Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is o...Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.展开更多
BACKGROUND Colon cancer is one of the most common malignant tumors of the digestive system.Liver metastasis after colon cancer surgery is the primary cause of death in patients with colon cancer.AIM To construct a nov...BACKGROUND Colon cancer is one of the most common malignant tumors of the digestive system.Liver metastasis after colon cancer surgery is the primary cause of death in patients with colon cancer.AIM To construct a novel nomogram model including various factors to predict liver metastasis after colon cancer surgery.METHODS We retrospectively analyzed 242 patients with colon cancer who were admitted and underwent radical resection for colon cancer in Zhejiang Provincial People’s Hospital from December 2019 to December 2022.Patients were divided into liver metastasis and non-liver metastasis groups.Sex,age,and other general and clinicopathological data(preoperative blood routine and biochemical test indexes)were compared.The risk factors for liver metastasis were analyzed using singlefactor and multifactorial logistic regression.A predictive model was then constructed and evaluated for efficacy.RESULTS Systemic inflammatory index(SII),C-reactive protein/albumin ratio(CAR),red blood cell distribution width(RDW),alanine aminotransferase,preoperative carcinoembryonic antigen level,and lymphatic metastasis were different between groups(P<0.05).SII,CAR,and RDW were risk factors for liver metastasis after colon cancer surgery(P<0.05).The area under the curve was 0.93 for the column-line diagram prediction model constructed based on these risk factors to distinguish whether liver metastasis occurred postoperatively.The actual curve of the column-line diagram predicting the risk of postoperative liver metastasis was close to the ideal curve,with good agreement.The prediction model curves in the decision curve analysis showed higher net benefits for a larger threshold range than those in extreme cases,indicating that the model is safer.CONCLUSION Liver metastases after colorectal cancer surgery could be well predicted by a nomogram based on the SII,CAR,and RDW.展开更多
The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.Th...The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.展开更多
BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approxi...BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approximately 25%of patients with CRLM have indications for liver resection at the initial diagnosis.Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.CASE SUMMARY A 42-year-old man was diagnosed with ascending colon cancer and liver metastases.Due to the huge lesion size and compression of the right portal vein,the liver metastases were initially diagnosed as unresectable lesions.The patient was treated with preoperative transcatheter arterial chemoembolization(TACE)consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®.After four courses,radical right-sided colectomy and ileum transverse colon anastomosis were performed.Postoperatively,the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins.Thereafter,S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy.Pathological examination of the resected specimen revealed a pathologically complete response(pCR).Intrahepatic recurrence was detected more than two months after the operation,and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®.Subsequently,the patient was treated with aγ-knife to enhance local control.Notably,a pCR was reached,and the patient's overall survival time was>9 years.CONCLUSION Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.展开更多
BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventio...BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very high.Fungal liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other complications.Fungal liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal therapy.CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy.Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver metastasis.After half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection.The results of pus culture showed Candida albicans,which was sensitive to fluconazole.The patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with azvudine.During antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy.Oral fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 wk.The patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal therapy.CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal therapy.Meanwhile,complications such as COVID-19 should be actively managed and nutritional support should be provided.展开更多
BACKGROUND Carcinoembryonic antigen(CEA)is a broad-spectrum tumor marker for differential diagnosis,monitoring,and response assessment of a variety of malignancies.AIM To evaluate whether serum CEA could predict the p...BACKGROUND Carcinoembryonic antigen(CEA)is a broad-spectrum tumor marker for differential diagnosis,monitoring,and response assessment of a variety of malignancies.AIM To evaluate whether serum CEA could predict the prognosis in patients with colorectal cancer liver metastasis(CRCLM)before and after liver resection(LR).METHODS PubMed,Embase,Cochrane,and Web of Science were systematically searched to retrieve literature,with a search cut-off date of February 27,2023.Articles were strictly screened for inclusion according to pre-specified inclusion and exclusion criteria.Data were pooled and analyzed using Stata 16.0.RESULTS This meta-analysis included 36 studies involving a total of 11143 CRCLM patients.The results showed that a high pre-LR serum CEA level was correlated with poor overall survival(OS)[hazard ratio(HR)=1.61,95%confidence interval(CI):1.49-1.75,P<0.001]and recurrence-free survival(HR=1.27,95%CI:1.11-1.45,P<0.001)in CRCLM patients.A high post-LR serum CEA level predicted poor OS(HR=2.66,95%CI:2.10-3.38,P<0.001).A comparison by treatment modality,analysis modality,patient source,and cutoff-value showed that overall,high preoperative and postoperative serum CEA levels remained correlated with a poor prognosis.CONCLUSION This study concluded that high pre-LR and post-LR serum CEA levels were significantly correlated with a poor prognosis in CRCLM patients.展开更多
BACKGROUND Leiomyosarcoma(LMS)has a poor prognosis and rarely originates from the colon.If resection is possible,surgery is the first treatment most commonly considered.Unfortunately,no standard treatment exists for h...BACKGROUND Leiomyosarcoma(LMS)has a poor prognosis and rarely originates from the colon.If resection is possible,surgery is the first treatment most commonly considered.Unfortunately,no standard treatment exists for hepatic metastasis of LMS;although,several treatments,such as chemotherapy,radiotherapy,and surgery,have been used.Subsequently,the management of liver metastases remains controversial.CASE SUMMARY We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon.A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months.Colonoscopy revealed a 4-cm diameter mass in the descending colon,40 cm from the anal verge.Computed tomography revealed intussusception of the descending colon due to the 4-cm mass.The patient underwent a left hemicolectomy.Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin,and negative for cluster of differentiation 34(CD34),CD117,and discovered on gastrointestinal stromal tumor(GIST)-1,which are characteristic of gastrointestinal LMS.A single liver metastasis developed 11 mo postoperatively;the patient subsequently underwent curative resection thereof.The patient remained disease-free after six cycles of adjuvant chemotherapy(doxorubicin and ifosfamide),and 40 and 52 mo after liver resection and primary surgery,respectively.Similar cases were obtained from a search of Embase,PubMed,MEDLINE,and Google Scholar.CONCLUSION Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.展开更多
