Clinical impact of carcinoembryonic antigen messenger ribonucleic acid expression in tumor-draining vein blood on postoperative liver metastasis in patients with colorectal carcinoma: a prospective, cohort study.

PURPOSE: This study was designed to determine the clinical impact of carcinoembryonic antigen messenger ribonucleic acid expression in tumor-draining vein blood on postoperative liver metastasis in patients with colorectal carcinoma. METHODS: The study comprised 37 patients with colorectal carcinoma who underwent laparotomy (Dukes A, 3; Dukes B, 16; Dukes C, 15; and Dukes D, 3). Blood samples were drawn from the tumor-draining vein and the tumor-feeding artery. Total ribonucleic acid was extracted from the blood and subjected to reverse transcriptase-polymerase chain reaction to detect carcinoembryonic antigen messenger ribonucleic acid. Tissue sections of tumor were stained with hematoxylin and eosin and were examined immunohistochemically. The duration of follow-up ranged from two years and three months to three years and six months. RESULTS: Expression of amplified carcinoembryonic antigen messenger ribonucleic acid in tumor-draining vein blood was positive in 16 (43 percent) of the 37 patients, while that in the feeding artery blood was positive in 3 patients (8 percent). There was no relation between the protein level of carcinoembryonic antigen and positive expression of carcinoembryonic antigen messenger ribonucleic acid. Positive expression of carcinoembryonic antigen messenger ribonucleic acid was observed in two patients with histologic evidence of massive venous invasion and in all three patients with synchronous liver metastasis. Immunohistochemical studies revealed that all tumor specimens with stromal type (5/5) of carcinoembryonic antigen staining had positive expression of carcinoembryonic antigen messenger ribonucleic acid. Postoperative liver metastasis was detected in four patients, three of whom (75 percent) had positive expression of carcinoembryonic antigen messenger ribonucleic acid in tumor-draining vein blood. CONCLUSIONS: Positive expression of carcinoembryonic antigen messenger ribonucleic acid in tumor-draining vein blood differed by the type of immunohistochemical staining with carcinoembryonic antigen. These data suggest that patients with positive expression of carcinoembryonic antigen messenger ribonucleic acid in tumor-draining vein blood may be at a high risk for postoperative liver metastasis.

Preoperative assessment of cancer in elderly patients: a pilot study.

The aim of this study was to assess the face validity and practical utility of the Preoperative Assessment of Cancer in the Elderly (PACE) tool in a sample of elderly patients with cancer. A prospective series of such patients with breast, colorectal, upper gastrointestinal, and other cancers were interviewed using the PACE; patients were scored for presurgical assessment using standard measures, including American Society of Anesthesiologists physical status, the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM), the Portsmouth POSSUM, and World Health Organization performance status before undergoing standard surgical management. Short-term surgical outcome (in terms of mortality and morbidity) and cancer site-specific data were collected to identify the risk groups. Seventy-two patients took part in the study (participation rate of 97%). The interview in which the questionnaire was given was found to take 20 minutes on average. Face validity was demonstrated, with clear comprehension of the requirements of the PACE being shown by all patients. The 2 groups identified according to the presence (n = 24) or absence (n = 48) of postoperative mortality/morbidity were compared according to components of the PACE. The study identified possible associations between these components and postoperative morbidity. No postoperative mortality was recorded; however, 24 patients (33%) had surgical complications. Performance status and Activities of Daily Living classification were found to be significantly related to postoperative short-term morbidity, whereas a lower score on the Mini Mental State Examination and a higher score on the Geriatric Depression Scale were found to be related to postoperative morbidity, although they did not achieve statistical significance because of the small numbers involved. The authors have demonstrated the practicality and face validity of PACE and identified some associations with postoperative morbidity. Based on the findings of this pilot study, a large, international multicenter trial is planned.

Extended lymphadenectomy and preoperative radiotherapy for lower rectal cancers.

BACKGROUND: Extended lymphadenectomy including lateral node dissection (EXT-L) contributes to a low incidence of local recurrence of lower rectal cancer. However, EXT-L is frequently associated with impairment of sexual and urinary function. We therefore compared the effectiveness of preoperative radiotherapy with that of EXT-L. METHODS: One hundred fifteen patients were studied. Seventy-eight patients underwent preoperative radiotherapy with a total dose of 50 Gy (Rad[+] group), and 37 did not (Rad[-] group). Seventy-five patients received EXT-L (EXT-L[+] group), and 40 did not (EXT-L[-] group). Patients were further divided into 4 subgroups (Rad[+]&EXT-L[-], Rad(+)&EXT-L[+], Rad[-]&EXT-L(+), and Rad[-]&EXT-L[-]), and clinicopathologic features were examined. In the Rad(+) group, the relation between the p53 gene and survival was also examined. RESULTS: There was a significant difference in disease-free survival between the Rad(+) and Rad(-) groups (5-year disease-free survival rate, 74.6% vs 45.9%; P =.006). However, there was no significant difference between the Rad(+)&EXT-L[-] and Rad[-]&EXT-L(+) groups. The p53 gene status did not affect survival in the Rad(+) group. CONCLUSIONS: This study suggests that in terms of curative effect, preoperative radiotherapy can be one alternative therapy in place of EXT-L for patients with lower rectal cancer.