该文旨在比较DeepSeek-V3.1与ChatGPT-5在结直肠癌肝转移(CRLM)多学科团队(MDT)决策中的应用表现,评估其与MDT专家意见的一致性,为大语言模型(LLMs)的临床实践提供循证依据与优化方向。该文基于真实世界数据与最新指南,设计了6例涵盖不...该文旨在比较DeepSeek-V3.1与ChatGPT-5在结直肠癌肝转移(CRLM)多学科团队(MDT)决策中的应用表现,评估其与MDT专家意见的一致性,为大语言模型(LLMs)的临床实践提供循证依据与优化方向。该文基于真实世界数据与最新指南,设计了6例涵盖不同肿瘤负荷、基因突变谱和体能状态的虚拟CRLM病例,通过结构化的提示策略,在DeepSeek-V3.1与ChatGPT-5模型中分别生成MDT治疗建议。由4名MDT专家采用7维度5级李克特量表对模型输出进行独立评审。并通过统计学分析对两款模型在各个病例、各项维度和各个学科的表现分别进行比较。2款大语言模型在所有病例中的综合得分均≥4.0分(满分5分),表明其在复杂的MDT决策场景下具备可接受的临床效能。在跨维度分析中,两者在清晰度、个体化程度、抗幻觉能力和伦理安全4项上得分较高,而在准确性、全面性和前沿性方面仍有一定提升空间。DeepSeek-V3.1在整体表现(4.27±0.77 vs 4.08±0.86)、前沿性(3.90±0.65 vs 3.24±0.72)与伦理安全(4.87±0.34 vs 4.58±0.65)方面显著优于ChatGPT-5(P<0.05);在放疗领域亦明显领先(4.55±0.67 vs 3.38±0.91,P<0.01)。ChatGPT-5则在胃肠外科领域表现优于DeepSeek-V3.1(4.48±0.67 vs 4.17±0.85,P=0.02)。DeepSeek-V3.1与ChatGPT-5均表现出为CRLM-MDT决策提供可靠建议的良好能力。其中,Deep Seek-V3.1在前沿知识整合、伦理安全性及放射肿瘤学领域展现出显著优势,而Chat GPT-5则在胃肠外科方面表现更优,二者形成优势互补。该文证实了大型语言模型作为“MDT协作者”的可行性,为缩小地域间诊疗水平差距、提升临床决策效率提供了一项便捷可靠的技术方案。展开更多
目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增...目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增生后再行右三肝切除.结果第1步手术后7 d,残肝体积从313.5 m L增加到559.1 m L,并在第1步手术后8 d,第2步手术行右三肝切除.第2步手术后8 d患者顺利出院,肝功能恢复基本正常,联合肝脏离断和门静脉结扎的二步肝切除诱导了残肝组织快速的增生.结论联合肝脏离断和门静脉结扎的二步肝切除提高了结直肠癌肝转移患者的可切除率.联合肝脏离断和门静脉结扎的二步肝切除有较高的并发症率和死亡率,因此需要仔细选择手术患者;该术式的可行性、安全性还需要进一步研究评估.展开更多
目的:评价结直肠癌肝转移(colorectal cancer liver metastases,CRLM)射频消融(radiofrequency ablation,RFA)治疗的可行性。方法:2003年12月至2008年11月67例结直肠癌肝转移患者在西安交通大学医学院第一附属医院接受了RFA治疗。根据实...目的:评价结直肠癌肝转移(colorectal cancer liver metastases,CRLM)射频消融(radiofrequency ablation,RFA)治疗的可行性。方法:2003年12月至2008年11月67例结直肠癌肝转移患者在西安交通大学医学院第一附属医院接受了RFA治疗。根据实施RFA治疗的方法将患者分成3组:经皮穿刺RFA(第1组)、开腹RFA(第2组)或经皮RFA与手术相结合的方法(第3组)。结果:RFA后90天,3组的死亡率均为零。一半的患者(34/67)出现手术后轻度发热。1/4的患者(17/67)有右肩部与右季肋部疼痛或不适。1例并发结肠瘘。随访显示1年、3年和5年生存率分别是100%、34.3%和4.5%。结论:对CRLM的患者,RFA或结合肝切除手术是相对微创、安全可行的方法,而且致死率低。展开更多
Colorectal cancer is the leading cause of cancer-related death globally.The liver is the most predominant site for metastatic disease.Approximately 20-30%of patients diagnosed with colorectal cancer develop liver meta...Colorectal cancer is the leading cause of cancer-related death globally.The liver is the most predominant site for metastatic disease.Approximately 20-30%of patients diagnosed with colorectal cancer develop liver metastases.Surgical resection is considered the only potentially curative treatment for colorectal liver metastases(CRLM)(1).Several studies have indicated that liver resection provides favorable long-term survival for patients with CRLM.Both open liver resection(OLR)and laparoscopic liver resection(LLR)are used to treat CRLM,and the incidence of LLR has been increasing.LLR is a minimally invasive technique that has become predominantly used for treating CRLM.The first international consensus conference in Louisville in 2008 recommended LLR for solitary tumors measuring≤5 cm in the anterolateral segments(2).The second international consensus conference in Morioka established minor LLR as a standard procedure(3).Recently,short-term outcomes have demonstrated that LLR leads to lower morbidity,less blood losses,fewer transfusions,and shorter hospital stays compared to OLR.展开更多
