Computed Tomographic Findings of Colorectal Liver Metastases Can Be Predictive for Recurrence After Hepatic Resection

Yamaguchi, Junya; Sakamoto, Ichiro; Fukuda, Toshio; Fujioka, Hikaru; Komuta, Kou; Kanematsu, Takashi

doi:10.1001/archsurg.137.11.1294

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…Radiological imaging studies have revealed subgroups of liver metastases with different contrast enhancement and delineation, supporting the hypothesis of morphological heterogeneity (Yamaguchi et al, 2002).…”

mentioning

confidence: 68%

“…These tumours co-opt the blood vessels of the alveolar septa and are comparable to the liver metastases with a replacement growth pattern. Computed tomographic (CT) imaging of liver metastases has been shown to be predictive for recurrence after hepatic resection (Yamaguchi et al, 2002). CT contrast-enhanced images of liver metastases were subtyped according to the shape of the metastases and the irregularity of the outline of the nodules.…”

Section: Tumourmentioning

confidence: 99%

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Breast adenocarcinoma liver metastases, in contrast to colorectal cancer liver metastases, display a non-angiogenic growth pattern that preserves the stroma and lacks hypoxia

et al. 2004

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Breast adenocarcinoma liver metastases, in contrast to colorectal cancer liver metastases, display a non-angiogenic growth pattern that preserves the stroma and lacks hypoxia Although angiogenesis is a prerequisite for the growth of most human solid tumours, alternative mechanisms of vascularisation can be adopted. We have previously described a non-angiogenic growth pattern in liver metastases of colorectal adenocarcinomas (CRC) in which tumour cells replace hepatocytes at the tumour -liver interface, preserving the liver architecture and co-opting the sinusoidal blood vessels. The aim of this study was to determine whether this replacement pattern occurs during liver metastasis of breast adenocarcinomas (BC) and whether the lack of an angiogenic switch in such metastases is due to the absence of hypoxia and subsequent vascular fibrinogen leakage. The growth pattern of 45 BC liver metastases and 28 CRC liver metastases (73 consecutive patients) was assessed on haematoxylin-and eosin-stained tissue sections. The majority of the BC liver metastases had a replacement growth pattern (96%), in contrast to only 32% of the CRC metastases (Po0.0001). The median carbonic anhydrase 9 (CA9) expression (M75 antibody), as a marker of hypoxia, (intensity Â % of stained tumour cells) was 0 in the BC metastases and 53 in the CRC metastases (Po0.0001). There was CA9 expression at the tumour -liver interface in only 16% of the BC liver metastases vs 54% of the CRC metastases (P ¼ 0.002). There was fibrin (T2G1 antibody) at the tumour-liver interface in only 21% of the BC metastases vs 56% of the CRC metastases (P ¼ 0.04). The median macrophage count (Chalkley morphometry; KP-1 anti-CD68 antibody) at the interface was 4.3 and 7.5, respectively (Po0.0001). Carbonic anhydrase 9 score and macrophage count were positively correlated (r ¼ 0.42; P ¼ 0.002) in all metastases. Glandular differentiation was less in the BC liver metastases: 80% had less than 10% gland formation vs only 7% of the CRC metastases (Po0.0001). The liver is a densely vascularised organ and can host metastases that exploit this environment by replacing the hepatocytes and co-opting the vasculature. Our findings confirm that a nonangiogenic pattern of liver metastasis indeed occurs in BC, that this pattern of replacement growth is even more prevalent than in CRC, and that the process induces neither hypoxia nor vascular leakage.

