinase inhibitors therapy in patients with advanced NSCLC resistant to EGFR-TKI.(Chin J Lab Med, 2016, 39: 170-175) Key words: Polymerase chain reaction; Lung neoplasms; Receptor, epidrmal growth factor; DNA mutational analysis

Gemcitabine-Based Regional Intra-Arterial Infusion Chemotherapy in Patients With Advanced Pancreatic Adenocarcinoma.

The present study was carried out to investigate the prognostic factors in patients who received intra-arterial infusion for advanced pancreatic cancer. In addition, the detailed procedure of intra-arterial infusion chemotherapy was described.A total of 354 patients with advanced unresectable pancreatic adenocarcinoma were recruited from January 2012, to April 2015, at Zhongshan Hospital Fudan University, Shanghai, China. Demographic and clinic characteristics of the patients were extracted from electronic medical records. Restricted cubic spline was used to assess the nonliner regression between baseline CA19-9 value and overall survival. Kaplan–Meier analysis and Cox proportional hazard models were used to estimate the association between overall survival and clinical characteristics.Of all 354 included patients, 230 (65%) were male (male/female ratio = 1.8), and 72 (20%) patients were diagnosed with detectable distant metastases. Pretreatment CA19-9 value of patients with metastases was significantly higher as compared to those with locally advanced cancer (median: 922.30 vs 357.00 U/mL, P = 0.0090). Totally 274 patients completed 1 cycle of intra-arterial infusion, whereas 80 patients received 2 or more cycles of the chemotherapy. For all the 354 patients, median OS was 7.0 months (95% CI: 6.0, 8.0 months) with a 6-, 12-, and 18-month survival rate of 0.48, 0.28, and 0.18, respectively. The median OS of patients, who received 1 cycle of intra-arterial infusion therapy, was 6.0 months (95% CI: 5.0, 8.0 months), which was similar to 7.0 months (95% CI: 6.0, 9.0 months) in patients who received 2 or more cycles. Restricted cubic spline revealed the nonline association between baseline CA19-9 and prognosis. The Cox proportional hazard model showed that age, CA19-9 baseline, CA19-9 value, and tumor location were significantly associated with the OS.In conclusion, the gemcitabine-based RIAC presented a potential treatment method for advanced pancreatic adenocarcinoma. Young age, pretreatment CA19-9 value <1000 U/mL, and tumor located at the head of pancreas indicated better response to the regional intra-arterial chemotherapy and better overall survival.

Endovascular treatment of popliteal artery aneurysm in a clinical analysis of 9 cases

To evaluate the efficacy of endovascular repair of popliteal artery aneurysm (PAA) and to summarize the clinical experience and lessons. A clinical data of 9 PAA cases (males 8, females 1, age range 55-84) undergoing endovascular repair from October 2006 to December 2014 at Zhongshan Hospital Fudan University were retrospectively analyzed. CT angiography was made in all of the 9 cases preoperatively, and 10 PAA were included in the analysis. Of the 9 cases, 6 cases were symptomatic. The mean diameter of PAA was 3.9 cm (range, 2.1-8.2). The technique successful rate of endovascular repair was 10/10. The preoperative complications were 2/10, including one case suffered hematoma in the arterial puncture site and 1 case with distal artery embolization. The mean follow-up was 33 months (range, 3-87). During the follow-up, 2 cases received the secondary intervention and drug thrombolysis because of the stent distal thrombosis. The stent-graft primary patency at 1 year was 78.8% (95% CI: 48%-91%). One case suffered stent fracture, and one case died of brainstem hemorrhage 15 months post endovascular repair of PAA. Endovascular treatment of PAA is safe and effective in perioperative and midterm follow-up. However, individual endovascular strategy and postoperative complications in the long-term follow-up should be payed more attention.

