Presurgical diagnostic accuracy of five imaging procedures in chemotherapy-naive (group A) or chemotherapy-pretreated (group B) patients with colorectal liver metastases (Italian PROMETEO Study).

Background: Whether repeat hepatectomy for colorectal liver metastases should be performed after chemotherapy or observation is unclear. Methods: We selected patients with resectable hepatic recurrence after their first hepatectomies performed between 2000 and 2015. They were classified according to the further treatment: Group A, prompt repeat hepatectomy; Group B, observation; and Group C, ≤6 months of chemotherapy. In Group B/C, patients who later underwent hepatectomy and those who did not due to disease progression were classified as B1/C1 and B2/C2, respectively. Predictors of B2/C2 were evaluated. Results: Groups A, B, and C consisted of 81, 36, and 17 patients, respectively. Recurrence-free interval was longer in Group A (median months; Group A, 10.3; Group B, 5.7; Group C, 3.5; p < 0.01). Group B1/C1 and B2/C2 included 34 and 19 patients, respectively. Five-year survival after recurrence of Group B1/C1 was 56%, which was comparable with Group A (56%, p = 0.77) and better than Group B2/C2 (0%, p < 0.01). Multivariate analysis showed synchronous colorectal liver metastases (OR 7.23) and recurrent hepatic tumor number (OR 4.04) were predictors of tumor progression. Conclusion: Selecting patients optimally either for prompt or delayed repeat hepatectomy following chemotherapy or observation is a feasible strategy.

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Identification of patients who most benefit from hepatic arterial infusion (HAI) combined or not with systemic chemotherapy for the treatment of unresectable colorectal liver metastases

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14565 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14565-14565

Author(s):

P. Pilati ◽

S. Mocellin ◽

M. Lise ◽

D. Nitti

Keyword(s):

Liver Metastases ◽

Colorectal Liver Metastases ◽

Systemic Chemotherapy ◽

Tumor Response ◽

Hepatic Arterial Infusion ◽

Arterial Infusion ◽

Tumor Load ◽

Group A ◽

Unresectable Colorectal Liver Metastases ◽

Group B

14565 Background: Although locoregional treatments such as hepatic arterial infusion (HAI) claim the advantage of delivering higher doses of anticancer agents directly into the affected organ, there is substantial lack of evidence for benefit in terms of overall survival (OS). To test the hypothesis that systemic chemotherapy affects OS of patients with unresectable colorectal liver metastases treated with HAI. Furthermore, we investigated patient- and tumor-related predictive factors that might identify patients who most benefit from HAI regimen. Methods: In this retrospective study, 153 consecutive patients treated at our institution were considered. In group-A (n=72), patients were treated with HAI alone (floxuridine (FUDR) 0.2 mg/Kg + leucovorin (LV) 4 mg/m2 + desamethasone 20 mg 14 days/month) between 1994 and 1999. In group-B (n=81), patients were treated with the same HAI regimen combined with systemic chemotherapy (5-fluorouracil (5FU) 450 mg/m2 + LV 20 mg/m2) between 1999 and 2003. Results: No difference in OS was observed between group-A and group-B (median OS: 18.0 and 19.1 months, respectively). Considering all patients (group A + group B), low tumor load was associated with a better tumor response rate, but none of the traditional clinico-pathological prognostic factors correlated with OS. Median OS was better in patients with less than 50% of liver parenchyma involvement (21.3 vs 13.2 months; P<0.0001) as well as in responders (complete or partial response) versus non-responders (24.4 vs 13.4 months; P<0.0001). The combination of low tumor load with good tumor response to HAI was the only variable retained at multivariate analysis, and identified a subgroup of patients with a very favorable clinical outcome (median survival: 34.2 months; hazard ratio: 0.347, CI: 0.249–0.564, P< 0.0001). Conclusions: Combination with 5FU+LV systemic chemotherapy did not lead to an OS benefit over FUDR-based HAI alone. The identification of tumor response predictors is urgently needed, as it would lead to the tailored treatment of patients with low load but unresectable metastatic liver disease who most benefit from HAI therapy. No significant financial relationships to disclose.

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Phase II/III Study of Radiofrequency Ablation Combined with Cytokine-Induced Killer Cells Treating Colorectal Liver Metastases

Cellular Physiology and Biochemistry ◽

10.1159/000452531 ◽

2016 ◽

Vol 40 (1-2) ◽

pp. 137-145 ◽

Cited By ~ 9

Author(s):

Xiaodong Li ◽

Xichao Dai ◽

Liangrong Shi ◽

Yong Jiang ◽

Xuemin Chen ◽

...

