Positioning of Bristol Stool Form Scale type 3 in constipation treatment satisfaction: A multicenter study in Japan.

BACKGROUND AND AIM: Many patients are not satisfied with chronic constipation (CC) treatments. The aim of this study was to identify factors linked to CC treatment satisfaction or dissatisfaction. METHODS: Our study population included patients who received CC treatment at a clinic or hospital. CC was diagnosed by a physician based on the patient's complaint. Treatment satisfaction was evaluated using the 28th question of the Patient Assessment of Constipation Quality of Life questionnaire. RESULTS: We conducted this study at 28 facilities. We included 167 patients (mean age 66.7 ± 15.2 years, male:female ratio is 1:3.07). Sixty-eight (40.7%) of patients were satisfied with their constipation treatment. Treatment dissatisfaction of CC was significantly associated with frequency of bowel movement <3/week (odds ratio [OR] = 0.376, 95% confidence interval [CI]: 0.156-0.904, P = 0.029) or Bristol Stool Form Scale (BSFS) type 3 (OR = 0.401, 95% CI: 0.170-0.946, P = 0.037). CONCLUSIONS: Our study showed that CC patients with BSFS type3 were not satisfied with constipation treatment. In general, BSFS types 3-5 are defined as normal stools. Therefore, BSFS type 3 may be set as a treatment goal even though the patient is not satisfied. The pathophysiology of CC differs by region and patient background. Therefore, parameters used to define successful treatment will be different by patient or region. We should reconsider the positioning of BSFS type 3 to improve treatment satisfaction for CC.

Efficacy of surgery for lung metastases from colorectal cancer synchronous to or following that for liver metastases.

AIM: To evaluate the validity of surgical therapy for isolated hepatic and pulmonary colorectal metastases. PATIENTS AND METHODS: Among 256 patients with liver resection for colorectal cancer metastases, 31 patients underwent resection for lung metastases synchronously or following liver resection. RESULTS: Twenty-nine patients (93.5%) underwent pulmonary resection for lung metastases after hepatectomy. Two patients (6.5%) with synchronously identified liver and lung metastases underwent staged liver and lung resection. The 5-, and 10-year overall survival rates were 77.5% and 39.5% after the initial liver resection and were 44.7% and 38.2% after the pulmonary resection, respectively. By multivariate analysis, the presence of three or more pulmonary metastases (risk ratio=3.692, 95% confidence interval C I=1.039-13.118, p=0.043) was an independent adverse prognostic factor. CONCLUSION: Surgical resection for both hepatic and pulmonary metastases from colorectal cancer appears feasible and efficacious in patients with <3 pulmonary metastases.

The influence of viral hepatitis status on long-term HCC outcome in patients with non-cirrhotic livers.

AIM: To evaluate the influence of viral hepatitis status on the long-term outcome of patients with hepatocellular carcinoma (HCC) in non-cirrhotic livers. PATIENTS AND METHODS: Two hundred and seventy-nine patients diagnosed with HCC underwent liver resection. Histologic examination of the resected liver confirmed the absence of cirrhosis in 145 patients. Clinical characteristics and surgical outcome were compared between patients with HCC derived from non-cirrhotic liver with (n=111) and without (n=34) viral hepatitis. RESULTS: One-, three- and five-year disease-specific survival rates in patients without viral markers (97.0%, 93.9% and 88.1%, respectively) were significantly higher than in patients with positive viral markers (97.2%, 81.0% and 62.3%, respectively) (p=0.0151). The five-year remnant liver recurrence-free survival rate in patients with negative viral markers (64.1%) was significantly higher than in patients with viral markers (44.9%) (p=0.0412). CONCLUSION: Hepatic resection is beneficial for HCC in non-cirrhotic livers patients without viral hepatitis.

Indication for hepatic resection in the treatment of liver metastasis from gastric cancer.

BACKGROUND: The significance of hepatic resection for liver metastasis after gastric cancer is not well established. This study aimed to evaluate the effect of hepatic resection in such patients. PATIENTS AND METHODS: A retrospective analysis was performed on the outcome of 63 patients with liver metastases without other non-curative factors of gastric cancer who underwent gastrectomy with or without hepatic resection. RESULTS: Overall 1-, 3-, and 5-year survival rates were 61.9%, 17.2%, and 10.3%, respectively, with a median survival time of 16 months. This increased to 82.3%, 46.4%, and 37.1%, respectively, with a median survival time of 31.2 months in patients who underwent hepatic resection. Multivariate analysis showed that hepatic resection was an independent prognostic factor. Moreover, unilobar liver metastases significantly influenced favorable prognosis in patients receiving hepatic resection by univariate analysis. CONCLUSION: In patients with liver metastases, hepatic resection may be a therapeutic option in the presence of unilobar liver metastases.

