International Journal of Medical Sciences

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13 December 2018

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Int J Med Sci 2013; 10(9):1231-1241. doi:10.7150/ijms.6244

Research Paper

Determining Timing of Hepatectomy for Colorectal Cancer with Distant Metastasis According to Imaging-Based Tumor Shrinkage Ratio

Yoshiyuki Sasaki, Shinji Osada, Ryuutarou Mori, Hisashi Imai, Yoshihiro Tanaka, Nobuhiro Matsuhashi, Naoki Okumura, Kenichi Nonaka, Takao Takahashi, Kazuhiro Yoshida

Surgical Oncology, Gifu University, Graduate School of Medicine


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.

Keywords: RNF8, tumor shrinkage rate, colorectal cancer, liver metastasis, chemotherapy, surgical resection

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How to cite this article:
Sasaki Y, Osada S, Mori R, Imai H, Tanaka Y, Matsuhashi N, Okumura N, Nonaka K, Takahashi T, Yoshida K. Determining Timing of Hepatectomy for Colorectal Cancer with Distant Metastasis According to Imaging-Based Tumor Shrinkage Ratio. Int J Med Sci 2013; 10(9):1231-1241. doi:10.7150/ijms.6244. Available from