The dual centre retrospective study by Chávez-Villa et al.assessed the rate of radiologically missed,occult colorectal liver metastases(CRLM)on pathologic evaluation of total hepatectomy specimens(1).Of the 14 pa...The dual centre retrospective study by Chávez-Villa et al.assessed the rate of radiologically missed,occult colorectal liver metastases(CRLM)on pathologic evaluation of total hepatectomy specimens(1).Of the 14 patients who underwent liver transplantation for unresectable CRLM,7(50%)patients were deemed to have radiographically viable tumours,as defined by fluorodeoxyglucose positron emission tomography(FDG-PET)avidity;the remainder had complete radiographic response.However,on pathologic assessment,11(78.6%)were noted to have viable tumours,with a median of two viable tumours,ranging from 0.2 to 6.5 cm in size.Three(21.4%)patients had complete radiological and pathological responses.展开更多
Colorectal cancer is the second leading cause of cancer-related death globally.Approximately half of colorectal cancer patients develop liver metastasis,and the overall prognosis is significantly influenced by the ext...Colorectal cancer is the second leading cause of cancer-related death globally.Approximately half of colorectal cancer patients develop liver metastasis,and the overall prognosis is significantly influenced by the extent of these liver metastases(1).Multiple studies have investigated the risk factors affecting survival in colorectal liver metastasis(CRLM),and have found that Kirsten rat sarcoma viral oncogene homolog(KRAS)mutation,v-Raf murine sarcoma viral oncogene homolog B1(BRAF)mutation,tumor morphology,carcinoembryonic antigen(CEA)levels,primary lymph node metastases,surgical margin width,primary tumor site(right or left),and the presence of extrahepatic disease influence survival following curative resection(1).展开更多
Background:In patients with colorectal liver metastases(CRLM),preoperative chemotherapy may increase resectability and survival outcomes.However,cytotoxic agents can also cause chemotherapy-associated liver injury(CAL...Background:In patients with colorectal liver metastases(CRLM),preoperative chemotherapy may increase resectability and survival outcomes.However,cytotoxic agents can also cause chemotherapy-associated liver injury(CALI),leading to increased rates of postoperative complications.This study evaluates the association between splenic hypertrophy(SH)after preoperative chemotherapy and postoperative liver-specific complications(LSC),in patients undergoing major liver resection for CRLM.Methods:This retrospective study included patients who underwent major curative liver resection of CRLM following preoperative chemotherapy at the University Hospital RWTH Aachen(UH-RWTH)between 2010-2021.Patients with missing radiological images,incomplete data on chemotherapy regimens,or prior splenectomy were excluded.Volumetric measurements of the spleen were performed on preoperative computerized tomography(CT)and magnetic resonance imaging(MRI)images,using segmentation software(3D-Slicer).Receiver-operating characteristic(ROC)analysis was performed to determine the optimal SH cut-off for predicting postoperative LSC.Independent risk factors of postoperative LSC were examined