Pulmonary metastasis from colorectal carcinoma with hepatic metastasis

Objective Although some beneficial effects of surgical treatments for pulmonary or hepatic metastases from colorectal carcinoma have been reported, identifying candidates for these aggressive surgical procedures is controversial. In this study, patients with pulmonary metastases from colorectal carcinoma, particularly those with pulmonary and hepatic metastases, were retrospectively analyzed. Methods Forty-six patients who had undergone complete resection for pulmonary metastases from colorectal carcinoma were retrospectively analyzed. Results The median follow-up period after pulmonary resection was 26 months, and the 5-year postoperative survival rate was 34%. The 5- and 10-year survival rates of patients with pulmonary metastasis alone, metachronous pulmonary metastasis after liver metastasis, and synchronous metastasis to the liver and lung were 75%, 75%, and 25% and 25%, 38%, and 0%, respectively, when calculated from the time of primary colorectal resection (P < 0.01). Patients with synchronous metastases had a poorer prognosis than did the patients in the other two groups. Conclusions Surgical treatments for patients with pulmonary metastasis alone or metachronous metastasis can provide a beneficial outcome. Patients with synchronous metastasis have a poor prognosis, and effective pre- and postoperative systemic treatments should be considered to prolong their survival.     

结直肠癌肝转移蛋白质组表达差异及其意义的研究

目的利用蛋白质组研究技术分离、鉴定结直肠癌肝转移相关蛋白,探讨结直肠癌肝转移分子机制。方法用等电聚焦/SDS聚丙烯酰胺双向凝胶电泳对比分析结直肠癌原发灶、癌旁肠黏膜和肝转移灶中蛋白质组表达差异,经MALDI-TOF-MS质谱分析、鉴定差异蛋白点,采用Western杂交检测结直肠癌肝转移相关蛋白表达。结果经双向电泳图像对比分析,癌旁肠黏膜组织中蛋白质斑点为(390±28)个,结直肠癌原发灶和肝转移灶中蛋白质斑点分别为(206±22)个和(236±19)个。结直肠癌肝转移灶中蛋白质表达与癌原发灶、癌旁肠黏膜相比差异有显著性意义(t=17.321、t=29.637,P<0.01)。对肝转移灶中一个特异蛋白质点行质谱检测,经Profound检索同源分析,确定该蛋白点相对分子质量为21.25×103,等电点为6.8,与细胞周期蛋白42(Cdc42)同源。Western杂交检测25例结直肠癌标本,癌旁肠黏膜中Cdc42表达检测为阴性。在癌原发灶中Cdc42表达阳性率为16%(4/25)。肝转移灶中检测Cdc42表达阳性率为100%(25/25)。结论结直肠癌肝转移蛋白质组表达差异研究有助于鉴定在肝转移中起重要作用的蛋白质,Cdc42作为结直肠癌肝转移相关蛋白,对癌细胞生物学行为改变有重要影响,可促进肝转移的发生。     

Carcinoembryonic antigen to detect hepatic metastases of colorectal cancers

Purpose. The spread of colorectal carcinoma (CRC) affects both staging and treatment. In this prospective study we examined the relationship between carcinoembryonic antigen (CEA) levels in bile, mesenteric venous blood, and peripheral venous blood, and the presence of occult hepatic metastases in patients with CRC.Methods. Sixty patients who underwent elective surgery at Ankara Oncology Hospital were voluntarily assigned to one of the three groups of 20 patients each. The control group consisted of patients operated on for benign biliary disorders, the second group consisted of patients with CRC without metastases, and the third group consisted of patients with CRC and isolated liver metastases. Bile, mesenteric venous blood, and peripheral venous blood was collected perioperatively for the measurement of CEA levels.Results. The bile CEA levels were significantly higher in the CRC patients with metastases than in those without metastases and the controls. The CEA levels in the mesenteric venous blood and peripheral venous blood were significantly higher in the two groups of CRC patients than in the control group. Overt hepatic metastases later developed in seven patients from the CRC without metastases group who had relatively high CEA levels, but the difference was not significant.Conclusion. The CEA levels in bile, mesenteric venous blood, and peripheral venous blood were increased in patients with CRC and liver metastases. The detection of elevated CEA levels in bile taken at surgery did not herald metachronous hepatic metastases in CRC patients without liver metastases.     

