Research progression in clinical treatment of gastric cancer in 2020 / 中华胃肠外科杂志

Gastric cancer is a common type of malignant tumors, but its clinical prognosis remains unsatisfactory. Up to 2020, a growing number of high-quality clinical researches has provided reliable evidence for clinical practice. Evidences from surgery, perioperative treatment and immunotherapy, such as changes in surgical methods, improvement of perioperative chemotherapy and combination of immune and chemotherapy strategy, provided the possibility to improve the clinical efficacy of gastric cancer. In our clinical practice, gastrointestinal surgeons need to integrate the current research progression and develop individualized strategy for different patients, which is expected to further improve the prognosis and quality of life for patients with gastric cancer.

How to carry out the translational medicine research effectively in gastrointestinal tumors / 中华胃肠外科杂志

As a new concept, the definition of translational medicine remains obscure. The translational medicine connects the bench to bedside, and its importance would be more remarkable. The development of gastrointestinal surgery reflects the idea of translational medicine. To carry out the translational study, the gastrointestinal surgeon must learn how to find subjects from clinical problems, how to collect complete information and tissues, how to collect complete information and tissues, how to collaborate with others from different fields and how to utilize all kinds of resources. By translational studies, gastrointestinal surgeons may further improve the survival of patients with gastrointestinal tumor.

Clinicopathological features and prognosis of chronic gastric ulcer with early canceration / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathological features and prognosis of chronic gastric ulcer with early canceration in order to provide useful information for diagnosis and treatment strategies.</p><p><b>METHODS</b>A retrospective review of clinical data and prognosis from 43 patients of chronic gastric ulcer with early canceration from 2003 to 2010 was conducted. These data were compared with those with primary intra-mucosa gastric cancer (type I and II 275 cases, type III 68 cases).</p><p><b>RESULTS</b>In 43 cases of chronic gastric ulcer with early canceration, 30 cases (69.8%) were male, 22 cases (51.2%) were younger than 60 years old. Lesions located in the body or antrum of the stomach in 39 cases (90.7%), were less than 2 cm in 26 cases (60.5%), were undifferentiated type in 23 cases (53.5%), and developed lymph node metastasis in 4 cases (9.3%). Lesions of 4 cases of chronic gastric ulcer with early canceration located in the upper third of the stomach, while those of type III primary intra-mucosal gastric cancer all located in the lower two thirds, and the difference was statistically significant (P<0.01). Compared to type III and type I and II primary intra-mucosal gastric cancer, chronic gastric ulcer with early canceration did not differ in clinicopathological characteristics such as histological type, vascular or lymphatic invasion, and lymph nodes metastasis (all P>0.05). The median follow-up time was 57 months (range 16 to 98 months). The 5-year overall survival was 95.3% in chronic gastric ulcer with early canceration group, similar to that of type I, II (97.4%) or type III (94.5%) primary intra-mucosal gastric cancer group (P>0.05).</p><p><b>CONCLUSIONS</b>The clinicopathological features of chronic gastric ulcer with early canceration are similar to those of primary intra-mucosal gastric cancer. The prognosis is promising for those patients undergoing surgical treatment.</p>

Improving comprehensive quality of gastrointestinal surgeons to cope with complicated medical environment / 中华胃肠外科杂志

The doctor-patient relationship has become increasingly tense. The requirement of the society for physicians, especially surgeons is higher. Apart from fine professional skills, surgeons must learn some other skills, such as communication, the ability of self-decompression, and the awareness of public relationship to deal with inculpation from the media and society. The medical record is more and more important nowadays, surgeons should pay enough attention to it. The public misunderstanding of the medical profession will surely harm both doctors and patients in the end.

