Objective To investigate the influence of cationic liposomemediated endostatin gene on colorectal cancer liver metastasis. Methods Animal model for colorectal carcinoma liver metastasis were established. The plasmid expressing endostatin genelipofectAMINE were injected in vein. Results After cationic liposomemediated endostatin gene were injected in vein, the incidence of liver metastasis and mean numbers of liver tumors were decreased, survival time of animal was significantly longer. Conclusion Intravenous injection of cationic liposomemediated endostatin gene can control the development of colorectal cancer liver metastasis effectively.
We evaluated the surgical results in 32 patients with liver metastasis from colorectal carcinoma. Twenty four patients had 1-3 metastatic hepatic nodules and 20 patients had synchronous hepatic metastasis. Liver resection was carried out simultaneously with radical resection of the primary tumour in 15 patients, 5 patients experienced resection 2 to 4 weeks later. Liver and primary tumour were resected as a whole in 5 patients with infiltrating metastasis from colonic carcinoma.Other operative types included atypical resections, left lateral lobectom and right posterior lobectomy, and right hemihepatactomy, right trilobectomy.Hepatic metastasis were all documented by pathology. The 3year and 5year survival rate were 37.5% and 25.0%, with no operative death. The authors believed that the number of metastasis is the most important factor influencing the surgical result, and liver resection is an effective form of treatment for patients with resectable liver metastasis from colorectal carcinoma, but the type of surgery shall be choosed reasonably.
Ｔｈｅ ｔｈｅｒａｐｅｕｔｉｃ ｒｅｓｕｌｔｓ ｏｆ ３６ ｃａｓｅｓ ｏｆ ｇａｓｔｒｉｃ ｃａｎｃｅｒ ｗｉｔｈ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｅｓ ｃｏｎｆｉｒｍｅｄ ｂｙ ｏｐｅｒａｔｉｏｎ ａｎｄ ｐａｔｈｏｌｏｇｉｃａｌ ｅｘａｍｉｎａｔｉｏｎ ａｒｅ ｒｅｐｏｒｔｅｄ．Ｉｔ ｓｕｇｇｅｓｔｓ ｔｈａｔ ｏｐｅｒａｔｉｏｎｓ ｓｈｏｕｌｄ ｎｏｔ ｂｅ ｇｉｖｅｎ ｕｐ ｅｖｅｎ ｈｅｐａｔｉｃ ｍｅｔａｓｔａｓｅｓ ｈａｖｅ ｏｃｃｕｒｅｄ．Ｒａｄｉｃａｌ ｒｅｓｅｃｔｉｏｎ ｏｆ ｐｒｉｍａｒｙ ｃａｎｃｅｒ ｃｏｎｃｏｍｉｔａｎｔ ｗｉｔｈ ｔｒｅａｔｍｅｎｔ ｏｆ ｍｅｔａｓｔａｓｉｓ ａｎｄ ｏｔｈｅｒ ｐｒｏｃｅｄｕｒｅｄ ｃｏｕｌｄ ｒｅｌｉｅｖｅ ｓｙｍｐｔｏｍｓ，ｐｒｏｍｏｔｅ ｓｕｒｉｖａｌ ｄｕｒａｔｉｏｎ ａｎｄ ｑｕａｌｉｔｙ．Ｐｒｏｃｅｄｕｒｅｄ ｆｏｒ ｔｒｅａｔｉｎｇ ｐｒｉｍａｒｙ ｈｅｐａｔｉｃ ｃａｎｃｅｒ ａｒｅ ａｌｓｏ ｕｓｅｆｕｌ ａｓ ｗｅｌｌ ａｓ ｍｅｔａｓｔａｔｉｃ ｈｅｐａｔｉｃ ｃａｎｃｅｒ．
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 analyze the relationship between Glasgow prognostic score （GPS）， liver metastasis， and prognosis of rectal caner. Methods Clinical data of 223 patients with rectal cancer who underwent operation in Chinese PLA General Hospital from Jun. 2005 to Dec. 2011 were retrospectively analyzed， and the relationship between preoperative GPS score， liver metastasis， and prognosis of rectal cancer were analyzed. Results Preoperative GPS score of patients with rectal cancer was related to invasion depth （P＜0.001）， vascular or lymphatic invasion （P＜0.001）， liver metastasis （P＜0.001）， TNM stage （P＜0.001）， levels of carcinoembryonic antigen （P=0.009）， levels of CA19-9（P＜0.001）， and levels of CA724 （P＜0.001）. Multivariate analysis results revealed that differentiation of tumor （poorly：OR=10.688）， vascular or lymphatic invasion （OR=4.918）， lymph node metastasis （OR=3.359）， and preoperative GPS score （score 2：OR=15.907） were related to liver metastasis；age （RR=2.121）， differentiation of tumor （poorly：RR=2.846）， invasion depth （RR=1.754）， TNM stage （stageⅡ：RR=7.447， stageⅢ：RR=9.030， stage Ⅳ：RR=13.325）， and preoperative GPS score （score 2：RR=2.471） were the independently prognostic factors of rectal cancer. The preo- perative GPS score were related with both liver metastasis and prognosis of rectal cancer. Conclusion Preoperative GPS score is associated with liver metastasis of rectal cancer， and it is considered to be a useful predictor of postoperative prognosis in rectal cancer.
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.
Objective To investigate the relation between the sites of colorectal cancer and liver metastatic distribution. Methods The enhanced multiple-slice spiral CT images and clinical data of 105 cases diagnosed colorectalcancer with liver metastases admitted from January 2010 to April 2012 were analyzed retrospectively. Primary site of the tumor， numbers of the metastases on CT images， and the anatomical position of the inferior mesenteric vein （IMV） terminates were recorded. Results ①The ratio of metastases in the right and left hemiliver was 2∶1 for 38 right-sided primary tumors as compared with 1.2∶1 for 67 left-sided primary tumors. The pattern of lobar distribution was significantly different in the two groups （χ2=8.709， P=0.003）. ②In the left-sided colon cancer group， the ratio of metastases in the right and left hemiliver was 65∶98 for 28 patients with IMV terminating in splenic vein （SpV）， 116∶52 for 36 patients with IMV terminating in superior mesenteric vein （SMV）， and 13∶15 for 3 patients with IMV terminating in the junction of SMV and SpV. The pattern of lobar distribution was significantly different among the three groups （χ2=28.575， P=0.000）. Further comparison between the former two groups， the difference was statistically significant （χ2=27.951， P=0.000）. ③In 25 patients with IMV terminating in SpV， the metastases of 19 cases were mainly distributed in the left lobe of liver （P=0.001）；In 34 patients with IMV terminating in SMV， the metastases of 25 cases located mainly in the right hepatic lobe （P=0.000）. Conclusions Right-sided colon cancers selectively involve the right lobe of liver， while left-sided tumors selectively involve the right lobe of liver when its IMV terminates in SMV and involve the left lobe when its IMV terminates in SpV， respectively. The discovery may help shorting the diagnostic workup in patients presenting with liver metastases from an unknown primary site， and may improve the detection rate of metastases in initial diagnosis and follow-up.