Keyword(s):

T Cells ◽

Radiofrequency Ablation ◽

Liver Metastases ◽

Phase Ii ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

T Cell Response ◽

Cik Cells ◽

Group A ◽

Group B

Purpose: This phase II/III, non-randomized clinical trial aimed to determine the efficacy and safety of the combination of radiofrequency ablation (RFA) and cytokine-induced killer (CIK) cells transfusion for patients with colorectal liver metastases (CRLMs). Experimental Design: A total of 60 eligible patients with CRLMs were enrolled and divided into Group A (RFA alone, n = 30) and Group B (RFA plus CIK, n = 30), and following enzyme-linked immunosorbent spot assay was performed in 8 patients with CEA > 50 ng/mL pre-RFA and 7 days post-RFA and CIK treatment, respectively. Results: The median progression-free survival (PFS) times of Group A and Group B were 18.5 months and 23 months, respectively (P = 0.0336). The 3-year progression-free rates were 13.3% in Group A and 20.3% in Group B, respectively. The median overall survival time was 43 months in Group A, and not reached in Group B. The 3-year survival rates were 64.6% in Group A and 81.0% in Group B, respectively (P = 0.1187). Among the 8 patients with CEA > 50ng/mL, 6 had increase of circulating CEA-specific T cells after RFA (P = 0.010). After CIK cell therapy, the number of CEA-specific T cells increased in all the 8 patients comparing with that pre-treatment (P = 0.001) and in 7 patients comparing with that post-RFA (P = 0.028). Conclusions: We firstly confirm that the combination of RFA and CIK cells boosts CEA-specific T cell response and shows to be an efficacious and safe treatment modality for patients with CRLMs.

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Liver stiffness measurement predicts the difficulty of Kasai procedure in biliary atresia: a single center retrospective analysis of 199 patients

BMC Pediatrics ◽

10.1186/s12887-019-1846-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Qiulong Shen ◽

Yajun Chen ◽

Chunhui Peng ◽

Wenbo Pang ◽

Zengmeng Wang ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Biliary Atresia ◽

Liver Stiffness ◽

Porta Hepatis ◽

Liver Stiffness Measurement ◽

Stiffness Measurement ◽

Kasai Procedure ◽

Group A ◽

Group B ◽

Sensitivity Specificity

Abstract Background Kasai procedure is the standard initial treatment of infants with biliary atresia. The key to perform a successful surgery is to accurately remove the fibrous portal plate near the liver hilum. Yet how to estimate surgical difficulty pre-operatively remains unclear. This study aims to design an algorithm that predicts the difficulty of Kasai procedure using liver stiffness measurement (LSM). Methods One hundred ninety-nine patients were included from April 2012 to December 2016. The patients were all surgically diagnosed with biliary atresia. Group A comprised of patients with porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was equal to or smaller than 90°), group B comprised of patients without porta hepatis retraction (the angle between the plane of the fibrous porta plate and the plane of the medial liver closest to the plate was greater than 90°). Liver function measurements and LSM were measured for all patients within three days before surgery. Results Our study included 19 cases in group A (9 males, 10 females) and 180 cases in group B (87 males, 93 females). LSM had statistical differences between the two groups, 28.10(14.90) kPa VS 10.89(7.10) kPa, P = 0.000. There was a significant relationship between LSM and operative age, TBA, AST, GGT (P = 0.000, 0.003, 0.003, 0.012, correlation coefficient = 0.323, 0.213, 0.207, 0.179). The AUROC of LSM was 0.919. When the cutoff value was 15.15 kPa(OR = 3.989; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.947, 0.750, 0.285, 0.992 and 0.768, respectively. When the value was 23.75 kPa(OR = 3.483; P = 0.000), the sensitivity, specificity, PPV, NPV and diagnostic accuracy were 0.631, 0.950, 0.571, 0.960 and 0.919, respectively. Conclusions LSM can be used to predict the difficulty in dissecting fibrous portal plate, and in turn, the difficulty of Kasai procedure. LSM > 23.75 kPa suggests a more complicated surgery.

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Major Hepatectomy for Colorectal Metastases in the Elderly: A Tertiary Center Experience

International Surgery ◽

10.9738/intsurg-d-14-00155.1 ◽

2015 ◽

Vol 100 (9-10) ◽

pp. 1276-1280

Author(s):

Osama Damrah ◽

Panagis M. Lykoudis ◽

Rafael Orti-Rodriguez ◽

Theodora Pissanou ◽

Dinesh Sharma ◽

...

