Analysis of prognostic factors in patients with pancreatic ductal adenocarcinoma and synchronous liver metastases after palliativet reatment / 中华胰腺病杂志

Objectives To explore the prognostic factors of patients with pancreatic ductal adenocarcinoma and synchronous liver metastases ( PALM ) receiving palliative treatment .Methods The clinical characteristics , therapeutic approaches and survival outcomes of 108 consecutive patients with PALM who were pathologically diagnosed and received only palliative treatment at Tianjin Medical University Cancer Hospital from January 2001 to December 2015 .were retrospectively analyzed .Survival rates were calculated by Kaplan-Meier method, and factors influencing the survival were analyzed by univariate and multivariate Cox proportional hazard regression model .Results Of these patients, 68 were male and 40 were female, with an average age of 58 years old.Seventy-seven (71.3%) cases or their relatives refused to receive anticancer therapies.Palliative treatments included choledochojejunostomy and /or gastrojejunostomy after exploratory laparotomy for 5 (4.6%) cases, percutaneous transhepatic biliary drainage (n=22, 19.4%), drug analgesia (n=79, 73.1%), drug analgesia combined with percutaneous neurolytic coeliac plexus block (n=17, 15.7%).The median survival time (MS)was 94 days in all patients.Karnofsky performance score (KPS)<80, lymph node metastases, ascites, fasting blood glucose ≥6.1 mmol/L and lactate dehydrogenase ( LDH ) ≥250 U/L were independent risk factors influencing prognosis of PALM . Three groups were categorized according to the number of the above 5 risk factors for 0~1 in low risk group, 2~3 in middle risk group and 4~5 in high risk group, and the MS of 3 groups was 137, 95 and 48 days, respectively, with an extremely statistical significance (P<0.0001).Conclusions KPS, lymph node metastases, ascites, fasting blood glucose and LDH were the risk factors for prognosis of PALM .Patient stratification according to the above factors is more advantageous for judging individualized prognosis and can provide reference for making clinical decision .

Prognostic factors for survival in patients with colorectal liver metastases: experience of a single brazilian cancer center / Fatores prognósticos de sobrevida em pacientes com metástases hepáticas colorretais

CONTEXT: Liver metastases are a common event in the clinical outcome of patients with colorectal cancer and account for 2/3 of deaths from this disease. There is considerable controversy among the data in the literature regarding the results of surgical treatment and prognostic factors of survival, and no analysis have been done in a large cohort of patients in Brazil. OBJECTIVES: To characterize the results of surgical treatment of patients with colorectal liver metastases, and to establish prognostic factors of survival in a Brazilian population. METHOD: This was a retrospective study of patients undergoing liver resection for colorectal metastases in a tertiary cancer hospital from 1998 to 2009. We analyzed epidemiologic variables and the clinical characteristics of primary tumors, metastatic disease and its treatment, surgical procedures and follow-up, and survival results. Survival analyzes were done by the Kaplan-Meier method and the log-rank test was applied to determine the influence of variables on overall and disease-free survival. All variables associated with survival with P<0.20 in univariate analysis, were included in multivariate analysis using a Cox proportional hazard regression model. RESULTS: During the period analyzed, 209 procedures were performed on 170 patients. Postope-rative mortality in 90 days was 2.9% and 5-year overall survival was 64.9%. Its independent prognostic factors were the presence of extrahepatic disease at diagnosis of liver metastases, bilateral nodules and the occurrence of major complications after liver surgery. The estimated 5-year disease-free survival was 39.1% and its prognostic factors included R1 resection, extrahepatic disease, bilateral nodules, lymph node involvement in the primary tumor and primary tumors located in the rectum. CONCLUSION: Liver resection for colorectal metastases is safe and effective and the analysis of prognostic factors of survival in a large cohort of Brazilian patients showed similar results to those pointed in international series. The occurrence of major postoperative complications appears to be able to compromise overall survival and further investigation in needed in this topic.

