Purpose Colorectal cancer is a common malignant tumor worldwide. In China, the ratio of rectal cancer to colon cancer in terms of incidence is close to 1: 1. Low rectal cancer accounts for more than half of all cases of rectal cancer. In recent years, the proportion of rectal cancer has trended downward, however the incidence of rectal cancer in younger adults is increasing. The CACA Guidelines for Holistic Integrative Management of Rectal Cancer were edited to help improve the diagnosis and comprehensive treatment in China. Methods This guideline has been prepared by consensuses reached by the CACA Committee of Colorectal Cancer Society, based on a careful review of the latest evidence including China’s studies, and referred to domestic and international relative guidelines, also considered China’s specific national conditions and clinical practice. Results The CACA Guidelines for Holistic Integrative Management of Rectal Cancer include the epidemiology of rectal cancer, prevention and screening, diagnosis, treatment of nonmetastatic and metastatic rectal cancer, follow-up, and whole-course rehabilitation management. Conclusion Committee of Colorectal Cancer Society, Chinese Anti-Cancer Association, standardizes the diagnosis and treatment of rectal cancer in China through the formulation of the CACA Guidelines.

BACKGROUND Colorectal cancer (CRC) is a common malignant tumor of the gastrointestinal tract. Lipid metabolism, as an important part of material and energy circulation, is well known to play a crucial role in CRC. AIM To explore the relationship between serum lipids and CRC development and identify aberrantly expressed cholesterol metabolism genes in CRC. METHODS We retrospectively collected 843 patients who had confirmed CRC and received surgical resection from 2013 to 2015 at the Cancer Hospital of the Chinese Academy of Medical Sciences as our research subjects. The levels of serum total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), LDL-C/HDL-C and clinical features were collected and statistically analyzed by SPSS. Then, we used the data from Oncomine to screen the differentially expressed genes (DEGs) of the cholesterol metabolism pathway in CRC and used Gene Expression Profiling Interactive Analysis to confirm the candidate DEGs. PrognoScan was used to analyze the prognostic value of the DEGs, and Search Tool for the Retrieval of Interacting Genes was used to construct the protein-protein interaction network of DEGs. RESULTS The serum HDL-C level in CRC patients was significantly correlated with tumor size, and patients whose tumor size was more than 5 cm had a lower serum HDL-C level (1.18 +/- 0.41 mmol/L vs 1.25 +/- 0.35 mmol/L, P < 0.01) than their counterparts. In addition, TC/HDL (4.19 +/- 1.33 vs 3.93 +/- 1.26, P < 0.01) and LDL-C/HDL-C (2.83 +/- 1.10 vs 2.61 +/- 0.96, P < 0.01) were higher in patients with larger tumors. The levels of HDL-C (P < 0.05), TC/HDL-C (P < 0.01) and LDL-C/HDL-C (P < 0.05) varied in different stages of CRC patients, and the differences were significant. We screened 14 differentially expressed genes (DEGs) of the cholesterol metabolism pathway in CRC and confirmed that lipoprotein receptor-related protein 8 (LRP8), PCSK9, low-density lipoprotein receptor (LDLR), MBTPS2 and FDXR are upregulated, while ABCA1 and OSBPL1A are downregulated in cancer tissue. Higher expression of LDLR (HR = 3.12, 95%CI: 1.77-5.49, P < 0.001), ABCA1 (HR = 1.66, 95%CI: 1.11-2.48, P = 0.012) and OSBPL1A (HR = 1.38, 95%CI: 1.01-1.89, P = 0.041) all yielded significantly poorer DFS outcomes. Higher expression of FDXR (HR = 0.7, 95%CI: 0.47-1.05, P = 0.002) was correlated with longer DFS. LDLR, ABCA1, OSBPL1A and FDXR were involved in many important cellular function pathways. CONCLUSION Serum HDL-C levels are associated with tumor size and stage in CRC patients. LRP8, PCSK9, LDLR, MBTPS2 and FDXR are upregulated, while ABCA1 and OSBPL1A are downregulated in CRC. Among them, LDLR, ABCA1, OSBPL1A and FDXR were valuable prognostic factors of DFS and were involved in important cellular function pathways.

