S1555 Stage IV Tail of the Pancreas Tumor Presenting With Obstructive Jaundice Secondary to Liver Metastasis

Abstract Background: Adrenocortical carcinoma(ACC) is a rare and highly invasive endocrine malignant tumor with poor prognosis and insensitivity tochemotherapy, which don't have effective treatment. Although Surgical resection is considered to be the main treatment for ACC, postoperative recurrence and metastasis have become the most important factors of death. Therefore, local treatments such as trans-catheter arterial chemo-embolization, radiofrequency ablation become be new treatment for ACC. Trans-catheter arterial chemo-embolization therapy for ACC patients with liver metastasis has good efficacy and can effectively reduce the tumor burden of patients, which is considered to be safe and easy for patients. Case presentation: We report a 47-year-old female patient diagnosed with stage Ⅳ ACC with liver metastases, who developed symptoms of acute adrenocortical dysfunctions after hepatic arterial catheter chemo-embolization.Conclusion: Trans-catheter arterial chemo-embolization therapy for ACC patients with liver metastasis is not completely safe, and there is a certain probability that it will lead to secondary adrenal dysfunction. Hydrocortisone supplementation can effectively alleviate the symptoms.

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Effective palliation of obstructive jaundice due to colorectal cancer liver metastasis

ANZ Journal of Surgery ◽

10.1111/ans.12277 ◽

2013 ◽

Vol 84 (6) ◽

pp. 493-494 ◽

Cited By ~ 1

Author(s):

Liam Quinn ◽

Seema Bagia

Keyword(s):

Colorectal Cancer ◽

Liver Metastasis ◽

Obstructive Jaundice ◽

Colorectal Cancer Liver Metastasis

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Resection of Adrenocortical Carcinoma with Bilobar Liver Metastasis Following Neoadjuvant Therapy Using a Modified Mini-ALPPS Approach: A Case Report

International Journal of Surgical Case Reports ◽

10.31487/j.ijscr.2020.01.06 ◽

2020 ◽

pp. 1-5

Author(s):

Daniel Anaya ◽

Bela Kis ◽

Daniel Anaya ◽

Jasmina Ehab ◽

Julie E. Hallanger Johnson ◽

...

Keyword(s):

Liver Metastasis ◽

Adrenocortical Carcinoma ◽

Stage Iv ◽

Complete Resection ◽

Curative Intent ◽

Extent Of Surgery ◽

Staged Approach ◽

Critical Components ◽

Multidisciplinary Teamwork ◽

Selection Of

Introduction: Adrenocortical carcinoma (ACC) is an aggressive tumor with high proportion of patients presenting with metastatic disease, most commonly in the liver. Prognosis in this population is extremely poor. Resection of the primary tumor and liver metastasis offers a survival benefit in well-selected patients. However, the extent of surgery is often significant and can limit the ability to accomplish a safe marginnegative resection. Presentation of case: A 35-year-old male presented with a large left ACC (15.2cm) and multiple bilobar liver metastases (1.5-12.5cm). He was treated with mitotane and chemotherapy / immunotherapy, with excellent response. Multidisciplinary discussion led to recommendations for a curative-intent approach with surgery. A staged approach was performed for the resection, using a modified Mini-ALPPS technique. A complete margin-negative resection of all disease was accomplished. The patient recovered well and remains free of disease 24-months following diagnosis. Discussion: This case highlights novel components of treatment for metastatic ACC and for hepatectomy for bilobar liver metastasis. The decisions to proceed to surgery for complete resection and to use a staged approach with a modified Mini-ALPPS technique were both critical components to render the patient disease-free. Appropriate expertise and multidisciplinary teamwork are essential for implementation of these approaches. Conclusion: Neoadjuvant chemotherapy for stage IV ACC can result in disease control and improved selection of candidates for curative-intent surgery. In the setting of bilobar liver disease and a large primary in place, a modified Mini-ALPPS approach provides a safe and feasible way to accomplish complete resection and improved survival.

