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1.
Seifert JK Springer A Baier P Junginger T 《International journal of colorectal disease》2005,20(6):507-520
Background and aims While there is promising survival data for cryosurgery of colorectal liver metastases, local recurrence following cryoablation remains a problem. We aimed to compare morbidity and mortality, as well as the recurrence pattern and survival after liver resection and cryotherapy (alone or in combination with resection) for liver metastases.Patients and methods Between 1996 and 2002, 168 patients underwent liver resection alone and 55 patients had cryotherapy (25 in combination with liver resection) for colorectal liver metastases. The patient, tumour and operative details were recorded prospectively and the two patient groups were compared regarding morbidity, survival and recurrence.Results More patients had a prior liver resection, liver metastases were smaller and less frequently synchronous, morbidity was significantly lower and hepatic recurrence was significantly more frequent in the cryotherapy group. Five-year survival rates following resection and cryotherapy were comparable (23 and 26% respectively), while overall and hepatic recurrence-free survival was inferior following cryotherapy.Conclusion Cryotherapy is a valuable treatment option for some patients with non-resectable colorectal liver metastases. While survival is comparable to that after resection, higher hepatic recurrence rates following cryotherapy should caution against the use of cryotherapy for resectable disease until the results of randomized controlled trials are available. 相似文献
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Vogl T Eichler K Zangos S Herzog C Hammerstingl R Balzer J Gholami A 《Journal of cancer research and clinical oncology》2007,133(3):177-184
Purpose To evaluate results in the palliative treatment of patients with liver metastases of uveal malignant melanoma using transarterial
chemoembolization (TACE).
Materials and methods Superselective TACE was repeatedly performed in 12 patients with liver metastases of uveal malignant melanoma. Six patients
presented with solitary liver metastases (6–12 cm in size) and six patients with oligonodular metastases (n ≤ 6). The embolization suspension consisted of a maximum of 10 mg/m2 Mitomycin C, 10 ml Lipiodol, and an injection of 200–450 mg resorbable microspheres for vascular occlusion. In the follow-up,
magnetic resonance imaging was performed in 3-month intervals.
Results The TACE procedure was well tolerated in all patients without any relevant side effects. Three patients responded to TACE
with a size reduction of more than 50% (partial response), five patients with stable disease, and four patients with progressive
disease with an increase in volume of more than 25%. Mean survival following primary tumor treatment was 32.9 months, and
after first embolization 19.5 months. Lower survival rates were recorded for the progressive group (16.5 months).
Conclusion Repeated TACE offers a palliative treatment option in patients with oligonodular liver metastases of uveal malignant melanoma. 相似文献
4.
Vibert E Bretagnol F Alves A Pocard M Valleur P Panis Y 《Diseases of the colon and rectum》2007,50(11):1776-1782
Purpose Surgery of the primary tumor in patients with colorectal cancer and unresectable synchronous liver metastases remains controversial.
This study was designed to evaluate predictive preoperative factors of early postoperative death (<3 months) in such patients.
Methods This study included 80 patients who underwent colorectal resection (n = 56) or diversion stoma (n = 24) for colorectal cancer
with unresectable liver metastases. Twenty-two patients (28 percent) died during the first three months after surgery with
two (2.5 percent) in-hospital postoperative deaths. Analysis of predictive preoperative factors for three-month postoperative
death risk was performed.
Results In univariate analysis, age older than 75 years (P = 0.01), American Society of Anesthesiologists grade > II (P = 0.009), symptomatic patient (P = 0.01), bowel obstruction (P = 0.03), aspartate aminotransferase serum level >50 (1.5 N) IU/L (P = 0.008), and alkaline phosphatase >200 (2 N) IU/L (P = 0.02) were prognostic risk factors for three-month death after surgery. In multivariate analysis, age older than 75 years
(relative risk = 7.9; P = 0.04) and aspartate aminotransferase serum level >50 IU/L (relative risk = 8.3; P = 0.03) were independent risk factors.