Application of enhanced recovery program after surgery(ERAS) in patients undergoing radical resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the enhanced recovery program after surgery (ERAS) with conventional perioperative management in patients undergoing radical resection for colorectal cancer.</p><p><b>METHODS</b>The ERAS protocol included a combination of evidence-based and consensus methodology. A total of 597 consecutive patients undergoing elective colorectal resection were randomized to either the ERAS(n=299) or the control group(n=298). Outcomes related to nutrition and metabolism index, stress index, and recovery index were measured and recorded.</p><p><b>RESULTS</b>Demographics and operative parameters were similar between the two groups(P>0.05). The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group. On postoperative day (POD) 1, the HOMA-IR in the ERAS group was significantly lower than that in the control group(P<0.01). The cortisol level in the control group was elevated on both POD 1(P<0.01) and POD 5(P<0.01) compared to the preoperative level. However, the cortisol level was not increased until POD 5(P<0.01) in the ERAS group. The levels of TNF-α, IL-1β, IL-6, and IFN-γ were reduced in the ERAS group, indicating less postoperative stress responses compared with the control group. In addition, ERAS group was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay [(5.7±1.6) d vs. (6.6±2.4) d, P<0.01] and expense[(15 998±2655) RMB vs. (17 763±3059) RMB, P<0.01] were reduced in the ERAS group. Twenty-eight patients(9.4%) in the control group and 29(9.7%) in the ERAS group developed complications, while the difference was not statistically significant(P>0.05).</p><p><b>CONCLUSION</b>ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety.</p>

Application of robotic system in gastrointestinal surgery / 中华胃肠外科杂志

Robotic system helps surgeons in performing surgery. Currently Da Vinci system is the most popular. Da Vinci system has been used for the stomach and bowel diseases in 27 cases(18 cases of stomach and 9 cases of colon and rectum) in the Zhongshan Hospital, Fudan University. Accurate preoperative staging is crucial, and Da Vinci system is advantageous in lymph node dissection, preservation of nerve plexus, and complete resection of mesorectum. Adoption of gastrointestinal tract reconstruction technique should depend on the operation and experience in surgery. Though Da Vinci system has limitations and the cost is high, it is believed to be the future trend.

Expression and prognostic value of M2 macrophages and regulatory T cells in gastric carcinoma tissue / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the prognostic value of M2 macrophages and regulatory T cells(Tregs) in gastric carcinoma.</p><p><b>METHODS</b>Clinicopathological characteristics and follow up data of 135 patients with gastric carcinoma were collected. Patients included were those who underwent D2 radical resection(R0) at Zhongshan Hospital of Fudan University from February 1999 to December 2005. Tissue chips of gastric carcinoma specimen were stained using immunohistochemistry to determine the cells density and number of M2(CD163 positive) and Tregs(Foxp3 positive).</p><p><b>RESULTS</b>The median positive cells density of M2 macrophages and Tregs in tumor tissue were 7.48/HP and 6.33/HP, respectively, higher than that in adjacent tissues(1.37/HP and 2.92/HP, P<0.001). The density of M2 macrophages was positively correlated with that of Treg cells(r=0.415, P<0.001) in tumor tissue. The median survival of patients with low expression of M2 and Tregs(n=43) was significantly longer than those with high expression of the 2 cells(n=45) (99.0 vs. 72.3 months, P<0.05).</p><p><b>CONCLUSION</b>Combined detection of M2 macrophages and Tregs may predict the prognosis of gastric carcinoma.</p>

Clinicopathological features and prognosis of cystic gastrointestinal stromal tumor / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological and molecular genetic characteristics of gastrointestinal stromal tumor (GISTs) with significant cystic changes, and to assess their biological behavior.</p><p><b>METHODS</b>Clinicopathological features of 7 patients with cystic GISTs treated at the Zhongshan Hospital of Fudan University from February 2005 to January 2010 were summarized retrospectively. The mutations status of c-kit and PDGFR-α were analyzed.</p><p><b>RESULTS</b>There were 2 males and 5 females aged from 46 to 76 years old. Primary site of GISTs included stomach(n=4), duodenum(n=1), and small intestinal(n=2). Tumor size ranged from 6 to 16 cm with obviously cystic changes. Tumor cells were found in the solid components under microscope, of which epithelioid cell type were found in 4 case and spindle cell type in 3 cases. The mitotic figures were no more than 3/50 HPF in all the patients. According to the NIH criteria, 4 were high-risk and 3 were low-risk. Based on morphological characteristics, 3 cases were as borderline tumor, 3 moderate-risk, and 1 moderate-risk. Gene mutation of exon 11 of c-kit were identified in 3 cases. During the follow up ranging from 9 to 80 months, all the 7 patients had cancer-free survival.</p><p><b>CONCLUSION</b>The biological behavior of cystic GIST is indolent with a low risk of malignancy and favorable prognosis.</p>

