Oba Atsushi, Mise Yoshihiro, Ito Hiromichi, Hiratsuka Makiko, Inoue Yosuke, Ishizawa Takeaki, Arita Junichi, Matsueda Kiyoshi, Takahashi Yu, Saiura Akio
Department of Hepatobiliary Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan.
Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan.
HPB (Oxford). 2018 Aug;20(8):708-714. doi: 10.1016/j.hpb.2018.02.377. Epub 2018 Mar 10.
Clinical implication of disappearing liver metastases (DLMs) from colorectal cancer after chemotherapy needs to be reviewed in the era of modern imaging studies.
Between 2010 and 2015, 184 patients underwent curative hepatectomy for colorectal liver metastases following preoperative chemotherapy. The sites of metastases detected on pre-chemotherapy CE-CT were examined post-chemotherapy using CE-CT, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), and contrast-enhanced intraoperative ultrasonography (CE-IOUS). DLMs were defined as tumors that disappeared on CE-CT post chemotherapy. The detection rate of DLMs with EOB-MRI and CE-IOUS were assessed, and the outcome of DLMs resected and those left in place were reviewed.
A total of 275 DLMs were noted in 59 patients. On EOB-MRI, 71 lesions (26%) were visible and were resected, 92% (65/71) of which contained viable disease. Using CE-IOUS, an additional 94 lesions were identified. A total of 165 DLMs (60%) were identified and resected by sequential use of EOB-MRI and CE-IOUS, 77% (127/165) of which contained viable disease. Of 110 DLMs not identified, 68 were resected, 4% (3/68) of which contained viable disease. Among 42 lesions left in place, 6 (14%) recurred during the median follow-up period of 27 (9-72) months.
EOB-MRI and CE-IOUS exploration identified clinically relevant DLMs containing viable disease with a high level of accuracy.
在现代影像学研究时代，有必要重新审视化疗后结直肠癌肝转移灶消失（DLMs）的临床意义。
2010年至2015年间，184例患者在术前化疗后接受了根治性肝切除术治疗结直肠癌肝转移。化疗前通过CE-CT检测到的转移灶部位，在化疗后使用CE-CT、钆乙氧基苄基二乙三胺五乙酸增强磁共振成像（EOB-MRI）和术中超声造影（CE-IOUS）进行检查。DLMs定义为化疗后在CE-CT上消失的肿瘤。评估EOB-MRI和CE-IOUS对DLMs的检出率，并回顾DLMs切除及未切除病例的结局。
59例患者共发现275个DLMs。在EOB-MRI上，71个病灶（26%）可见并被切除，其中92%（65/71）含有存活肿瘤细胞。使用CE-IOUS又发现了94个病灶。通过序贯使用EOB-MRI和CE-IOUS共识别并切除了165个DLMs（60%），其中77%（127/165）含有存活肿瘤细胞。在未被识别的110个DLMs中，68个被切除，其中4%（3/68）含有存活肿瘤细胞。在42个未切除的病灶中，6个（14%）在中位随访期27（9 - 72）个月内复发。
EOB-MRI和CE-IOUS探查能够高度准确地识别出含有存活肿瘤细胞且具有临床相关性的DLMs。