Effect of obesity on laparoscopy-assisted distal gastrectomy compared with open distal gastrectomy for gastric cancer.

BACKGROUND AND OBJECTIVES: This study compared surgical outcomes between patients undergoing laparoscopy-assisted distal gastrectomy (LADG) and those undergoing open distal gastrectomy (ODG) from the viewpoint of obesity. METHODS: Between June 2002 and May 2008, 146 patients with preoperatively diagnosed early gastric cancer who underwent LADG (n = 90) or ODG (n = 56) were enrolled in this study and compared in terms of clinicopathological findings and operative outcome. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed as identifiers of obesity using FatScan software. The relationship between obesity and operative outcomes after LADG and ODG was evaluated. RESULTS: There were no significant correlations between intraoperative blood loss (IBL) and any obesity-related factors, or between operation time (OT) and any obesity-related factors in the LADG group. There was a significant correlation between IBL and BMI (r = 0.486, P = 0.0001), IBL and VFA (r = 0.456, P = 0.0003), IBL and SFA (r = 0.311, P = 0.0193), OT and BMI (r = 0.406, P = 0.0017), OT and VFA (r = 0.314, P = 0.0178), and between OT and SFA (r = 0.382, P = 0.0034) in the ODG group. CONCLUSIONS: LADG may be a useful operative manipulation that is not influenced by obesity, whereas ODG may be influenced by obesity even after reaching the surgical plateau.

Technique of right hemihepatectomy preserving ventral right anterior section guided by area of hepatic venous drainage.

BACKGROUND: Although the consequences of partial venous outflow interruption have attracted only limited attention in liver surgery, maximal preservation of liver function after hepatic resection requires preservation of circulation in the remnant liver, especially hepatic vein drainage. METHODS: Data from 30 patients undergoing 3-dimensional imaging were analyzed to clarify the relationship between the area of the ventral right anterior section (RAS) and that drained by regional hepatic vein tributaries. The feasibility of our preliminary technique of right hemihepatectomy preserving the ventral RAS also was evaluated. RESULTS: The median estimated volume of the ventral RAS was 230 mL (range, 88-391). The average ratio of this estimated volume of the ventral RAS to total estimated liver volume was 18.0 +/- 4.9%. The median volume of the territory served by middle hepatic vein (MHV) tributaries draining the ventral RAS, expressed as a percentage of the whole volume of the ventral RAS, was 82.5%. Findings in fusion images of portal and hepatic vein territories demonstrated an area of MHV tributaries comparable with the ventral RAS area in 73.3% of all cases. As for the results of right hemihepatectomy with the ventral RAS preserved, no tumor was exposed on transection surfaces, and no recurrence took place within the preserved ventral RAS of the remnant liver. CONCLUSION: Procedures considering the importance of regional venous drainage offer the possibility of reducing the extent of surgery without loss of effectiveness.

Influence of chemotherapy on liver regeneration induced by portal vein embolization or first hepatectomy of a staged procedure for colorectal liver metastases.

BACKGROUND: Although portal vein embolization (PVE) and staged hepatectomy (StHx), as well as prehepatectomy chemotherapy, have improved the resectability rate of patients with multiple bilobar colorectal liver metastases, the impact of prehepatectomy chemotherapy on liver hypertrophy following PVE and/or StHx has remained unclear. METHODS: Sixty patients who underwent PVE followed by one-stage hepatectomy and StHx with or without PVE were analyzed. Liver hypertrophy following PVE and/or the first hepatectomy of StHx and the clinical course after final hepatectomy was compared between patients with and without prehepatectomy chemotherapy. RESULTS: No difference of volume of the future liver remnant (FLR) before or after the procedure was seen between the chemotherapy group and the nonchemotherapy group. Even in 38 patients who underwent right PVE prior to a planned right hemihepatectomy, the chemotherapy group (n = 14) and the nonchemotherapy group (n = 24) were comparable in terms of volumes of FLR before (P = 0.71) and after (P = 0.29) PVE and posthepatectomy courses. However, the liver hypertrophy ratio for patients showing steatosis in adjacent nonmalignant liver parenchyma, which frequently is induced by chemotherapy, was lower than that for patients without steatosis (P = 0.04). CONCLUSIONS: Although prehepatectomy chemotherapy did not impair liver hypertrophy, PVE and/or StHx accompanied by prehepatectomy chemotherapy should be performed with particular care to minimize risk of liver failure after the procedure.