Keyword(s):

Overall Survival ◽

Liver Resection ◽

Elderly Patients ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Major Hepatectomy ◽

Major Liver Resection ◽

Primary Tumor Site ◽

Group A

The purpose of this retrospective study was to investigate whether patients over 70 years old are at significantly higher risk for worse outcomes following major liver resection. Hepatic resection is the only treatment offering long-term survival for patients with colorectal liver metastases. As the population considered for metastasectomy is aging, there are still controversial published results regarding the safety of major hepatectomy in elderly patients. Between December 2002 and April 2010, 327 patients underwent major liver resection for colorectal liver metastasis. Patients were stratified into 2 groups: group A, <70 years old; and group B, ≥70 years old. Recorded, analyzed, and compared data across groups included the following: (1) patient characteristics including age, sex, American Society of Anesthesiologists performance status, primary tumor site and stage, adjuvant chemotherapy, number and size of metastatic lesions; (2) perioperative data including extent of resection, in-hospital mortality, postoperative morbidity, length of hospital stay, length of intensive treatment unit stay and blood loss; and (3) overall survival. The patients' characteristics were similar as were the characteristics of their tumors. There was no difference in overall morbidity (25% versus 22%) or postoperative mortality (2.6% versus 2.9%) (P = 0.44 and 0.57, respectively). The overall survival was 67% versus 62% in group A and B, respectively (P = 0.09). Elderly patients can safely undergo major liver resection for colorectal liver metastases with short- and long-term outcomes comparable with younger patients.

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Linked color imaging confers benefits in profiling H. pylori infection in the stomach

Endoscopy International Open ◽

10.1055/a-0895-5377 ◽

2019 ◽

Vol 07 (07) ◽

pp. E885-E892 ◽

Cited By ~ 1

Author(s):

Xiaotian Sun ◽

Yiliang Bi ◽

Bing Nong ◽

Duanmin Hu ◽

Xiaomin Sun ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Youden Index ◽

Controlled Clinical Trial ◽

Diagnostic Efficiency ◽

Color Imaging ◽

Diagnostic Efficacy ◽

Group A ◽

Linked Color Imaging ◽

H Pylori ◽

Group B

Abstract Background and study aims There is a high prevalence of Helicobacter pylori infection. White light endoscopy (WLE) can be used for evaluating the mucosal lesions, but it does not have high diagnostic efficiency. Linked color imaging (LCI) is a newly developed endoscopic imaging technique. The aim of this study was to compare LCI with WLE in detecting and staging H. pylori infection in the stomach in a randomized controlled clinical trial. Patients and methods A total of 253 patients who had indications for gastroduodenoscopy were enrolled and randomized into Group A (n = 127), who underwent WLE followed by LCI, and Group B (n = 126), who underwent LCI followed by WLE. Clinical data were collected and the diagnostic accuracy of WLE and LCI was calculated and compared. Results The overall diagnostic accuracy of WLE and LCI for H. pylori infection was 31.5 % (n = 40) and 50.4 % (n = 64) in Group A (P = 0.001), and 36.5 % (n = 46) and 49.2 % (n = 62) in Group B (P = 0.029). In both groups, LCI had higher sensitivity, specificity, and Youden index scores than WLE. Four stages were defined in the course of H. pylori infection in the stomach. LCI staging results were more highly consistent with pathological staging than were WLE staging results (kappa value 0.772 vs. 0.516). The LCI observations were closely correlated with the pathology. Conclusion LCI had a higher diagnostic efficacy for H. pylori infection in the stomach. Endoscopic color features under LCI can help to stage and profile H. pylori-associated gastritis.

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Should liver metastases of breast cancer be biopsied to improve treatment choice?

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.18_suppl.cra1008 ◽

2010 ◽

Vol 28 (18_suppl) ◽

pp. CRA1008-CRA1008 ◽

Cited By ~ 13

Author(s):

M. A. Locatelli ◽

G. Curigliano ◽

L. Fumagalli ◽

V. Bagnardi ◽

G. Aurilio ◽

...