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Prognostic Factors of Colorectal Cancer: A Comparative Study on Patients With or Without Liver Metastasis

Frontiers in Oncology ◽

10.3389/fonc.2021.626190 ◽

2021 ◽

Vol 11 ◽

Author(s):

Honghua Peng ◽

Guifeng Liu ◽

Ying Bao ◽

Xi Zhang ◽

Lehong Zhou ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Risk Factor ◽

Liver Metastasis ◽

Adjuvant Therapy ◽

Independent Risk Factor ◽

Stage Iv ◽

Genetic Alterations ◽

Stage Ii ◽

Independent Risk Factors

BackgroundRadical or palliative surgery with subsequent adjuvant therapy is the routine treatment for stage II/III colorectal cancer(CRC) and some stage IV CRC patients. This study aimed to clarify the prognostic clinicopathological and genetic factors for these patients.MethodsFifty-five stage II-IV CRC patients undergoing surgery and adjuvant therapy were recruited, including patients without liver metastasis(5 at stage II, 21 at stage III) and with liver metastasis(29 at stage IV). Genetic alterations of the primary cancer tissues were investigated by whole exome sequencing(WES). Patients were followed up to 1652 days(median at 788 days).ResultsThe mutational landscape of primary CRC tissue of patients with or without liver metastasis was largely similar, although the mutational frequency of TRIM77 and TCF7L2 was significantly higher in patients with liver metastasis. Several main driver gene co-mutations, such as TP53-APC, APC-KRAS, APC-FRG1, and exclusive mutations, such as TP53-CREBBP, were found in patients with liver metastasis, but not in patients without liver metastasis. No significant difference was found between the two groups in aberrant pathways. If stage II-IV patients were studied altogether, relapse status, SUPT20HL1 mutations, Amp27_21q22.3 and Del8_10q23.2 were independent risk factors(P<0.05). If patients were divided into two groups by metastatic status, surgery types and Amp6_20q13.33 were independent risk factors for patients without liver metastasis(P<0.05), while TRIM77 mutations were the only independent risk factor for patients with liver metastasis(P<0.05).ConclusionsSurgery types and Amp6_20q13.33 were independent risk factors for CRC patients without liver metastasis, and TRIM77 mutations were the independent risk factor for CRC patients with liver metastasis.

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Alternating hepatic arterial infusion and systemic chemotherapy for stage IV colorectal cancer with synchronous liver metastasis

Oncology Reports ◽

10.3892/or.16.4.865 ◽

2006 ◽

Cited By ~ 2

Author(s):

Masaya Mukai ◽

Yasuhisa Oida ◽

Takayuki Tajima ◽

Kyoko Kishima ◽

Hiromi Ninomiya ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Metastasis ◽

Systemic Chemotherapy ◽

Stage Iv ◽

Hepatic Arterial Infusion ◽

Synchronous Liver Metastasis ◽

Arterial Infusion ◽

Stage Iv Colorectal Cancer

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Study to Evaluate OrienX010 in Combination With JS001 in the Treatment of Stage IV (M1c) Liver Metastasis From Melanoma

Case Medical Research ◽

10.31525/ct1-nct04206358 ◽

2019 ◽

Author(s):

Keyword(s):

Liver Metastasis ◽

Stage Iv

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Relationship between liver metastases and PD-1 blockade in melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.3072 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 3072-3072 ◽

Cited By ~ 1

Author(s):

James Chi-Chiang Lee ◽

Katy K. Tsai ◽

Alain Patrick Algazi ◽

Michael Rosenblum ◽

Jeffrey Bluestone ◽

...

