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Proposal of a new and simple staging system of colorectal liver metastasis

World Journal of Gastroenterology 2006年第43期12卷 6961-6965页

作者： ikuo nagashima Tadahiro Takada Hirokazu Nagawa Tetsuichiro Muto Kota Okinaga Department of Surgery Teikyo University School of Medicine Tokyo Japan Department of Surgical Oncology Graduate School of Medicine University of Tokyo Tokyo Japan

AIM： To create a new, simple and useful staging system for colorectal liver metastasis analogous to the Tumor Node Metastasis classification system of International Union Against Cancer. METHODS： A retrospective review was undertaken of 81 consecutive patients who underwent partial hepatectomy for colorectal liver metastases （group 1）. Clinical and pathological features of both primary and metastatic liver cancers were entered into a multivariate analysis to determine independent variables helpful in accurately predicting long-term prognosis after hepatectomy. Using selected variables, we created a new staging system like TNM classification. The usefulness of the new staging system was examined in a series of 92 patients from another hospital （group 2）. RESULTS： Multivariate analysis showed that 81 patients in group 1 had significant multiple hepatic tumors with the largest tumor being more than 5 cm in diameter, resectable extrahepatic distant metastases, and independent prognostic factors for poor survival after hepatectomy. Using these three variables, we created a new staging system to classify patients with colorectal liver metastases. Finally, our new staging system classified the patients both in group 1 and in group 2. CONCLUSION： Our new staging system of colorecta liver metastasis is simple and useful for staging patients.

关键词： Colorectal liver metastasis Staging system Prognostic factor

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Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection:Comparison of our scoring system to the positive number of risk factors

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World Journal of Gastroenterology 2006年第39期12卷 6305-6309页

作者： ikuo nagashima Tadahiro Takada Miki Adachi Hirokazu Nagawa Tetsuichiro Muto Kota Okinaga Department of Surgery Teikyo University School of Medicine Tokyo Japan Department of Surgical Oncology University of Tokyo Graduate School of Medicine Tokyo Japan

AIM： To select accurately good candidates of hepatic resection for colorectal liver metastasis.METHODS： Thirteen clinicopathological features, which were recognized only before or during surgery, were selected retrospectively in 81 consecutive patients in one hospital （Group Ⅰ ）. These features were entered into a multivariate analysis to determine independent and significant variables affecting long-term prognosis after hepatectomy. Using selected variables, we created a scoring formula to classify patients with colorectal liver metastases to select good candidates for hepatic resection. The usefulness of the new scoring system was examined in a series of 92 patients from another hospital （Group Ⅱ ）, comparing the number of selected variables.RESULTS： Among 81 patients of Group Ⅰ, multivariate analysis, i.e. Cox regression analysis, showed that multiple tumors, the largest tumor greater than 5 cm in diameter, and resectable extrahepatic metastases were significant and independent prognostic factors for poor survival after hepatectomy （P 〈 0.05）. In addition, these three factors： serosa invasion, local lymph node metastases of primary cancers, and postoperative disease free interval less than 1 year including synchronous hepatic metastasis, were not significant, however, they were selected by a stepwise method of Cox regression analysis （0.05 〈 P 〈 0.20）. Using these six variables, we created a new scoring formula to classify patients with colorectal liver metastases. Finally, our new scoring system not only classified patients in Group I very well, but also that in Group Ⅱ, according to long-term outcomes after hepatic resection. The positive number of these six variables also classified them well.CONCLUSION： Both, our new scoring system and the positive number of significant prognostic factors are useful to classify patients with colorectal liver metastases in the preoperative selection of good candidates for hepatic resection.

关键词： Colorectal cancer Liver metastasis Hepatic resection Prognostic factor

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Hepatic steatosis as a possible risk factor for the development of hepatocellular carcinoma after eradication of hepatitis C virus with antiviral therapy in patients with chronic hepatitis C

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World Journal of Gastroenterology 2007年第39期13卷 5180-5187页

作者： Atsushi Tanaka Satoko Uegaki Hiroko Kurihara Kiyoshi Aida Masaki Mikami ikuo nagashima Junji Shiga Hajime Takikawa Department of Medicine Teikyo University School of MedicineKagaItabashi-kuTokyo 173-8605Japan Department of Pathology Teikyo University School of MedicineKagaItabashi-kuTokyo 173-8605 Japan Department of Surgery Teikyo University School of Medicine Kaga Itabashi-ku Tokyo 173-8605 Japan

AIM: To elucidate risk factors contributing to the development of hepatocellular carcinoma (HCC) among patients with sustained viral response (SVR) after interferon (IFN) treatment and to examine whether HCV-RNA still remained in the liver of SVR patients who developed HCC. METHODS: Two-hundred and sixty-six patients, who achieved SVR, were enrolled in this study. We retrospectively reviewed clinical, viral and histological features of the patients, and examined whether the development of HCC depends on several clinical variables using Kaplan-Meier Method. RT-PCR was used to seek HCV-RNA in 3 out of 7 patients in whom liver tissue was available for molecular analysis. RESULTS: Among the enrolled 266 patients with SVR, HCC developed in 7 patients (7/266; 2.6%). We failed to detect HCV-RNA both in cancer and non-cancerous liver tissue in all three patients. The cumulative incidence for HCC was significantly different depending on hepatic fibrosis (F3-4) (P = 0.0028), hepatic steatosis (Grade 2-3) (P = 0.0002) and age (≥ 55) (P = 0.021) at the pre-interferon treatment. CONCLUSION: The current study demonstrated that age, hepatic fibrosis, and hepatic steatosis at pre- interferon treatment might be risk factors for developing HCC after SVR.

关键词： Hepatitis C virus Chronic hepatitis C Hepatocellular carcinoma Hepatic steatosis Hepaticfibrosis Interferon therapy Sustained viral response

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