Keyword(s):

Breast Cancer ◽

Liver Metastases ◽

Primary Tumor ◽

Treatment Choice ◽

Her2 Status ◽

Her2 Positive ◽

Tissue Samples ◽

Er Positive ◽

Group A ◽

Group B

CRA1008 Background: Decision making on systemic treatment of women with metastatic breast cancer is based on features like estrogen receptor (ER), progesterone receptor (PgR), and HER2 status assessed on the primary tumor. We evaluated the concordance of receptor status between primary tumor and liver metastases (mts) and its impact on treatment choice. Methods: We retrospectively analyzed a database including ultrasound guided liver biopsies performed from 1995 to 2008. All tissue samples, both from primary tumor and liver mts, were analyzed for ER, PgR and HER2 status. Clinical and biological data were obtained from medical charts. Differences between proportions were evaluated using the Pearson chi-square test. Results: We identified 255 consecutive patients (pts) with matched primary and liver tissue samples. Median time from primary diagnosis to liver biopsy was 3.4 years (range 0-18.3 years). Changes in ER status were observed in 41/255 pts (16.0%). 16/58 pts (27.6%) changed from ER-negative to ER-positive and 25/197 pts (12.7%) changed from ER-positive to ER-negative (p=0.0066). Changes in PgR status were observed in 76/255 pts (29.8%). 18/91 pts (19.8%) changed from PgR-negative to -positive and 58/164 pts (64.6%) from PgR-positive to PgR-negative (p <0.0001). 12/52 pts (23.1%) changed from ER- and PgR-negative to ER- or PgR-positive (group A) and 27/203 pts (13.3%) changed from ER- or PgR-positive to ER- and PgR-negative (group B) (p=0.087). In the group A the treatment of 4/12 pts (33.3%) was changed after biopsy: 2/4 started endocrine treatment (HT) and 2/4 stopped it. In group B the treatment of 18/27 pts (66.6%) was changed after biopsy: 17/18 stopped HT. Changes in HER2 status were observed in 22/167 pts (13.1%): 6/116 pts (5.1%) changed from HER2-negative to HER2-positive and 16/51 pts (31.4%) changed from HER2-positive to negative (p≤0.0001). In this group pts started and/or stopped a trastuzumab containing treatment after biopsy. Conclusions: There was a discordance in receptor status between primary tumor and liver mts, which led to change in therapy for 48/255 of pts (18.8%). Biopsy of metastases for reassessment of biological features should be considered in all pts when safe and easy to perform, since it is likely to impact treatment choice. No significant financial relationships to disclose.

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Surgical management of synchronous colorectal liver metastases: Simultaneous versus staged resections.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.616 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 616-616

Author(s):

Igor Shchepotin ◽

Andrii Lukashenko ◽

Olena Kolesnik ◽

Anton Burlaka

Keyword(s):

Colorectal Cancer ◽

Surgical Treatment ◽

Postoperative Complications ◽

Liver Metastases ◽

Metastatic Cancer ◽

Economic Effect ◽

Hepatic Metastases ◽

Group A ◽

Bed Days ◽

Group B

616 Background: Surgical treatment of metastatic colorectal cancer remains the only method that improves overall 5-year survival. This study aimed to compare the surgical outcome and survival benefit between synchronous and staged resection of liver metastases from colorectal cancer. Methods: Clinicopathologic data, treatments, and postoperative outcomes from 110 patients who underwent simultaneous (48 patients, group A) or staged (62 patients, group B) colorectal and hepatic resections at clinic of National cancer institute in period of 2008-2013 were reviewed. Results: Postoperative complications in patients with simultaneous resections (group A) were observed in 13 cases (27.1%), including 5, 1, 4, 2, 0, and 1 of grades I, II, IIIa, IIIb, IV, and V, respectively. Similar results have been reported in group B after staged resections, where overall postoperative complications registered in 16 patients (25.8 %), including 4, 3, 6, 3, 0 of grades I, II, IIIa, IIIb, and IV respectively. Overall level of post-operative complications in the groups A and B after surgical stages finishing did not differ statistically (p=0.96). Shorter operative intervention duration was registered in the group A – (311±10.1) min, whereas in the group B it was (496.6±16.2) min (р<0.001). Patients after staged resection stayed in clinic for a longer time – 23.9±0.8 bed-days, when simultaneous resections provided with shorter recovery terms in post-operative period – 9.8±0.5 bed-days (p<0.001). Overall 3-year survival in the group of patients with simultaneous resections (group А) was 42 % and in the group B 55 % (р=0.22). Conclusions: Analysis of our research indicated necessity of the development of differentiated approach in management of synchronous colorectal liver metastatic cancer. Simultaneous resections of colorectal cancer primary lesions and hepatic metastases were safe and could serve as a primary option for selected patients. Subsequent research should be directed towards study of prognosis factors and criteria for patients’ selection for surgical treatment groups, assessment of economic effect, and patients life quality.

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Evaluation of hepatectomy, radiofrequency ablation, and transarterial chemoembolization for the local treatment of liver metastases in gastric cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.200 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 200-200

Author(s):

Lin Chen ◽

Jiyang Li ◽

Jianxin Cui ◽

Hongqing Xi ◽

Aizhen Cai ◽

...