AIM:To investigate the serological diagnostic factors for liver metastasis in patients with colorectal cancer.METHODS:One hundred and six adult in-patients with colorectal cancer were studied and divided into patients...AIM:To investigate the serological diagnostic factors for liver metastasis in patients with colorectal cancer.METHODS:One hundred and six adult in-patients with colorectal cancer were studied and divided into patients with liver metastasis(n = 56) and patients without liver metastasis(n = 50).Serum levels of tumor and biochemical markers for liver were measured at the time of diagnosis.RESULTS:The mean survival time was 55.9 mo,36.8 mo and 68.3 mo for the overall patients,patients with liver metastasis and patients without liver metastasis,respectively.Lactate dehydrogenase(LDH) level was significantly correlated with the survival time of colorectal cancer patients.The levels of alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase(GGT),LDH and carcinoembryonic antigen(CEA) were significantly higher in patients with liver metastasis than in those without liver metastasis.Patients with lymph node metastasis had a higher risk of liver metastasis than those without lymph node metastasis.The cut points of LDH,GGT and CEA for screening liver metastasis were 180 U/L,30 U/L and 5.0 μg/L,respectively.The sensitivity was 64.3%,69.6% and 70.4%,and the specificity was 64.0%,60.0% and 52.4%,respectively.The sensitivity of parallel test was 85.2% for LDH and CEA,and 92.6% for GGT and CEA,respectively.The specificity of serial test was 85.7% for LDH(or GGT) and CEA.CONCLUSION:Early diagnosis of liver metastasis is of great significance.The sensitivity and specificity of combined tumor and biochemical markers are rather good in screening colorectal liver metastasis.展开更多
In resectable colorectal liver metastasis(CRLM) the role and use of molecular biomarkers is still controversial. Several biomarkers have been linked to clinical outcomes in CRLM, but none have so far become routine fo...In resectable colorectal liver metastasis(CRLM) the role and use of molecular biomarkers is still controversial. Several biomarkers have been linked to clinical outcomes in CRLM, but none have so far become routine for clinical decision making. For several reasons, the clinical risk score appears to no longer hold the same predictive value. Some of the reasons include the ever expanding indications for liver resection, which now increasingly tend to involve extrahepatic disease, such as lung metastases(both resectable and non-resectable) and the shift in indication from "what is taken out"(e.g., how much liver has to be resected) to "what is left behind"(that is, how much functional liver tissue the patient has after resection). The latter is amenable to modifications by using adjunct techniques of portal vein embolization and the associating liver partition and portal vein ligation for staged hepatectomy techniques to expand indications for liver resection. Added to this complexity is the increasing number of molecular markers, which appear to hold important prognostic and predictive information, for which some will be discussed here. Beyond characteristics of tissue-based genomic profiles will be liquid biopsies derived from circulating tumor cells and cell-free circulating tumor DNA in the blood. These markers are present in the peripheral circulation in the majority of patients with metastatic cancer disease. Circulating biomarkers may represent more readily available methods to monitor, characterize and predict cancer biology with future implications for cancer care.展开更多
BACKGROUND Synchronous liver metastasis(SLM)is an indicator of poor prognosis for colorectal cancer(CRC).Nearly 50%of CRC patients develop hepatic metastasis,with 15%-25%of them presenting with SLM.The evaluation of S...BACKGROUND Synchronous liver metastasis(SLM)is an indicator of poor prognosis for colorectal cancer(CRC).Nearly 50%of CRC patients develop hepatic metastasis,with 15%-25%of them presenting with SLM.The evaluation of SLM in CRC is crucial for precise and personalized treatment.It is beneficial to detect its response to chemotherapy and choose an optimal treatment method.AIM To construct prediction models based on magnetic resonance imaging(MRI)-radiomics and clinical parameters to evaluate the chemotherapy response in SLM of CRC.METHODS A total of 102 CRC patients with 223 SLM lesions were identified and divided into disease response(DR)and disease non-response(non-DR)to chemotherapy.After standardizing the MRI images,the volume of interest was delineated and radiomics features were calculated.The MRI-radiomics logistic model was constructed after methods of variance/Mann-Whitney U test,correlation analysis,and least absolute shrinkage and selection operator in feature selecting.The radiomics score was calculated.The receiver operating characteristics curves by the DeLong test were analyzed with MedCalc software to compare the validity of all models.Additionally,the area under curves(AUCs)of DWI,T2WI,and portal phase of contrast-enhanced sequences radiomics model(Ra-DWI,Ra-T2WI,and Ra-portal phase of contrast-enhanced sequences)were calculated.The radiomicsclinical nomogram was generated by combining radiomics features and clinical characteristics of CA19-9 and clinical N staging.RESULTS The AUCs of the MRI-radiomics model were 0.733 and 0.753 for the training(156 lesions with 68 non-DR and 88 DR)and the validation(67 lesions with 29 non-DR and 38 DR)set,respectively.Additionally,the AUCs of the training and the validation set of Ra-DWI were higher than those of Ra-T2WI and Ra-portal phase of contrast-enhanced sequences(training set:0.652 vs 0.628 and 0.633,validation set:0.661 vs 0.575 and 0.543).After chemotherapy,the top four of twelve deltaradiomics features of Ra-DWI in the DR group belonged to gray-level run-length matrices radiomics parameters.The radiomics-clinical nomogram containing radiomics score,CA19-9,and clinical N staging was built.This radiomics-clinical nomogram can effectively discriminate the patients with DR from non-DR with a higher AUC of 0.809(95%confidence interval:0.751-0.858).CONCLUSION MRI-radiomics is conducive to predict chemotherapeutic response in SLM patients of CRC.The radiomics-clinical nomogram,involving radiomics score,CA19-9,and clinical N staging is more effective in predicting chemotherapeutic response.展开更多
BACKGROUND The presence of liver metastasis(LM) is an independent prognostic factor for shorter survival in non-small cell lung cancer(NSCLC) patients.The median overall survival of patients with involvement of the li...BACKGROUND The presence of liver metastasis(LM) is an independent prognostic factor for shorter survival in non-small cell lung cancer(NSCLC) patients.The median overall survival of patients with involvement of the liver is less than 5 mo.At present,identifying prognostic factors and constructing survival prediction nomogram for NSCLC patients with LM(NSCLC-LM) are highly desirable.AIM To build a forecasting model to predict the survival time of NSCLC-LM patients.METHODS Data on NSCLC-LM patients were collected from the Surveillance,Epidemiology,and End Results database between 2010 and 2018.Joinpoint analysis was used to estimate the incidence trend of NSCLC-LM.Kaplan-Meier curves were constructed to assess survival time.Cox regression was applied to select the independent prognostic predictors of cancer-specific survival(CSS).A nomogram was established and its prognostic performance was evaluated.RESULTS The age-adjusted incidence of NSCLC-LM increased from 22.7 per 1000000 in 2010to 25.2 in 2013,and then declined to 22.1 in 2018.According to the multivariable Cox regression analysis of the training set,age,marital status,sex,race,histological type,T stage,metastatic pattern,and whether the patient received chemotherapy or not were identified as independent prognostic factors for CSS(P < 0.05) and were further used to construct a nomogram.The C-indices of the training and validation sets were 0.726 and 0.722,respectively.The results of decision curve analyses(DCAs) and calibration curves showed that the nomogram was well-discriminated and had great clinical utility.CONCLUSION We designed a nomogram model and further constructed a novel risk classification system based on easily accessible clinical factors which demonstrated excellent performance to predict the individual CSS of NSCLC-LM patients.展开更多
BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment...BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment of tumors by cryoablation can cause anti-tumor immune responses.CASE SUMMARY A 16-year-old woman with SPT of the pancreas developed liver metastases 5.3 years after complete resection of the primary pancreatic tumor. She was admitted with chief complaints of abdominal pain in the upper abdomen and a weight loss of approximately 5 kg over 4 mo. Carbohydrate antigen(CA) 125,carcinoembryonic antigen, and CA 199 were normal. An abdominal computed tomography scan found multiple nodules in the right lobe of the liver that measured approximately 13.5 cm × 10.8 cm × 21.4 cm. Immunohistochemical staining results showed that CD10 and CD56 were positive, and the patient was diagnosed with SPT of the pancreas with liver metastasis. The patient underwent percutaneous cryoablation and interventional embolization. During the 5-year follow-up, the patient remained disease-free after cryoablation, with relatively normal immune function.CONCLUSION Herein, we for the first time report the treatment of liver metastasis from SPT of the pancreas using cryoablation plus interventional embolization, which could be a promising alternative therapy for pancreatic SPT liver metastasis.展开更多
BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, n...BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, non-thermal local ablation method for solid tumors, which can induce cell membrane permeabilization,resulting in unrecoverable nanoscale perforation and apoptotic cell death without damaging the structural components of tissues.CASE SUMMARY We report the case of a 66-year-old female patient with liver metastasis from pancreatic cancer with a pathological diagnosis of poorly differentiated adenocarcinoma. Carbohydrate antigen 19-9 was elevated to 420.3 U/m L.Computed tomography showed a pancreas mass of 2.7 cm × 2.5 cm and single liver metastasis of 1.4 cm × 1.1 cm in the S6 area. The patient underwent IRE and arterial infusion chemotherapy and received tegafur. The therapeutic effect of the combination treatment has been evaluated as complete response. To date, the patient has survived for > 12 mo and is receiving tegafur as maintenance therapy(at the time this case report was written).CONCLUSION IRE plus arterial infusion chemotherapy and tegafur may be synergistic,providing a reference for treating liver metastasis from pancreatic cancer.展开更多
The aberrant use of alcohol is a major factor in cancer progression and metastasis.Contributing mechanisms include the systemic effects of alcohol and the exchange of bioactive molecules between cancerous and non-canc...The aberrant use of alcohol is a major factor in cancer progression and metastasis.Contributing mechanisms include the systemic effects of alcohol and the exchange of bioactive molecules between cancerous and non-cancerous cells along the brain-gut-liver axis.Such interplay leads to changes in molecular,cellular,and biological functions resulting in cancer progression.Recent investigations have examined the role of extracellular vesicles(EVs)in cancer mechanisms in addition to their contribution as diagnostic biomarkers.Also,EVs are emerging as novel cell-free mediators in pathophysiological scenarios including alcohol-mediated gut microbiome dysbiosis and the release of nanosized EVs into the circulatory system.Interestingly,EVs in cancer patients are enriched with oncogenes,miRNA,lipids,and glycoproteins whose delivery into the hepatic microenvironment may be enhanced by the detrimental effects of alcohol.Proof-of-concept studies indicate that alcohol-associated liver disease is impacted by the effects of exosomes,including altered immune responses,reprogramming of stromal cells,and remodeling of the extracellular matrix.Moreover,the culmination of alcoholrelated changes in the liver likely contributes to enhanced hepatic metastases and poor outcomes for cancer patients.This review summarizes the numerous aspects of exosome communications between organs with emphasis on the relationship of EVs in alcohol-associated diseases and cancer metastasis.The potential impact of EV cargo and release along a multi-organ axis is highly relevant to the promotion of tumorigenic mechanisms and metastatic disease.It is hypothesized that EVs target recipient tissues to initiate the formation of prometastatic niches and cancer progression.The study of alcohol-associated mechanisms in metastatic cancers is expected to reveal a better understanding of factors involved in the growth of secondary malignancies as well as novel approaches for therapeutic interventions.展开更多
Alcohol intake is a risk factor for cancer development and metastatic disease progression.Extracellular vesicle(EV)-mediated interorgan communication is assumed to be significant in boosting tumorigenic pathways and d...Alcohol intake is a risk factor for cancer development and metastatic disease progression.Extracellular vesicle(EV)-mediated interorgan communication is assumed to be significant in boosting tumorigenic pathways and disease progression.Recent research indicates that exosomes have a variety of roles in the development of cancer during pathophysiological conditions.The involvement of EV signaling during cancer progression in the alcohol environment is unknown.Therefore,understanding communication networks and the role of EVs as biomarkers can contribute significantly to developing strategies to address the serious public health problems associated with alcohol consumption and cancer.展开更多
Objective To evaluate the toxic effects and efficacy of the intra-arterial chrono-chemotherapy on patients with liver metastasis arised from colorectal cancer. Methods Chemotherapy of 42 patients were randomly divided...Objective To evaluate the toxic effects and efficacy of the intra-arterial chrono-chemotherapy on patients with liver metastasis arised from colorectal cancer. Methods Chemotherapy of 42 patients were randomly divided into group A (n = 20) with continuously constant arterial infusion, and group B (n = 22) with arterial chrono-modulated infusion. And the toxic effects and efficacy of two groups were compared. Results A significant difference was found in the toxic effects of digestive system between the two groups. The treatment response was similar in the two groups. Conclusions Intra-arterial chrono-chemotherapy may decrease the toxic effects and improve the life quality of these patients. (J Intervent Radiol, 2006, 15: 487-490)展开更多