Peroral endoscopic myotomy for esophageal achalasia: report of 42 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for esophageal achalasia (AC).</p><p><b>METHODS</b>The clinical data of 42 patients diagnosed as AC and received POEM in the Zhongshan Hospital of Fudan University between August 2010 and March 2011 were reviewed retrospectively. The key procedures of POEM included esophageal mucosal incision, submucosal "tunneling" by endoscopic submucosal dissection(ESD) technique, endoscopic myotomy of the circular muscle, and closure of mucosal incision by hemostatic clips.</p><p><b>RESULTS</b>The mean age of 42 cases was 43.9(range 10-70) years. The mean duration of disease was 8.7 years (range, 3 months to 50 years). The mean operative time was (68.5 ± 25.5) (range 23-180) minutes with a mean submucosal tunneling length of(10.5 ± 1.5)(range 8-15) cm. The average length of endoscopic myotomy of inner circular muscle was(9.5 ± 2.5)(range 7-13) cm. No serious complications related to POEM were encountered. The median follow-up period was 2.5(range 1-6) months. Dysphagia symptom was relieved significantly during the follow-up period in 41 patients; one patient had dysphagia and vomiting 15 days after the operation. Endoscopic observation showed a submucosal fistula which was managed by endoscopic incision.</p><p><b>CONCLUSIONS</b>As a novel minimally invasive therapy for AC, POEM appears to have definite short-term outcomes and can rapidly alleviate dysphagia symptom. Further observations and long follow-up are needed to evaluate long-term outcome and complications.</p>

Da Vinci robot-assisted gastrectomy with lymph node dissection for gastric cancer: a case series of 9 patients / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the technical feasibility, effectiveness, and safety of robot-assisted gastrectomy(RAG) with lymphadenectomy using the Da Vinci system.</p><p><b>METHODS</b>A total of 9 patients in our institute from March 17 to April 24 2010 underwent RAG. Clinicopathologic characteristics and surgical outcomes were summarized.</p><p><b>RESULTS</b>All operations were performed successfully without conversion to either open or laparoscopic approach. There were 5 total gastrectomies,2 distal gastrectomies, 1 proximal gastrectomy and 1 wedge gastrectomy with D(1) or D(2) lymphadenectomy. The total operative time was 150 to 440 minutes. Total blood loss ranged from 10 to 100 ml. The ranges of harvested lymph nodes were 19-24 for D(1) patients and 28-38 for D(2) patients. There was 1 case of postoperative gastric leakage, which were managed conservatively.</p><p><b>CONCLUSIONS</b>RAG with lymphadenectomy can be applied safely and effectively for patients with gastric cancer.</p>

A retrospective survival analysis of with pulmonary metastasis from colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the survival rate after pulmonary resection for metastatic colorectal cancer(CRC).</p><p><b>METHODS</b>Clinical data of 77 patients with pulmonary metastasis from CRC between January 2005 and October 2008 in the Zhongshan Hospital, Fudan University were retrospectively analyzed.</p><p><b>RESULTS</b>There were 38 patients with synchronous pulmonary metastasis, of whom 2 underwent resection for pulmonary metastasis. The median survival time of two groups was 25 months and 18 months, which was not significantly different (P=0.33). There were 39 cases of metachronous pulmonary metastasis, of whom 28 received pulmonary metastasis resection. The 1-year and 3-year survival rates of 2 groups were 93.3% and 58.5%, and 38.8% and 19.1%, respectively. The median survival time of two groups was 26.7 months and 8 months, and the difference was statistically significant (P=0.004).</p><p><b>CONCLUSION</b>Surgical resection can improve the survival rate in patients with pulmonary metastasis from colorectal cancer.</p>