using logistic regression.Results:A total of 115 patients were included in the study,of which 78(68%)received oxaliplatin as part of their preoperative chemotherapy regimen.A threshold of 8.6%SH(Youden Index=0.25)was identified as predictive of postoperative LSC.Patients with SH>8.6%(n=62)received oxaliplatin significantly more often(84%vs.49%;P<0.001)and exhibited higher rates of liver fibrosis(72%vs.52%,P=0.03)and LSC(63%vs.38%,P=0.007).Multivariable logistic regression analysis identified SH>8.6%as an independent risk factor for LSC(odds ratio 2.86,95%confidence interval:1.104-7.402,P=0.03).Conclusions:Preoperative SH may be a valuable predictor of postoperative LSC in patients undergoing major liver resection for CRLM,following chemotherapy.Further studies are necessary to investigate the impact on a larger cohort and find preventive strategies to mitigate and treat CALI.展开更多
Colorectal cancer remains a leading cause of cancer-related mortality worldwide,with the liver being the most common site of metastatic spread.Surgical resection has long been considered the gold standard treatment fo...Colorectal cancer remains a leading cause of cancer-related mortality worldwide,with the liver being the most common site of metastatic spread.Surgical resection has long been considered the gold standard treatment for colorectal liver metastases(CRLM),offering 5-year overall survival rates ranging from 25%to 47%in selected patients(1,2).However,only approximately 20-25%of patients with CRLM are candidates for surgical resection due to strict eligibility criteria,anatomical constraints,underlying liver disease,or comorbidities(3).This significant limitation has driven the development of alternative local treatment modalities,particularly thermal ablation techniques.展开更多
Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in pati...Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).展开更多
The TransMet trial is a multicenter,prospective,randomized controlled study aimed at comparing the efficacy of liver transplantation combined with chemotherapy(LT+CT)versus chemotherapy(CT)alone in patients with unres...The TransMet trial is a multicenter,prospective,randomized controlled study aimed at comparing the efficacy of liver transplantation combined with chemotherapy(LT+CT)versus chemotherapy(CT)alone in patients with unresectable colorectal liver metastases(CRLM)(1).Patient enrollment took place between February 2016 and July 2021.This study enrolled patients aged 18 to 65 years with liver-confined metastases who demonstrated either a partial response or disease stabilization after at least 3 months of CT.The primary objective of the study was to assess 5-year overall survival(OS),with secondary outcomes including 3-year OS,3-and 5-year progression-free survival(PFS),as well as recurrence rates.展开更多