BACKGROUND Uveal melanoma is the most common primary intraocular malignant tumor affecting the eyes in adults.Nearly half of all primary uveal melanoma tumors metastasize;yet,there are currently no effective treatment...BACKGROUND Uveal melanoma is the most common primary intraocular malignant tumor affecting the eyes in adults.Nearly half of all primary uveal melanoma tumors metastasize;yet,there are currently no effective treatments for metastatic uveal melanoma.At the time of diagnosis,less than 4%of patients with uveal melanoma have detectable metastatic disease.Uveal melanoma disseminates hematogenously,with the most common site of metastasis being liver(93%),followed by lung(24%)and bone(16%).CASE SUMMARY A 57-year-old woman was diagnosed with a dysplastic nevus on her eyelid,which was histologically confirmed as malignant melanoma after resection.The patient had no evidence of metastasis to other organs and received both radiation therapy and chemotherapy.After systemic treatment,a metastatic left neck lymph node was found and another round of chemotherapy was performed after resection.Positron emission tomography-Computed Tomography tracking after completion of chemotherapy revealed two metastatic liver nodules.The patient underwent partial liver resection and showed no signs of recurrence at 1 year after surgery.CONCLUSION Surgery is an effective treatment for metastatic uveal melanoma.In patients with liver metastatic lesions,hepatectomy improves outcome.展开更多
BACKGROUND Adenoid cystic carcinoma(ACC)is a common malignant tumor of salivary gland.The lung and liver are frequent sites of distant metastasis.Liver metastasis as the initial clinical manifestation of sublingual gl...BACKGROUND Adenoid cystic carcinoma(ACC)is a common malignant tumor of salivary gland.The lung and liver are frequent sites of distant metastasis.Liver metastasis as the initial clinical manifestation of sublingual gland ACC is very rare.CASE SUMMARY A 51-year-old Chinese woman presented with a painless mass in the right lobe of liver.The tumor was composed of ductal cells and myoepithelial cells with a morphology including tubiform and cribriform structures.Immunostaining results showed ductal cells positive for CK7,CK14,CK19,CD117,and 34βE12,and negative for MYB,vimentin,ER,PR,and CEA.The myoepithelial cells were positive for p63,calponin and CK5/6.Metastatic salivary ACC was considered,and a sublingual gland mass was revealed by computed tomography.Histological evaluation confirmed primary sublingual gland ACC.Fluorescence in situ hybridization(FISH)did not find an MYB-NFIB fusion gene in specimens from either the primary or metastatic ACC tumors.The sublingual gland ACC relapsed in 20 mo.The recurrent lesion disappeared following local radiation therapy and computed tomography-guided radioactive seed implantation.The patient remains in good condition until now.CONCLUSION Metastatic sublingual gland ACC with initial clinical manifestation as a liver mass is very rare,and was pathologically confirmed in this patient by its histological appearance.Primary hepatic tumors and metastatic carcinomas should be included in the differential diagnosis.Immunohistochemical detection of MYB protein and MYB-NFIB fusion gene detection by FISH can be helpful,but occasional negative results confuse the diagnosis.展开更多
BACKGROUND The duration of surveillance after curative resection of colorectal cancer(CRC)is generally 5 years.The overall incidence of recurrence more than 5 years after surgery for CRC in Japan has been reported to ...BACKGROUND The duration of surveillance after curative resection of colorectal cancer(CRC)is generally 5 years.The overall incidence of recurrence more than 5 years after surgery for CRC in Japan has been reported to be 0.6%.Moreover,it is rare for CRC to have metachronous liver metastasis more than 10 years after surgery.Here,we present a case of liver metastasis detected 11 years after the curative resection of rectal cancer.CASE SUMMARY A 72-year-old man was referred to our hospital after a liver tumor was detected by abdominal ultrasonography at another hospital.He had undergone surgery for rectal cancer 11 years previously.Contrast-enhanced computed tomography(CT)showed a tumor with a diameter of approximately 8 cm in the posterior segment,which was weakly and gradually enhanced.18F-fluorodeoxyglucose-positron emission tomography/CT showed an abnormally high uptake on the tumorous lesion,which showed that the tumor appeared to spread convexly along the intrahepatic bile ducts.Intrahepatic cholangiocarcinoma was therefore diagnosed,and he had an extended right posterior sectionectomy and regional lymph node dissection.Histopathological examination showed that the tumor was a moderately differentiated adenocarcinoma and showed the same pathological characteristics as the rectal cancer.Immunohistological examination showed that the cancer cells of both the liver tumor and rectal cancer were positive for cytokeratin(CK)20 and weakly positive for CK 7.These findings were consistent with the liver metastasis from the rectal cancer.CONCLUSION It is possible that a liver tumor is metastatic in a patient with a previous history of CRC,even if it was more than 10 years earlier.展开更多
There remains a persistent unmet need to detect the disease nonresponse(nonDR)subgroup before adjuvant therapy in synchronous liver metastasis patients with colorectal cancer.Ma’s radiomics-clinical nomogram shows po...There remains a persistent unmet need to detect the disease nonresponse(nonDR)subgroup before adjuvant therapy in synchronous liver metastasis patients with colorectal cancer.Ma’s radiomics-clinical nomogram shows potential for the early detection of nonDR subgroups,but it is not good enough owing to at least three limitaions,which we address in this letter to the editor.First,the study did not explore RAS/BRAF mutations,HER2 amplifications,etc.to complement the current nomogram.Second,the nomogram was not validated in left-and rightsided tumors separately.Third,the most critical factor for determining the success of adjuvant therapy should be resectability rather than tumor size shrinkage,which was used in the study.展开更多
文摘Colorectal cancer liver metastasis(CRLM)presents a clinical challenge,and optimizing treatment strategies is crucial for improving patient outcomes.Surgical resection,a key element in achieving prolonged survival,is often linked to a heightened risk of recurrence.Acknowledging the potential benefits of preoperative neoadjuvant chemotherapy in managing resectable liver metastases,this approach has gained attention for its role in tumor downsizing,assessing biological behavior,and reducing the risk of postoperative recurrence.However,the use of neoadjuvant chemotherapy in initially resectable CRLM sparks ongoing debates.The balance between tumor reduction and the risk of hepatic injury,coupled with concerns about delaying surgery,necessitates a nuanced approach.This article explores recent research insights and draws upon the practical experiences at our center to address critical issues regarding considerations for initially resectable cases.Examining the criteria for patient selection and the judicious choice of neoadjuvant regimens are pivotal areas of discussion.Striking the right balance between maximizing treatment efficacy and minimizing adverse effects is imperative.The dynamic landscape of precision medicine is also reflected in the evolving role of gene testing,such as RAS/BRAF and PIK3CA,in tailoring neoadjuvant regimens.Furthermore,the review emphasizes the need for a multidisciplinary approach to navigate the comp-lexities of CRLM.Integrating technical expertise and biological insights is crucial in refining neoadjuvant strategies.The management of progression following neoadjuvant chemotherapy requires a tailored approach,acknowledging the diverse biological behaviors that may emerge.In conclusion,this review aims to provide a comprehensive perspective on the considerations,challenges,and advancements in the use of neoadjuvant chemotherapy for initially resectable CRLM.By combining evidencebased insights with practical experiences,we aspire to contribute to the ongoing discourse on refining treatment paradigms for improved outcomes in patients with CRLM.