Risk factors for postoperative pancreatic leakage after D(2) resection of gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the incidence of pancreatic fistula following D(2) gastrectomy and associated risk factors.</p><p><b>METHODS</b>A total of 132 consecutive cases of gastric cancer underwent D(2) gastrectomy between Jul 1, 2009 and Dec 2009. Amylase concentration of the drainage fluid and serum amylase concentration were tested on day 1, 4, 7 after operation. Univariate analyses were performed to evaluate the significance of various covariates as risk factors for the pancreatic fistula-related complications.</p><p><b>RESULTS</b>The incidence of pancreatic fistula was 17.4%. None of the following factors including age, gender, tumor location, tumor stage, N stage, range of resection, fistula output, and serum amylase were associated with pancreatic fistula.</p><p><b>CONCLUSION</b>The incidence of pancreatic fistula following D(2) gastrectomy is high. Drainage tube is necessary to prevent serious complications.</p>

Prognostic analysis of 669 liver metastasis of colorectal cancer cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the relation between different therapy and survival rate of liver metastasis of colorectal cancer (LMCC).</p><p><b>METHODS</b>Clinical data of 669 LMCC patients,collected from Fudan University Zhongshan Hospital from January 2000 to July 2008, were analyzed retrospectively.</p><p><b>RESULTS</b>Of the 669 cases, 379 cases were synchronous liver metastases(SLM) and 290 cases were metachronous liver metastases(MLM). There were no significant differences in age, gender and position of primary tumor between SLM and MLM groups(P>0.05), but as to liver metastasis characteristics(liver lobe involved, focus number and maximal focus diameter) and CEA, CA19-9 before therapy,there were significant differences(P<0.05). Two hundred and fifty-three cases underwent curative hepatic resection, including 123 cases in SLM and 130 cases in MLM. Until October 31, 2008, all the cases were followed up. The median survival time of SLM was(11+/-1) months and of MLM(23+/-2) months(P<0.01). Five-year survival rate of SLM was 6.4% and of MLM 11.4%(P<0.01). As to different treatments, median survival time and 5-year survival rate of curative hepatic resection group were 37 months and 35.6%, and of non-operation groups(i.e. intervention, chemotherapy, radiofrequency therapy and percutaneous ethanol injection) were 5 to 26 months and 0 to 3.6% respectively(P<0.05).</p><p><b>CONCLUSIONS</b>Curative hepatic resection is the first choice of liver metastasis of colorectal cancer, which can improve the survival rate. Resection rate and survival of MLM are better than those of SLM.</p>

Cellular immunity induced by CD40 ligand-activated dendritic cells in CEA transgenic mice / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the role of CD40 ligand (CD40L) in dendritic cells (DC) of CEA transgenic mice and to evaluate the specific cellular immunity induced by activated DC.</p><p><b>METHODS</b>Bone marrow cells of the CEA transgenic mice were used to generate immature dendritic cells under the condition of GM-CSF and IL-4. CD40L was added to activate dendritic cells into mature phenotype. Dendritic cells cancer vaccine was pulsed with CEA526-533 peptide which made the vaccine specific for cancer immunity. The immunophenotype molecules were identified by flow cytometry. The cytokines produced by cells were determined by ELISA. T cells proliferation was measured by (3)H-thymidine essays.</p><p><b>RESULTS</b>Immunophenotype molecules expressions of CD40L-activated dendritic cells were significantly higher than those in control group. IL-12 secretion by CD40L-activated dendritic cells was (937.81+/-51.99) pg/10(6) DC, significantly higher than that in control group [(83.06+/-8.58) pg/10(6) DC, P<0.01]. CD8(+) T cells proliferation induced by CD40 L-activated dendritic cells was stronger as compared to control group (P<0.05), and the secretion of IFN-gamma was(33.900+/-4.550) ng/L, significantly higher than that in control group [(5.226+/-0.460) ng/L, P<0.01]. Splenocytes proliferation induced by CD40 L-activated dendritic cells was stronger as compared to control group (P<0.01), and the secretion of IFN-gamma was (69.802+/-11.407) ng/L, significantly higher than that in control group [(2.912+/-0.562) ng/L, P<0.01].</p><p><b>CONCLUSION</b>The method of using CD40L to stimulate bone marrow-delivered dendritic cells promotes the maturation and activation of dendritic cells, which enhances the cellular immunity in CEA transgenic mice.</p>

