Comparison of WHO and RECIST Criteria for Response in Metastatic Colorectal Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study compared the WHO criteria with the response evaluation criteria in solid tumors (RECIST) in the same patients with metastatic colorectal cancer in order to determine the significance of the RECIST. In addition, this study compared the estimations of medical oncologists with those of a radiologist. MATERIALS AND METHODS: Between 2002 and 2005, a total of 48 patients (male: female ratio, 29: 19; median age, 58 years) with measurable lesions receiving chemotherapy for metastatic colorectal carcinoma were enrolled in this study. Two medical oncologists and one radiologist, who were blinded to the patients' condition, independently reviewed all the CT images. The results were compared using a kappa test. RESULTS: The kappa test for concordance between the WHO and RECIST criteria of the medical oncologists and the radiologist were 0.908 and 0.841, respectively. The level of concordance between the investigators using the WHO and RECIST were 0.722 and 0.753, respectively. CONCLUSIONS: The RECIST criteria are comparable to the WHO criteria in evaluating the response of colorectal carcinoma, but have simple and reproducible guidelines. The use of RECIST is recommended for evaluating the treatment efficacy in clinical trials and practice.

Ileostomy Related Complications

PURPOSE: Ileostomy may affect various aspects of life style of the patient. Moreover the complication after ileostomy formation or closure may lower the life quality of the patient. The purpose of this study is to investigate ileostomy related complications and elucidate associated factors. METHODS: We recruited 103 patients who underwent ileostomy in Asan Medical Center between July 1989 and June 2000. All ileostomies are constructed through the rectus muscle at the right lower quadrant of the abdomen. To mnimize peristomal skin irritation, at least two to three centimeters of the ileum lies above the skin level. We analyzed complications after ileostomy formation in relation to underlying diseases, types and purpose of ileostomy. Also, we analyzed complication after ileostomy closure in relation to underlying diseases, time interval and method of take-down. Results are compared using chi-square test. Statistical significance was assigned to a P value of<0.05. RESULTS: Complications of ileostomy formation were developed in 17 (16.5%) cases; 8 peristomal dermatitis, 3 wound infection, 2 prolapse, 1 stenosis, 1 perforation, 1 bleeding, 1 high output ileostomy. There was no significant difference of complication rate in relation to underlying diseases, types and purpose of ileostomy. Ileostomy take-down was performed in 55 (53.4%) cases of 103 patients. Complications related with ileostomy take-down were developed in 18 (32.7%) cases; 7 wound infection, 5 intestinal obstruction, 2 incisional hernia, 2 enterocutaneous fistula, 1 anastomosis leakage, 1 bleeding. There was no significant difference of complication rate in relation to time interval or method of take-down. However, complication rate of ileostomy take-down was significantly increased in patient with inflammatory bowel disease. CONCLUSIONS: Ileostomy formation is simple and safe surgical procedure. We couldn't find any factor affecting the morbidity of ileostomy formation or closure. However, complication rate after ileostomy closure, especially in patient with inflammatory bowel disease, is relatively high.

Characteristic Clinical Behaviors of and Prognosis for Mucinous Adenocarcinomas in the Colon and Rectum

PURPOSE: The clinical significance of a mucinous-type colorectal adenocarcinoma is still controversial. Mucinous colorectal adenocarcinomas have been suggested to have distinct clinicopathologic features, i.e., early-onset, right-side dominancy, and poor prognosis. We aimed to verify the biological behaviors of and survivals for mucinous adenocarcinomas compared with non-mucinous adenocarcinomas. METHODS: Using a database of colorectal cancers at Asan Medical Center between 1989 and 2000, we enrolled 121 mucinous adenocarcinoma and 2,289 non-mucinous adenocarcinoma patients in this study. Clinical, pathological characteristics of and prognoses for mucinous adenocarcinomas were analyzed and compared with those for non-mucinous adenocarcinomas, retrospectively. The median follow-up period was 24 (0~113) months for mucinous adenocarcinomas and 32 (0~130) months for non-mucinous adenocarcinoma. RESULTS: Compared to non-mucinous adenocarcinomas, mucinous adenocarcinomas showed distinctive clinicopathologic features of early-onset (P<0.001), frequent family history (P<0.001), right-side dominancy (P=0.010), advanced stage at diagnosis (P<0.001), and common peritoneal seeding at diagnosis (P<0.001). The recurrence rate in the mucinous adenocarcinoma group was 45.2% during the follow-up period: 21.6% distant metastasis, 14.3% peritoneal dissemination, 5.7% local recurrence, and 3.6% simultaneous local recurrence and distant metastasis. The five-year survival rates in stages II and III were 70% and 48.7%, respectively, for mucinous adenocarcinomas and 92% and 50.2%, respectively, for non-mucinous adenocarcinomas. This difference was statistically significant. CONCLUSIONS: Mucinous adenocarcinomas seem to have distinct biologic behaviors with different clinicopathologic features and poor prognosis. A surgical approach with a follow-up schedule considering the characteristics of mucinous adenocarcinomas is needed.

Pulmonary Metastases after Curative Resection in Patients with Colorectal Carcinomas

PURPOSE: Pulmonary metastases from colorectal carcinomas have been reported to occur in 10% of all patients who undergo a curative resection. A number of studies have reported aggressive treatments, including lung resection, for pulmonary metastases that appear to prolong the survival in selected cases. The aim of this study was to assess the clinical characteristics, and the prognostic factors of pulmonary metastases, as well as the outcomes after resection of the pulmonary metastases. METHODS: A retrospective study was performed on 104 patients who presented with primary pulmonary metastases without metastases in other organs after a curative resection for a colorectal carcinoma between January 1994 and December 2000 at Asan Medical Center. Pulmonary metastases were diagnosed by using serial changes in the chest X-ray and the CT. Univariate (log-rank) and multivariate (Cox's model) analyses were employed to identify the prognostic factors. RESULTS: The mean interval between colorectal resection and pulmonary metastases (disease-free interval) was 22 (range: 4~64) months. Fifty-eight of 104 patients had pulmonary metastases originating from rectal cancer. More than half of the patients (55.7%) had bilateral multiple metastases. Fifty-six of 104 patients underwent chemotherapy, 28 conservative therapy, and 20 a pulmonary resection with the extent of the resection varying from a wedge resection of the metastatic nodule to a lobectomy. Prolonged survival was associated with serum CEA levels at the diagnosis of the metastases (P=0.02) and with the type of treatment (P<0.01). CONCLUSIONS: The s-CEA level at the diagnosis of the pulmonary metastases appears to be a reliable predictor of survival in patients with pulmonary metastases from colorectal cancer. Resection of the pulmonary metastasis in colorectal cancer may significantly prolong survival. Thus, aggressive therapy, including surgery, should be considered for pulmonary metastatic tumors in selected groups.