Keyword(s):

Overall Survival ◽

Radiofrequency Ablation ◽

Survival Rate ◽

Liver Metastases ◽

Transarterial Chemoembolization ◽

Local Treatment ◽

R0 Resection ◽

Curative Gastrectomy ◽

Group A ◽

Group B

200 Background: The optimal local treatment for liver metastases remains controversial. Except for hepatectomy, radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are both effective and low risk treatment modality with more expanded indications in patients with liver metastases. Thus, the aim of this study is to evaluate the efficacy of different methods for the local treatment of GCLM. Methods: From January 2006 to December 2015, 97 consecutive patients were eligible and included in a prospective database. They all received multidisciplinary treatments based on curative gastrectomy and local treatments (hepatectomy, RFA and TACE) for liver metastases. The 97 patients enrolled in a cohort study were divided into two groups, Group A (37 patients, curative hepatectomy with or without other local treatments) and Group B (60 patients, palliative RFA and/or TACE).The primary endpoints were overall survival (OS) and 5-year survival rate. Results: Baseline characteristics in the two groups were comparable. Correlation analysis found that interval time of metachronous, neutrophil to lymphocyte ratio and body mass index were not significantly linear associated with survival, with ρ = 0.051, ρ = 0.014 and ρ = 0.056, respectively. The overall survival time between the two groups were 94.1 months and 57.2 months, with 1-year, 3-year and 5-year survival rate 83.3%, 50.0% and 30.6% in Group A, respectively; and 83.7%, 28.6% and 18.4% in Group B, respectively (P = 0.049). Furthermore, subgroup analyses proved that among these three local treatments, hepatectomy was the most effective method (P = 0.014), with significantly difference from RFA (P = 0.001). Nevertheless, combination with RFA and/or TACE did not improve patients’ benefits (P = 0.062). And TACE has a similar (P = 0.227) efficacy with RFA, but significantly less costs. Conclusions: Hepatectomy is the optimal local treatment for liver metastases when the surgical R0 resection was intended. And it is not necessary to combine with other local treatments. As palliative local treatment, TACE is an acceptable method with relatively high cost-effective.

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Phase I and Pharmacokinetic Study of E7070, a Novel Chloroindolyl Sulfonamide Cell-Cycle Inhibitor, Administered as a One-Hour Infusion Every Three Weeks in Patients With Advanced Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2002.09.030 ◽

2002 ◽

Vol 20 (16) ◽

pp. 3508-3521 ◽

Cited By ~ 37

Author(s):

E. Raymond ◽

W.W. ten Bokkel Huinink ◽

J. Taïeb ◽

J.H. Beijnen ◽

S. Faivre ◽

...

Keyword(s):

Cell Cycle ◽

Maximum Tolerated Dose ◽

Tumor Burden ◽

Eligibility Criteria ◽

Time Curve ◽

Cell Cycle Inhibitor ◽

Pretreated Group ◽

Heavily Pretreated ◽

Group A ◽

Group B

PURPOSE: The objectives were to determine the maximum-tolerated dose, the recommended dose, the dose-limiting toxicity, the pharmacokinetics, and the activity of E7070, a novel cell-cycle inhibitor. PATIENTS AND METHODS: E7070 was given as a 1-hour intravenous infusion every 3 weeks in two groups of patients with advanced solid tumors who met prespecified eligibility criteria (group A) or who met the same eligibility criteria but in addition were less heavily pretreated and had more favorable liver functions (group B). RESULTS: Forty patients (31 patients in group A and nine patients in group B) were entered. Dose escalation proceeded through eight levels (range, 50 to 1,000 mg/m2). In group A, neutropenia and thrombocytopenia were dose-limiting toxicities occurring during the first cycle in two of seven patients treated at the doses of 700 mg/m2 and two of four patients treated at 800 mg/m2. Identical dose-limiting toxicities were observed in zero of six and two of three patients from group B at doses of 800 and 1,000 mg/m2, respectively. Other toxicities included acne-like skin eruption, mucositis, conjunctivitis, nausea, fatigue, and alopecia. At doses greater than 400 mg/m2, the area under the concentration-time curve increased disproportionately to the administered dose. Tumor stabilization lasting ≥ 6 months was observed in six assessable patients. CONCLUSION: The recommended doses of E7070 in this schedule were 700 mg/m2 (group A) and 800 mg/m2 in patients who were less heavily pretreated (group B) with a moderate tumor burden. Prolonged disease stabilization observed in this study might warrant further investigation of E7070 in selected tumor types.

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