Conclusions In patients with colorectal cancer and synchronous unresectable liver metastases, the three-month mortality rate was high
(28 percent). Thus, better knowledge of risk factors could help select patients who could possibly benefit from surgery. The
study suggested that age older than 75 years and liver cytolysis (>1.5 N) are associated with an increased three-month postoperative
death risk. In these patients, surgery should be avoided.
Read at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005. 相似文献
5.
Bockhorn M Sotiropoulos GC Sgourakis G Neuhaus JP Molmenti EP Lang H Frilling A Broelsch CE 《International journal of colorectal disease》2009,24(1):83-86
Background and aims As the mean life expectancy rises, the incidence of patients 75 years of age and older who present with colorectal liver metastases
continues to increase. The purpose of our study was to evaluate the outcome of major hepatic resections in the elderly population.
Patient and methods From April 1998 to December 2006, 572 consecutive patients with colorectal liver metastases were treated at our Institution.
Of these, 59 were 75 years or older. There was an intent to proceed with major liver resections in all cases. Data were analyzed
according to diagnosis, comorbidities, extent of liver resection, postoperative complications, overall survival, and disease-free
survival.
Results Surgical treatment included right hepatectomies (n = 8), left hepatectomies (n = 4), and sectionectomies (more than three segments; n = 33). Fourteen (n = 14) patients received an explorative laparotomy alone. Morbidity and hospital mortality were 10% and 3%, respectively.
Overall survival of 1, 3, and 5 years was 90%, 64%, and 33%, respectively. The corresponding disease-free survival was 74%,
42%, and 32%. Resection margin (R class) was the only predictor of survival by both uni- and multivariate analyses.
Conclusion Hepatic resections can be performed safely in selected patients 75 years of age or older. 相似文献
6.
Jianmin Xu Ye Wei Yunshi Zhong Jia Fan Jian Zhou Lunxiu Qin Li Ren Xinyu Qin 《International journal of colorectal disease》2009,24(4):419-425
Objective The objective of this study was to investigate whether hepatic resection (HR) can increase the survival of liver metastasis
of colorectal cancer (CRC).
Materials and methods CRC patients (n = 669) with liver metastasis treated at the Zhongshan Hospital, Fudan University from 1/2000 to 7/2007 were included in the
study to investigate the relationship between HR and cancer survival.
Results CRC patients (n = 669) with liver metastases who had primary tumor resection were grouped in synchronous liver metastasis (SLM; 56.7%, n = 379) and metachronous liver metastasis (MLM) groups (43.3%, n = 290). Hepatic resection rates were lower (32.5%, n = 123) in the SLM than the MLM group (44.8%, n = 130, P < 0.05). The 30-day mortality rate in the MLM (2.3%) was significantly lower than SLM (2.4%) groups. The 5-year survival
rates (36.6%) was same compared to SLM group (33.1%, P > 0.05). One-, 2-, and 3-year survival of stages I and II operation cases were 92.5% vs 86.5%, 0.7% vs 58.0%, and 42.1% vs
44.9% (P > 0.05) in the SLM group, respectively. Recurrence after first hepatic resection associated with a 2.23-fold increased risk
of death (P < 0.01). Incision margins larger than 1 cm and HR for recurrence associated with 34% and 27% (P < 0.05) decreased death risk.
Conclusions Hepatic resection could help the survival of liver metastasis of colorectal cancer, and stage I surgery is safe for this disease.
Xu Jianmin, Wei Ye, and Zhong Yunshi contributed equally to this paper. 相似文献
7.
