JAMES S. WAGNER

Five-year survival after resection of hepatic metastases from colorectal cancer is 25%. Although resection palliates some patients who do not live that long, 50% of patients so treated are not helped at all. Until ignorance of a cancer's real stage is resolved by improved techniques, the evaluation and choice of therapy can be based only upon knowledge of the natural history of untreated metastases and determinants of prognosis derived from treated patients. Analysis of the survival rates of 252 patients who had biopsy proven, unresected hepatic metastases that were the only evidence of residual disease shows the extent to which natural history, rather than resection, may determine length of survival-- and indicates the need for critical analysis of 2- and 3-year survival rates reported after any therapy. Study of 141 patients who had hepatic metastases resected shows that the stage of the primary lesion, being female, and the absence of extrahepatic metastases are significant determinants of favorable prognosis after resection of hepatic metastases.

Toll like receptors (TLRs) are crucial molecules for activation of adaptive immune system. We analyzed the distribution of TLR2 (T/C1350) and TLR4 (Asp299Gly) SNPs among 53 kidney transplanted patients, determined by Real time PCR with TaqMan probes. According to the obtained genotype patients were grouped into wild type or heterozygous group. Regarding the TLR4 gene, there were 5 heterozygous patients and 48 wild-types and for TLR2 gene there were 6 heterozygous and 47 wild type patients. Data on history of kidney function and immunosuppressive therapy were taken from medical records. Median time after transplantation was 8 years (min. 3, max. 24). Univariate analysis showed significant difference in serum urea concentration between wild-types and heterozygous patients for TLR2 gene and for TLR4 gene, respectively. Patients with wild type TLR2 and those with wild type TLR4 had higher urea concentrations, for TLR2 median 9.9, 3.8-58.3 mmol/l vs 6.2, 4.9-12 mmol/l ; z=-2.076, p=0.037, and for TLR 4 median 9.9, 3.8-58.3 mmol/l vs 5.5, 4.0-9.9 mmol/l ; z=-2.313, p=0.018 (Mann-Whitney test). Those TLR2 and TLR4 gene SNPs related differences in urea were not confirmed by multivariate analysis, when taken urea and time after transplantation as covariates, even though the patients with wild type TLR2 and TLR4 did not differ from heterozygous in the time after transplantation by univariate statistical analysis, respectively. Heterozygosity of the analyzed SNPs of TLR2 and TLR4 gene might still be protective regarding urea level in kidney transplanted patients. Further research in larger group is needed to confirm these findings.