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31.
BACKGROUND/AIMS: The assessment of response to chemotherapy of solid tumors is generally made by measurement of tumors visualized by imaging, commonly computed tomography scanning. However, response assessment based on imaging is not always feasible because patients often have disease not measurable by imaging study, such as diffuse peritoneal dissemination. Furthermore, response assessment by imaging is expensive and time consuming. This study was carried out in an effort to evaluate the correlation between serial change on imaging and on CEA (carcinoembryonic antigen) levels for assessing chemotherapeutic response of patients with metastatic colorectal cancer. METHODOLOGY: Between May 1998 and August 1999, a total of 40 patients with metastatic colorectal carcinoma were enrolled in this study. All the patients had to have measurable lesions. Oral tegafur-uracil 300 mg/m2/day and folinic acid 60 mg/day were administered concurrently for four weeks, repeated every five weeks, as the first-line treatment. Tumor marker CEA was examined before and during the whole course of treatment. Response based on CEA assessment was defined as a more-than 50% drop in serum CEA level for more than four weeks. The correlation between serial change on CEA and on imaging for assessing chemotherapeutic response was evaluated. RESULTS: Forty patients received a total of 318 courses of treatment and a response rate of 32.5% (95% confidence interval, 18.0% to 47.0%), including five complete responses and eight partial responses, was achieved by imaging studies. The pretreatment CEA levels were elevated beyond the normal cut-off value in 34 (85%) patients. The response rate evaluated by CEA assessment was 42.5% (17/40). Nine responders (22.5%) based on CEA had no remission on imaging. Agreement in assessment by imaging study and by CEA was observed in 20 patients (50%), including eight responders, five stable diseases, and seven progressive diseases. The sensitivity of falling CEA levels in the prediction of true responders on imaging was 62%. The sensitivity of elevated CEA levels for the prediction of progressive disease was 70%. Concerning the diagnostic accuracy, change in CEA levels in the prediction of true responders and progressive disease on imaging were 65% and 85%, respectively. On a follow-up of 24 months, patients with remarkable falling CEA levels survived significantly longer than non-responders (P = 0.0184, log-rank test). CONCLUSIONS: The measurement of CEA levels might be useful in monitoring chemotherapeutic response and in predicting the prognosis of patients with metastatic colorectal cancer. Serum CEA level may be used as a means of monitoring chemotherapeutic response when imaging study is unsuitable for assessing the response in clinical practice.  相似文献   
32.
PURPOSE: It has been shown that the R497K polymorphism of the epidermal growth factor receptor (EGFR) has attenuated functions in ligand binding, tyrosine kinase activation, and growth stimulation. Because the activation of EGFR results in an unfavorable prognosis of patients with colorectal carcinoma, a pilot study was conducted to assess the influence of this polymorphism on colorectal carcinoma patients. EXPERIMENTAL DESIGN: We retrospectively analyzed the effect of the R497K polymorphism of EGFR on clinicopathologic features in 209 colorectal carcinoma patients, including 100 with stage II/III colorectal carcinoma receiving curative surgery and the other 109 with metastatic diseases. RESULTS: An excellent correlation in codon 497 statuses examined by patients' WBCs and tumor tissues was found but no significant between-group difference in patients with or without colorectal carcinoma (P = 0.97). A marked decrease on EGFR phosphorylation (P < 0.01) and c-Myc activation (P = 0.02) was observed in patients with R497K polymorphism, which is associated with decreased invasion (P = 0.01), lower nodal involvement (P = 0.02), reduced subsequent metastasis (P < 0.01), and longer disease-free (P < 0.01) as well as overall (P < 0.01) survival in stage II/III colorectal carcinoma patients who had received curative surgery. For patients with metastatic colorectal carcinoma, this polymorphism was associated with a higher response to 5-fluorouracil/oxaliplatin treatment (P = 0.02) and a longer survival (P < 0.01). By multivariate analysis, this polymorphism was also identified as an independent prognostic factor (P = 0.03). CONCLUSIONS: These data suggest that the R497K polymorphism of the EGFR, by reducing its activation and a consequential down-regulation of its target genes, could be a key determinant for reduced tumor recurrence of stage II/III colorectal carcinoma patients receiving curative surgery and a longer survival of patients with stage II/III as well as metastatic colorectal carcinoma.  相似文献   
33.
