| Part I Relevant factors of synchronous colorectal liver metastasis (SCLM)and the prognostic factors after curative surgeryAIM To investigate the relevant factors of synchronous colorectal livermetastasis (SCLM) and the prognostic factors after curative surgery.METHODS Clinicopathological and follow-up data of colorectal cancer（CRC）were collected, who had beentreated in Eastern Hepatobiliary Hospital from2001-2010. Cases were divided into two groups: synchronous colorectal livermetastasis (SCLM) and non-metastasis, according to metastasis’ status. Chi-squaredtest was used to analyze the relevant factors of SCLM, while Kaplan–Meier analysisand log rank test were used to analyze the prognostic factors.RESULTS171cases met the criteria, of which55were SCLM and116werenon-metastasis. Follow-up data of41SCLM patients were available. Chi-squared testsuggested serum CEA level (P<0.001), vascular invasion (P<0.001), depth of invasion(P=0.029), lymph node metastasis (P<0.001) and location for the primary tumor(P<0.001) were associated with synchronous liver metastasis. The distribution of theliver metastasis (P<0.001) and postoperative chemotherapy (P<0.001) are theprognostic factors for SCLM.CONCLUSION SCLM are correlated with the progress of the primary cancer.Patients with CRC should alert the synchronous liver metastasis, especially thoseaccompanied with abnormality of the relevant factors. Patients of SCLM should begiven standard chemotherapy and close follow-up after surgery. Part II Twist2is over-expressed in colorectal cancer (CRC) and is avaluable prognostic biomarkerAIM To investigate the significance of Twist2for colorectal cancer (CRC).METHODS In this study,93CRC patients were included who receivedcurative surgery in Eastern Hepatobiliary Surgery Hospital from January2001to December2010. Records ofpatients’ clinicopathologicalcharacteristics and follow updata were reviewed. Formalin-fixed, paraffin-embedded tissue blocks were used toobserve the protein expression of Twist2. Two independent pathologists who wereblinded to the clinical information performed semiquantitative scoring ofimmunostaining. A total score of3–6(sum of extent+intensity) was considered asTwist2-positive expression. An exploratory statistical analysis was conducted todetermine the association between Twist2expression and clinicopathologicalparameters. Furthermore, the variables associated with prognosis were analyzed byCox’s proportional hazards model. Kaplan–Meier analysis was used to plot survivalcurves according to different expression levels of Twist2..RESULTS Twist2-positive expression was observed in66(71.0%) samplesand mainly located in the cytoplasm. There were no significant correlations betweenTwist2expression and any of the clinicopathological parameters. Multivariateanalysis revealed that bad M-stage [hazard ratio (HR)=7.694,95%confidenceinterval (CI)=2.927-20.224, P <0.001] and Twist2-positive (HR=5.744,95%CI=1.347-24.298, P=0.018) were the independent risk factors for poor overall survival(OS), while Twist2-positive (HR=3.264,95%CI=1.455-7.375, P=0.004), badN-stage (HR=2.149,95%CI=1.226-3.767, P=0.008) and bad M-stage (HR=10.907,95%CI=4.937-24.096, P <0.001) were independently associated with poordisease-free survival (DFS). Survival curves showed a definite trend forTwist2-negative patients to have longer OS and DFS than Twist2-negative patients,not only overall, but also for patients in different stages, especially for DFS of patientsin stage III (P=0.033) and IV (P=0.026).CONCLUSION Our data suggests, for the first time, that Twist2is a valuableprognostic biomarker for CRC, particularly for patients in stage III and IV. |
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