title: Impact of biomarkers expression before and after portal vein embolization on recurrence after two-stage hepatectomy for colorectal liver metastases.
abstract: BACKGROUND
  The adverse oncological effect of portal vein embolization (PVE) in patients with colorectal liver metastases (CLM) remains controversial. This study was designed to evaluate the effect of PVE on change of tumor characteristics using tumor specimens obtained from sequential hepatectomy before and after PVE.
  
  
  METHODS
  Between December 1996 and April 2009, among 55 patients who achieved two-stage hepatectomy (TSH) combined with PVE, 39 had available cancer tissue blocks from both the first- and second-stage hepatectomy and constituted the study population. The immunohistochemistry of Ki67 and Bcl-2 before and after PVE was performed. Biomarker expressions and clinicopathological variables were assessed and their impact on recurrence was analyzed.
  
  
  RESULTS
  Whereas tumor volume and carcinoembryonic serum level significantly increased after PVE, the expression of Ki67 and Bcl-2 remained similar before and after PVE. The Bcl-2 ratio (expressed as Bcl-2 after PVE over Bcl-2 before PVE) was an independent prognostic factor for recurrence-free survival (P=0.030). Patients with Bcl-2 ratio ≤ 1 had a significantly longer median recurrence-free survival compared with those with Bcl-2 ratio >1 receiving or not receiving adjuvant chemotherapy (24.8 months versus 8.9 or 5.8 months, respectively).
  
  
  CONCLUSIONS
  Bcl-2 ratio may predict early recurrence and identify patients who do not require postoperative chemotherapy in patients undergoing TSH with PVE for CLM.
authors: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67098, Strasbourg Cedex, France.
authors: Masato
authors: M
authors: Narita
authors: Elie
authors: E
authors: Oussoultzoglou
authors: Marie-Pierre
authors: MP
authors: Chenard
authors: Pascal
authors: P
authors: Fuchshuber
authors: Edoardo
authors: E
authors: Rosso
authors: Patrick
authors: P
authors: Pessaux
authors: Daniel
authors: D
authors: Jaeck
authors: Philippe
authors: P
authors: Bachellier
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D002272:Carcinoembryonic Antigen / Q000096:biosynthesis; D015179:Colorectal Neoplasms / Q000378:metabolism / Q000556:secondary / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008113:Liver Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy; D011169:Portal Vein; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000096:biosynthesis; D012189:Retrospective Studies
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D019394:Ki-67 Antigen; D019253:Proto-Oncogene Proteins c-bcl-2