BACKGROUND/AIMS: The employment of laparoscopy in the treatment of locally advanced colorectal cancer is still questioned by many surgeons, mainly due to the fear of spreading tumors by the laparoscopic procedure. However, it is still unknown whether laparoscopy is actually associated with increased tumor dissemination, especially for those with tumor invasion through the serosa. The main purpose of this study is to investigate the effect of pneumoperitoneum on the intra-abdominal tumor growth and spreading of colon cancer cells by an animal study of murine model. METHODOLOGY: Under anesthesia, 10(6) tumor cells (CT26) were inoculated into the lower abdominal cavity of BALB/c mice by a mini-laparotomy. The mice were randomized to undergo pneumoperitoneum with CO2 (n=10), helium (n=10), or to act as controls (n=10). Pneumoperitoneum was established over 20 min at a pressure of 10cm H2O. The distribution pattern and the weight of peritoneal tumor growth of each mouse were recorded and analyzed at 15 days after surgery. RESULTS: The mean ratios of the tumor mass over the total body weight of the mice were 0.77+/-1.13% (control group), 4.30+/-0.86% (CO2 pneumoperitoneum), and 2.17+/-0.88% (helium pneumoperi-toneum). The mean tumor weight ratio (3.23+/-1.38%) of the pneumoperitoneal group was 4 times larger than that of the control group (p<0.001). Regarding the use of different insufflation gases over tumor growth, CO2 accelerates tumor growth more significantly than helium (p<0.001). Intraabdominal distribution (p=0.047) and diaphragm spreading (p<0.001) were significantly greater in the pneumoperitoneum group than the control group. CONCLUSIONS: The results of this animal study imply that presence of a pneumoperitoneum enhances the implantation and growth of free intraperitoneal malignant colon cancer cells in this in vivo mouse model. The results of the current study suggest that insufflation during pneumoperitoneum may play an important role in the development of peritoneal dissemination when there are free tumor cells in the intra-abdominal cavity, and the effect of using CO2 might be greater than that of using helium.  相似文献   
34.
Prognostic value of DNA ploidy patterns of colorectal adenocarcinoma   总被引:1,自引:0,他引:1  
BACKGROUND/AIMS: The significance of prognostic value of DNA ploidy patterns of colorectal cancer has not yet been fully understood. The present study was designed to determine the prognostic value of DNA ploidy patterns for colorectal adenocarcinomas after resection. METHODOLOGY: We have prospectively collected tumor specimens from 420 patients with colorectal cancer since 1996. The DNA ploidy patterns were determined with the use of DNA flow cytometry. The correlation of DNA ploidy pattern and various characteristics of tumors and the prognostic significance of DNA ploidy patterns were evaluated by univariate as well as Cox's proportional hazard model. The disease-free survival curves were calculated with Kaplan-Meier's analysis, and the survival difference was determined by log-rank test. RESULTS: DNA ploidy patterns were diploid in 115 (27.4%) and aneuploid in 305 patients (72.6%). The pattern of DNA ploidy did not correlate with age, gender, location, differentiation, and stage of the tumors. In 146 patients who were followed up for at least 2 years, the disease-free survival curves were similar between the diploid and aneuploid group. Multivariate analysis disclosed that tumor staging was associated with the survival of patients but the DNA ploidy pattern had no prognostic significance. CONCLUSIONS: The DNA ploidy pattern was not a significant prognostic factor in short-term follow-up.  相似文献   
35.
BACKGROUND/AIMS: The aim of this study was to evaluate the relationship of the disease recurrence and prognosis of rectal cancer with anastomosis leakage after curative low anterior resection. METHODOLOGY: The records of 566 patients with primary rectal adenocarcinoma in the Veterans General Hospital-Taipei, Taiwan between 1991 and 1997 were reviewed. Patients who did not have anastomosis (abdominoperineal resection 72, Hartmann's operation 15), did not have curative resection (62) or expired within 30 days after operation (11) were excluded from the study. Another 34 patients were excluded because they did not visit our clinic or could not be reached by telephone or questionnaire after operation. 372 patients who received restorative curative resection with a colorectal anastomosis were analyzed. The product-limit method (Kaplan-Meier) and Cox proportional hazard model were used to analyze survival rate and tumor recurrence. RESULTS: Twenty-five out of the 406 patients had anastomosis leakage after the operation. The 5-year disease-free, local recurrence-free survival of the leakage group (32.5%, 58.7%) was significantly lower than that of the non-leakage group (71%, 88.3%). The multivariate analysis showed TNM staging (p = 0.0001) and histological differentiation (p = 0.0002) were associated with overall tumor recurrence. The factors affected local tumor recurrence were TNM staging (p = 0.006) and anastomosis leakage (p = 0.014). CONCLUSIONS: These results suggested that anastomotic leakage after curative rectal surgery is associated with the local tumor recurrence-free survival rate even after adjusting for stage.  相似文献   
36.

