High lung shunt fraction in colorectal liver tumors is associated with distant metastasis and decreased survival.
High lung shunt fraction in colorectal liver tumors is associated with distant metastasis and decreased survival.
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DOI：
10.1016/j.jvir.2014.06.019
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Oklu R
中科院分区：
文献类型：
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作者：
Deipolyi AR;Iafrate AJ;Zhu AX;Ergul EA;Ganguli S;Oklu R
肝转移瘤内的肿瘤内血管分流可以为循环肿瘤细胞（CTC）提供穿过毛细血管床并进入远端部位的管道。我们评估了肿瘤内分流与转移和临床结果的关系。在5/07至8/12的62例接受选择性内放疗（SIRT）的肝转移结直肠癌患者中，通过经导管注射放射性粒子后的大聚集白蛋白扫描计算肺分流分数（LSF）。我们评估了LSF、肝肿瘤负荷和全身化疗与生存率和肺转移的关系。LSF和肿瘤负荷也在接受SNaPshot分析的基因谱分析的患者亚组中进行了评估。LSF较高的患者更可能发生肺转移和生存率降低，而肿瘤负荷与此无关。有基因突变的患者LSF显著高于无基因突变的患者。SIRT前接受化疗且LSF低的患者SIRT后生存期最长。LSF可能是比肿瘤大小更可靠的转移标志物。肝转移瘤内血管分流导致的LSF增加是远处病变的指标，与SIRT后生存率降低相关。肿瘤内分流可以为CTC提供一个通道，以进入更远的器官，绕过肝实质的过滤，并且可能是结直肠癌转移的重要因素。
Intratumoral vascular shunting within liver metastases may provide a conduit for circulating tumor cells (CTCs) to traverse capillary beds and access distant sites. We assessed how intratumoral shunting relates to metastasis and to clinical outcome. Lung shunt fraction (LSF) was calculated from macroaggregated albumin scan following transcatheter injection of radioactive particles in 62 colorectal cancer patients with liver metastases evaluated for selective internal radiation therapy (SIRT) from 5/07 to 8/12. We assessed how LSF, liver tumor burden, and systemic chemotherapy relate to survival and the presence of lung metastases. LSF and tumor burden were also assessed in a subset of patients who underwent genetic profiling with SNaPshot analysis. Patients with higher LSF were more likely to have lung metastases and decreased survival, whereas tumor burden was not associated. Patients with genetic mutations had significantly higher LSF than those with no mutations. Patients who received chemotherapy prior to SIRT and had low LSF had the longest post-SIRT survival. LSF may be a more robust marker of metastasis than tumor size. Increased LSF due to vascular shunting within liver metastasis is an indicator of distant lesions and is associated with decreased survival after SIRT. Intratumoral shunting may provide a conduit for CTCs to access more remote organs, bypassing filtration by liver parenchyma and may be an important factor in metastatis from colorectal cancer.