目的 分析门静脉系统三维解剖结构及其与左侧结直肠癌肝转移灶分布的关系。方法 选取2009年11月至2012年9月期间笔者所在医院行上腹部CT检查的181 例患者作为研究对象，观察其CT影像学资料并重建门静脉系统三维图像，进行门静脉系统解剖结构分型，并分析其中61例左侧结直肠癌伴肝转移患者的CT或MR二维图像及其临床资料，记录肿瘤原发部位，观察肝转移病灶的位置、数目以及门静脉系统的解剖类型。结果 肠系膜上静脉（SMV）和脾静脉（SV）汇合成门静脉主干（MPV），在肝门处分为门静脉右支（RPV）和门静脉左支（LPV） 进入肝脏（A型）者占83.98% （152/181），其中肠系膜下静脉（IMV）汇入SMV （A1亚型） 65例 （35.91%），IMV汇入SV （A2亚型）64例（35.36%），IMV汇入门静脉角（A3亚型） 23例（12.71%）；其他变异（B、C和D型）者29例，占16.02%。61例左侧结直肠癌伴肝转移患者中，IMV汇入门静脉角者12例，其肝转移灶均分布在肝左右叶（100%）；而IMV汇入SMV或SV者49例，其肝转移灶分布在肝左右叶者30例（61.22%），分布在肝左或右叶者19例（38.78%），两种IMV汇入门静脉类型其肝转移灶分布构成比的差异有统计学意义（P＜0.05）。在39例IMV汇入SV的患者中，肝内门静脉为2支型（A2亚型）者28例，其肝转移灶分布在肝左右叶者21例（75.00%），分布在肝左或右叶者7例（25.00%）；而肝内门静脉为3支型（B2＋C2亚型）的11例中，肝转移灶分布在肝左右叶者3例（27.27%），分布在肝左或右叶者8例（72.73%），两者的肝转移灶分布构成比的差异也有统计学意义（P＜0.01）。结论 门静脉系统的解剖结构复杂多变，与左侧结直肠癌肝转移病灶的分布密切相关。
Objective To investigate the change of immunologic gene expression in cases of colorectal cancer with liver metastasis. Methods The total RNAs were extracted from tumor tissues of original lesions in 16 patients with colorectal cancer， DNA microarray was used to examine the change of immunologic gene expression in colorectal cancer patients with or without liver metastasis. Results Compared with samples without liver metastases， the expressions of 11 immunologic genes obviously down-regulated in the tumor tissues of colorectal cancer patients with liver metastasis， including：carboxypeptidase D；Fc fragment of IgE， high affinityⅠreceptor for gamma polypeptide；Fc fragment of IgG， low affinityⅢa receptor （CD16a）；free fatty acid receptor 2；interleukin 2 receptor gamma；protein tyrosine phosphatase receptor type C；complement factor B；major histocompatibility complex， classⅡ， DM alpha；major histocompatibility complex， classⅡ， DM beta；major histocompatibility complex， classⅡ， DQ alpha 1；granzyme B. The functions involved the growth and activation of immunologic cell， signal transduction， cell apoptotic， cell factors， receptors， complement， apoptotic， and immunogenicity of tumor cell. Conclusions Down-regulation of a various of immunologic gene expression in colorectal cancer patients with liver metastasis inhibits the function of immunology， and tumor cells escaped the destruction of immunology system results in metastasis.
ObjectiveTo understand the latest progress of conversion therapies on increasing surgical resection rate of patients with liver metastasis from colorectal carcinoma, evaluate the clinical value of prognostic evaluation model in surgical resection of patients with liver metastasis from colorectal carcinoma, further offer guidance in comprehensive treatment to control disease and improve the quality of life. MethodsThe literatures about new progress in surgical treatment of liver metastasis from colorectal carcinoma at domestic and abroad were reviewed, including the indication of operation, prognostic evaluation model, and how to increase the resection rate for liver metastasis from colorectal carcinoma patients with conversion therapies. ResultsPart of patients with liver metastasis from colorectal carcinoma could get surgeries after accepting positive conversion therapies.For the patients with liver metastases from colorectal carcinoma did not accepted surgeries all the way, it was a safe and effective treatment method by different conversion therapies such as neoadjuvant chemotherapy, molecular targeted therapy, transcatheter arterial chemoembolization, radiofrequency ablation, and so on, and it could improve the quality of life and prolong the survival time. ConclusionsDoctors should pay attention to conversion therapies of patients with liver metastasis from colorectal carcinoma, and promote the usage of the prognostic evaluation model in liver metastasis from colorectal carcinoma.
ObjectiveTo understand the latest progress of transcatheter arterial chemoembolization (TACE)-based combination therapies for unresectable liver metastasis from colorectal carcinoma, and to explore the safe and effective combination therapies in order to controlling the rapid progress of disease and improving the quality of life of patients. MethodsThe literatures about TACE-based combination therapies of liver metastasis from colorectal carcinoma and the latest advance in researches of this field at home and abroad were collected, and the application of combination therapies, the advantages and features of the combined treatments were reviewed. ResultsTACE was a safe and effective therapeutic modality in treating primary liver cancer or secondary liver cancer.Compared with a single treatment, TACE-based combination therapies had distinct advantages to patients with liver metastasis from colorectal carcinoma not only improved the quality of life but also prolonged the survival time.With the emerging of various kinds of new drugs and the rapid development of a variety of interventional treatments, it could bring long-term survival benifit for patients with liver metastasis from colorectal carcinoma. ConclusionsDoctors should pay attention to the combined treatments of patients with liver metastasis from colorectal carcinoma, improve the knowledge of personalized medication about advanced tumors and actively promote more usage of combination therapies.