Kumar L Malik PS Prakash G Prabu R Radhakrishnan V Katyal S Hariprasad R 《Annals of hematology》2011,90(11):1317-1328
Limited information is available from developing countries about complications, pattern of infections, and long-term outcome
of patients following high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ASCT). Between April,
1990 and December 2009, 228 patients underwent ASCT. Patients’ median age was 48 years, ranging from 11 to 68 years. There
were 158 males and 70 females. Indications for transplant included multiple myeloma, n = 143; lymphoma, n = 44 (Hodgkin’s, n = 25 and non-Hodgkin’s, n = 19); leukemia, n = 22; and solid tumors, n = 18. Patients received HDCT as per standard protocols. Following ASCT, 175 (76.7%) patients responded; complete, 98 (43%);
very good partial response, 37 (16.2%); and partial response, 40 (17.5%). Response rate was higher for patients with good
Eastern Cooperative Oncology Group (ECOG) performance status (0–2 vs. 3–4, p < 0.001), pretransplant chemo-sensitive disease (p < 0.001) and those with diagnosis of hematological malignancies (p < 0.003). Mucositis, gastrointestinal, renal, and liver dysfunctions were major nonhematologic toxicities, 3.1% of patients
died of regimen-related toxicities. Infections accounted for 5.3% of deaths seen before day 30. At a median follow-up of 66 months
(range, 9–234 months), median overall (OS) and event-free survival (EFS) were 72 months (95% CI 52.4–91.6) and 24 months (95%
CI 17.15–30.9), respectively. For myeloma, OS and EFS were 79 months (95% CI 52.3–105.7) and 30 months (95% CI 22.6–37.4),
respectively. Pretransplant good performance status and achievement of significant response following transplant were major
predictors of survival. Our analysis demonstrates that such procedure can be successfully performed in a developing country
with results comparable to developed countries. 相似文献
8.
Titu LV Breen DJ Nicholson AA Hartley J Monson JR 《Diseases of the colon and rectum》2006,49(6):810-815
Purpose This study was designed to determine whether routine follow-up by magnetic resonance imaging improves the detection of resectable
liver metastases from colorectal cancer and patients' survival.
Methods Patients who underwent curative surgery for colorectal cancer were included in a program of liver surveillance by routine
magnetic resonance imaging, in addition to the standard follow-up protocol consisting of clinical examination and biochemical
tests. The median follow-up was 41 (interquartile range, 30–53) months, with a median magnetic resonance imaging surveillance
period of 20 (interquartile range, 12–27) months. Cases were analyzed for mode of diagnosis, resectability, and overall survival.
Results Liver metastases were found in 37 (13 percent) of 293 patients studied. Magnetic resonance imaging diagnosed hepatic metastases
with 84 percent sensitivity and 90 percent specificity. In 28 (76 percent) patients, carcinoembryonic antigen and/or liver
function tests were abnormally elevated and 5 patients (14 percent) were symptomatic. Hepatic resection was possible in only
nine patients (24 percent). Magnetic resonance imaging detected all resectable cases, whereas traditional follow-up would
have missed three (33 percent) cases suitable for surgery.
Conclusions Although magnetic resonance imaging surveillance increased the number of patients suitable for liver resection by 50 percent,
these represented only 1 percent of the patients included in the study. Whether these results are enough to justify the allocation
of expensive resources is controversial.
Reprints are not available. 相似文献
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10.
Thelen A Jonas S Benckert C Spinelli A Lopez-Hänninen E Rudolph B Neumann U Neuhaus P 《International journal of colorectal disease》2007,22(10):1269-1276
Background and aims The surgical strategy for treatment of synchronous liver metastases from colorectal cancer remains controversial. This retrospective
analysis was conducted to compare the postoperative outcome and survival of patients receiving simultaneous resection of liver
metastases and primary colorectal cancer to those receiving staged resection.
Materials and methods Between January 1988 and September 2005, 219 patients underwent liver resection for synchronous colorectal liver metastases,
of whom, 40 patients received simultaneous resection of liver metastases and primary colorectal cancer, and 179 patients staged
resections. Patients were identified from a prospective database, and records were retrospectively reviewed. Patient, tumor,
and operative parameters were analyzed for their influence on postoperative morbidity and mortality as well as on long-term
survival.
Results Simultaneous liver resections tend to be performed for colon primaries rather than for rectal cancer (p = 0.004) and used less extensive liver resections (p < 0.001). The postoperative morbidity was comparable between both groups, whereas the mortality was significantly higher
in patients with simultaneous liver resection (p = 0.012). The mortality after simultaneous liver resection (n = 4) occurred after major hepatectomies, and three of these four patients were 70 years of age or older. There was no significant
difference in long-term survival after formally curative simultaneous and staged liver resection.