Importance of complete pathologic response to prehepatectomy chemotherapy in treating colorectal cancer metastases.

OBJECTIVE: We studied the influence of complete pathologic response of colorectal cancer liver metastases to prehepatectomy chemotherapy on longterm survival after hepatectomy. SUMMARY BACKGROUND DATA: Although complete response seen on imaging may be a useful criterion for evaluating efficacy of chemotherapy, complete clinical response by imaging has shown limited predictive value for complete pathologic response in treating colorectal liver metastases. METHODS: We retrospectively analyzed data from 63 patients who received preoperative chemotherapy and underwent hepatectomy. RESULTS: Of 472 liver metastases evaluated, 86 were no more visible from images after chemotherapy. We excluded 14 of these metastasis treated with local ablation. Of the remaining 72 metastasis, 22 (30.6%) were microscopically persistent metastases or recurrences in situ. Liver metastases with complete pathologic response had smaller diameters at diagnosis than others (P < 0.001), and microscopic cancer deposits surrounding macroscopic tumors were less frequent in patients with complete pathologic response than others (P < 0.05). Outcomes were favorable in patients whose liver metastases all showed a complete pathologic response. Even patients with complete pathologic response in only some metastases showed higher overall and disease-free survival rates than pathologic nonresponders (P = 0.001 and P = 0.002, respectively). Presence or absence of metastases showing complete pathologic response was an independent prognostic factor (relative risk, 4.464; P = 0.0099). CONCLUSIONS: Little correlation was observed between imaging response of colorectal cancer liver metastases to chemotherapy and pathologic response. Liver surgery should be undertaken even after a complete response by imaging. Outcome after hepatectomy was favorable in patients showing complete pathologic response of least one metastasis.

Efficacy of repeat hepatic resection for recurrent hepatocellular carcinomas.

BACKGROUND: This study evaluated the efficacy of repeat hepatic resection for recurrent hepatocellular carcinoma (HCC) and the clinicopathological factors influencing overall survival after resection. METHODS: From 1992 to 2005, 231 patients underwent curative hepatic resection for HCC at Yokohama City University, Japan. Of these, 105 patients developed intrahepatic recurrence, and 24 repeat hepatectomies were performed for recurrent HCC. Survival data were analysed, and prognostic factors for repeat hepatic resection were determined. RESULTS: The overall cumulative 1-, 3- and 5-year survival rates and the median survival time of the patients after initial hepatic resection (n= 231) did not differ from those of the patients after repeat hepatic resection (n= 24), with values of 91.3, 70.2 and 49.1%, and 57 months, versus 91.7, 73.1 and 50.9%, and 61.5 months, respectively (P= 0.875). The operative time and blood loss in patients who underwent repeat hepatic resection did not differ from those who underwent primary resection. Multivariate analysis identified portal invasion at the first hepatic resection and a disease-free interval of 1.5 years since the previous surgery.

[A case of advanced gastric cancer effectively treated on an outpatient basis by biweekly S-1 and docetaxel combination chemotherapy].

A 70-year-old male patient had advanced gastric cancer with severe lymph node metastasis. He was treated by combination chemotherapy of S-1 120 mg/body (1-week administration and 1-week rest)and docetaxel (DOC) 40 mg/body( day 1 and 15). After 2 courses of treatment, the primary lesion was remarkably improved and para-aortic lymph nodes disappeared by CT scan, so we diagnosed it as a partial response (PR). Anemia (WHO grade 3) was observed as toxicity and treated with transfusion. This regimen could be performed on an outpatient basis for over 2 years, and the response was maintained on CT and endoscopic examination after 20 courses of treatment. The biweekly docetaxel and S-1 combination chemotherapy was thought to be an effective method as chemotherapy for an outpatient with advanced gastric cancer.

[A case of advanced gastric cancer successfully treated by combination therapy of S-1 and docetaxel].

