Surgical Oncology, Gifu University, Graduate School of Medicine, Japan.
Int J Med Sci. 2013 Aug 1;10(9):1231-41. doi: 10.7150/ijms.6244. Print 2013.
The optimal timing of surgical resection of liver metastasis remains controversial, and guidelines regarding the upper limits of operative indications have not yet been defined. Surgical indication for metastasis from colorectal cancer (CLM) based on results of preoperative chemotherapy and RNF8 was investigated.
Differences in CLM size on CT were evaluated as shrinkage rate/day by dividing tumor shrinkage rates by the interval in days between CT. Levels of RNF8 of resected colorectal cancer and CLM frozen specimen were detected.
When the cut line for shrinkage rate at 12 weeks was set at 0.35%, disease-free survival was significantly better in patients with a shrinkage rate >0.35% vs. ≤0.35% (p=0.003). RNF8 expression was significantly higher in Tis (p=0.001). In liver metastasis, RNF8 expression level was significantly lower in patients with partial response to FOLFOX than with stable disease, (p=0.017).
A strategy of FOLFOX administration for 12 weeks to patients with low RNF8 expression and hepatectomy planned after 4 weeks rest may be accepted as the best therapeutic option for treating CLM.
肝转移灶的最佳手术切除时机仍存在争议，关于手术适应证上限的指南尚未确定。本研究旨在探讨基于术前化疗和 RNF8 结果的结直肠癌肝转移（CLM）的手术适应证。
通过将肿瘤缩小率除以 CT 检查之间的天数，计算 CT 上 CLM 大小的缩小率/天差异。检测切除的结直肠癌和 CLM 冷冻标本中的 RNF8 水平。
当将 12 周的缩小率截止线设定为 0.35%时，缩小率>0.35%的患者无疾病生存率显著优于缩小率≤0.35%的患者（p=0.003）。Tis 中 RNF8 的表达显著更高（p=0.001）。在肝转移中，与疾病稳定相比，对 FOLFOX 有部分反应的患者的 RNF8 表达水平显著更低（p=0.017）。
对于 RNF8 低表达的患者给予 FOLFOX 治疗 12 周，然后休息 4 周后行肝切除术的策略可能被视为治疗 CLM 的最佳治疗选择。