Conclusion Simultaneous liver and colorectal resection is as efficient as staged resections in the treatment of patients with colorectal
cancer and synchronous liver metastases. To perform simultaneous resections safely a careful patient selection is necessary.
The most important criteria to select patients for simultaneous liver resection are age of the patient and extent of liver
resection. 相似文献
11.
Ralf Konopke Stephan Kersting Marius Distler Jeannine Dietrich Jörg Gastmeier Axel Heller Eberhard Kulisch Hans‐Detlev Saeger 《Liver international》2009,29(1):89-102
Background: Patient outcome after resection of colorectal liver metastases can be predicted by various prognostic factors. Aims: Development of a model for risk stratification based on analysis of prognostic factors. Methods: Data of 201 patients were collected prospectively and included in a single‐centre trial. A total of 20 factors were analysed as to their influence on recurrence‐free and overall survival. Independent prognostic factors were entered into a model of a clinical risk score. Results: Median recurrence‐free survival reached 24 months for all patients; median overall survival was 50 months. Only a synchronous manifestation of primary colorectal carcinoma and liver metastases, the presence of four or more metastases and a carcino‐embryonic antigen level of 200 ng/ml or more significantly influenced recurrence‐free and overall survival in the multivariate analysis. The derived risk stratification grouped the patients according to the following criteria: low risk, zero prognostic factors (n=112); intermediate risk, one factor (n=74); high risk, two or more factors (n=15). The median recurrence‐free survival for low, intermediate and high risk were 30.0, 23.0 and 11.0 months, respectively; the median overall survival was 94.0, 40.0 and 33.0 months. Compared with the low‐risk group, patients with intermediate risk demonstrated an increased hazard ratio (HR) of 1.57‐fold for recurrence (P=0.018) and 1.91‐fold for mortality (P=0.007). For the high‐risk group, the HR rose significantly to 3.26 for recurrence (P<0.0005) and to 3.10 for mortality (P=0.001). Conclusions: The presented clinical score may allow for patients with colorectal liver metastases to be stratified appropriately and for optimization of their subsequent therapeutic management. 相似文献
12.
Resection of liver metastases from colorectal cancer 总被引:5,自引:0,他引:5
Ib Krogh Pedersen M.D. Flemming Burcharth M.D. Ole Roikjær M.D. Helge Baden M.D. 《Diseases of the colon and rectum》1994,37(11):1078-1082
PURPOSE: This study was undertaken to determine the indications for and value of liver resection for metastases from colorectal cancer. METHODS: From 1978 through 1991, 66 patients were operated on for liver metastases from colorectal cancer. All patients had had a curative resection of their colorectal cancer. Forty resections of the liver were major anatomic resections. RESULTS: Five patients died in the postoperative period. All resections were intended to be curative, but in 16 of the patients the resection became noncurative. None of these patients lived more than two years after liver resection. Fifty patients with a curative resection had a three-year survival rate of 36 percent, postoperative death included. Recurrence in the liver was observed in 30 patients (60 percent) from 3 to 33 (median, 11) months after the liver resection. Four patients had repeated resections performed. Two of them are alive without recurrences 34 and 60 months after the first liver resection, respectively. The difference in survival between curative and noncurative liver resection was highly significant (P=0.01). CONCLUSIONS: Sex, age, Dukes stage of primary colorectal cancer, synchronous or metachronous appearance of metastases, or number of metastases could not predict long-term prognosis. The only factors of predictive value were tumor size less than 4 cm in diameter, a free resection margin, and no extrahepatic tumor. If it is possible to do a curative resection, there should be few contraindications against liver surgery as it is the only treatment that can demonstrate long-term survival for approximately one-third of the patients, and it is the only possibility of a cure. 相似文献
13.