Keyword(s):

Liver Metastasis ◽

Liver Metastases ◽

Stage Iv ◽

Rejection Rate ◽

Metastatic Tumor ◽

Tumor Rejection ◽

Cd8 Cells ◽

The Mean ◽

Organ Site ◽

Response Site

3072 Background: WhilePD-1 blockade is effective in melanoma, durable responses remain elusive. We have previously reported that liver metastasis is associated with reduced response rates and that the fraction of CTLA4 hi/PD-1 hi CD8+ cells (“activated-exhausted” or T-ex cells) within the TIL is predictive of response to PD-1 blockade. Here, we explore the biology behind liver metastasis in human melanoma and in animal models. Methods: Patients with metastatic melanoma with or without liver metastasis were biopsied pre- PD-1 treatment and immune infiltrates were analyzed by FACS. The CD8 fraction was gated on CTLA4 and PD-1. C57BL/6 mice were implanted with a “primary” subcutaneous tumor and a “metastatic” tumor in the liver or the lungs (control), and given systemic PD-1 blockade therapy. Results: Patients with melanoma and liver metastasis (n = 25) had 15.2% T-ex cells while those without liver metastasis (n = 76) had 26.5 % T-ex cells, p = 0.0092. A T-ex fraction < 20% was significantly associated with lack of PD-1 response, p < 0.005. In C57BL/6 mice implanted with a B16 tumor (subQ & liver) treated with PD-1 antibody, 0/35 mice achieved subQ tumor rejection while in the SubQ only mice 9/30 mice (30%) rejected their tumors. The mean tumor size of mice with Sub Q+liver metastasis was 139.2 mm2 vs subQ only mice 23.4 mm2 at d 14, p = 0.002. Mice with liver metastasis showed a T-ex fraction 31.9% vs 67.3%without liver met, p = 0.0003. In contrast, in mice made lung metastatic, the subQ tumor rejection rate was 7/20 (35%), with T-ex infiltrate at 57.9%. The implantation of liver metastases from an unrelated MC38 tumor does not protect the subQ tumor from immune rejection. Conclusions: The presence of liver metastases is associated with reduced response to PD-1 blockade and reduced T-ex infiltrate in patients with stage IV melanoma. Mechanistic studies using a mouse model of syngeneic organ site specific metastasis confirms that the liver metastasis results in reduced antigen specific T cell at distant sites, resulting in reduced response. Site of metastasis may determine immune responsiveness in both mouse models and in humans with melanoma.

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Barriers for access to isolated liver metastasis treatment in colon cancer in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.833 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 833-833

Author(s):

Andre Luiz De Souza ◽

Ritesh Rathore ◽

Shiva Kumar Reddy Mukkamalla

Keyword(s):

United States ◽

Colon Cancer ◽

Liver Metastasis ◽

Neoadjuvant Chemotherapy ◽

Multidisciplinary Treatment ◽

Hepatic Metastases ◽

Stage Iv ◽

The United States ◽

Quality Healthcare ◽

Isolated Liver

833 Background: Multidisciplinary treatment of stage IV colon cancer with isolated hepatic metastases implies patient’s access to quality healthcare. Here, we evaluate barriers for access to hepatic metastasectomy in the United States. Methods: The National Cancer Database was queried for stage IV colon cancer patients with isolated liver metastasis diagnosed from 2010-2014. Patient demographics, T and N staging, laterality and surgery were among the variables of interest. Pearson Chi square test was used for statistical analysis Results: A total of 3145 patients were identified for analysis. Moderately differentiated, T3 and N1 tumors were the most frequent tumors to be treated with perioperative and neoadjuvant chemotherapy. Neoadjuvant and perioperative chemotherapy correlated with age (p<0.0001) and year of diagnosis (p=0.0289). Left sided tumors were more likely to receive perioperative and neoadjuvant chemotherapy compared to right sided or transverse tumors (p<0.0001). Conclusions: With various degrees of utilization of perioperative and neoadjuvant chemotherapy based on demographic and clinical variables, there exists a great need to close the gap in access to chemotherapy and surgery for colorectal cancer isolated liver metastases. [Table: see text]

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