Development of an Algorithm to Predict Recurrences After Resection of Liver Metastases in Patients With Metastatic Colorectal Cancer.

BACKGROUND/AIM: Hepatic recurrences after resection of metastatic lesions in advanced colorectal cancer (CRC) have an enormous impact on patient prognosis. Response evaluation criteria in solid tumor (RECIST) or morphologic response on computed tomography (CT) have been reported as surrogate prognostication markers. This study assessed a novel algorithm for the prognostication of liver metastasis treatment. PATIENTS AND METHODS: Forty-seven patients with liver metastases from CRC who underwent liver resection after systemic chemotherapy were included. The CT values examined before and after chemotherapy were collected. The velocity of CT values (CTvΔ) was calculated, and the subjects were divided into CTvΔ_high and _low groups. Clinicopathological variables, recurrence-free survival (RFS), and overall survival (OS) were statistically compared between the two groups. In addition, the effect of the combined evaluation of CTvΔ and carcinoembryonic antigen (CEA) was evaluated. RESULTS: In univariate analyses, the hazard ratio (HR) for a recurrence after liver resection was relatively higher in the RECIST_stable disease (SD) or _progressive disease (PD) and the CTvΔ_low groups. In multivariate analysis, the HR was significantly higher in the CEA_high, the RECIST_SD or PD, and the CTvΔ_low groups. The RFS was significantly longer in the CTvΔ_high group. Furthermore, the combination of CTvΔ and CEA predicted the RFS and OS. CONCLUSION: Our algorithm using CTvΔ could be a useful tool to select patients suitable for liver resection of hepatic CRC metastases.

Lateral lymph-node dissection for rectal cancer: meta-analysis of all 944 cases undergoing surgery during 1975-2004.

BACKGROUND: Colorectal cancer is the third most common cancer and leading cause of cancer-related death in Japan. One of the major problems in rectal cancer surgery is local recurrence. Pelvic sidewall dissection (PSD) has the potential to reduce local recurrence. PATIENTS AND METHODS: This study included all 994 patients with rectal cancer who underwent curative surgery from January 1975 until December 2004, at the Kurume University Hospital in Fukuoka, Japan. The patients were analyzed to determine whether lateral lymph node (LLN) metastasis correlates with clinicopathological factors, and to determine a diagnostic tool based on magnetic resonance imaging (MRI) findings. RESULTS: The rate of positive LLNs in patients who underwent PSD was 7.5% in the upper rectum, and 14.5% in the lower rectum. Logistic regression analysis disclosed that perirectal lymph nodes metastasis was associated with an increased incidence of positive LLNs and had a greater hazard ratio. Positive LLNs were frequently found to be located along the internal iliac artery (47 patients; 89%) or around the oburator vessels and nerve (17 patients; 32%). MRI has become a promising diagnostic tool in patients with rectal cancer including LLN estimation. CONCLUSION: We speculate that PSD may be a good candidate as an effective strategy for lower rectal cancer. In further studies, it is important to investigate the validity of PSD for its potential clinical use in lower rectal cancer therapy and prognosis.