Clinicopathologic and immunohistochemical study of early colorectal cancer with liver metastases 总被引:1,自引:0,他引:1
Seven (3.3%) of 213 patients who underwent surgery for early colorectal cancer (invasion limited to no deeper than the submucosa)
at the National Cancer Center Hospital, Tokyo, between 1986 and 1995 had synchronous (2 patients) or metachronous (5 patients)
liver metastases. The average period from surgical resection of the primary colorectal cancer to the diagnosis of liver metastases
was 25 months (range, 0–52 months). The clinicopathologic and immunohistochemical features of the primary lesions in these
patients were compared with these features in the lesions in consecutive patients with early colorectal cancer who had no
evidence of liver metastases within at least 5 years after colorectal resection. Venous invasion was more frequent in the
primary lesions with liver metastases than in those without liver metastases (57% vs 0%; P = 0.0035). Expression of p53 and CD44v9 was more frequent in the primary lesions with liver metastases (71% and 100%) than
in those without metastases (56% and 72%). In contrast, MUC2 expression was more frequent in the primary lesions without liver
metastases (72%) than in those with metastases (43%). Venous invasion is considered to be closely related to liver metastasis,
and the immunohistochemical expression of p53 and CD44v9 provides useful information for identifying those patients with early
colorectal cancer who have a high risk of developing liver metastases.
Received: June 16, 1998/Accepted: October 23, 1998 相似文献
14.
Aim: To compare the surgical treatment outcomes between patients with colorectal liver metastases (CLM) and non‐colorectal liver metastases (NCLM). Methods: The study population consisted of 132 patients undergoing hepatectomy at Tianjin Medical University Cancer Hospital between January 1996 and December 2008. Survival analyses were used to assess the differences in prognosis and survival between groups. Results: The primary tumor site was colorectal in 60 (45.5%), breast in 16 (12.1%), lung in 14 (10.6%), non‐colorectal gastrointestinal in 12 (9.1%), genitourinary in 10 (7.6%), pancreatobiliary tumor (n = 8, 6.1%) and others in 12 (9.1%). A curative liver resection was performed in all patients by pathological findings. After a median follow‐up of 32 months, the overall 3‐ and 5‐year survival rate was 44.7 and 29.5% in all patients, respectively. The 3‐ and 5‐year survival rates were 53.3 and 36.7% for liver metastases from colorectal tumors, 62.5 and 43.8% from breast, 60.0 and 40.0% from genitourinary neoplasm, 41.7 and 25.0% from non‐colorectal gastrointestinal cancer, 28.5 and 15.0% from lung, 12.5 and 0% from pancreatobiliary malignancies, and 41.7 and 8.3% from other sites, respectively. Conclusions: Hepatic resection is an effective and safe treatment for liver metastases mainly depending on primary tumor sites. Hepatic metastases from non‐colorectal gastrointestinal cancer, pulmonary and pancreatobiliary malignancies have the worst prognosis; those from breast and genitourinary neoplasm show the best prognosis. 相似文献
15.
Michael Palmer M.D. Dr. Nicholas J. Petrelli M.D. Lemuel Herrera M.D. 《Diseases of the colon and rectum》1989,32(8):698-701
After an explanation of alternative treatment modalities, 30 patients with unresectable liver metastases from colorectal adenocarcinoma
chose to have no treatment. Fourteen patients (47 percent) had synchronous liver metastases and 16 (53 percent) had metachronous
lesions. Thirteen of the 30 patients (43 percent) had histologic documentation of liver metastases, with the remaining 17
patients diagnosed by liver scan, ultrasonography, or computerized axial tomography. Twenty-four of 30 patients (80%) had
less than 25 percent liver involvement (Stage I), 23 of 24 patients had alkaline phosphatase levels less than twice normal,
and 20 of 24 patients were asymptomatic from their liver metastases. The remaining six patients had liver stages II or III
at the time of diagnosis. Overall mean survival of the 30 reported patients with untreated metastatic colorectal cancer to
liver is 16 months (range, 2 to 58 months; median survival, 12 months). 相似文献
16.