A 73-year-old man with gastric cancer of Borrmann type 3 accompanied with N3 was treated by combination therapy of S-1 and docetaxel (DOC). He received DOC intravenously at 45 mg/m/2 on day 1 and 15, and S-1 orally at 120 mg/body on day 1 to 7 and day 15 to 21. This treatment was repeated every 28 days as one course. After 4 courses of treatment, a CT scan revealed partial response of the lymph node metastases, and imaging modalities showed complete response of the primary lesion. The serum CEA value normalized after 4 courses of treatment. Toxicities included leukocytopenia (grade 3-4) and neutropenia (grade 3-4). Chemotherapy in the outpatient setting was possible by reduction of dose (DOC 45-->40-->35 mg/m2). Total gastrectomy was performed after 4 courses of treatment. The histological effect of primary lesion was judged to be Grade 2.

Hepatocellular carcinoma occurring in a young Crohn's disease patient.

Reported herein is a case of hepatocellular carcinoma (HCC) occurring in a 25-year-old Japanese man who was diagnosed with Crohn's disease (CD) at 14 years of age; treatment included predonisolone, azathioprine, and infliximab. The tumor was located in right upper lobe and the size was 8 cm in diameter; histology was poorly differentiated HCC with pleomorphic cellular changes. Adjacent normal liver showed no evidence of cirrhosis or viral hepatitis. Until now, only six cases of HCC arising in patients with CD have been reported in the English-language literature. Most of these patients had early onset of CD and HCC: none had cirrhosis or virus hepatitis. Most patients had a long disease history of CD and were being medicated with several immunosuppressive agents. Some factors associated with CD might indirectly or directly be related to the development of HCC in CD patients, although the possibility that these HCC occurred coincidentally in CD patients, including the present patient, cannot be ruled out. Accumulation of cases is necessary to evaluate the relationship between CD and HCC precisely.

Phase II study of weekly paclitaxel as a second-line treatment for S-1-refractory advanced gastric cancer.

BACKGROUND: We retrospectively evaluated the efficacy of weekly paclitaxel therapy as second-line treatment for patients with advanced gastric cancer that was refractory to S-1. PATIENTS AND METHODS: In total, 33 patients received intravenous paclitaxel (80 mg m(-2)) on days 1, 8 and 15 as part of a 4-week cycle. RESULTS: Eight patients showed a partial response, 11 showed stable disease and 14 showed disease progression. In total, 171 courses (mean=5.2; range=3-16) were administered. Thirteen cases subsequently underwent third-line treatment. The median survival time and time to progression from the time of second-line treatment was 8.0 months and 4.2 months, respectively. The most common haematological toxicities were leukopenia and neutropenia. Non-haematological toxicities were generally mild to moderate and controllable. CONCLUSION: This study showed favourable therapeutic outcomes for advanced gastric cancer patients. However, it will be necessary to confirm the advantages of paclitaxel treatment for S-1-refractory advanced gastric cancer in a larger population.

Validity of hepatic resection of colorectal liver metastases in the elderly (75 years and older).

AIM: To evaluate the validity of surgical therapy for colorectal liver metastases in the elderly patients. PATIENTS AND METHODS: Between 1992 and 2004, 401 patients were diagnosed as having liver metastases from colorectal cancer. These comprised 64 patients aged 75 years or older and 337 patients aged less than 75 years. RESULTS: Two hundred and thirty-two patients (57.9%) underwent potentially curative hepatic resection. Postoperative complications occurred in 29.6% of the older patients and in 23.4% of the younger patients. Mortality was 0% in the older group and 0.5% in the younger group. The overall 5-year survival rates of the older and younger group were 33.2% and 47.9%, respectively (p < 0.01). The proportion of patients who died of other diseases was significantly higher in the older (11.1%) than the younger group (2.0%) (p = 0.04). CONCLUSION: Age cannot be regarded as a medical contraindication for hepatic resection of colorectal liver metastases.

Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer.

BACKGROUND: Some studies have found high incidences of intraoperative and postoperative complications for patients with gastric cancer. To determine the predictive factors for the surgical complications of laparoscopic gastric surgery, surgical outcomes were evaluated. METHODS: Between April 2002 and December 2007, 152 patients with preoperatively diagnosed early gastric cancer who underwent laparoscopy-assisted distal gastrectomy (LADG) were enrolled. Visceral (VFA) and subcutaneous fat areas (SFA) were assessed by Fat Scan software. The predictive factors for surgical complications of LADG were evaluated by univariate and logistic regression analyses. RESULTS: Of 152 patients, conversion to open surgery due to uncontrollable bleeding was observed in nine male patients, and postoperative complications were detected in seven male and one female patient (four anastomotic leakage, two intraabdominal abscess, one pancreatic fistula, and one lymphorrhea). High body mass index (BMI) and high VFA independently predicted conversion to open surgery and postoperative complications. VFA was significantly higher, operation time was longer, blood loss was greater, and SFA was lower in male than in female patients, whereas no significant difference was observed in BMI between male and female patients. CONCLUSIONS: High BMI and high VFA can predict technical difficulties during laparoscopic gastric surgery and postoperative complications. Particularly, LADG should be performed cautiously to prevent surgical complications for male patients with high VFA. Predictive impact of VFA should be further determined in a larger set of patients.