基金reviewed and approved by the Institutional Review Board of Zhejiang Provincial People’s Hospital(Approval No.2023-338).
文摘BACKGROUND Colon cancer is one of the most common malignant tumors of the digestive system.Liver metastasis after colon cancer surgery is the primary cause of death in patients with colon cancer.AIM To construct a novel nomogram model including various factors to predict liver metastasis after colon cancer surgery.METHODS We retrospectively analyzed 242 patients with colon cancer who were admitted and underwent radical resection for colon cancer in Zhejiang Provincial People’s Hospital from December 2019 to December 2022.Patients were divided into liver metastasis and non-liver metastasis groups.Sex,age,and other general and clinicopathological data(preoperative blood routine and biochemical test indexes)were compared.The risk factors for liver metastasis were analyzed using singlefactor and multifactorial logistic regression.A predictive model was then constructed and evaluated for efficacy.RESULTS Systemic inflammatory index(SII),C-reactive protein/albumin ratio(CAR),red blood cell distribution width(RDW),alanine aminotransferase,preoperative carcinoembryonic antigen level,and lymphatic metastasis were different between groups(P<0.05).SII,CAR,and RDW were risk factors for liver metastasis after colon cancer surgery(P<0.05).The area under the curve was 0.93 for the column-line diagram prediction model constructed based on these risk factors to distinguish whether liver metastasis occurred postoperatively.The actual curve of the column-line diagram predicting the risk of postoperative liver metastasis was close to the ideal curve,with good agreement.The prediction model curves in the decision curve analysis showed higher net benefits for a larger threshold range than those in extreme cases,indicating that the model is safer.CONCLUSION Liver metastases after colorectal cancer surgery could be well predicted by a nomogram based on the SII,CAR,and RDW.
文摘The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.
文摘BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approximately 25%of patients with CRLM have indications for liver resection at the initial diagnosis.Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.CASE SUMMARY A 42-year-old man was diagnosed with ascending colon cancer and liver metastases.Due to the huge lesion size and compression of the right portal vein,the liver metastases were initially diagnosed as unresectable lesions.The patient was treated with preoperative transcatheter arterial chemoembolization(TACE)consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®.After four courses,radical right-sided colectomy and ileum transverse colon anastomosis were performed.Postoperatively,the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins.Thereafter,S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy.Pathological examination of the resected specimen revealed a pathologically complete response(pCR).Intrahepatic recurrence was detected more than two months after the operation,and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®.Subsequently,the patient was treated with aγ-knife to enhance local control.Notably,a pCR was reached,and the patient's overall survival time was>9 years.CONCLUSION Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.
文摘BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery.However,for patients who have undergone Whipple surgery,the probability of developing a liver abscess after liver interventional surgery is very high.Fungal liver abscess has a high mortality rate,especially when complicated with malignant tumors,diabetes,coronavirus disease 2019(COVID-19)and other complications.Fungal liver abscess is rare,and there are no guidelines or expert consensus on the course of antifungal therapy.CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy.Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy,followed by ablation of the liver metastasis.After half a month of liver metastasis ablation,the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection.The results of pus culture showed Candida albicans,which was sensitive to fluconazole.The patient underwent percutaneous catheter drainage,antifungal therapy with fluconazole,and antiviral therapy with azvudine.During antifungal therapy,the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy.Oral fluconazole was continued for 1 wk outside the hospital,and fluconazole was used for a total of 5 wk.The patient recovered well and received 4 cycles of fluorouracil,leucovorin,oxaliplatin,and irinotecan after 2 mo of antifungal therapy.CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection,percutaneous catheter drainage,and 5 wk of antifungal therapy.Meanwhile,complications such as COVID-19 should be actively managed and nutritional support should be provided.
文摘BACKGROUND Carcinoembryonic antigen(CEA)is a broad-spectrum tumor marker for differential diagnosis,monitoring,and response assessment of a variety of malignancies.AIM To evaluate whether serum CEA could predict the prognosis in patients with colorectal cancer liver metastasis(CRCLM)before and after liver resection(LR).METHODS PubMed,Embase,Cochrane,and Web of Science were systematically searched to retrieve literature,with a search cut-off date of February 27,2023.Articles were strictly screened for inclusion according to pre-specified inclusion and exclusion criteria.Data were pooled and analyzed using Stata 16.0.RESULTS This meta-analysis included 36 studies involving a total of 11143 CRCLM patients.The results showed that a high pre-LR serum CEA level was correlated with poor overall survival(OS)[hazard ratio(HR)=1.61,95%confidence interval(CI):1.49-1.75,P<0.001]and recurrence-free survival(HR=1.27,95%CI:1.11-1.45,P<0.001)in CRCLM patients.A high post-LR serum CEA level predicted poor OS(HR=2.66,95%CI:2.10-3.38,P<0.001).A comparison by treatment modality,analysis modality,patient source,and cutoff-value showed that overall,high preoperative and postoperative serum CEA levels remained correlated with a poor prognosis.CONCLUSION This study concluded that high pre-LR and post-LR serum CEA levels were significantly correlated with a poor prognosis in CRCLM patients.
