Determining timing of hepatectomy for colorectal cancer with distant metastasis according to imaging-based tumor shrinkage ratio.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Surgical Oncology, Gifu University, Graduate School of Medicine, Japan.
Yoshiyuki
Y
Sasaki
Shinji
S
Osada
Ryuutarou
R
Mori
Hisashi
H
Imai
Yoshihiro
Y
Tanaka
Nobuhiro
N
Matsuhashi
Naoki
N
Okumura
Kenichi
K
Nonaka
Takao
T
Takahashi
Kazuhiro
K
Yoshida
D000368:Aged; D015153:Blotting, Western; D045744:Cell Line, Tumor; D015179:Colorectal Neoplasms / Q000150:complications* / Q000378:metabolism / Q000601:surgery*; D004268:DNA-Binding Proteins / Q000378:metabolism; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000378:metabolism / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D044767:Ubiquitin-Protein Ligases
D004268:DNA-Binding Proteins; C486521:RNF8 protein, human; D044767:Ubiquitin-Protein Ligases
RNF8; chemotherapy; colorectal cancer; liver metastasis; surgical resection; tumor shrinkage rate