We enjoyed the article by Kampf et al.(1)on obesity and its association with fatty liver and post-hepatectomy liver failure(PHLF).They concluded that obesity,defined by body mass index(BMI),was associated with liver s...We enjoyed the article by Kampf et al.(1)on obesity and its association with fatty liver and post-hepatectomy liver failure(PHLF).They concluded that obesity,defined by body mass index(BMI),was associated with liver steatosis and fibrosis;however,postoperative complications,including PHLF after liver resection,were comparable regardless of BMI,suggesting that liver resection is safely performed in obese patients.However,the surgical method for obese patients is also important,and Inoue et al.have reported that open liver resection for colorectal liver metastases(CRLM)in obese patients resulted in a significantly higher risk of infectious complications than laparoscopic liver resection(2).展开更多
With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal...With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC). Keywords: Thermal ablation;radiofrequency ablation (RFA);microwave ablation (MWA);colorectal cancer liver metastasis (CRLM)展开更多
Excessive fructose diet is closely associated with colorectal cancer(CRC)progression.Nevertheless,fructose’s specific function and precise mechanism in colorectal cancer liver metastasis(CRLM)is rarely known.Here,thi...Excessive fructose diet is closely associated with colorectal cancer(CRC)progression.Nevertheless,fructose’s specific function and precise mechanism in colorectal cancer liver metastasis(CRLM)is rarely known.Here,this study reported that the fructose absorbed by primary colorectal cancer could accelerate CRLM,and the expression of KHK-A,not KHK-C,in liver metastasis was higher than in paired primary tumors.Furthermore,KHK-A facilitated fructose-dependent CRLM in vitro and in vivo by phosphorylating PKM2 at Ser37.PKM2 phosphorylated by KHK-A inhibited its tetramer formation and pyruvic acid kinase activity but promoted the nuclear accumulation of PKM2.EMT and aerobic glycolysis activated by nuclear PKM2 enhance CRC cells’migration ability and anoikis resistance during CRLM progression.TEPP-46 treatment,targeting the phosphorylation of PKM2,inhibited the pro-metastatic effect of KHK-A.Besides,c-myc activated by nuclear PKM2 promotes alternative splicing of KHK-A,forming a positive feedback loop.展开更多
文摘该文旨在比较DeepSeek-V3.1与ChatGPT-5在结直肠癌肝转移(CRLM)多学科团队(MDT)决策中的应用表现,评估其与MDT专家意见的一致性,为大语言模型(LLMs)的临床实践提供循证依据与优化方向。该文基于真实世界数据与最新指南,设计了6例涵盖不同肿瘤负荷、基因突变谱和体能状态的虚拟CRLM病例,通过结构化的提示策略,在DeepSeek-V3.1与ChatGPT-5模型中分别生成MDT治疗建议。由4名MDT专家采用7维度5级李克特量表对模型输出进行独立评审。并通过统计学分析对两款模型在各个病例、各项维度和各个学科的表现分别进行比较。2款大语言模型在所有病例中的综合得分均≥4.0分(满分5分),表明其在复杂的MDT决策场景下具备可接受的临床效能。在跨维度分析中,两者在清晰度、个体化程度、抗幻觉能力和伦理安全4项上得分较高,而在准确性、全面性和前沿性方面仍有一定提升空间。DeepSeek-V3.1在整体表现(4.27±0.77 vs 4.08±0.86)、前沿性(3.90±0.65 vs 3.24±0.72)与伦理安全(4.87±0.34 vs 4.58±0.65)方面显著优于ChatGPT-5(P<0.05);在放疗领域亦明显领先(4.55±0.67 vs 3.38±0.91,P<0.01)。ChatGPT-5则在胃肠外科领域表现优于DeepSeek-V3.1(4.48±0.67 vs 4.17±0.85,P=0.02)。DeepSeek-V3.1与ChatGPT-5均表现出为CRLM-MDT决策提供可靠建议的良好能力。其中,Deep Seek-V3.1在前沿知识整合、伦理安全性及放射肿瘤学领域展现出显著优势,而Chat GPT-5则在胃肠外科方面表现更优,二者形成优势互补。该文证实了大型语言模型作为“MDT协作者”的可行性,为缩小地域间诊疗水平差距、提升临床决策效率提供了一项便捷可靠的技术方案。
文摘目的探讨联合肝脏离断和门静脉结扎的2步肝切除新技术在提高结直肠癌肝转移患者可切除的意义.方法结直肠癌肝转移患者接受联合肝脏离断和门静脉结扎的2步肝切除,手术第1步,门静脉右支结扎后离断右三肝和左外侧叶肝实质,待健侧肝组织增生后再行右三肝切除.结果第1步手术后7 d,残肝体积从313.5 m L增加到559.1 m L,并在第1步手术后8 d,第2步手术行右三肝切除.第2步手术后8 d患者顺利出院,肝功能恢复基本正常,联合肝脏离断和门静脉结扎的二步肝切除诱导了残肝组织快速的增生.结论联合肝脏离断和门静脉结扎的二步肝切除提高了结直肠癌肝转移患者的可切除率.联合肝脏离断和门静脉结扎的二步肝切除有较高的并发症率和死亡率,因此需要仔细选择手术患者;该术式的可行性、安全性还需要进一步研究评估.