文摘BACKGROUND Leiomyosarcoma(LMS)has a poor prognosis and rarely originates from the colon.If resection is possible,surgery is the first treatment most commonly considered.Unfortunately,no standard treatment exists for hepatic metastasis of LMS;although,several treatments,such as chemotherapy,radiotherapy,and surgery,have been used.Subsequently,the management of liver metastases remains controversial.CASE SUMMARY We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon.A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months.Colonoscopy revealed a 4-cm diameter mass in the descending colon,40 cm from the anal verge.Computed tomography revealed intussusception of the descending colon due to the 4-cm mass.The patient underwent a left hemicolectomy.Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin,and negative for cluster of differentiation 34(CD34),CD117,and discovered on gastrointestinal stromal tumor(GIST)-1,which are characteristic of gastrointestinal LMS.A single liver metastasis developed 11 mo postoperatively;the patient subsequently underwent curative resection thereof.The patient remained disease-free after six cycles of adjuvant chemotherapy(doxorubicin and ifosfamide),and 40 and 52 mo after liver resection and primary surgery,respectively.Similar cases were obtained from a search of Embase,PubMed,MEDLINE,and Google Scholar.CONCLUSION Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.
基金Supported by Cancer Institute and Hospital,Tianjin Medical University
文摘AIM:To investigate the serological diagnostic factors for liver metastasis in patients with colorectal cancer.METHODS:One hundred and six adult in-patients with colorectal cancer were studied and divided into patients with liver metastasis(n = 56) and patients without liver metastasis(n = 50).Serum levels of tumor and biochemical markers for liver were measured at the time of diagnosis.RESULTS:The mean survival time was 55.9 mo,36.8 mo and 68.3 mo for the overall patients,patients with liver metastasis and patients without liver metastasis,respectively.Lactate dehydrogenase(LDH) level was significantly correlated with the survival time of colorectal cancer patients.The levels of alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase(GGT),LDH and carcinoembryonic antigen(CEA) were significantly higher in patients with liver metastasis than in those without liver metastasis.Patients with lymph node metastasis had a higher risk of liver metastasis than those without lymph node metastasis.The cut points of LDH,GGT and CEA for screening liver metastasis were 180 U/L,30 U/L and 5.0 μg/L,respectively.The sensitivity was 64.3%,69.6% and 70.4%,and the specificity was 64.0%,60.0% and 52.4%,respectively.The sensitivity of parallel test was 85.2% for LDH and CEA,and 92.6% for GGT and CEA,respectively.The specificity of serial test was 85.7% for LDH(or GGT) and CEA.CONCLUSION:Early diagnosis of liver metastasis is of great significance.The sensitivity and specificity of combined tumor and biochemical markers are rather good in screening colorectal liver metastasis.
文摘In resectable colorectal liver metastasis(CRLM) the role and use of molecular biomarkers is still controversial. Several biomarkers have been linked to clinical outcomes in CRLM, but none have so far become routine for clinical decision making. For several reasons, the clinical risk score appears to no longer hold the same predictive value. Some of the reasons include the ever expanding indications for liver resection, which now increasingly tend to involve extrahepatic disease, such as lung metastases(both resectable and non-resectable) and the shift in indication from "what is taken out"(e.g., how much liver has to be resected) to "what is left behind"(that is, how much functional liver tissue the patient has after resection). The latter is amenable to modifications by using adjunct techniques of portal vein embolization and the associating liver partition and portal vein ligation for staged hepatectomy techniques to expand indications for liver resection. Added to this complexity is the increasing number of molecular markers, which appear to hold important prognostic and predictive information, for which some will be discussed here. Beyond characteristics of tissue-based genomic profiles will be liquid biopsies derived from circulating tumor cells and cell-free circulating tumor DNA in the blood. These markers are present in the peripheral circulation in the majority of patients with metastatic cancer disease. Circulating biomarkers may represent more readily available methods to monitor, characterize and predict cancer biology with future implications for cancer care.
基金Supported by The fund of Medical and Health Research Projects of Health Commission of Zhejiang Province,No.2019KY035.
文摘BACKGROUND Synchronous liver metastasis(SLM)is an indicator of poor prognosis for colorectal cancer(CRC).Nearly 50%of CRC patients develop hepatic metastasis,with 15%-25%of them presenting with SLM.The evaluation of SLM in CRC is crucial for precise and personalized treatment.It is beneficial to detect its response to chemotherapy and choose an optimal treatment method.AIM To construct prediction models based on magnetic resonance imaging(MRI)-radiomics and clinical parameters to evaluate the chemotherapy response in SLM of CRC.METHODS A total of 102 CRC patients with 223 SLM lesions were identified and divided into disease response(DR)and disease non-response(non-DR)to chemotherapy.After standardizing the MRI images,the volume of interest was delineated and radiomics features were calculated.The MRI-radiomics logistic model was constructed after methods of variance/Mann-Whitney U test,correlation analysis,and least absolute shrinkage and selection operator in feature selecting.The radiomics score was calculated.The receiver operating characteristics curves by the DeLong test were analyzed with MedCalc software to compare the validity of all models.Additionally,the area under curves(AUCs)of DWI,T2WI,and portal phase of contrast-enhanced sequences radiomics model(Ra-DWI,Ra-T2WI,and Ra-portal phase of contrast-enhanced sequences)were calculated.The radiomicsclinical nomogram was generated by combining radiomics features and clinical characteristics of CA19-9 and clinical N staging.RESULTS The AUCs of the MRI-radiomics model were 0.733 and 0.753 for the training(156 lesions with 68 non-DR and 88 DR)and the validation(67 lesions with 29 non-DR and 38 DR)set,respectively.Additionally,the AUCs of the training and the validation set of Ra-DWI were higher than those of Ra-T2WI and Ra-portal phase of contrast-enhanced sequences(training set:0.652 vs 0.628 and 0.633,validation set:0.661 vs 0.575 and 0.543).After chemotherapy,the top four of twelve deltaradiomics features of Ra-DWI in the DR group belonged to gray-level run-length matrices radiomics parameters.The radiomics-clinical nomogram containing radiomics score,CA19-9,and clinical N staging was built.This radiomics-clinical nomogram can effectively discriminate the patients with DR from non-DR with a higher AUC of 0.809(95%confidence interval:0.751-0.858).CONCLUSION MRI-radiomics is conducive to predict chemotherapeutic response in SLM patients of CRC.The radiomics-clinical nomogram,involving radiomics score,CA19-9,and clinical N staging is more effective in predicting chemotherapeutic response.