Ralf Konopke Stephan Kersting Alfred Bunk Janine Dietrich Axel Denz Jörg Gastmeier Hans-Detlev Saeger 《International journal of colorectal disease》2009,24(6):687-697
Background/aims Despite advances in diagnosis and treatment, the rate of complications after resection for colorectal liver metastases remains
high. An awareness of risk factors is essential for the rates of morbidity and mortality to fall to optimal levels.
Materials and methods Of the 240 patients who underwent resection for the first manifestation of colorectal liver metastases, 49 patients with lobectomy
or extended hepatectomy (major resections) and 58 with wedge resections within only one liver segment (minor resections) form
the basis of this report. A total of 16 variables were analyzed to find the risk factors linked to postoperative morbidity
and mortality.
Results/findings Thirty-four patients (31.8%) suffered postoperative complications, and one patient died during the hospital stay (0.9%). In
the major resection group, multivariate analysis showed that neoadjuvant chemotherapy [odds ratio (OR): 2.4; p = 0.005], vascular clamping (OR: 1.4; p = 0.008), and intraoperative blood loss with transfusion of three to six packed red cell units (OR: 1.2; p = 0.029) were significantly associated with postoperative morbidity. Vascular clamping was an independent predictor for biliary
fistula (OR: 1.2; p = 0.029). Postoperative temporary liver failure was influenced by neoadjuvant chemotherapy (OR: 3.4; p = 0.010), vascular clamping (OR: 1.5; p = 0.015), and requirement of blood transfusion (OR: 2.1; p = 0.016). After minor resections, only a decreased postoperative serum cholinesterase B level was an independent predictor
for complications (OR: 2.2; p = 0.001), as well as for hemorrhage (OR: 1.6; p = 0.023). Postoperative mortality was not predicted by any of the factors that were analyzed.
Interpretation/conclusion Factors for complications differ depending on the extent of colorectal liver metastasis resection. Only knowledge and particular
consideration of these factors may provide for an optimal postoperative outcome for the individual patient.
Ralf Konopke and Stephan Kersting contributed equally to this work 相似文献
17.
《HPB : the official journal of the International Hepato Pancreato Biliary Association》2022,24(1):40-46
BackgroundThe clinical value of immune checkpoint expression as prognostic biomarker in bevacizumab-pretreated patients with resected microsatellite-stable (MMS) colorectal liver metastases is unclear and was retrospectively investigated in this study.MethodsExpression analyses of IDO-1, PD-L1, and CTLA-4 were performed by immunohistochemistry in resected bevacizumab-pretreated colorectal liver metastases. Association of immune checkpoint expression in tumor cells and immune cells with response and clinical outcome was investigated. Expression profiles were compared with those of patients with anti-EGFR-targeted therapy and lung metastases, respectively.ResultsOne hundred thirty-six patients with MMS disease were investigated (79 (58.1%) male/57 (41.9%) female, median age 62.9 years (range 31.0–80.4)). High expression of IDO-1 in immune cells was associated with longer OS (not reached versus 44.8 months, HR 0.23 (95% CI 0.09, 0.55), P = 0.001). Low expression of CTLA-4 in tumor cells was associated with better histological response (26 major, 19 partial, 18 none versus 14 major, 23 partial, 30 none, P = 0.032). Expression profiles differed compared to patients with anti-EGFR-targeted therapy and patients with lung metastases.ConclusionImmune checkpoint expression was associated with response and survival. IDO-1 may serve as a novel prognostic and/or predictive biomarker in patients with MMS colorectal liver metastases. 相似文献
18.