趋化因子受体CCR6/CCL20在结直肠癌肝转移中的作用

目的观察CCR6／CCL20在结直肠癌肝转移中的作用。方法应用Westernblot检测60结直肠癌患者标本中肿瘤组织、邻近正常黏膜以及肝转移组织中CCR6／CCL20通路成员的表达情况，免疫组织化学法检测CCR6／CCL20在细胞水平的分布。结果结直肠癌组织中CCR6与CCL20表达水平明显增高，分别为正常黏膜的3．4倍、2．2倍（P〈0．05）；CCR6表达水平与TNM分期相关（P〈0．05）；CCR6／CCL20在结直肠癌组织中表达情况呈线性相关，相关系数为0．437，P〈0．05。结论趋化因子受体CCR6／CCL20在结直肠癌与肝转移组织中呈高表达，CCR6／CCL20信号转导通路可能在结直肠癌肝转移过程中起一定作用。     

原发性结直肠癌肝转移危险因素分析

目的：初步判断结直肠癌患肝转移的危险性，方法：选择10个可能会影响肝转移的因素：患年龄、性别、地区分布、肿瘤病理类型、部位、大小、浸润深度、侵犯肠管周径、术前癌胚抗原（CEA）水平及淋巴结转移情况，建立原发性结直肠癌肝转移危险性预测的Logistic回归模型，结果：年龄、术前CEA水平和淋巴结转移情况这3个因素对肝转移影响较为显，其回归系数分别为0．0215，0．9584和0．6404；标准误分析为0．0113，0．02740和0．29892；P值分别为0．0379，0．0005、0．0268。其他因素如浸润肠壁深度及侵犯肠管周径等对肝转移的发生也有影响，但非独立的危险因素。结论：年龄、术前CEA水平和淋巴结转移情况是原发性结直肠癌肝转移的3个显性的危险因素。     

结直肠癌肝转移的射频治疗

目的探讨结直肠癌肝转移的可靠治疗方法.方法对29例诊断为结直肠癌肝转移的患者,行B超引导下多电极射频治疗,并在治疗前后用R超和CT检测比较各肿瘤直径大小、血供与坏死情况.结果 29例结直肠癌肝转移患者射频治疗前CT检测转移瘤直径为(7 5 ± 3.1)cm;治疗后为(4 5±1 3)cm(P＜0.001)转移瘤结节坏死在60%以上者2O例(69.0%),其中完全坏死1 8例(62 1%),临床症状和肝功能均改善.结论 B超引导下多电极射频治疗结直肠癌肝转移是一种安全有效的治疗方法.     

巨噬细胞移动抑制因子与大肠癌肝转移的关系

目的检测巨噬细胞移动抑制因子（macrophage migration inhibitory factor,MIF）在大肠癌组织、大肠癌肝转移灶中的表达以及大肠癌患者血清中的水平,初步分析MIF与大肠癌肝转移的关系。方法应用免疫组化技术,检测49例大肠癌组织及其癌旁相对正常肠组织,与10例大肠癌肝转移组织及转移灶旁相对正常肝组织,以及5例正常肝组织中MIF的表达。应用ELISA法测定30例大肠癌患者和17例健康志愿者血清MIF水平。采用Logistic回归分析大肠癌肝转移与各种临床病理因素、血清MIF水平的关系。结果（1）大肠癌组织中MIF的表达有肝转移者高于没有肝转移者,大肠癌患者有肝转移者血清MIF水平也高于无肝转移者。（2）肝内大肠癌转移组织中MIF表达阳性。（3）大肠癌肝转移灶旁相对正常肝组织与正常肝组织MIF表达阴性。（4）Logistic回归分析结果显示,大肠癌患者血清MIF水平是影响大肠癌肝转移的独立危险因素（OR=1.245,OR的95%CI为1.017～1.524,P=0.034）。结论MIF在大肠癌肝转移中可能发挥着重要的作用。     

Skeletal muscle metastasis from colorectal adenocarcinoma: A literature review

BACKGROUNDColorectal adenocarcinoma is the third most common cancer worldwide. It accounts for almost 10% of all cancer-related deaths. Skeletal muscle is a very unusual site for metastasis from colorectal cancers and is associated with a poor prognosis and high mortality.AIMTo review the literature for cases of skeletal muscle metastasis (SMM) from colorectal adenocarcinoma.METHODSA systematic literature search using a validated search strategy was carried out to identify the incidence of SMM associated with colorectal adenocarcinoma. The studies identified were tabulated in a PRISMA, and data was extracted in a tabulated form.RESULTSTwenty-nine studies were included in this literature review. SMM was most commonly detected in the thigh muscles. Most of the tumours had originated from the rectum or the right colon. The histopathology of the primary tumour was generally advanced. The mean time interval between the primary tumour and onset of SMM was 22 mo. In 3 cases, asymptomatic SMM had been picked up by advanced imaging systems, like fluorodeoxyglucose-positron emission tomography scan.CONCLUSIONSMM from colorectal adenocarcinomas is a rare complication. However, it is possible that the low incidence could be due to under-reporting. Early use of advanced imaging techniques and a high index of clinical suspicion might increase the reporting of SMM from colorectal adenocarcinoma.     