Purpose

This retrospective study aimed to determine the effects of diabetes on overall survival (OS) and cancer-specific survival (CSS) in patients with newly diagnosed colon cancers, with particular focus on the impact of diabetes on survival at each stage of colon cancer.

Methods

From January 1999 to January 2008, 2762 consecutive patients diagnosed with colon cancer in Taipei Veterans General Hospital were enrolled. The general characteristics as well as presence of diabetes prior to colon cancer diagnosis were identified. Cox proportional hazard analyses were used for prognostic factors determination; and survival was analyzed using the Kaplan?CMeier method with log-rank test.

Results

A total of 469 patients (17%) had diabetes at diagnosis of colon cancer. Patients with diabetes had baseline characteristics comparable to those without diabetes with the exception that the patients with diabetes were older (>65?years). Diabetes significantly and negatively impacted OS and CSS in multivariate analyses. After adjusting for possible confounding factors, the prognostic impact of diabetes on OS and CSS was particularly significant in patients with stage II colon cancer.

Conclusions

Diabetes is a poor prognostic factor in patients with newly diagnosed colon cancer, and it may directly impact the tumor behavior of stage II disease. Further study is required to elucidate the underlying pathophysiologic mechanisms.  相似文献   
37.

Purpose

Carcinoembryonic antigen (CEA) measurements performed preoperatively and during the early postoperative period were examined prospectively to assess their prognostic value for colorectal cancer (CRC) patients receiving curative surgery.

Methods

Between 2000 and 2004, 1,361 patients with CRC who underwent curative surgery at the Taipei Veterans General Hospital were enrolled prospectively. CEA was measured prior to surgery and during the third or fourth postoperative week. The endpoint was length of postoperative disease-free survival, and prognostic importance was determined using the log-rank test and Cox regression hazard model.

Results

Six hundred (44.1%) CRC patients had high CEA concentrations preoperatively, and 188 (13.8%) patients retained high values postoperatively. Within the median follow-up period of 61 (6?C108) months, CRC recurred in 313 patients. By univariate analysis TNM staging, tumor differentiation, lymphovascular invasion, preoperative CEA concentration, and postoperative CEA concentration affected the outcome. By multivariate analysis, the prognostic importance of postoperative CEA was retained (95% CI, 1.73?C3.01; HR?=?2.28) but that of preoperative CEA was lost (95% CI, 0.82?C1.33; HR?=?1.05). CRC recurred earlier in patients with high postoperative CEA concentrations; metastasis to the liver was common (72.3%) among patients in this group.

Conclusions

Early postoperative CEA concentration is an independent prognostic factor for CRC. Patients with high postoperative CEA values should receive aggressive follow-up examinations for early relapse of CRC, with special attention paid to recurrence at the liver.  相似文献   
38.

Background  

An elevated plasma level of C-reactive protein (CRP) is a risk for, and prognostic factor of, colorectal cancer (CRC). In other reports of CRP concerning cardiovascular disease, CRP level correlated with its gene polymorphisms. We hypothesized that CRP polymorphisms associate risk and prognosis of CRC.  相似文献   
39.
40.
A 24-year-old man presented with lower abdominal pain that had been present for 18 hours. Physical examination revealed mild tenderness in the lower abdomen. Digital rectal examination revealed a tender point approximately 9 cm above the anal verge. Transrectal sonographic examination demonstrated an ovoid echogenic noncompressible mass surrounded by a hypoechoic halo attached to the wall of the rectosigmoid junction. A diagnosis of epiploic appendagitis was made on the basis of sonographic findings and was subsequently confirmed with contrast-enhanced CT.  相似文献   
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