ObjectiveTo analyze the influence of different surgical methods on survival and relapse-free survival in colorectal liver metastases. MethodsClinical data of 71 cases of colorectal liver metastases who treated in PLA General Hospital from January 2002 to may 2013 were collected retrospectively, to analyzed the effect of different surgical methods on survival and relapse-free survival of this kind of cases. ResultsAll of primary lesions underwent radical resection. And for the liver metastases, 20 cases didn't received any intervention (non-intervention group), 20 cases underwent resection of liver metastases, 20 cases underwent radiofrequency ablation, and 11 cases underwent radiofrequency ablation and resection of liver metastases (all 61 cases who received intervention were classified to intervention group). Results of Cox proportional hazards model showed that, in the condition of controlling other confounding factors, intervention can improve the survival (HR=1.724, P=0.043) and relapse-free survival (HR=0.701, P=0.048) of cases of colorectal liver metastases, cases who received intervention had better survival situation and the relapse-free survival situation. ConclusionFor cases of colorectal liver metastases, in condition of radical operation for colorectal cancer, the intervention for liver metastases can prolong the survival time and relapse-free survival time.
ObjectiveBy analyzing the correlation between the clinicopathological features of patients with colorectal liver metastases (CRLM) and their postoperative survival, this study is aimed to identify new and accurate prognostic indicators on the prognoses to provide a reference of the treatment strategy selection for patients with CRLM. MethodsThe clinical data of 233 patients with CRLM who received operation treatments in the Eastern Hepatobiliary Hospital of the Second Military Medical University from January 2006 to December 2009 were retrospectively investigated, and their clinicopathological features, as well as their prognosis were analyzed. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival. ResultsThe median survival time after cancer resection was 37.0 months, with cumulative 1-year, 3-year, and 5-year survival rates of 93.0%, 61.0%, and 17.0%, respectively. The median survival time, with cumulative 3-year, and 5-year survival rates of patients who had received radical operations was better than the others who received palliative operations:40.53 months vs 27.20 months, 59.0% vs 29.0%, and 20.0% vs 0(P < 0.05), respectively. In overall surviva, the results of univariate analysis showed that 13 factors, including surgical method, the first relapse after liver metastasis resection, the number of liver metastases, surgical margin, other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, whether any chronic liver disease was associ-ated, preoperative serum CEA level, preoperative serum CA19-9 leve, the position of the liver metastases, whether the liver metastasis capsule was complete, TNM stagethe of primary cancer, whether the liver metastasis was simultaneous liver metastases, and the maximum diameter of the liver metastases, were closely related to the clinicopathological features associated with prognosis and the differences were statistically significant (P < 0.05). The results of multivariate survival analysis demonstrated that received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM (P < 0.05). ConclusionsIt is important for long-term survival of patients with CRLM who were received operations. Received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases>3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM.
This study aims to investigate the value of pre-treatment computed tomography (CT) texture analysis in predicting therapeutic response of liver metastasis from colorectal cancer after combined targeting chemotherapy. A total of 82 patients with colorectal cancer liver metastases who underwent chemotherapy combined with targeted therapy (cetuximab) between March 2011 and October 2017 comprised this retrospective study population. According to the RECIST1.1, the best curative effect evaluation of patients was recorded. Complete response (CR) and partial response (PR) were assigned to the response group, and the stable disease (SD) and progressive disease (PD) were assigned to the non-response group. The CT texture analysis was based on the Omini-Kinetics software, and the three-dimensional (3D) texture analysis was performed on the marked lesion on portal phase. The differences of texture parameters between the response group and the non-response group were compared. The receiver operating characteristic (ROC) curves were depicted on the parameters which with statistically difference, to characterize value in predicting the response to target-combined chemotherapy. The differences of Entropy, Energy, Variance, std. Deviation, Quantile95 and sumEntropy between the two groups in pre-treatment lesions were significant (P < 0.05). And lesions with higher Entropy, lower Energy, higher Variance, higher std Deviation and higher sumEntropy seemed to indicate a better therapeutic response. When sumEntropy > 0.867, good diagnostic efficiency could be obtained, with sensitivity of 60.5% and specificity of 79.5%, respectively. In conclusion, texture parameters derived from baseline CT images of colorectal cancer liver metastasis have the potential value acting as imaging biomarkers in predicting tumor response to combined target chemotherapy.
ObjectiveTo summarize the research progress and clinical efficacy of hepatic artery infusion chemotherapy in the treatment of colorectal cancer liver metastasis.MethodThe literatures of hepatic artery infusion chemotherapy for colorectal cancer liver metastasis were collected and reviewed.ResultsThe incidence of colorectal cancer liver metastasis was high, which affected the prognosis of patients. Surgical treatment was the preferred treatment for colorectal cancer liver metastasis. Hepatic arterial infusion chemotherapy could be used for preoperative neoadjuvant therapy and postoperative adjuvant therapy.ConclusionsHepatic arterial infusion chemotherapy is an effective local treatment for colorectal cancer liver metastasis and can be used as a supplement to surgical treatment. Compared with systemic chemotherapy, hepatic arterial infusion chemotherapy combined with systemic chemotherapy can improve the overall survival and disease-free survival, reduce the risk of intrahepatic recurrence, and improve the prognosis of patients.