CONTEXTO: As metástases hepáticas são evento comum na evolução clínica de pacientes com câncer colorretal e são responsáveis por 2/3 dos óbitos por esta doença. Há grande controvérsia entre os dados publicados na literatura quanto a resultados de tratamento cirúrgico e seus fatores prognósticos e não há análise, em casuísticas maiores, destes aspectos em uma grande coorte de pacientes no Brasil. OBJETIVOS: Caracterizar os resultados do tratamento cirúrgico de pacientes com metástases hepáticas de tumores colorretais e estabelecer os fatores prognósticos de sobrevida em uma população. MÉTODO: Estudo retrospectivo de pacientes submetidos a ressecção hepática de metástases colorretais em hospital oncológico terciário, de 1998 a 2009. Foram analisadas variáveis epidemiológicas e dos tumores primários da doença metastática e seu tratamento, dos procedimentos cirúrgicos e do seguimento e os resultados de sobrevidas. Para as análises de sobrevida foram utilizadas as curvas de Kaplan-Meyer e o teste de log-rank foi aplicado para determinar a influência das variáveis estudadas nas sobrevidas global e livre de doença. Aquelas variáveis em que este teste apresentou P<0,20 em análise univariada, foram incluídas em análise multivariada pelo modelo de regressão de Cox. RESULTADOS: No período analisado, 209 procedimentos foram realizados em 170 pacientes. A mortalidade em 90 foi de 2,9%. A sobrevida global em 5 anos foi de 64,9%. Os fatores prognósticos independentes de sobrevida global foram a presença de doença extra-hepática no momento do diagnóstico das metástases hepáticas, de nódulos em ambos os lobos hepáticos e a ocorrência de complicações maiores após a cirurgia. A sobrevida livre de doença estimada em 5 anos foi de 39,1% e seus fatores prognósticos incluíram a ressecção R1, a presença de doença extra-hepática, doença bilobar, a presença de acometimento linfonodal no tumor primário e tumores primários localizados no reto. CONCLUSÃO: A ressecção de metástases hepáticas de câncer colorretal se demonstrou segura e eficaz em nosso meio, com resultados semelhantes aos apresentados por outras grandes séries internacionais. A ocorrência de complicações pós-operatórias parece poder comprometer os resultados de sobrevida global obtidos e investigação mais aprofundada se faz necessária neste sentido.

Comparative study of therapeutic efficacy of systemic therapy with FOLFOX-6 and hepatic arterial infusion for hepatic metastases from colorectal cancer / 中华肝胆外科杂志

Objective To compare the efficacy and side effects between systemic chemotherapy and hepatic arterial infusion by combination of oxaliplatin and 5-fluorouracil (FOLFOX-6) with 5-fluorouracil in the patients who have developed hepatic metastasis after colorectal cancer operation. The factors that would affect the prognosis without operational treatment were also analyzed. Methods 46patients who had signed the informed consents were allocated into two groups: the group with general chemotherapy (Trial Group includes 26 cases) and the one with hepatic arterial infusion chemotherapy (Control Group includes 20 cases). The total effective rate, the prognosis, the cytoxicitic side effects,quality of life, the total survival rate and the responses were the main parameters determined. Kaplan-Meier was used to analyze Mono-factor to the prognostic responses and the Cox mode was used to analyze poly-factor to the prognostic responses. Results The overall survival rate was significantly higher by using systemic treatment versus HAI(median, 15. 0 v 11.2 months;P＜0.05). The difference in overall responsive rate (CR+PR) between the two groups was statistically significant (50% v 10%;P=0. 011). No significant difference was found in PS scale during the treatment. (P=0. 126). Except for myelosuppression and abdominal pain, no significant difference was found in the other side effects. Univariate analysis revealed that the invasive lesions to serosa, the distribution of liver metastases, the size and number of liver metastases, primary carcinoma involving lymph nodes and the treatment were correlated with prognoses. Cox regression analysis showed that the larger diameter of liver metastases, the number of liver lesions, primary carcinomas involved in serosal layer and the treatment modules were independent prognostic factors. Conclusions The oxaliplatin-based FOLFOX-6 chemotherapy regiment has a better responsive rate and survival rate than the traditional infusion with 5-fluorouracil to the main hepatic artery for interventional therapy. The diameter of the hepatic metastasis larger than 5em, multiple hepatic metastasis and the primary lesions penetrating serosal layer suggest the poor prognosis. The oxaliplatin-based systematic chemotherapy has a better prognosis. Therefore,it is worth carrying on further study on modification of traditional hepatic arterial infusion and on evaluation of therapy by combination of the hepatic arterial infusion with the systematic chemotherapy.

Factors analysis on liver metastasis from rectal cancer / 中国医师进修杂志

Objective To detect the clinical factors related with liver metastasis in young patients with rectal cancer.Methods Three hundred and fifty young patients with rectal cancer were collected to set up the database.Single and multi-factor Logistic regression was applied to indicate the independent factors relating to liver metastasis.The regression equation to predict probability of liver metastasis from rectal cancer was established.Results Liver metastasis was 120 cases (34.3%).Single-factor analysis revealed that patho-organization type,pathologytype,infiltration extent,blood vessel invasion (BVI),TNM stage,operation character,the preoperative level of carcino-embryonic antigen,histology grading were related with liver metastasis.Multi-factor analysis revealed that only BVI (P=0.001),TNM stage (P=0.001),pathoorganization type (P=0.005),the preoperative level of CEA (P=0.008) and operation character (P=0.032) were independent factors to predict probability of liver metastasis.Conclusions Rectal cancer of young patients who being with BVI,advanced phase,high preoperative level of CEA,radical operation or poor differentiation degree,are apt to develop liver metastasis.They should be given further individualized intensive adjuvant treatment.