Cashen A Juckett M Jumonville A Litzow M Flynn PJ Eckardt J LaPlant B Laumann K Erlichman C DiPersio J 《Annals of hematology》2012,91(1):33-38
The inhibition of histone deacetylase (HDAC) can induce differentiation, growth arrest, and apoptosis in cancer cells. This
phase II multicenter study was undertaken to estimate the efficacy of belinostat, a potent inhibitor of both class I and class
II HDAC enzymes, for the treatment of myelodysplastic syndrome (MDS). Adults with MDS and ≤2 prior therapies were treated
with belinostat 1,000 mg/m2 IV on days 1–5 of a 21-day cycle. The primary endpoint was a proportion of confirmed responses during the first 12 weeks
of treatment. Responding patients could receive additional cycles until disease progression or unacceptable toxicity. Twenty-one
patients were enrolled, and all were evaluable. Patients were a median 13.4 months from diagnosis, and 14 patients (67%) had
less than 5% bone marrow blasts. Seventeen patients (81%) were transfusion dependent. Prior therapy included azacytidine (n = 7) and chemotherapy (n = 8). The patients were treated with a median of four cycles (range, 1–8) of belinostat. There was one confirmed response—hematologic
improvement in neutrophils—for an overall response rate of 5% (95% CI, 0.2–23). Median overall survival was 17.9 months. Grades
3–4 toxicities considered at least to be possibly related to belinostat were: neutropenia (n = 10), thrombocytopenia (n = 9), anemia (n = 5), fatigue (n = 2), febrile neutropenia (n = 1), headache (n = 1), and QTc prolongation (n = 1). Because the study met the stopping rule in the first stage of enrollment, it was closed to further accrual. 相似文献
19.
Is Glucagonoma of the Pancreas a Curable Disease? 总被引:1,自引:0,他引:1
Chu Q Al-Kasspooles M Smith J Nava H Douglass H Driscoll D Gibbs J 《Journal of gastrointestinal cancer》2001,29(3):155-162
Background. Glucagonomas are rare neuroendocrine tumors of the pancreas. Because of its rarity, its natural history is not well understood.
Aim. We evaluated the natural history of glucagonomas treated at a teritary care cancer center.
Methods. A retrospective analysis of 12 patients during 1970 to 2000 was performed. Six patients (50%) had a tumor located in the
head of the pancreas.
Results. Abdominal pain (83%) and weight loss (75%) were the most common symptoms. Median tumor size was 6 cm (range 0.04–10). Seven
patients (58%) had liver metastases. Five patients (42%) underwent curative resection. Overall median survival was 66 mo,
and 5-yr overall survival was 66%. Five-yr overall survival was 83% for patients who had resection versus 50% for the non-resected
patients (p=0.04). Patients who were disease-free had a complete resection of the primary tumor and no liver involvement.
Conclusions. Glucagonomas generally present with liver metastases at the time of diagnosis. Cure is only possible if the disease
is localized and completely resected. 相似文献
20.
Maria Teresa Diz-Lois Jesús Garcia-Buela Francisco Suarez Susana Sangiao-Alvarellos Ovidio Vidal Fernando Cordido 《Endocrine》2009,35(3):467-476
Anorexia is a problem of paramount importance in patients with advanced liver failure. Ghrelin has important actions on feeding
and weight homeostasis. Concentrations of ghrelin are controversial in liver cirrhosis. Our aim was to study fasting ghrelin
and their response to an oral glucose tolerance test (OGTT) in liver failure patients and normal subjects. Methods We included 16 patients with severe liver failure prior to liver transplantation. As a control group we included 10 age-
and BMI-matched healthy subjects. After an overnight fast, 75 g of oral glucose were administered; glucose, insulin, and ghrelin
were obtained at baseline and at times 30, 60, 90, and 120 min, respectively. Results Fasting ghrelin (median and range) were statistically significantly lower for patients compared to the controls, 527 (377–971)
pg/ml vs. 643 (523–2163) pg/ml, P = 0.045, for patients and controls, respectively. The area under the curve for total ghrelin post-OGTT were lower in end-stage
liver failure patients than in the control group, 58815 (44730–87420) pg/ml min vs. 76560 (56160–206385) pg/ml min, for patients
and controls, respectively, P = 0.027. Conclusions Ghrelin levels are significantly decreased both fasting and post-OGTT in patients with liver failure candidates for transplantation.
Decreased ghrelin levels could contribute to anorexia in patients with cirrhosis. 相似文献