Clinical utility of contrast-enhanced three-dimensional ultrasound imaging with Sonazoid: findings on hepatocellular carcinoma lesions.

OBJECTIVES: We investigated clinical utility of contrast-enhanced three-dimensional ultrasound (CE 3D US) imaging with contrast medium Sonazoid for demonstrating characteristic enhancement of hepatocellular carcinoma (HCC). METHODS: Among 115 focal liver tumors undergoing CE 3D US imaging, 70 HCCs confirmed with contrast-enhanced multi-detector computed tomography, contrast-enhanced magnetic resonance imaging or histopathologic examination were retrospectively analyzed. CE 3D US imaging was performed using Autosweep 3D scan functionality in the early, middle and late phase, after bolus injection of 0.2 ml Sonazoid. The CE 3D tomographic images reconstructed in parallel slices and sonographic angiogram images were independently reviewed by two reviewers. Kappa values were used to assess inter-reviewers' agreement. RESULTS: TUI images showed most of HCCs were detected with intratumoral vessels and early tumor enhancement in the early phase, expressed homogenous or heterogeneous tumor enhancement in the middle phase, and became hypoechoic or isoechoic in the late phase. The kappa values in the early, middle and late phase for inter-reviewer agreements regarding the characteristic enhancement of tumors were 0.817, 0.774, and 0.785. In addition, TUI images demonstrated satellite foci and tortuous tumor vessels in three orthogonal planes. Sonographic angiogram reconstructed by different rendering modes showed the vessels and tumor stain in spatial view. The spatial configuration of anatomic structures was revealed on basis of both TUI and sonographic angiogram images. CONCLUSION: CE 3D US imaging, with spatial visualization, is clinically useful to exhibit the characteristic enhancement of HCC tumors objectively.

Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly.

BACKGROUND: To date, it has been unclear whether laparoscopy-assisted distal gastrectomy (LADG) is a suitable treatment for elderly patients with early gastric cancer. This study retrospectively compared surgical outcomes between elderly and nonelderly patients with gastric cancer. METHODS: The study group was comprised of 211 patients who underwent distal gastrectomy between April 2000 and March 2007. Of these, 130 patients (26 aged >or=75 years and 104 aged <75 years) underwent LADG, and the remaining 81 patients underwent conventional open distal gastrectomy (ODG). Short- and long-term patient outcomes were evaluated. RESULTS: The operation time was significantly longer in the LADG group than in the ODG group (262.6 versus 234.3 min, p = 0.005), but the other short-term outcomes did not differ between the two groups. When performed by an experienced surgeon, blood loss was significantly reduced, while operation time for LADG was similar to that for ODG. Within the LADG group, incidences of comorbid disease and lymph-node metastasis were significantly greater, the histological tumor type was significantly more differentiated, and the macroscopically depressed tumor type was less common in elderly patients. However, the incidence of postoperative morbidity did not differ between the elderly and nonelderly groups (11.5% versus 3.8%, p = 0.1201), and there was no significant difference in postoperative course. Logistic regression analysis showed that body mass index, but not chronological age, was an independent predictive factor of postoperative morbidity (odds ratio = 3.674, p = 0.045). There were no significant differences in overall or disease-specific survival between elderly and nonelderly patients. CONCLUSION: LADG is an effective treatment for elderly patients with early gastric cancer if it is performed by an experienced surgeon. A high-volume study is needed to confirm this rationale.

Three-dimensional contrast-enhanced sonography of vascular patterns of focal liver tumors: pilot study of visualization methods.