结直肠癌肝转移的外科治疗

目的　探讨结、直肠癌肝转移的外科治疗。方法　对１９９３ 年１ 月至１９９９ 年１ 月的１９ 例结、直肠癌肝转移患者行外科治疗。其中６ 例同期切除,１０ 例分期切除,１ 例肝动脉结扎加无水乙醇注射,２ 例通过肝动脉结扎加化学药物治疗（化疗） 泵灌注化疗而获得二期手术切除机会。手术方式行肝不规则楔形切除１６ 例,左半肝切除２ 例。结果　术后１、３、５ 年生存率分别为８９％ 、５８％ 、２１％ 。６ 例同期肝切除者平均生存期２３ 个月,１０ 例分期肝切除者的平均生存期为３２ 个月。结论　掌握手术时机和适应证,积极进行肝动脉灌注化疗,提高手术切除成功率是提高存活率的关键。     

大肠癌肝转移的诊断及外科治疗

对１９６例大肠癌肝转移患者的临床病理特点及表现进行分析，结果显示：（１）８７．８％的病人血清ＣＥＡ升高；（２）Ｂ超与ＣＴ对检测原发灶复发及转移性肝癌十分必要；（３）对肝转移灶，可视病人的具体情况选择与大肠癌同时或分期切除；（４）单个孤立或地一段的多个肝转移灶在行楔形成肝段切除后，其预后不逊于肝叶切除。     

Management of colorectal polyp cancers

INTRODUCTION

Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated.

METHODS

A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group.

RESULTS

Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors.

CONCLUSIONS

Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.     

基于Web of Science数据库的2000—2019年结直肠癌肝转移文献计量分析

背景与目的:近年来,结直肠癌肝转移(CRLM)问题广受学界关注,相关研究文献大量涌现。本研究通过分析近20年国际上CRLM研究的文献分布规律和研究热点,为把握该领域未来研究方向提供参考依据。方法:从Web of Science核心合集数据库检索2000-2019年CRLM领域的相关文献,使用文献计量工具Bibexcel提取年发文量、国家、期刊、关键词等字段,并通过Excel软件和Pajek软件绘制图表和知识图谱。利用VOSviewer软件对作者个体、机构、国家合作网络和高频关键词进行共现和聚类分析。结果:共检索到CRLM相关文献7 965篇,2007年以后年发文量均在400篇以上,美国、日本和中国是发文量最多的国家,分别为1 728、1 108、1 078篇;从基金分布来看,高产文章主要来自国家级基金。期刊主要集中于JOURNAL OF CLINICAL ONCOLOGY、ANNALS OF ONCOLOGY等肿瘤学科高质量期刊;H指数20及以上的作者美国有12位,法国有5位;高频关键词53个,聚类分析将高频关键词聚类为5类,依次手术和化疗、预后因素、辅助诊断、化疗药物、腹膜转移癌。结论:在过去的近20年间,国际CRLM研究活动和合作不断增加,但是不同国家之间仍具有较大差距。总的来说,这项文献计量学研究确定了CRLM研究的三大热点:手术治疗及预后、化学治疗和辅助诊断。因此,对这些课题的进一步研究,可能更有助于促进治疗策略的临床转化,在不久的将来使CRLM的诊疗和个性化防治更加精准和有效。     

大肠癌肝转移的临床病理学特点

目的：研究大肠癌肝转移的临床病理学特点。方法：按照有无肝转移，将633例大肠癌分为两组，分析其与临床病理学诸因素的关系。结果：肝转移率为5．53％。大肠癌浸润肠壁深度、组织学类型、大体分型、静脉受侵、淋巴结转移及侵犯肠管周径与肝转移的发生有显著关系；而与年龄、性别及部位无明显关系。结论：大肠癌肝转移的发生与病理学诸因素有关。     

Feasibility of adjuvant hepatic arterial infusion of chemotherapy after radiofrequency ablation with or without resection in patients with hepatic metastases from colorectal cancer