[目的]探讨直肠癌新辅助放化疗(nCRT)后pCR的预测因素,并分析pCR对术后并发症的影响.[方法]回顾性分析中国科学院大学附属肿瘤医院2008-2016年收治的接受新辅助治疗并进行根治性手术切除直肠癌患者456例.依据术后病理将患者分为pCR组和非pCR组.单因素和多因素分析pCR的影响因素,并分析两组术后并发症情况.[结果]456例患者中,98例(21.4％)达到pCR,pCR组和非pCR组患者在年龄、性别、肿瘤分化、临床T和N期、手术类型、放疗剂量和术后并发症方面无明显差异,与pCR相关的因素包括肿瘤大小、治疗前CEA水平、放疗剂量以及手术间隔时间超过8周;多因素分析结果显示,治疗前CEA水平(OR=0.440,95％CI:0.254～0.837,PP=0.017)和手术间隔时间(OR=2.641,95％CI:1.385～5.104,P=0.003)是pCR的独立预测因素.[结论]治疗前CEA水平和手术间隔时间与nCRT后pCR率有关,pCR不增加术后并发症的发生风险.

目的 探讨结直肠神经内分泌癌(NEC)患者临床病理特征与预后的关系.方法 选取2012年1月1日至2020年7月31日在浙江省肿瘤医院接受手术治疗且术后病理证实为结直肠NEC的28例患者为研究对象,分析其临床病理特征与预后的关系.结果 就诊时是否发生转移以及不同肿瘤类型、Ki-67增殖指数的患者术后3年累计生存率比较,差异均有统计学意义(均P<0.05);不同性别、年龄、肿瘤直径以及突触素、嗜铬粒素A、神经元特异性烯醇化酶表达是否阳性患者术后3年累计生存率比较,差异均无统计学意义(均P>0.05).28例患者术后3年累计生存率为50.0％,就诊时发生转移患者的预后明显差于未转移患者(P<0.05),混合性腺神经内分泌癌(MANEC)患者的预后明显差于单纯NEC患者(P<0.05),Ki-67增殖指数>55％的患者预后明显差于≤55％的患者(P<0.05).结论 就诊时发生转移、MANEC、Ki-67增殖指数增高的结直肠NEC患者预后较差.

目的 探讨局部晚期直肠癌(LARC)患者术前同步放射治疗及化学治疗联合热疗的临床疗效.方法 选取2009年7月至2013年12月在浙江省肿瘤医院确诊为LARC(美国癌症联合委员会分期T3～T4伴或不伴淋巴结转移)的67例患者为研究对象,行术前新辅助放射治疗及化学治疗联合热疗,放射治疗总剂量为50 Gy,放射治疗前1 h内进行热疗(每周2次),持续5周.放射治疗结束4～6周后对LARC患者进行手术治疗.对所有患者的临床疗效进行评价,并采用Kaplan-Meier绘制生存曲线进行分析.结果 67例患者中共64例患者接受手术治疗,且均恢复顺利出院;余3例因拒绝切除肛门而放弃手术治疗.96.9％(62/64)的患者达到R0切除,89.1％(57/64)的患者出现局部降期,23.4％(15/64)的患者病理完全缓解(pCR),76.6％(49/64)的患者病理示无淋巴结转移(ypN-),Ⅲ级不良反应发生率为14.9％(10/67).术后随访3～72个月,5年总生存率为81.2％(52/64),5年肿瘤无病生存率为70.3％(45/64).同时,pCR患者的生存曲线明显优于非pCR患者(χ2=4.132,P=0.042),ypT0～T2患者的生存曲线明显优于ypT3～T4患者(χ2=14.791,P<0.001),ypN-患者的生存曲线明显优于ypN+患者(χ2=12.402,P<0.001).结论 新辅助放射治疗及化学治疗联合热疗治疗LARC可以显著提高LARC患者的pCR、R0切除率及保肛率,肿瘤退缩明显,且不会增加治疗相关不良反应,患者耐受性较好.