OBJECTIVE: We investigated visualization methods of 3D sonography with a perflubutane-based contrast agent in the imaging evaluation of vascular patterns of focal liver tumors. MATERIALS AND METHODS: Eighty-four patients with focal liver tumors underwent automatic scanning with 3D sonography 20-60 seconds after administration of a perflubutane contrast agent. The confirmed final diagnoses were 50 hepatocellular carcinomas, 20 metastatic lesions, nine hemangiomas, and five cases of focal nodular hyperplasia. Tomographic sonographic images reconstructed in 3D parallel slices and rendered sonographic images resembling angiograms were reviewed by two readers. RESULTS: Sonographic angiograms rendered by maximum intensity of gray values in surface smooth mode showed tumor vessels and early tumor enhancement. The average intensity of gray values with surface texture mode showed unenhanced areas within tumors. Interobserver agreement for classifying enhancement patterns with both tomographic sonography and sonographic angiography was excellent (kappa=0.84). The main pattern, intratumoral vessels with early homogeneous or heterogeneous tumor enhancement, had a sensitivity of 97% (average of both readers), specificity of 94%, and positive predictive value (PPV) of 96% for hepatocellular carcinomas. The presence of tumor vessels with early peripheral ringlike tumor enhancement had a sensitivity of 90%, specificity of 95%, and PPV of 86% for metastatic lesions. Peripheral nodular enhancement had a sensitivity of 84%, specificity of 99%, and PPV of 89% for hemangioma. The presence of spoke-wheel arteries with early tumor enhancement had a sensitivity of 80%, specificity of 100%, and PPV of 100% for focal nodular hyperplasia. CONCLUSION: Three-dimensional sonography with a perflubutane-based contrast agent is useful in the evaluation of vascular patterns of focal liver tumors.

Prognostic factors after resection of pancreatic cancer.

OBJECTIVES: The purpose of this study was to identify important prognostic factors related to the status of a pancreatic tumor, its treatment, and the patient's general condition. METHODS: Between April 1992 and December 2006, 140 patients underwent a pancreatic resection for invasive ductal carcinoma. Prognostic factors were defined by univariate and multivariate analyses. RESULTS: The study included 103 tumors in the head of the pancreas and 37 tumors in the body or tail. The median survival time and the actuarial 5-year survival rate for all patients were 14.5 months and 12.3%, respectively. Using the significant prognostic factors identified by univariate analysis, multivariate analysis revealed that a preoperative serum CA19-9 concentration>100 U/ml (HR=1.84, p=0.0074), a tumor size>3 cm (HR=1.74, p=0.0235), venous involvement (HR=2.39, p=0.0006), a transfusion requirement of >or=1000 ml (HR=2.23, p=0.0006), and a serum albumin concentration on 1 postoperative month (1POM)<3 g/dl (HR=2.40, p=0.0009) were significant adverse prognostic factors. The presence of hypoalbuminemia on 1POM significantly correlated with a longer surgical procedure (p=0.0041), extended nerve plexus resection around the superior mesenteric artery (p=0.0456), and a longer postoperative hospital stay (p=0.0063). CONCLUSION: To improve long-term survival, preserving the patient's general condition by performing a curative resection with a short operation time and minimal blood loss should be the most important principle in the surgical treatment of pancreatic cancer.

Overexpression of the fibroblast growth factor receptor-1 gene correlates with liver metastasis in colorectal cancer.

Expression of the fibroblast growth factor (FGF)-1, FGF-2, fibroblast growth factor receptor (FGFR)-1, and FGFR-2 genes has been reported in various cancers and is associated with poor outcomes in patients with solid tumors. This study examined the relations between the relative expression of the FGF genes and clinicopathological factors, especially invasion and metastasis, in patients with colorectal cancer. We studied surgical specimens of cancer tissue and adjacent normal mucosa obtained from 202 patients with untreated colorectal carcinoma. The relative expression levels of FGF-1, FGF-2, FGFR-1, and FGFR-2 mRNA in cancer and in normal adjacent mucosa were measured by quantitative real-time, reverse-transcription polymerase chain reaction. The relative expression level of the FGFR-2 gene was higher in normal adjacent mucosa than in cancer, whereas the relative expression levels of the FGF-1, FGF-2, and FGFR-1 genes were similar. FGFR-1 gene expression levels were higher in the presence than in the absence of liver metastasis. An analysis of the relation between clinicopathological features and gene expression showed that overexpression of FGFR-1 correlated with liver metastasis. Our results suggested that overexpression of the FGFR-1 gene might lead to liver metastasis in colorectal cancer. Overexpression of the FGFR-1 gene may thus be a useful predictor of liver metastasis in patients with colorectal cancer.