Background: The safety of combined hepatic artery infusion chemotherapy (HAI) and radiofrequency ablation (RFA) for liver metastases has not been assessed. We conducted a study to determine the feasibility of using HAI after RFA for colorectal cancer (CRC) liver metastases.Methods: Between 1996 and 2001, patients with hepatic metastases from CRC were enrolled onto a prospective study of RFA plus HAI consisting of continuous-infusion floxuridine and bolus fluorouracil. Surgical complications, treatment-related toxicities, and patient outcomes were recorded.Results: Fifty patients were treated with RFA and HAI with or without resection. A median of two lesions per patient, with a median greatest diameter of 2.0 cm, were treated with RFA. Postoperative complications, including 1 death, occurred in 11 of 50 patients. Toxicity from HAI was relatively mild. At 20 months median follow-up, 32% of patients remained disease free. Ten percent of patients had recurrences at the site of RFA, 30% developed new liver metastases, and 48% developed extrahepatic disease.Conclusions:RFA of CRC liver metastases followed by HAI is feasible and is associated with acceptable complication and toxicity rates. The high rate of disease recurrence in our patients indicates that novel combinations of regional and systemic therapies are needed to improve patient outcomes.     

结直肠癌临床病理特征与复发和转移的相关性研究

目的探讨导致结直肠癌术后复发和转移的临床病理因素。方法通过单因素分析和多因素的Logistic回归分析方法,将结直肠癌根治术后复发或转移的104例患者(研究组)与未复发和转移患者(对照组)的临床资料进行对比分析。结果多因素的Logistic回归分析结果提示,只有Dukes分期与结直肠癌的复发相关(P=0.004);但在DukesC期中,研究组低分化腺癌和黏液腺癌比对照组显著增加(P<0.001),提示在DukesC期时,组织学类型与复发相关。Dukes分期(P=0.001)、微血管内有癌栓(P=0.020)和血清癌胚抗原(CEA)水平(P=0.010)与结直肠癌的转移相关(P值分别为0.001、0.020和0.010)。结论Dukes分期与结直肠癌术后的复发和转移均相关;而微血管内有癌栓、血清CEA水平则与结直肠癌的转移相关。     

抑癌基因PTEN与人大肠癌转移的相关性研究

目的　探讨抑癌基因PTEN的表达在大肠癌转移侵袭过程中的作用。方法　 (1)应用Nothernblot和免疫组织化学的方法检测 47例大肠癌组织中PTENmRNA和蛋白的表达 ,分析其与大肠癌转移的关系。 (2 )利用Westernblot法检测不同转移潜能的大肠癌细胞系内PTEN蛋白的表达水平 ,说明PTEN蛋白的表达对大肠癌细胞转移潜能的影响。 (3 )用阳离子脂质体作载体 ,将PTEN基因转染大肠癌细胞株LOVO后 ,采用计数细胞悬液加到粘附底物后 2 0和 12 0min的细胞贴壁数用以测定细胞粘附能力 ,采用Costar的浸润小室检测PTEN基因转染前后细胞的浸润能力。结果　 (1)在有淋巴结及远处转移的大肠癌组织中 ,PTENmRNA和蛋白的表达显著低于无转移者 ;(2 )转移潜能高的LOVO细胞PTEN的表达量通过显著低于转移潜能较低的HT 2 9、LS 174T ;(3 )LOVO、转染 pcDNA3 .0 PTEN的细胞 (LOVO/pcDNA3 .0 PTEN )在特异性粘附底物(Laminin)上 2 0min时贴壁率分别为 (18.6± 1.4) %和 (13 .9± 0 .5 ) % (P <0 .0 5 ) ,12 0min时贴壁率分别为 (71.2± 2 .5 ) %和 (5 6.0± 1.6) % (P <0 .0 5 ) ;(4 )采用Costar的浸润小室对LOVO、LOVO/pcDNA3 .0 PTEN细胞的浸润能力分析结果显示 :细胞悬液静置培养 6h后 ,对照细胞LOVO浸润穿透多聚碳膜的细胞数为 (1     

大肠癌发生和肝转移的蛋白质组学研究

目的 利用蛋白质组研究技术分离、鉴定大肠癌肝转移相关蛋白。方法 用等电聚焦／SDS聚丙烯酰胺双向凝胶电泳对比分析12例大肠癌患者原发灶、癌旁肠黏膜和肝转移灶中疏水蛋白表达差异,经肽质量指纹谱分析、鉴定差异蛋白点。结果 双向电泳图像对比分析表明,正常结直肠黏膜组织、癌原发灶和肝转移灶中蛋白质表达有显著差异。对9个差异表达蛋白点分析鉴定,钙调蛋白联合体、核糖核酸酶-6-前体蛋白以及XP-040720蛋白在正常肠黏膜表达,但在癌原发灶和肝转移组织中表达缺失。前阿朴脂蛋白在正常肠黏膜、癌原发灶及肝转移灶中呈递增表达。β-珠蛋白在肝转移灶和正常肠黏膜中表达,而在癌原发灶中表达缺失。Cdc42蛋白在肝转移灶中特异表达。差异蛋白点C4、N7和N9肽指纹谱与已知蛋白同源性低,为候选大肠癌发生和肝转移相关新蛋白。结论 钙调蛋白联合体、核糖核酸酶-6-前体蛋白、α-甘露糖苷酶Ⅰ表达缺失与大肠癌发生和肝转移有关;前阿朴脂蛋白增强表达与大肠癌发生和肝转移有关;Cdc42蛋白、β-珠蛋白表达与肝转移有关。     