Background: The purpose of this study was to explore the molecular mechanism underlying the interaction between ring finger protein 6 (RNF6) and glycogen synthase kinase 3ll (GSK3ll) in colorectal cancer (CRC). Methods: In this study, cell models of overexpressed or silenced RNF6 were established by liposome transfection, and IM-12 was used as the inhibitor of GSK3ll. Real-time quantitative PCR and western blots were used to detect the expression of RNF6, p-GSK3ll, GSK3ll, and ll-catenin, and MTT assays were used to quantify cell proliferation. The tumorigenicity of cells was observed by plate clonal formation assay; the invasiveness of cells was examined in Transwell Boyden chambers, and the migratory capacity of cells was tested by scratch wound assays. The rat CRC model was induced by AOM/DSS, in which we verified activity in the Wnt/ll-catenin pathway by examining GSK3ll phosphorylation. Results: RNF6 was upregulated in CRC samples and cell lines. Silencing or overexpressing RNF6 in colorectal cancer cells inhibited or promoted, respectively, the proliferation, tumorigenicity, invasion and migration of CRC cells, as well as expression of p-GSK3ll, GSK3ll and ll-catenin. IM-12 reversed the Wnt/ll-catenin-activated state change induced by RNF6 silencing and the inhibition of cell proliferation, tumorigenicity, invasion and migration. The same results were observed in vivo in the rat CRC model. Conclusions: Overexpression of RNF6 in CRC increased the GSK3ll phosphorylation level, which led to activation of the Wnt/ll-catenin pathway and promoted the invasion and migration of CRC cells, suggesting that RNF6 may be a novel target for the treatment of CRC.

BACKGROUND Colorectal high-grade neuroendocrine neoplasms (HGNENs) are rare and constitute less than 1% of all colorectal malignancies. Based on their morphological differentiation and proliferation identity, these neoplasms present heterogeneous clinicopathologic features. Opinions regarding treatment strategies for and improvement of the clinical outcomes of these patients remain controversial. AIM To delineate the clinicopathologic features of and explore the prognostic factors for this rare malignancy. METHODS This observational study reviewed the data of 72 consecutive patients with colorectal HGNENs from three Chinese hospitals between 2000 and 2019. The clinicopathologic characteristics and follow-up data were carefully collected from their medical records, outpatient reexaminations, and telephone interviews. A survival analysis was conducted to evaluate their outcomes and to identify the prognostic factors for this disease. RESULTS According to the latest recommendations for the classification and nomenclature of colorectal HGNENs, 61 (84.7%) patients in our cohort had poorly differentiated neoplasms, which were categorized as high-grade neuroendocrine carcinomas (HGNECs), and the remaining 11 (15.3%) patients had well differentiated neoplasms, which were categorized as high-grade neuroendocrine tumors (HGNETs). Most of the neoplasms (63.9%) were located at the rectum. More than half of the patients (51.4%) presented with distant metastasis at the date of diagnosis. All patients were followed for a median duration of 15.5 mo. In the entire cohort, the median survival time was 31 mo, and the 3-year and 5-year survival rates were 44.3% and 36.3%, respectively. Both the univariate and multivariate analyses demonstrated that increasing age, HGNEC type, and distant metastasis were risk factors for poor clinical outcomes. CONCLUSION Colorectal HGNENs are rare and aggressive malignancies with poor clinical outcomes. However, patients with younger age, good morphological differentiation, and without metastatic disease can have a relatively favorable prognosis.

