Clinical implications of disappearing colorectal liver metastases have changed in the era of hepatocyte-specific MRI and contrast-enhanced intraoperative ultrasonography

Oba, Atsushi; Mise, Yoshihiro; Ito, Hiromichi; Hiratsuka, Makiko; Inoue, Yosuke; Ishizawa, Takeaki; Arita, Junichi; Matsueda, Kiyoshi; Takahashi, Yu; Saiura, Akio

doi:10.1016/j.hpb.2018.02.377

Cited by 36 publications

(27 citation statements)

References 20 publications

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“…The size of the study population varied from 15 to 184 patients, with the total number of liver lesions ranging from 37 to 533. Of all studies, three claimed that they were prospectively designed 11,19,20 , eleven were retrospectively designed 9,10,[21][22][23][24][25][26][27][28][29] , and the remaining were unclear [30][31][32] . The principal characteristics of the included studies are summarized in Table 1 and Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…For the patient selection domain, three studies were considered to possess a high risk of bias due to nonconsecutive enrollment procedures 22,24,29 . Two studies were considered to have high concern for applicability; one study only included patients with histologically uniform primary tumor and with oligometastasis (<5 metastases) 24 , and one study addressed only those LM that responded to preoperative chemotherapy 28 . For the index test domain, there was a high risk of bias in two studies, as it was not clear whether the interpretation of MRI was blinded to the reference standard 9,29 .…”

Section: Quality Assessment and Evaluation Of Publication Bias The Qmentioning

confidence: 99%

“…Additionally, our results showed that MRI detection accuracy for CRLM was greater in studies from Asia than in those from Europe or America, although this difference was statistically nonsignificant. It is unclear why the result favored studies from Asia, however, the four studies from Asia were almost all the most recently published papers (one in 2015 9 , one in 2017 31 , and the other two in 2018 10,28 ). Although our results did not show a year-related trend when the studies before and after 2010 were compared, a previous meta-analysis did indicate that MRI sensitivity in the detection of CRLM in studies after 2004 was significantly increased compared with those before 2004 36 .…”

Section: Covariates Subgroupsmentioning

confidence: 99%

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Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis

Mao

Chen

Wang

et al. 2020

Sci Rep

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the prognosis of colorectal cancer (cRc) is largely dependent on the early detection of hepatic metastases. With the advantages of nonradioactivity and the availability of multiple scanning sequences, the efficacy of magnetic resonance imaging (MRI) in the detection of colorectal liver metastases (cRLM) is not yet clear. We performed this meta-analysis to address this issue. pubMed, embase, and the cochrane Library were searched for studies reporting diagnostic performance of MRi for cRLM. Descriptive and quantitative data were extracted. The study quality was evaluated for the identified studies and a random effects model was used to determine the integrated diagnosis estimation. Metaregression and subgroup analyses were implemented to investigate the potential contributors to heterogeneity. As a result, seventeen studies were included for analysis (from the year 1996 to 2018), comprising 1121 patients with a total of 3279 liver lesions. The pooled sensitivity, specificity, and diagnostic odds ratio were 0.90 (95% confidence intervals (CI): 0.81-0.95), 0.88 (0.80-0.92), and 62.19 (23.71-163.13), respectively. The overall weighted area under the curve was 0.94 (0.92-0.96). Using two or more imaging planes and a quantitative/semiquantitative interpretation method showed higher diagnostic performance, although only the latter demonstrated statistical significance (P < 0.05). Advanced scanning sequences with DWI and liver-specific contrast media tended to increase the sensitivity for cRLM detection. We therefore concluded that contemporary MRi has high sensitivity and specificity for screening CRLM, especially for those with advanced scanning sequences. Using two or more imaging planes and adopting a quantitative/semiquantitative imaging interpretation may further improve diagnosis. However, the MRi results should be interpreted with caution because of substantial heterogeneity among studies. Colorectal cancer (CRC) is one of the most common malignancies in the world. In recent decades, the mortality rate of CRC has decreased due to the development of diagnostic techniques and optimization of treatment strategies, including surgery, chemotherapy and palliative therapies 1. However, the incidence of CRC is increasing in the general population, especially in those younger than 40 years old 2. The prognosis of CRC patients is largely dependent on local tumor staging and the presence of distant metastasis. In those metastatic cases, the liver is the most frequently involved organ, followed by the lung 3,4. Almost one out of five patients present with liver metastases (LM) at the diagnosis of CRC 5 , and up to 50% of patients manifests LM at some time during the disease course 6 .

