Znajda Tamara L, Hayashi Shinichi, Horton Peter J, Martinie John B, Chaudhury Prosanto, Marcus Victoria A, Jass Jeremy R, Metrakos Peter
Department of Surgery and Hepatic, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
J Gastrointest Surg. 2006 Apr;10(4):483-9. doi: 10.1016/j.gassur.2006.01.002.
Accepted management for colorectal cancer (CRC) involves resection of the primary neoplasm and chemotherapy; the debate continues over the most beneficial order of these components. Preoperative chemotherapy aimed at liver metastases may result in complete pathologic response and replacement of the malignancy with scar. The McGill University liver diseases database was retrospectively reviewed. Forty-one patients receiving treatment between December 2003 and August 2004 were identified, their medical records examined, and liver histology reviewed. The histology of the remnants was linked to the appearance of the lesions on preresection imaging and to the primary colorectal neoplasms. Twenty-seven of the 41 patients (66%) received preoperative chemotherapy (oxaliplatin or irinotecan). Features of the primary neoplasm that predicted resolution of the metastases were absence of tumor budding (P = 0.04), absence of a diffusely infiltrative tumor margin (P = 0.02), and loss of expression of the DNA repair gene O6-methylguanine-DNA methyltransferase (P = 0.08). Oxaliplatin and irinotecan demonstrate beneficial effects in treating hepatic colorectal metastases and should be considered in such patients before resection. We propose the acronym RUMP to denote the remnants of uncertain malignant potential remaining. Further investigation is required to determine any correlation between the drug received and the resulting lesion.
结直肠癌（CRC）公认的治疗方法包括原发性肿瘤切除和化疗；关于这些治疗环节的最佳顺序仍存在争议。针对肝转移的术前化疗可能会导致完全病理缓解，并使恶性肿瘤被瘢痕组织取代。对麦吉尔大学肝病数据库进行了回顾性研究。确定了2003年12月至2004年8月期间接受治疗的41例患者，检查了他们的病历，并对肝脏组织学进行了复查。残余组织的组织学与切除术前影像学上病变的表现以及原发性结直肠肿瘤相关联。41例患者中有27例（66%）接受了术前化疗（奥沙利铂或伊立替康）。预测转移灶消退的原发性肿瘤特征包括无肿瘤芽生（P = 0.04）、无弥漫性浸润性肿瘤边缘（P = 0.02）以及DNA修复基因O6-甲基鸟嘌呤-DNA甲基转移酶表达缺失（P = 0.08）。奥沙利铂和伊立替康在治疗肝结直肠癌转移方面显示出有益效果，此类患者在切除术前应考虑使用。我们提出首字母缩写词RUMP来表示残留的具有不确定恶性潜能的组织。需要进一步研究以确定所接受的药物与所产生病变之间的任何相关性。