文摘BACKGROUND The presence of liver metastasis(LM) is an independent prognostic factor for shorter survival in non-small cell lung cancer(NSCLC) patients.The median overall survival of patients with involvement of the liver is less than 5 mo.At present,identifying prognostic factors and constructing survival prediction nomogram for NSCLC patients with LM(NSCLC-LM) are highly desirable.AIM To build a forecasting model to predict the survival time of NSCLC-LM patients.METHODS Data on NSCLC-LM patients were collected from the Surveillance,Epidemiology,and End Results database between 2010 and 2018.Joinpoint analysis was used to estimate the incidence trend of NSCLC-LM.Kaplan-Meier curves were constructed to assess survival time.Cox regression was applied to select the independent prognostic predictors of cancer-specific survival(CSS).A nomogram was established and its prognostic performance was evaluated.RESULTS The age-adjusted incidence of NSCLC-LM increased from 22.7 per 1000000 in 2010to 25.2 in 2013,and then declined to 22.1 in 2018.According to the multivariable Cox regression analysis of the training set,age,marital status,sex,race,histological type,T stage,metastatic pattern,and whether the patient received chemotherapy or not were identified as independent prognostic factors for CSS(P < 0.05) and were further used to construct a nomogram.The C-indices of the training and validation sets were 0.726 and 0.722,respectively.The results of decision curve analyses(DCAs) and calibration curves showed that the nomogram was well-discriminated and had great clinical utility.CONCLUSION We designed a nomogram model and further constructed a novel risk classification system based on easily accessible clinical factors which demonstrated excellent performance to predict the individual CSS of NSCLC-LM patients.
文摘BACKGROUND Solid pseudopapillary tumor(SPT) of the pancreas is a rare pancreatic tumor and 10% to 15% of cases are associated with metastasis. Cryoablation is a new method that can induce tumor necrosis, and treatment of tumors by cryoablation can cause anti-tumor immune responses.CASE SUMMARY A 16-year-old woman with SPT of the pancreas developed liver metastases 5.3 years after complete resection of the primary pancreatic tumor. She was admitted with chief complaints of abdominal pain in the upper abdomen and a weight loss of approximately 5 kg over 4 mo. Carbohydrate antigen(CA) 125,carcinoembryonic antigen, and CA 199 were normal. An abdominal computed tomography scan found multiple nodules in the right lobe of the liver that measured approximately 13.5 cm × 10.8 cm × 21.4 cm. Immunohistochemical staining results showed that CD10 and CD56 were positive, and the patient was diagnosed with SPT of the pancreas with liver metastasis. The patient underwent percutaneous cryoablation and interventional embolization. During the 5-year follow-up, the patient remained disease-free after cryoablation, with relatively normal immune function.CONCLUSION Herein, we for the first time report the treatment of liver metastasis from SPT of the pancreas using cryoablation plus interventional embolization, which could be a promising alternative therapy for pancreatic SPT liver metastasis.
文摘BACKGROUND Pancreatic cancer has a poor prognosis;40%–50% of patients have liver metastases at the time of initial diagnosis and only 15%–20% undergo surgical resection. Irreversible electroporation(IRE) is a new, non-thermal local ablation method for solid tumors, which can induce cell membrane permeabilization,resulting in unrecoverable nanoscale perforation and apoptotic cell death without damaging the structural components of tissues.CASE SUMMARY We report the case of a 66-year-old female patient with liver metastasis from pancreatic cancer with a pathological diagnosis of poorly differentiated adenocarcinoma. Carbohydrate antigen 19-9 was elevated to 420.3 U/m L.Computed tomography showed a pancreas mass of 2.7 cm × 2.5 cm and single liver metastasis of 1.4 cm × 1.1 cm in the S6 area. The patient underwent IRE and arterial infusion chemotherapy and received tegafur. The therapeutic effect of the combination treatment has been evaluated as complete response. To date, the patient has survived for > 12 mo and is receiving tegafur as maintenance therapy(at the time this case report was written).CONCLUSION IRE plus arterial infusion chemotherapy and tegafur may be synergistic,providing a reference for treating liver metastasis from pancreatic cancer.
基金by Biomedical Laboratory Research and Development,VA Office of Research and Development,No.BX004127(to McVicker BL and Tobi M).
文摘The aberrant use of alcohol is a major factor in cancer progression and metastasis.Contributing mechanisms include the systemic effects of alcohol and the exchange of bioactive molecules between cancerous and non-cancerous cells along the brain-gut-liver axis.Such interplay leads to changes in molecular,cellular,and biological functions resulting in cancer progression.Recent investigations have examined the role of extracellular vesicles(EVs)in cancer mechanisms in addition to their contribution as diagnostic biomarkers.Also,EVs are emerging as novel cell-free mediators in pathophysiological scenarios including alcohol-mediated gut microbiome dysbiosis and the release of nanosized EVs into the circulatory system.Interestingly,EVs in cancer patients are enriched with oncogenes,miRNA,lipids,and glycoproteins whose delivery into the hepatic microenvironment may be enhanced by the detrimental effects of alcohol.Proof-of-concept studies indicate that alcohol-associated liver disease is impacted by the effects of exosomes,including altered immune responses,reprogramming of stromal cells,and remodeling of the extracellular matrix.Moreover,the culmination of alcoholrelated changes in the liver likely contributes to enhanced hepatic metastases and poor outcomes for cancer patients.This review summarizes the numerous aspects of exosome communications between organs with emphasis on the relationship of EVs in alcohol-associated diseases and cancer metastasis.The potential impact of EV cargo and release along a multi-organ axis is highly relevant to the promotion of tumorigenic mechanisms and metastatic disease.It is hypothesized that EVs target recipient tissues to initiate the formation of prometastatic niches and cancer progression.The study of alcohol-associated mechanisms in metastatic cancers is expected to reveal a better understanding of factors involved in the growth of secondary malignancies as well as novel approaches for therapeutic interventions.