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Section: Resultsmentioning

confidence: 99%

Section: Quality Assessment and Evaluation Of Publication Bias The Qmentioning

confidence: 99%

Section: Covariates Subgroupsmentioning

confidence: 99%

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Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis

Mao

Chen

Wang

et al. 2020

Sci Rep

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“…Routine use of preoperative chemotherapy was not adopted until 2010. After 2010, preoperative chemotherapy was routinely performed for patients with ≥ four CRLMs or those with CRLMs > 50 mm or those with resectable extrahepatic metastases by imaging studies [24].…”

Section: Indications For Hepatectomy For Crlmsmentioning

confidence: 99%

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

Hata

Mise

Sato

et al. 2020

Preprint

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Background Limited data describe the therapeutic practice and outcomes of colorectal liver metastases (CRLMs) in elderly patients. We aimed to evaluate the impact of age on multidisciplinary treatment for CRLMs. Methods We reviewed treatment and outcomes for patients in different age groups who underwent initial hepatectomy for CRLMs from 2004 through 2012. Results We studied 462 patients who were divided into three groups by age: ≤ 64 years (n = 265), 65-74 years (n = 151), and ≥ 75 years (n = 46). The rate of major hepatectomy and incidence of postoperative complications did not differ between groups. Adjuvant chemotherapy was used less in the ≥ 75 -year group (19.6%) than that in the ≤ 64 (54.3%) or 65-74 age group (43.5%). Repeat hepatectomy for liver recurrence was performed less in the ≥ 75 -year group (35%) than in the ≤ 64 (57%) or 65-74 (66%) age group. The 5-year disease-specific survival (DSS) rate of 44.2% in the ≥ 75 -year group was lower than in the ≤ 64 (59.0%) or 65-74 (64.7%) age group. Multivariate analysis revealed age ≥ 75 years was an independent predictor of poor DSS. Conclusions Liver resection for CRLMs can be performed safely in elderly patients. However, repeat resection for recurrence are performed less frequently in the elderly, which may lead to the poorer disease-specific prognosis.

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“…However, no universal approach exists for the assessment and management of DLM. Using recent advances in MRI technology combined with intraoperative ultrasound (IOUS), it has been possible to identify DLM with residual tumors with accuracies reaching as high as 83 and 90% [8,9]. It is however unclear whether it is safe to leave in situ those CRLM that have become undetectable by pre-and intraoperative imaging after chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review

et al. 2020

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Background Approximately 30% of patients with colorectal cancer develop colorectal liver metastases (CRLM). CRLM that become undetectable by imaging after chemotherapy are called disappearing liver metastases (DLM). But a DLM is not necessarily equal to cure. An increasing incidence of patients with DLM provides surgeons with a difficult dilemma: to resect or to not resect the original sites of DLM? The aim of this review was to investigate to what extent a DLM equates a complete response (CR) and to compare outcomes. Methods This review was conducted in accordance with the PRISMA guidelines and registered in Prospero (registration number CRD42017070441). Literature search was made in the PubMed and Embase databases. During the process of writing, PubMed was repeatedly searched and reference lists of included studies were screened for additional studies of interest for this review. Results were independently screened by two authors with the Covidence platform. Studies eligible for inclusion were those reporting outcomes of DLM in adult patients undergoing surgery following chemotherapy. Results Fifteen studies were included with a total of 2955 patients with CRLM. They had 4742 CRLM altogether. Post-chemotherapy, patients presented with 1561 DLM. Patients with one or more DLM ranged from 7 to 48% (median 19%). Median DLM per patient was 3.4 (range 0.4–5.6). Patients were predominantly evaluated by contrast-enhanced computed tomography (CE-CT) before and after chemotherapy, with some exceptions and with addition of magnetic resonance imaging (MRI) in some studies. Intraoperative ultrasound (IOUS) was universally performed in all but two studies. If a DLM remained undetectable by IOUS, this DLM represented a CR in 24–96% (median 77.5%). Further, if a DLM on preoperative CE-CT remained undetectable by additional workup with MRI and CE-IOUS, this DLM was equal to a CR in 75–94% (median 89%). Patients with resected DLM had a longer disease-free survival compared to patients with DLM left in situ but statistically significant differences in overall survival could not be found. Conclusion Combination of CE-CT, MRI, and IOUS showed promising results in accurately identifying DLM with CR. This suggests that leaving DLM in situ could be an alternative to surgical resection when a DLM remains undetectable by MRI and IOUS.

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Clinical implications of disappearing colorectal liver metastases have changed in the era of hepatocyte-specific MRI and contrast-enhanced intraoperative ultrasonography

Abstract: EOB-MRI and CE-IOUS exploration identified clinically relevant DLMs containing viable disease with a high level of accuracy.

Cited by 36 publications

References 20 publications

Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis

Diagnostic performance of magnetic resonance imaging for colorectal liver metastasis: A systematic review and meta-analysis

Original Clinical Investigation Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

Imaging in disappearing colorectal liver metastases and their accuracy: a systematic review

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