BACKGROUND Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL. AIM To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms. METHODS This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis. RESULTS The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group (P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation (P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386; 95% CI:1.808-16.042; P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer. CONCLUSION Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

Background: Chemotherapy is the most important treatment method against cancer, in addition to surgery and radiotherapy. However, Multidrug Resistance (MDR) in cancer always results in the failure of chemotherapy. Effective chemotherapy agents need to be delivered efficiently, distributed mostly in the tumor tissue, and highly internalized by tumor cells to eventually inhibit proliferation or promote death of the tumor cells. A growing number of studies have indicated that any defects that emerge during these steps could contribute to the occurrence of MDR in tumors. Carbon Nanotubes (CNTs) are newly developed biocompatible materials that can be designed to deliver anticancer agents by functionalizing the CNTs with drugs. Enhanced drug delivery efficiency and improved treatment efficacy have been observed through CNT-based drug delivery systems. However, some reports have shown that the simple administration of CNTs can reverse MDR in cancer and enhance chemotherapy efficacy without anticancer agents attached to the surface of the CNTs. Objective: Through an extensive review of previous reports in regard to CNTs and chemotherapy, this paper aims to identify the various mechanisms of CNTs that inhibit MDR in cancer and enhance chemotherapy sensitivity. Results: CNTs can increase the antitumor effects of chemotherapy agents. CNTs can not only increase drug delivery accuracy and efficiency but also promote drug uptake, decrease drug efflux, improve tumor hypoxia conditions, and induce autophagy and apoptosis in tumor cells, which make the tumor more sensitive to antitumor agents.

OBJECTIVE:To investigate the effect of previous abdominal surgery(PAS) on laparoscopic resection of colorectal cancer.METHODS:The retrospective cohort study was adopted.Clinical data of consecutive colorectal cancer patients with PAS history (past history of at least one abdominal surgery, exclusion of previous inguinal hernia repair, simple laparoscopic approach, appendectomy of the right lower quadrant and endoscopic therapy) undergoing laparoscopic surgery at the Cancer Hospital of Chinese Academy of Medical Sciences between 2010 and 2015 were collected, meanwhile other colorectal cancer patients without PAS history were selected according to 1 to 1 match in age, sex, body mass index, American Society of Anesthesiologists score, tumor location, type of surgery, and staging of tumor. A total of 464 pairs were successfully matched. Intraoperative and postoperative conditions, perioperative complications and prognosis were compared between the two groups.RESULTS:In PAS group, there were 341 males (73.5%) and 123 females (26.5%) with a median age of 62 (24-85) years; 317(68.3%) cases with only one previous abdominal surgery and 147(31.7%) with more than one; 389(83.8%) cases with abdominal midline incisions, 37(8.0%) with transverse incisions, 34(7.3%) with right subcostal incision and 4(0.9%) with left subcostal incision; 146(31.5%) cases undergoing gynecologic surgery, 84(18.1%) cholecystectomy, 52(11.2%) gastroduodenal surgery, 89(19.2%) colorectal surgery, 11(2.4%) small intestine surgery, 23(5.0%) hapatectomy, 16(3.4%) pancreatic surgery, 8(1.7%) urological surgery, 18(3.9%) retroperitoneal tumor resection and 1(0.2%) other surgery. In no PAS group, there were 328 males (70.7%) and 136 females (29.3%) with a median age of 62(24-86) years. No significant differences in baseline data were found between the two groups (all P>0.05). As compared to no PAS group, PAS group had longer mean operative time [(208.0±27.0) minutes vs. (179.0±15.3) minutes, t=4.695, P=0.003] and higher rate of conversion to laparotomy [18.1%(84/464) vs. 11.6%(54/464), χ2=7.217, P=0.003]. In the PAS group, conversion to laparotomy was more common due to adhesion reaction [8.8%(41/464) vs. 4.5%(21/464), χ2=4.886, P=0.007]. There were no significant differences between the two groups in intraoperative bleeding and transfusion, lymph node dissection, circumferential margin and surgical margin, time to the first diet and postoperative hospital stay(all P>0.05). No significant differences in intraoperative and postoperative morbidity of complication were found between PAS group and no PAS group [3.7%(17/464) vs. 2.8%(13/464), P=0.346; 20.3%(94/464) vs. 18.5%(86/464), P=0.739]. Median follow-up of the whole patients was 32.0(0.5-79.0) months, and there was no significant difference between the two groups [PAS group 31.0(0.5-79.0) months vs. no PAS group 33.0(1.0-75.0) months, P=0.391]. In PAS and no PAS group, the 3-year disease-free survival rate was 68.1%(95%CI: 62.0%-74.2%) and 68.5%(95%CI: 63.0%-74.0%)(P=0.764), and 3-year overall survival rate was 78.5%(95%CI: 72.8%-81.4%) and 80.2%(95%CI:74.3%-86.1%)(P=0.528) respectively, whose differences were not significant.CONCLUSION:Except higher risk of conversion to laparotomy due to adhesion reaction, laparoscopic resection of colorectal cancer is safe and feasible in patients with PAS, and the prognosis is not affected by PAS.