文摘目的:评价结直肠癌肝转移(colorectal cancer liver metastases,CRLM)射频消融(radiofrequency ablation,RFA)治疗的可行性。方法:2003年12月至2008年11月67例结直肠癌肝转移患者在西安交通大学医学院第一附属医院接受了RFA治疗。根据实施RFA治疗的方法将患者分成3组:经皮穿刺RFA(第1组)、开腹RFA(第2组)或经皮RFA与手术相结合的方法(第3组)。结果:RFA后90天,3组的死亡率均为零。一半的患者(34/67)出现手术后轻度发热。1/4的患者(17/67)有右肩部与右季肋部疼痛或不适。1例并发结肠瘘。随访显示1年、3年和5年生存率分别是100%、34.3%和4.5%。结论:对CRLM的患者,RFA或结合肝切除手术是相对微创、安全可行的方法,而且致死率低。
文摘Colorectal cancer is the leading cause of cancer-related death globally.The liver is the most predominant site for metastatic disease.Approximately 20-30%of patients diagnosed with colorectal cancer develop liver metastases.Surgical resection is considered the only potentially curative treatment for colorectal liver metastases(CRLM)(1).Several studies have indicated that liver resection provides favorable long-term survival for patients with CRLM.Both open liver resection(OLR)and laparoscopic liver resection(LLR)are used to treat CRLM,and the incidence of LLR has been increasing.LLR is a minimally invasive technique that has become predominantly used for treating CRLM.The first international consensus conference in Louisville in 2008 recommended LLR for solitary tumors measuring≤5 cm in the anterolateral segments(2).The second international consensus conference in Morioka established minor LLR as a standard procedure(3).Recently,short-term outcomes have demonstrated that LLR leads to lower morbidity,less blood losses,fewer transfusions,and shorter hospital stays compared to OLR.
文摘The dual centre retrospective study by Chávez-Villa et al.assessed the rate of radiologically missed,occult colorectal liver metastases(CRLM)on pathologic evaluation of total hepatectomy specimens(1).Of the 14 patients who underwent liver transplantation for unresectable CRLM,7(50%)patients were deemed to have radiographically viable tumours,as defined by fluorodeoxyglucose positron emission tomography(FDG-PET)avidity;the remainder had complete radiographic response.However,on pathologic assessment,11(78.6%)were noted to have viable tumours,with a median of two viable tumours,ranging from 0.2 to 6.5 cm in size.Three(21.4%)patients had complete radiological and pathological responses.
文摘Colorectal cancer is the second leading cause of cancer-related death globally.Approximately half of colorectal cancer patients develop liver metastasis,and the overall prognosis is significantly influenced by the extent of these liver metastases(1).Multiple studies have investigated the risk factors affecting survival in colorectal liver metastasis(CRLM),and have found that Kirsten rat sarcoma viral oncogene homolog(KRAS)mutation,v-Raf murine sarcoma viral oncogene homolog B1(BRAF)mutation,tumor morphology,carcinoembryonic antigen(CEA)levels,primary lymph node metastases,surgical margin width,primary tumor site(right or left),and the presence of extrahepatic disease influence survival following curative resection(1).
基金supported by the START-Program(#01/23)of the Faculty of Medicine of the RWTH Aachen University,Aachen,Germany。
文摘Background:In patients with colorectal liver metastases(CRLM),preoperative chemotherapy may increase resectability and survival outcomes.However,cytotoxic agents can also cause chemotherapy-associated liver injury(CALI),leading to increased rates of postoperative complications.This study evaluates the association between splenic hypertrophy(SH)after preoperative chemotherapy and postoperative liver-specific complications(LSC),in patients undergoing major liver resection for CRLM.Methods:This retrospective study included patients who underwent major curative liver resection of CRLM following preoperative chemotherapy at the University Hospital RWTH Aachen(UH-RWTH)between 2010-2021.Patients with missing radiological images,incomplete data on chemotherapy regimens,or prior splenectomy were excluded.Volumetric measurements of the spleen were performed on preoperative computerized tomography(CT)and magnetic resonance imaging(MRI)images,using segmentation software(3D-Slicer).Receiver-operating characteristic(ROC)analysis was performed to determine the optimal SH cut-off for predicting postoperative LSC.Independent risk factors of postoperative LSC were examined using logistic regression.Results:A total of 115 patients were included in the study,of which 78(68%)received oxaliplatin as part of their preoperative chemotherapy regimen.A threshold of 8.6%SH(Youden Index=0.25)was identified as predictive of postoperative LSC.Patients with SH>8.6%(n=62)received oxaliplatin significantly more often(84%vs.49%;P<0.001)and exhibited higher rates of liver fibrosis(72%vs.52%,P=0.03)and LSC(63%vs.38%,P=0.007).Multivariable logistic regression analysis identified SH>8.6%as an independent risk factor for LSC(odds ratio 2.86,95%confidence interval:1.104-7.402,P=0.03).Conclusions:Preoperative SH may be a valuable predictor of postoperative LSC in patients undergoing major liver resection for CRLM,following chemotherapy.Further studies are necessary to investigate the impact on a larger cohort and find preventive strategies to mitigate and treat CALI.