Evaluation the value of number of metastatic perigastric lymph nodes on prognosis in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To find out a simple and reproductive prognostic index in gastric cancer patients,which can be used as a comparable parameter among different regions of China.</p><p><b>METHODS</b>The perigastric metastatic lymph nodes(PGMLN) with long-term survival data were retrospectively evaluated in 148 gastric cancer patients, undergone potentially curative resections.</p><p><b>RESULTS</b>The 3-year cumulative survival rate was 62.8% and the survival rate decreased significantly with the increase of PGMLN, especially when the PGMLN was more than 6. The PGMLN had a clear linear relationship with total positive lymph nodes(r=0.94, P<0.01), while it had little correlation with total resected lymph nodes(r=0.18,P=0.2).</p><p><b>CONCLUSIONS</b>PGMLN is a convenient and reliable prognostic factor in gastric cancer patients, which may be a good candidate of comparable parameters among different regions of China.</p>

Evaluation of the preoperative staging of rectal cancer by magnetic resonance imaging / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of MRI in preoperative staging of rectal cancer.</p><p><b>METHODS</b>The data of 156 rectal cancer patients,undergone MRI scans from December 2004 to June 2006 in our hospital, were analyzed retrospectively. Findings of MRI were compared with postoperative pathological examinations.</p><p><b>RESULTS</b>Intracavitary localized parenchyma tumors were seen in 72 cases, and intestinal wall abnormal incrassation or stricture in other 84 cases from MRI scan. Sixteen cases had rectal polyps simultaneously, 2 cases ovarian cysts, 13 cases anterior-sacral metastases and 2 cases bone metastases. The sensitivity and specificity of T(1-2), T(3) and T(4) rectal cancer by MRI examination were 25%(8/32), 93.3%(84/90), 94.1%(32/34) and 100%(124/124), 57.6%(38/66), 96.7%(118/122) respectively. In MRI imaging, metastatic para-rectal lymph node was diagnosed as the diameter >5 mm or abnormal border or mixed resonance, with a sensitivity of 85.1%(80/94) and specificity of 45.2%(28/62).</p><p><b>CONCLUSION</b>MRI has high accuracy for preoperative staging of rectal cancer, and is useful to detect the serosal infiltration and lymph node metastasis.</p>

Endoscopic submucosal dissection for gastrointestinal stromal tumors: a report of 20 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the removal of small gastrointestinal stromal tumor (GIST).</p><p><b>METHODS</b>GIST diagnosed by endoscopic ultrasonography (EUS) was managed by ESD with the needle knife as follows:(1)Injecting normal saline into the submucosa. (2)Pre-cutting the surrounding mucosa of the lesion. (3) Dissecting the submucosal tissue to display GIST and resecting the lesion completely.</p><p><b>RESULTS</b>Of 20 GISTs, 12 located in gastric fundus, and 1 in gastric antrum, 3 in gastric body and 4 in rectum. Lesion diameter ranged from 0.5 to 3.2 cm and the mean resected size was 1.6 cm. Among 20 lesions, 19 were resected with ESD completely, and 1 received additional operation because of tumor residual in the wound after ESD. The success rate of ESD was 95.0% (19/20). The mean ESD procedure time was 87.5 min (ranging from 60 to 150 min). None of the patients had delayed bleeding after ESD. Perforations occurred in 3 cases after the dissection of the GIST, which were closed with metallic endoclips without additional surgical suture. The perforation rate of ESD was 15.0% (3/20). The follow up ranged from 2 to 12 months, and no recurrence was observed by EUS except the above-mentioned case undergone additional operation.</p><p><b>CONCLUSION</b>ESD is effective and safe for small GIST, which can resect the whole lesion and provide pathological information.</p>