Objective To investigate the expression and clinical significance of chymase protein in colorectal cancer tissue. Methods 135 colorectal cancer patients who underwent radical resection were collected at the Cancer Hospital Chinese Academy of Medical Sciences and the Second Affiliated Hospital of Harbin Medical University between September 2010 and September 2012. The expression of Chymase protein in colorectal cancer tissue was detected by immunohistochemistry, and the relationship between Chymase protein and clinicopathological data and prognosis was analyzed. Results The expression of chymase protein in colorectal cancer tissue was lower than that of the adjacent tissues, the difference was of statistically significance (Χ2=4.305, P=0.038). In colorectal cancer tissue, the expression of chymase protein was decreased in distant metastatic patients (P=0.002), the expression of chymase protein was decreased in late N staging (Χ2=54.81, P<0.001), the expression of chymase protein was decreased in Ⅲ+ Ⅳ patients (Χ2=50.84, P<0.001), survival analysis indicated that patients with low expression of chymase protein had poor prognosis (X2=10.501, P=0.001). Conclusion Chymase protein may be a molecular target for prognosis of colorectal cancer. Key words: Colorectal neoplasms; Neoplasm metastasis; Prognosis; Chymase

Objective The aim of the present study was to determine the factors influencing prognosis after radical resection in patients with stage Ⅱ colorectal cancer (CRC).Methods Data were collected from 280 patients with stage Ⅱ CRC who received treatment at Chinese Academy of Medical Sciences and Peking Union Medical College between January 2008 and December 2008.All the enrolled patients were followed up until death or until December 2016.Clinically factors affecting early relapse and overall survival rates following the surgery were analyzed.Results A multivariate analysis revealed that tumor invasion depth,vascular invasion,postoperative carcinoembryonic antigen (CEA) level and number of lymph nodes retrieved.were independent predictors of early relapse in postoperative colorectal cancer patients.A combination of tumor invasion depth,vascular invasion,postoperative CEA level and the number of lymph nodes retrieved showed that the greater the number of predictors involved,the higher the likelihood of early relapse and the poorer the overall survival.Conclusion T4 invasion,vascular invasion,postoperative CEA level and the number of examined lymph nodes may significantly affect the prognosis of stage Ⅱ CRC patients after radical resection.The risks of early relapse and worse clinical prognosis were strongly associated with the four parameters.