文摘Alcohol intake is a risk factor for cancer development and metastatic disease progression.Extracellular vesicle(EV)-mediated interorgan communication is assumed to be significant in boosting tumorigenic pathways and disease progression.Recent research indicates that exosomes have a variety of roles in the development of cancer during pathophysiological conditions.The involvement of EV signaling during cancer progression in the alcohol environment is unknown.Therefore,understanding communication networks and the role of EVs as biomarkers can contribute significantly to developing strategies to address the serious public health problems associated with alcohol consumption and cancer.
文摘Objective To evaluate the toxic effects and efficacy of the intra-arterial chrono-chemotherapy on patients with liver metastasis arised from colorectal cancer. Methods Chemotherapy of 42 patients were randomly divided into group A (n = 20) with continuously constant arterial infusion, and group B (n = 22) with arterial chrono-modulated infusion. And the toxic effects and efficacy of two groups were compared. Results A significant difference was found in the toxic effects of digestive system between the two groups. The treatment response was similar in the two groups. Conclusions Intra-arterial chrono-chemotherapy may decrease the toxic effects and improve the life quality of these patients. (J Intervent Radiol, 2006, 15: 487-490)
文摘BACKGROUND Uveal melanoma is the most common primary intraocular malignant tumor affecting the eyes in adults.Nearly half of all primary uveal melanoma tumors metastasize;yet,there are currently no effective treatments for metastatic uveal melanoma.At the time of diagnosis,less than 4%of patients with uveal melanoma have detectable metastatic disease.Uveal melanoma disseminates hematogenously,with the most common site of metastasis being liver(93%),followed by lung(24%)and bone(16%).CASE SUMMARY A 57-year-old woman was diagnosed with a dysplastic nevus on her eyelid,which was histologically confirmed as malignant melanoma after resection.The patient had no evidence of metastasis to other organs and received both radiation therapy and chemotherapy.After systemic treatment,a metastatic left neck lymph node was found and another round of chemotherapy was performed after resection.Positron emission tomography-Computed Tomography tracking after completion of chemotherapy revealed two metastatic liver nodules.The patient underwent partial liver resection and showed no signs of recurrence at 1 year after surgery.CONCLUSION Surgery is an effective treatment for metastatic uveal melanoma.In patients with liver metastatic lesions,hepatectomy improves outcome.
文摘BACKGROUND Adenoid cystic carcinoma(ACC)is a common malignant tumor of salivary gland.The lung and liver are frequent sites of distant metastasis.Liver metastasis as the initial clinical manifestation of sublingual gland ACC is very rare.CASE SUMMARY A 51-year-old Chinese woman presented with a painless mass in the right lobe of liver.The tumor was composed of ductal cells and myoepithelial cells with a morphology including tubiform and cribriform structures.Immunostaining results showed ductal cells positive for CK7,CK14,CK19,CD117,and 34βE12,and negative for MYB,vimentin,ER,PR,and CEA.The myoepithelial cells were positive for p63,calponin and CK5/6.Metastatic salivary ACC was considered,and a sublingual gland mass was revealed by computed tomography.Histological evaluation confirmed primary sublingual gland ACC.Fluorescence in situ hybridization(FISH)did not find an MYB-NFIB fusion gene in specimens from either the primary or metastatic ACC tumors.The sublingual gland ACC relapsed in 20 mo.The recurrent lesion disappeared following local radiation therapy and computed tomography-guided radioactive seed implantation.The patient remains in good condition until now.CONCLUSION Metastatic sublingual gland ACC with initial clinical manifestation as a liver mass is very rare,and was pathologically confirmed in this patient by its histological appearance.Primary hepatic tumors and metastatic carcinomas should be included in the differential diagnosis.Immunohistochemical detection of MYB protein and MYB-NFIB fusion gene detection by FISH can be helpful,but occasional negative results confuse the diagnosis.
文摘BACKGROUND The duration of surveillance after curative resection of colorectal cancer(CRC)is generally 5 years.The overall incidence of recurrence more than 5 years after surgery for CRC in Japan has been reported to be 0.6%.Moreover,it is rare for CRC to have metachronous liver metastasis more than 10 years after surgery.Here,we present a case of liver metastasis detected 11 years after the curative resection of rectal cancer.CASE SUMMARY A 72-year-old man was referred to our hospital after a liver tumor was detected by abdominal ultrasonography at another hospital.He had undergone surgery for rectal cancer 11 years previously.Contrast-enhanced computed tomography(CT)showed a tumor with a diameter of approximately 8 cm in the posterior segment,which was weakly and gradually enhanced.18F-fluorodeoxyglucose-positron emission tomography/CT showed an abnormally high uptake on the tumorous lesion,which showed that the tumor appeared to spread convexly along the intrahepatic bile ducts.Intrahepatic cholangiocarcinoma was therefore diagnosed,and he had an extended right posterior sectionectomy and regional lymph node dissection.Histopathological examination showed that the tumor was a moderately differentiated adenocarcinoma and showed the same pathological characteristics as the rectal cancer.Immunohistological examination showed that the cancer cells of both the liver tumor and rectal cancer were positive for cytokeratin(CK)20 and weakly positive for CK 7.These findings were consistent with the liver metastasis from the rectal cancer.CONCLUSION It is possible that a liver tumor is metastatic in a patient with a previous history of CRC,even if it was more than 10 years earlier.
文摘There remains a persistent unmet need to detect the disease nonresponse(nonDR)subgroup before adjuvant therapy in synchronous liver metastasis patients with colorectal cancer.Ma’s radiomics-clinical nomogram shows potential for the early detection of nonDR subgroups,but it is not good enough owing to at least three limitaions,which we address in this letter to the editor.First,the study did not explore RAS/BRAF mutations,HER2 amplifications,etc.to complement the current nomogram.Second,the nomogram was not validated in left-and rightsided tumors separately.Third,the most critical factor for determining the success of adjuvant therapy should be resectability rather than tumor size shrinkage,which was used in the study.
