Shifting from clinical to biologic indicators of prognosis after resection of hepatic colorectal metastases

Pawlik, Timothy M.; Choti, Michael A.

doi:10.1007/s11912-007-0021-4

Cited by 16 publications

(11 citation statements)

References 99 publications

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“…[8][9][10] In fact, high levels of pre-hepatectomy CEA have been associated with long-term post-operative outcomes and have been incorporated into clinical risk scores. 5,6,[11][12][13] Many of these studies have, however, reported different pre-operative CEA cut-off levels (i.e. >5, 10, >30, >60, >100 and >200 ng/mL) as being independently predictive of prognosis.…”

Section: Introductionmentioning

confidence: 99%

Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

Sasaki

Margonis

Andreatos

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

Sasaki

Margonis

Andreatos

et al. 2016

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“…Predictors of clinical outcome following liver resection have been thoroughly investigated and include the following: Primary tumour grade; number and size of liver metastases and whether they are synchronous or metachronous; period of disease-free survival; presence of extrahepatic disease; and resection margin (6,7). These parameters have significant limitations and are based on population data rather than being individualized for each patient.…”

Section: Introductionmentioning

confidence: 99%

The incidence of mismatch repair gene defects in colorectal liver metastases

Alvarado-Bachmann

Smith

Gundara

et al. 2014

Molecular Medicine Reports

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Abstract. Knowledge of the molecular biology of primary colorectal cancer (CRC) has improved in recent years, and one reason for this is the identification of microsatellite instability (MSI), which occurs in up to 15% of sporadic CRC. However, less is known regarding the processes involved in colorectal liver metastases (CRLM). Increasing numbers of patients with CRLM are suitable for curative resection, so the identification of molecular markers may improve patient selection. The aim of the present study was to characterise the incidence of MSI in resected CRLM. Fifty-one sequentially resected CRLM specimens were selected. Clinicopathologic data was collated and immunohistochemistry for MLH1 and MSH2 was performed on paraffin sections of the CRLM specimens. The association between abnormal staining and the clinicopathological data was examined. The median age of the subjects in the current study was 65 years, the average number of CRLM was 2 and the median overall survival time was 42.1 months post liver resection. None of the 50 resected specimens demonstrated abnormal staining for MLH1 or MSH2. Compared with the previously reported incidence of MSI in primary CRC, the low incidence of MSI in the current cohort of CRLM precludes its use as a marker for use in making clinical decisions regarding this condition.

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“…This underscores the need for a new prognostic model that uses biologic and clinicopathologic factors to guide treatment of the patients with SCLM (11,12).…”

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confidence: 99%

“…This underscores the need for a new prognostic model that uses biologic and clinicopathologic factors to guide treatment of the patients with SCLM (11,12). 18 F-FDG PET/CT uses the increased rates of glucose metabolism in tumors to characterize the biology of different cancers, with several studies having reported that high rates of 18 F-FDG uptake in tumors are associated with increased aggressiveness and poor survival (13,14).…”

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confidence: 99%

Prognostic Value of Metabolic Parameters in Patients with Synchronous Colorectal Cancer Liver Metastasis Following Curative-Intent Colorectal and Hepatic Surgery

et al. 2014

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Synchronous colorectal cancer liver metastasis (SCLM) remains a clinical challenge, largely because of the limited availability of tools that use reliable prognostic indicators to guide treatment. This study assessed the prognostic ability of preoperative 18 F-FDG PET/ CT in patients with SCLM who had undergone curative-intent colorectal and liver surgery. Methods: All included patients had undergone simultaneous colorectal and hepatic surgery to treat SCLM. Cox regression for survival analysis was undertaken using clinicopathologic variables and metabolic parameters (metabolic tumor volume [MTV], total lesion glycolysis [TLG], and peak standardized uptake value [SUV peak ]) as covariates, with tumor recurrence and death used as endpoints. Results: One hundred twenty patients (82 men, 38 women; mean age ± SD, 59.9 ± 10.1 y) met the inclusion and exclusion criteria. Univariate analysis showed that MTV, TLG, and the size of hepatic metastases were significant indicators of both recurrence-free survival and overall survival, whereas those of primary colorectal tumors were not. Multivariate analysis revealed that the SUV peak of primary tumors and hepatic metastases remained significant after adjusting for other clinicopathologic variables, whereas the MTV and TLG of hepatic metastases became insignificant after adjusting for differences in tumor size. The combination of a high SUV peak of hepatic metastases and a low SUV peak of primary tumors was related to poor prognosis under the multivariate model. Conclusion: In patients with SCLM who underwent curative-intent colorectal and liver surgery, metabolic parameters of hepatic metastases possess prognostic significance whereas those of primary colorectal tumors do not. For hepatic metastases, the SUV peak is an independent prognostic factor, whereas MTV and TLG are surrogate measures of tumor size. Reduced recurrencefree survival rates are associated with higher SUV peak for hepatic metastases and lower SUV peak for primary tumors. Further studies are needed to elucidate the underlying mechanisms. Col orectal cancer (CRC) accounts for much of the global morbidity and mortality associated with cancer, especially in developed countries. The liver is the single most common site of distant metastasis; up to 50% of CRC patients develop liver metastasis during the course of the disease, and 20%225% of patients with newly diagnosed CRC present with synchronous liver metastasis at the time of initial diagnosis (1-3).Hepatic metastasectomy is the standard of care to treat liver metastasis when curative surgery is feasible. However, the prognosis after hepatectomy is poor, with the 5-and 10-y survival rates after hepatectomy being approximately 40% and 25%, respectively (4). The prognosis is even poorer for patients with synchronous hepatic metastasis (a hepatic metastasis presented at the same time of its primary colorectal tumor) than for those with metachronous hepatic metastasis (a hepatic metastasis that has developed after the resection of the primary colorectal tumor) ...

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Shifting from clinical to biologic indicators of prognosis after resection of hepatic colorectal metastases

Cited by 16 publications

References 99 publications

Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

Pre-hepatectomy carcinoembryonic antigen (CEA) levels among patients undergoing resection of colorectal liver metastases: do CEA levels still have prognostic implications?

The incidence of mismatch repair gene defects in colorectal liver metastases

Prognostic Value of Metabolic Parameters in Patients with Synchronous Colorectal Cancer Liver Metastasis Following Curative-Intent Colorectal and Hepatic Surgery

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