基金supported by grants from Natural Science Foundation of Ningbo(grant No.2024J039).
文摘Colorectal cancer remains a leading cause of cancer-related mortality worldwide,with the liver being the most common site of metastatic spread.Surgical resection has long been considered the gold standard treatment for colorectal liver metastases(CRLM),offering 5-year overall survival rates ranging from 25%to 47%in selected patients(1,2).However,only approximately 20-25%of patients with CRLM are candidates for surgical resection due to strict eligibility criteria,anatomical constraints,underlying liver disease,or comorbidities(3).This significant limitation has driven the development of alternative local treatment modalities,particularly thermal ablation techniques.
文摘Surgical margin is an important prognosticator in patients undergoing hepatectomy for colorectal liver metastases(CRLM)(1).However,the incidence of cut-end recurrence is relatively low,approximately 5-20%,even in patients with pathologically positive(R1)resection(1).Therefore,cut-end recurrence is not an underlying cause of poor prognosis in patients with narrow surgical margin,but it is thought to reflect tumor progression and biology(1,2).
文摘The TransMet trial is a multicenter,prospective,randomized controlled study aimed at comparing the efficacy of liver transplantation combined with chemotherapy(LT+CT)versus chemotherapy(CT)alone in patients with unresectable colorectal liver metastases(CRLM)(1).Patient enrollment took place between February 2016 and July 2021.This study enrolled patients aged 18 to 65 years with liver-confined metastases who demonstrated either a partial response or disease stabilization after at least 3 months of CT.The primary objective of the study was to assess 5-year overall survival(OS),with secondary outcomes including 3-year OS,3-and 5-year progression-free survival(PFS),as well as recurrence rates.
文摘We enjoyed the article by Kampf et al.(1)on obesity and its association with fatty liver and post-hepatectomy liver failure(PHLF).They concluded that obesity,defined by body mass index(BMI),was associated with liver steatosis and fibrosis;however,postoperative complications,including PHLF after liver resection,were comparable regardless of BMI,suggesting that liver resection is safely performed in obese patients.However,the surgical method for obese patients is also important,and Inoue et al.have reported that open liver resection for colorectal liver metastases(CRLM)in obese patients resulted in a significantly higher risk of infectious complications than laparoscopic liver resection(2).
文摘With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC). Keywords: Thermal ablation;radiofrequency ablation (RFA);microwave ablation (MWA);colorectal cancer liver metastasis (CRLM)
基金funded by the National Natural Science Foundation(Grant Number 82273406)Basic Research Program of Jiangsu Province(Grant No.BK20201491,China)+2 种基金Nature Key Research and Development Program of Jiangsu Province(BE2021742,China)Jiangsu Province Capability Improvement Project through Science,Technology and Education(Jiangsu Provincial Medical Key Discipline,ZDXK202222,China)the National Natural Science Foundation(Grant Number 82203656,China).
文摘Excessive fructose diet is closely associated with colorectal cancer(CRC)progression.Nevertheless,fructose’s specific function and precise mechanism in colorectal cancer liver metastasis(CRLM)is rarely known.Here,this study reported that the fructose absorbed by primary colorectal cancer could accelerate CRLM,and the expression of KHK-A,not KHK-C,in liver metastasis was higher than in paired primary tumors.Furthermore,KHK-A facilitated fructose-dependent CRLM in vitro and in vivo by phosphorylating PKM2 at Ser37.PKM2 phosphorylated by KHK-A inhibited its tetramer formation and pyruvic acid kinase activity but promoted the nuclear accumulation of PKM2.EMT and aerobic glycolysis activated by nuclear PKM2 enhance CRC cells’migration ability and anoikis resistance during CRLM progression.TEPP-46 treatment,targeting the phosphorylation of PKM2,inhibited the pro-metastatic effect of KHK-A.Besides,c-myc activated by nuclear PKM2 promotes alternative splicing of KHK-A,forming a positive feedback loop.