MLL-AF9 rearrangement in myeloid sarcomas involving the breast

Dear Editor, A 29-year-old woman (patient 1) presented to our facility in August 2011 for migrating arthralgia at bilateral elbow and knee joints. CT scan revealed coarse articular surface of bilateral sacroiliac joints with slight irregularity. Serological tests for autoantibodies were all negative. Three months later, palpable masses were sequentially reported at the left and right breast. Fine needle biopsy of the left breast indicated malignancy with hematopoietic origin. Bone marrow aspiration revealed acute myeloid leukemia with FAB AML-M4 morphology. Flow cytometric study showed 21 % malignant cells of marrow sample, which had an expression of surface markers including CD117, CD33, CD38, CD15, CD64, CD4, and CD56. Malignant cells possessed a recurrent cytogenetic aberration shown by G-banding as 47, XX, + 8, t(9;11)(p22;q23). Further molecular surveys confirmed the existence of an MLL-AF9 fusion gene. Patient 2 was a 28year-old woman who presented to our facility in October 2012 because of a palpable mass at left breast for 4 months. Fine needle biopsy indicated malignancy with hematopoietic origin. Bone marrow aspiration revealed acute myeloid leukemia with FAB AML-M4 morphology. Flow cytometric study showed 76 % malignant cells of marrow sample, which had an expression of surface markers including CD117, CD13, CD33, CD34, CD38, MPO, and HLA-DR. No overt cytogenetic aberration was shown by G-band karyotyping, but further molecular surveys disclosed the existence of an MLL-AF9 fusion gene. Mutational surveys in both patients revealed no acute myeloid leukemia (AML)-related mutations involving FLT3, NPM1, CEBPA, or C-KIT. They achieved hematological complete remission after two courses of chemotherapy utilizing idarubicin and cytarabine regimen and underwent consolidation with mid-dose cytarabine. Myeloid sarcoma (MS), previously referred to as granulocytic sarcoma or chloroma, is a rare entity of AML [1]. It represented a mixed group of AMLs with overt extramedullary involvement including the skin, lymph node, bone, testis, central nervous system, intestine, and other soft tissues. Breast involvements, even solitary extramedullary cases without evidence of bone marrow lesion, have been well described [2–4]. The presentation of accompanying AML varied among cases, which could occur prior to, simultaneous with, or months later than the diagnosis of myeloid sarcoma [1–6]. Cytogenetic data of MS are relatively limited, partly due to operational difficulties during sampling and banding procedures. Certain cytogenetic aberrations as t(8:21) were related to pediatric patients, especially those with lesions at orbital level [5]. On the other hand, it was reported by Pileri et al. that MLL rearrangement, trisomy 8, and monosomy 7 occurred more frequently among adult patients [6]. Interestingly, both cases of breast involvement with confirmed cytogenetic aberrations reported by Pileri et al. demonstrated trisomy 8, one of which might also harbored MLLAF9 rearrangement (Table 1). Although chromosomal abnormalities including trisomy 8 and t(9;11) have been associated with MS, the possible link between MLL-AF9 and MS has not been frequently reported [7, 8]. MLL-AF9 rearrangement is found in 2–5 % of AML and up to 25 % in de novo M5a of children, while trisomy 8 appears as additional cytogenetic abnormality in 20% of cases harboring MLL-AF9 [9]. MLL-AF9, as well as additional trisomy 8, seemed to demonstrate a strikingly high prevalence among MS patients with breast involvement, but its prognostic value could not be adequately evaluated in this small cohort. Contemporary molecular surveys might help to B. Wu : F. Li (*) : S. Zou Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai 200032, China e-mail: li.feng@zs-hospital.sh.cn

Membranoproliferative glomerulonephritis associated with IgA-λ monoclonal gammopathy

Dear Editor, From September 2008 to April 2013, 4 patients were found to have amonoclonal IgA-λ component by serum immunofixation electrophoresis among 29 membranoproliferative glomerulonephritis (MPGN) patients, pathologically confirmed via renal biopsy during the same period in our facility (Table 1). All patients were male, and the median age was 53.0(45–65) years. The severity of proteinuria and renal insufficiency varied among patients. The extent of plasma cell dyscrasia was categorized as monoclonal gammopathy of undetermined significance (MGUS) in three patients and POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) in the other. The diagnosis of MPGN was made via light microscopic observations, and interestingly, no IgA or λ light chain deposit was detected by immunofluorescence surveys. Electron microscopy revealed thickening of basement membrane (inner layer in particular), cellular interposition, diffuse effacement of the foot processes of podocytes, and scattered deposits in subendothelial and mesangial regions (Fig. 1). Patient 1 was treated with prednisone and cyclophosphamide, and proteinuria decreased from 1.86 to 0.34 g/24 h at 3year follow-up. Patient 2 was treated with dexamethasone and thalidomide, but proteinuria increased from 0.24 to 0.81 g/24 h after 1 year. Patients 3 and 4 did not get any specific treatment. The serum creatinine level was stable in all patients during follow-up (0.72– 1.22 mg/dl). The spectrum of renal involvement secondary to plasma cell diseases have been drastically expanded recently. Aside from previously acknowledged entities, including myeloma cast nephropathy, AL amyloidosis, monoclonal immunoglobulin deposition disease, and light chain proximal tubulopathy, the territory of primary glomerulonephritis has also been shattered [1, 2]. Proliferative glomerulonephritis secondary to monoclonal IgG, IgA, or immunoglobulin light chain deposits has been well-described since 2004 [3–5]. The most recent candidate for this heterogeneous group was proposed by Sethi et al. in 2010. In a single-center study, they identified 28 monoclonal/biclonal Igs among total 126 MPGN patients, in which 68 cases were hepatitis negative and evaluated for gammopathy [6]. IgM-κ and IgG-κ were most commonly encountered, and more than half of the patients were categorized as MGUS. Under these circumstances, a recent perspective article in Blood proposed the terminology “monoclonal gammopathy of renal significance (MGRS)” [2]. Here, we presented the first report of MPGN associated with IgA-λ monoclonal gammopathy. Along with the other two patients with IgM-κ and IgG-κ paraproteins, the overall occurrence of monoclonal gammopathy among MPGN B. Wu :W. Wang : F. Li (*) : S. Zou :Y. Cheng Department of Hematology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Shanghai 200032, China e-mail: li.feng@zs-hospital.sh.cn

Endoscopic submucosal dissection in the treatment of giant gastrointestinal lipomas