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mentioning

confidence: 68%

Section: Tumourmentioning

confidence: 99%

Breast adenocarcinoma liver metastases, in contrast to colorectal cancer liver metastases, display a non-angiogenic growth pattern that preserves the stroma and lacks hypoxia

et al. 2004

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“…In a study by Lunevicius [8] that focussed on those tumours surrounded by desmoplastic stroma, it was suggested that local, but not distant, recurrence following liver surgery was lower in the desmoplastic group and that overall survival was greater in these patients, although this was not statistically significant. In another study, computed tomographic imaging of liver metastases has been shown to be predictive for recurrence after hepatic resection [9]. When liver metastases were subtyped according to the shape of the metastases and the irregularity of the outline of the nodules on the CT image, liver metastases with the most irregular shape and contour were predictive of reduced 5 year disease-free survival.…”

Section: Introductionmentioning

confidence: 94%

The histological growth pattern of colorectal cancer liver metastases has prognostic value

Eynden

Bird

Majeed

et al. 2012

Clin Exp Metastasis

114

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Little is known about the biological characteristics that determine the prognosis of colorectal cancer (CRC) liver metastases. In previous work we reported three different histological patterns of the tumour-liver interface of CRC liver metastases, termed the pushing, replacement and desmoplastic growth pattern (GP). The purpose of this study was to confirm differences in angiogenic and hypoxic properties of CRC liver metastases with different GPs in a large data set and to study the value of the GP as a prognostic factor. In 205 patients undergoing a resection of CRC liver metastases, the GP of the metastasis was determined using haematoxylin-eosin and Gordon Sweet's silver staining. The tumour cell proliferation fraction (TCP%), endothelial cell proliferation fraction (ECP%) and carbonic anhydrase 9 (CA9) expression were determined using immunohistochemistry. Standard clinicopathological data and overall survival were recorded. 27.8, 15.6, 34.6 and 17.6 % of liver metastases had a replacement, pushing, desmoplastic and mixed GP, respectively. Analyses of TCP%, ECP% and CA9 expression demonstrated that CRC liver metastases with a replacement GP are non-angiogenic, while the ones with a pushing GP are the most angiogenic with angiogenesis being, at least partially, hypoxia-driven. GP (pushing or not) was the only independent predictor of survival at 2 years. CRC liver metastases grow according to different GP patterns with different angiogenic properties. At 2 years of follow-up a GP with a pushing component was an independent predictor of poor survival, suggesting that the pushing GP is characterized by a more aggressive tumour biology. Further elucidation of the mechanisms and biological pathways involved in and responsible for the differences in GP between CRC liver metastases in different patients might lead to therapeutic agents and strategies taking advantage of this 2 year 'window of opportunity'.

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“…Histological factors, including resection margins and infiltrative growth pattern, have been found to be predictive of survival 12 ; however, these are not useful pre-operative criteria. Further prognostic indicators include CT determination of pathologic growth pattern, 38 cell-cycle proteins Rb and p53 expression, thymidylate synthase 39 and antiapoptotic protein mcl-1, 40,41 and perioperative detection of circulating cancer cells. 42 As medical science progresses, these may become more available and be incorporated into any predictive score; however, at present, these sophisticated investigations are unlikely to be readily available in daily clinical practice.…”

Section: Commentmentioning

confidence: 99%

The Clinical Risk Score

Mann

Metcalfe²,

Leopardi³

et al. 2004

Arch Surg

106

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The purpose of this study was to examine the validity of the clinical risk score (CRS), a prognostic tool developed by Fong et al, when translated to another center. Design: This study assesses 5 independent preoperative prognostic criteria, nodal status of the primary lesion, disease-free interval, number of hepatic metastases, size of the largest metastasis, and preoperative carcinoembryonic antigen level, to determine a preoperative CRS for each patient included in the study.

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Computed Tomographic Findings of Colorectal Liver Metastases Can Be Predictive for Recurrence After Hepatic Resection

Cited by 9 publications

References 18 publications

Breast adenocarcinoma liver metastases, in contrast to colorectal cancer liver metastases, display a non-angiogenic growth pattern that preserves the stroma and lacks hypoxia

Breast adenocarcinoma liver metastases, in contrast to colorectal cancer liver metastases, display a non-angiogenic growth pattern that preserves the stroma and lacks hypoxia

The histological growth pattern of colorectal cancer liver metastases has prognostic value

The Clinical Risk Score

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