A Rare Metastatic Liver Cancer: Hemangiopericytoma

Hemangiopericytoma is a rare tumor, and especially when it arises in the peritoneal cavity. We present here the case of a 60-year-old woman with an isolated recurrent hemangiopericytoma in the liver. The patient presented to us for evaluation of palpable RUQ mass 7 years after she had undergone her first resection of a malignant hemangiopericytoma arising from the greater omentum. She has been lost to follow up 6 months after the first surgery. Various imaging studies showed a single large liver tumor that was hypervascular, well-capsulated and had central necrosis. She was negative for HBs-Ag and Anti-HCV. Under an impression of the recurrent malignant hemangiopericytoma, a right trisegmentectomy was performed for complete resection of the tumor. The pathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Even though the incidence of hemangiopericytomas is low, malignant hemangiopericytomas have displayed frequent recurrences after long disease- free periods. A recurrent hemangiopericytoma is not easily detected early during follow-up until it is symptomatic because this tumor has no specific tumor marker and it has diverse sites of recurrence. We think that Positron Emission Tomogram (PET) can be a useful tool for detection of recurrent hemangiopericytoma. We describe herein the clinically relevant information about hemangiopericytomas, and we particulary focus on the features of this tumor after the surgical resection.

Intraabdominal Desmoplastic Small Round Cell Tumor: Report of Two Cases

Intraabdominal desmopl small round cell tumor is a rare neoplasm predominant in adolescent or young adult male. The tumor is characterized by widespread growht along the peritoneal surfaces of the abdomen and pelvis,typical histologic features, and a specific immunohistochemical staining pattern. We report the clinical,radiologic, and pathologc findings of intraabdominal desmoplastic small round cell tumor.

Transcatheter Arterial Chemoembolization of Liver Metastasis of Gastrointestinal Leiomyosarcoma

PURPOSE: To evaluate the usefulness of transcatheter arterial chemoembolization (TACE) in the management of gastrointestinal leiomyosarcoma metastatic to the liver. MATERIALS AND METHODS: Ten patients with gastrointestinal leiomyosarcoma and hepatic metastasis underwent TACE after surgical resection of the primary tumor. All of the leiomyosarcomas originated from the stomach (n=5), duodenum (n=1) or jejunum(n=4), and the interval between primary tumor resection and hepatic metastasis was 1-120 (mean 26) months. Using an emulsion of 3-20 mL of Lipiodol and 15-60 mg of doxorubicin. TACE was performed, and in five patients, gelfoam embolization was added. Therapeutic response was evaluated by follow-up CT, and nine patients underwent repeated TACE (range :2-9 times ; interval : 1-9 months). RESULTS: On celiac arteriography, all cases showed hypervascular tumor staining. As an initial therapeutic response based on CT assessment, more than 50% regression of the tumor (partial remission) was achieved in seven patients, and in the remaining three, regression was 20-30% (stable disease) ; neither complete remission nor progression was seen. With regard to long-term survival, five patients died at 5, 8, 14, 20 and 49 (median, 19) months after initial TACE. The remaining five, in whom follow-up has extended for 13-54 months, are still alive. Overall, survival time ranged from 5-54 (median, 19) months, and except for postembolization syndrome, there was no specific complication. The period of durable tumor regression before progression ranged from 6 to 54 (median, 17) months. CONCLUSION: TACE can be a safe and effective method for the palliation of gastrointestinal leiomyosarcoma metastatic to the liver.