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) in the treatment of giant gastrointestinal lipomas.Methods From August 2007 to August 2010,the clinical data of 32 patients with giant gastrointestinal lipomas treated by ESD at Endoscopy Center,Zhongshan Hospital Fudan University were retrospectively analyzed.Among 32 cases of giant gastrointestinal lipomas,one case was in esophagus,six cases in stomach,two cases in duodenum,seven cases in ileocecal valve,15 cases in colon and one case in rectum. Preoperative diagnostic accuracy of endoscopic uhrasonography (EUS) was 93.8％ (30/32).The maximum diameter of tumor ranged from 3.0 cm to 8.0 cm (average 4.2 cm).Results All tumors were successfully dissected under endoscopy.The success rate was 100％ (32/32).The operation time was between 25 minutes and 110 minutes (average 37 minutes).The average intraoperative blood loss was 40 ml,and no perforation and delayed bleeding was found after ESD. All were proved to be lipomas by histopaphology after operation.The rate of follow-up was 90.6％ (29/32).The follow-up time was from six to 36 months.Conclusion ESD is a safe and effective method for the treatment of giant gastrointestinal lipomas,which can be applied extensively in clinical. Key words: Endoscopy, digestive system; Gastric mucosa; Intestinal mucosa; Gastrointestinal neoplasms ; Lipoma

Definitive diagnosis of hepatic sinusoidal obstruction syndrome induced by pyrrolizidine alkaloids

Hepatic sinusoidal obstruction syndrome (HSOS) induced by a Chinese medicinal herb Tusanqi is increasingly being reported in recent years. The aim of the study was to investigate the possibility of using blood pyrrole-protein adducts test as a confirmatory diagnostic method. Patients with HSOS according to international diagnostic criteria associated with Tusanqi from January 2006 to August 2010 in Zhongshan Hospital Fudan University were included and clinical features were collected. Pyrrole-protein adducts in blood sample were determined with ultra performance liquid chromatography-mass spectrometry (UPLC-MS) while pyrrolizidine alkaloids (PAs) in available herbal preparations were analyzed by high performance liquid chromatography-ultraviolet (HPLC-UV). Five patients (age 41-72 years, median age 54 years, all women) were included. Ascites (5/5), jaundice (5/5) and hepatomegaly (4/5) were common manifestations. The imaging features were diffused, patchy hepatic enhancement, periportal edema and ascites. Pathology ascertained that blood flow was obstructive at the site of sinusoid. PAs (Seneionine and seneciphylline) were identified in all the three available herbal preparations ingested by the HSOS patients. Pyrrole-protein adducts were unequivocally found in all the five blood samples. Two patients recovered, two developed chronic illness and one died due to liver failure and hepatic encephalopathy. The detection of blood pyrrole-protein adducts using a UPLC-MS approach is a specific, reliable, unambiguous and confirmatory test for HSOS induced by PA, and should be used together with the conventional HSOS clinical diagnostic criteria for the definitive diagnosis of PA-induced HSOS.

Effects of circumferential stretch vs. deep injury on the in-stent neointimal formation in the atherosclerotic iliac rabbit arteries

Effects of circumferential stretch vs. deep injury on the in-stent neointimal formation in the atherosclerotic iliac rabbit arteries Jianing Yue , Takamitsu Nakamura, Yuqi Wang , Weiguo Fu, Dongming Guo , Nicolas Chronos c Vascular Surgery Department of Zhongshan Hospital Fudan University, Shanghai, China Department of Internal Medicine II, University of Yamanashi, Chuo, Japan Saint Joseph's Translational Research Institute, Atlanta, GA, USA

Prognostic analysis of 669 liver metastasis of colorectal cancer cases

To evaluate the relation between different therapy and survival rate of liver metastasis of colorectal cancer (LMCC). Clinical data of 669 LMCC patients,collected from Fudan University Zhongshan Hospital from January 2000 to July 2008, were analyzed retrospectively. Of the 669 cases, 379 cases were synchronous liver metastases(SLM) and 290 cases were metachronous liver metastases(MLM). There were no significant differences in age, gender and position of primary tumor between SLM and MLM groups(P>0.05), but as to liver metastasis characteristics(liver lobe involved, focus number and maximal focus diameter) and CEA, CA19-9 before therapy,there were significant differences(P<0.05). Two hundred and fifty-three cases underwent curative hepatic resection, including 123 cases in SLM and 130 cases in MLM. Until October 31, 2008, all the cases were followed up. The median survival time of SLM was(11+/-1) months and of MLM(23+/-2) months(P<0.01). Five-year survival rate of SLM was 6.4% and of MLM 11.4%(P<0.01). As to different treatments, median survival time and 5-year survival rate of curative hepatic resection group were 37 months and 35.6%, and of non-operation groups(i.e. intervention, chemotherapy, radiofrequency therapy and percutaneous ethanol injection) were 5 to 26 months and 0 to 3.6% respectively(P<0.05). Curative hepatic resection is the first choice of liver metastasis of colorectal cancer, which can improve the survival rate. Resection rate and survival of MLM are better than those of SLM.