Objective To evaluate short-time outcomes of laparoscopic surgery and open surgery (OS) for left-sided colon cancer. Methods Clinical data of 144 patients who received LAP or OS left hemicolectomy in Chinese Academy of Medical Science and Peking Union Medical College from January 2010 to March 2016 were collected and analyzed. These patients were divided into LAP group (n=66) and OS group (n=78). The operation time, intraoperative blood loss, the number of dissected lymph nodes and short-time outcomes were compared between two groups. Results There was a significant difference in operating time between the LAP group (151.36±26.98) min and the OS group (190.30±15.30) min (t=-5.130, P=0.0014). There was no significant difference in intraoperative blood loss between the LAP group (75±29.92) ml and the OS group (76.87±24.59) ml (t=-0.836, P=0.4613). There was a significant difference in length of surgical incision between the LAP group (6.88±3.00) cm and the OS group (15.57±2.22) cm (t=-28.484, P<0.001).There was no significant difference in number of swollen lymph nodes between the LAP group (21.58±8.57) and the OS group (23.82±10.96) (t=-0.283, P=0.2670). The average postoperative evacuation time (P=0.0015), getting out-of-bed time (P=0.0009), time to eat food (P=0.0018) were shorter in LAP group than in OS group.The hospital stays were shorter in LAP group than in OS group (t=-3.762, P=0.0364). there was no statistically significant difference between the two groups in postoperative complications (P=0.333). Conclusions LAP for left sided colon cancer is safe and reliable. Compared to the OS group, LAP has advantages including less surgery time, smaller surgical incision, faster recovery and shorter hospital stays. Key words: Colorectal neoplasms; Laparoscopes; Surgical procedures, minimally invasive; Laparotomy

Objective To evaluate the outcomes of surgery combined with intraoperative radiotherapy in the manage-ment of locally advanced gastric cancer. Method 24 patients with locally advanced gastric cancer who underwent sur-gery and intraoperative radiotherapy were included in the prospective analysis. Kaplan-Meier analysis was used to calcu-late the recurrence-free survival rate and overall survival rate, and Cox proportional hazard model was utilized to investi-gate the factors influencing postoperative recurrence. Result Of the 24 patients, 21 received radical gastrectomy with D2 lymphadenectomy, 3 patients had palliative surgery, in which 2 had R1 resection and 1 had R2 resection. All patients were treated with intraoperative radiotherapy (1500 cGy, 6 MeV). There was no report of post-operative or radiotherapy related complications. After a median follow-up of 19.5 months (2-63 months), local recurrence developed in 1 patient, 2 had lung metastasis, and peritoneal cavity recurrence was observed in 3, while liver metastasis developed in 7 patients, and the local control rate reached 95.8%. In Kaplan-Meier analysis, the postoperative median progression-free survival (PFS) and overall survival was 18 months and 23 months, respectively, and the 5-year overall survival rate was 35.4%. No independent factors of PFS were founded in Cox proportional hazards model analysis. Conclusion Intraoperative ra-diotherapy is an efficient and comprehensive strategy in the management of locally advanced gastric cancer, with a re-markable increase in the improvement of local control rate.

For patients with advanced colon cancer, radical surgery is the only way to get a cure. This patient′s preoperative TNM stage was cT4bN2M1a. After the conversion therapy in other hospital, the condition was stable, accompanying intestinal obstruction symptoms, after MDT comprehensive evaluation in our hospital, right hemicolectomy resection was performed.

Objective To investigate the relationship between expression of CCL2 in the primary colorectal cancer and synchronous liver metastasis.Methods Clinicopathological data of 197 cases with colorectal cancer from Jan.1999 to Dec.2003 in Department of Abdominal Surgery, Cancer Hospital ( Institute) ,CAMS was retrospectively reviewed.104 cases of colorectal cancer without recurrence in 5 years and 93 cases with synchronous liver metastasis were included.The expression of CCL2 was tested in the paraffin primary tumors by immunohistochemistry. The correlation between liver metastasis and clinicopathological factors including CCL2 was done by univariate and multivariate analysis.Results Tumor size,lymph node, CEA and CCL2 were independent factors in multivariate analysis ( P <0.05 ).Liver metastasis risk was 5.828(95% CI:2.212 ~15.355)for the high expression of CCL2(P<0.05).Liver metastasis was the only factor related to CCL2 in the relationship analysis,while there was no significance between CCL2 and tumor invasion,lymph node and CEA(P>0.05).Conclusion The close relationship of tumor size, lymph node, CEA and CCL2 between synchronous colorectal cancer liver metastasis was confirmed.The mechanism of CCL2 underlies the colorectal liver metastasis maybe different from the other clinicopathological factors.