Contrast Enhancement Patterns of Hepatic Masses using Three Phase Spiral CT

PURPOSE: To compare the contrast enhancement patterns of hepatocellular carcinomas(HCCs), hemangiomas, and metastases on three-phase images with spiral CT for differential diagnosis. MATERIALS AND METHODS: Three-phasespiral CT scan was performed in 73 patients with hepatic masses. CT scanning was performed with a table speed of 10mm/sec, section thickness of 10mm, and a reconstruction interval of 5mm, 100-150ml of contrast medium was injected intravenously with an automatic injector at a rate of 2-3mL/sec. CT scans were obtained at 30, 70 and 180 seconds after the start of contrast material injection. RESULTS: The enhancement patterns of 136 lesions in 53 patients with HCCs were as follows : 47 lesions(35%) were totally high and 55(40%) were mixed in the early phase ;30 lesions(22%) were mixed and 66(49%) were totally low in the portal phase ; and 105 lesions(78%) were totally low in the delayed phase. In hemangiomas of 23 lesions in 15 patients, 7 lesions(30%) were peripherally high and11(48%) were totally low in the arterial phase ; 4 lesions(17%) were totally high and 12(53%) were peripherally high in the portal phase ; 10 lesions(42%) were totally high and 4(18%) were peripherally high in the deayed phase. In metastatic liver mali gnancies of 42 lesions in 5 patients, 13 lesions(31%) were peripherally high and 22(52%) were totally low in the arterial phase ; 32 lesions(77%) were totally low in the portal phase, and 35(83%)were totally low in the delayed phase. CONCLUSION: Three-phase spiral CT scanning is a useful diagnostic methodin the differential diagnosis of hepatic masses including HCCs, hemangiomas, and hepatic metastases.

Hepatoid Adenocarcinoma of the Stomach: Radiologic Findings

PURPOSE: Hepatoid adenocarcinoma of the stomach is a variant of gastric carcinoma with both adenocarcinoma and hepatocellular carcinomatous differentiations. Until recently, few reports had been published. The purpose of this study was to evaluate the radiologic characteristics of eleven hepatoid adenocarcinomas of the stomach aswell as patterns of metastasis. MATERIALS AND METHODS: Eleven pathologically proven cases of hepatoidadeno carcinoma of the stomach were retrospectively reviewed. Radiologic studies available were CT in eight patients, abdominal ultrasonography in ten, upper GI series in seven, and hepatic angiography in two. Pathologicand radiologic characteristics of these lesions, patterns of metastasis, if present, and labolatory data(AFP andCEA) were evaluated. RESULTS: Tumors were seen in the antrum and body in five patients, in the antrum in five, and in the body of the stomach in one. Six tumors were classified as Borrmann type 3, four as Borrmann type 2, andone as Borrmann type 4. Nine cases showed hepatic metastasis. Portal vein thrombosis was present in three cases ;two were accompanied by multiple liver metastasis and the other had portal venous thrombosis. Lymph nodemetastasis was identified in 11 cases ; N1 in five, N2 in five, and extensive retroperitoneal paraaortic and left supraclavicular lymphadenopathy in one. Angiography showed hypervascular metastatic liver masses in two cases.There was no evidence of metastasis to the mesentery, omentum, and peritoneum. Serum AFP was elevated in tencases(mean : 24752.2 ; median : 4230 ng/ml). CONCLUSION: Radiologic findings of hepatoid adenocarcinoma of thestomach appear similar to those of non-hepatoid adenocarcinoma. However, elevation of AFP and early liver metastasis without peritoneal metastasis is suggestive of hepatoid adenocarcinoma of the stomach.

Detection of Liver Metastases: Usefulness of Dynamic Spiral CT during the Portal Phase with a Higher IV Injection Rate of Contrast Material

PURPOSE: To evaluate the usefulness of dynamic spiral computed tomography(CT) during the portal phase with ahigher IV injection rate of contrast material in detecting hepatic metastases. MATERIALS AND METHODS: We reviewed two-phase dynamic spiral CT in 44 patients with hepatic metastases of pathologically proven primary malignancy. One hundred and fifty ml. of non-ionic contrast material was administered with a power injector at a rate of 5ml/sec., and two-phase images at 55-80 sec.(portal phase) and 2-5 min.(equilibrium phase) were obtained after thestart of bolus injection. Two phase images were compared for detectability of hepatic metastases according tosize, number and enhancement pattern. RESULTS: In cases of metastases less than 1cm, 113 lesions(100%) that showed clearly defined hypodense lesions were detected in the portal phase of dynamic CT. However, the equilibriumphase images showed hypodense lesions in 58 cases(51%) and isodense lesions in 55cases(49%). In cases of metastases 1-2cm in size, the portal phase images detected 70 hypodense lesions(92%) and six hyperdense lesions(8%). In the equilibrium phase, however, the lesions were hypodense in 54 cases(71%), hyperdense infour(5%), and isodense in 18(24%). In cases of metastases larger than 2 cm, portal phase images showed 29 hypodense lesions(97%) and one hyperdense lesion(3%). In the equilibrium phase, however, the lesions were hypodense in 25 cases(83%), hyperdense in two(7%), and mixed in three(10%). As compared with the portal phase, most metastatic lesions were detected as poorly defined hypodense or isodense lesions in the equilibrium phase and decrease in size due to peripheral enhancement. CONCLUSION: Dynamic spiral CT during the portal phase with a higher IV injection rate(5 ml/sec) of contrast material is a useful method for detecting hepatic metastases, especially small lesions less than 1cm.