Establish predictive model of colorectal cancer by using surface enhanced laser desorption/ionization-time of flight-mass spectrometry / 中华外科杂志

<p><b>OBJECTIVE</b>To establish serum proteome fingerprinting predictive models and search for proteins associated with colorectal cancer.</p><p><b>METHODS</b>Thirty-six randomly selected colorectal cancer patients and 36 cases with hernia or gall bladder diseases scheduled for elective operation were enrolled as cancer group and control group respectively. Peripheral venous blood samples were collected before the operations. Special serum protein or peptide fingerprint was investigated by using surface enhanced laser desorption/ ionization-time of flight-mass spectrometry (SELDI-TOF-MS) measurement after blood sample had been treated with weak cation exchange protein chip (CM10) for each case. The obtained data were analyzed by Biomarker Wizard software to screen serum proteome tumor markers and set up diagnosis predictive model for colorectal cancer. Blind validation of the model with 44 healthy controls and 88 colorectal cancer patients were carried out by using Biomarker Patterns Software.</p><p><b>RESULTS</b>In comparing colorectal cancer group with control group, 5 specific protein peaks (P < 0.05) were found. The predictive model had a sensitivity of 100% and a specificity of 97.2%. A sensitivity of 71.6% and a specificity of 72.7% was got with the blind validation. The specific protein peaks with a mass-to-charge ratio (m/z) of 8908 and 13,707 showed in all the results and it showed their strong relationship with colorectal cancer.</p><p><b>CONCLUSIONS</b>The predictive models built by the differences of serum proteome fingerprint could be a very useful diagnostic tool in colorectal cancer. Proteins with m/z of 8908 and 13,707 would possibly be the tumor markers of colorectal cancer.</p>

Clinical analysis of 18 cases with postsurgical gastroparesis syndrome after pancreaticoduodenectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the prevention and treatment for postsurgical gastroparesis syndrome (PGS) after pancreaticoduodenectomy.</p><p><b>METHODS</b>The data of 18 PGS cases after pancreaticoduodenectomy were analyzed.</p><p><b>RESULTS</b>PGS of these 18 patients occurred within 4-10 days after operation. All of the PGS patients were cured with mean 25.4 days by conservative therapy and no one received re-operation. PGS was closely associated with the operation procedure (chi(2)=3.90, P<0.05)and postoperative complications (chi(2)=3.92, P<0.05).</p><p><b>CONCLUSIONS</b>Incidence of PGS can be decreased by improvement of surgical procedure and prevention of abdominal complications. PGS can be cured by conservative therapy generally. Re-operation should be avoided.</p>

Application of SELDI-TOF-MS in detection of liver metastasis from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To establish a serum protein fingerprint model for prediction of liver metastasis from colorectal cancer by SELDI-TOF-MS analysis, and to determine the differentiatial proteins associated with the metastatic liver cancers.</p><p><b>METHODS</b>Data were collected from the Department of General Surgery in Zhongshan Hospital. A group of patients with colorectal cancer (CRC) without liver metastasis (n = 36) and another group with liver metastasis (n = 36) were included in this study. Serum samples were collected from peripheral venous blood before operation. Special serum protein or peptide fingerprint was determined by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). The obtained data were analyzed by Biomarker Wizard software to screen the serum protein markers discriminating colorectal cancer patients with and without liver metastasis. A serum protein fingerprint model was established. This model was blindly verified in of CRC patients with and 44 cases without liver metastasis.</p><p><b>RESULTS</b>Comparing the characteristic proteins in those two groups of patients, 10 specific protein peaks were identified with statistical significance (P < 0.05). According to m/z growing from small to large, they were: 2398, 2814, 4084, 4289, 4465, 6422, 6619, 11 482, 11 649 and 13 714. The predictive model had a sensitivity of 91.7% and a specificity of 97.2%. The validation showed a sensitivity of 75.0% and a specificity of 81.8%.</p><p><b>CONCLUSION</b>A predictive model based on differentiatial serum protein fingerprint with high sensitivity and specificity has been successfully established. It should be a very useful tool in detection and diagnosis of liver metastasis in colorectal cancer patients.</p>