同时性结直肠癌肝转移的临床病理特征分析

目的遴选同时性结直肠癌肝转移的危险因素，为预测和早期诊断肝转移提供参考依据。方法收集2003年1月至2006年12月间收治的367例原发性结直肠癌患者的临床病理资料，对患者的年龄、性别、血型、肿瘤家族史、是否合并肝炎肝硬化、有无合并肠梗阻、术前癌胚抗原（CEA）和CA19－9、原发肿瘤部位和大小、分化程度、肿瘤侵及深度、有无淋巴结转移、肿瘤分期等19项因素进行统计分析。结果本组发生同时性结直肠癌肝转移56例．占同期结直肠癌患者的15．3％。在发病年龄、是否有肠梗阻、是否有盆腔转移结节及肿瘤浸润深度方面，肝转移和无肝转移两组患者之间差异有统计学意义（P〈0．05）。右侧结肠癌肝右叶转移瘤者明显多于左叶，而左侧结肠癌转移瘤多分布于全叶。当术前CEA大于22．1μg／L时，患者发生肝转移的可能性增加。结论结直肠癌同时性肝转移与患者年龄、是否存在肠梗阻、盆腔有无转移及CEA水平存在密切关系。     

经皮射频治疗结直肠癌肝转移31例

目的 评价B超引导经皮射频（PRFA）治疗结直肠癌肝转移的疗效。方法 应用PRFA治疗结直肠癌肝转移31例共55个病灶，肿瘤直径1．5～8．5cm。应用RF2000射频仪和10电极LeVeen针，病灶〉2．5cm者予分层多点叠合毁损，〉5．0cm或多发者配合肝动脉导管化疗栓塞术（TACE）及无水酒精注射疗法（PEI），随访观察病灶影像形态表现、血清CEA变化和患者生存率。结果 PRFA后反应期3～7d，包括局部疼痛不适、发热、ALT升高等；并发肝曲结肠穿孔和腹壁穿刺道转移各1例；小肿瘤（〈3．0cm）完全坏死率达92．9％（26／28），3．1～5．0cm的肿瘤完全坏死率为73．3％（11／15），病灶〉5cm者均未完全坏死；1、2、3年生存率分别为87．1％、77．5％和54．8％。结论 PRFA是治疗结直肠癌肝转移的一种微创疗法，对〈3．0cm肿瘤疗效显著，对大肿瘤可联合TACE、PEI等进行综合治疗。     

靶向巨噬细胞移动抑制因子的siRNA对小鼠大肠癌肝转移的影响

目的 探讨靶向巨噬细胞移动抑制因子(MIF)的小干扰RNA (siRNA)对BALB/C小鼠大肠癌肝转移的影响及其可能的机制。方法 盲肠造疝原位接种瘤块法建立BALB/C小鼠大肠癌肝转移模型。将成功建模的小鼠随机分为3组。分别每周2次肿瘤原位注射相同体积的靶向MIF的siRNA( MIF siRNA,0.15 ng/kg)、非特异性siRNA( NS-siRNA,0.15 ng/kg)及生理盐水(NS,0.15 ng/kg),治疗4周。治疗结束3d后,处死小鼠。肝脏连续切片,苏木素-伊红(HE)染色观察各组大肠癌肝转移;酶联免疫吸附试验(ELISA)检测血清MIF及血管内皮生长因子(VEGF)浓度;免疫组织化学染色检测肝转移灶微血管密度(MVD)。结果 MIF siRNA组、NS-siRNAR组及NS组的大肠癌肝转移率分别为10％、60％与70％(x2=8.30,P＜0.05),小鼠血清MIF分别为(20±4)、(72±8)与(78 ±7) ng/L(P ＜0.05);小鼠血清VEGF分别为(20±4)、(77±9)与(77±10) ng/L(P＜0.05);肝转移灶的MVD分别为19±3、29 ±6与35±7(P＜0.05)。结论 靶向MIF的siRNA降低了小鼠大肠癌肝转移的发生率,其机制可能是靶向MIF的siRNA抑制了MIF表达,下调VEGF的表达,减少了MVD。