Preoperative carcinoembryonic antigen and albumin in predicting survival in patients with colon and rectal carcinomas

OBJECTIVE

To examine the relationship between postoperative outcomes of colorectal carcinoma patients and preoperative serum carcinoembryonic antigen (CEA) and albumin (ALB) levels and evaluate if these levels can accurately predict outcomes and/or be factor indicating adjuvant chemotherapy.

BACKGROUND

CEA is a marker for colorectal carcinoma and its level usually increases before a distant metastasis is detected. Also, a low level of serum ALB is usually found in metastatic colorectal carcinoma patients.

STUDY

A retrospective cohort study of patients with colorectal carcinomas who were treated with curative surgery in Songklanagarind Hospital between 1998 and 2002.

RESULTS

One hundred seventy patients were identified with a median survival of 1131 days (range 71 to 2293 d) and with an overall 5-year survival rate of 54%. Patients were stratified using CEA at 5 ng/mL and an ALB level at 3.5 g/dL into 4 groups: (1) low CEA, high ALB; (2) low CEA, low ALB; (3) high CEA, high ALB; and (4) high CEA, low ALB. The 5-year survival rates for groups 1 to 4 were 66%, 63%, 46%, and 34%, respectively. There was statistically significant difference in 5-year survival between the well-differentiated tumor with low CEA and the poorly differentiated tumor with high CEA (P=0.0115). The high CEA patients who had the well-differentiated tumor had longer survival than those with a poorly differentiated tumor (P=0.0412).

CONCLUSIONS

A preoperative CEA level greater than or equal to 5 ng/mL and ALB level less than 3.5 g/dL predict a poor survival chance for colorectal carcinoma patients. In high CEA patients, tumor differentiated is an independent factor affecting survival.

[The prospective study on application of parenteral nutrition with alanyl-glutamine dipeptide in chemotherapy of gastrointestinal neoplasms patients]

BACKGROUND & OBJECTIVE

There is an argument on whether or not glutamine-supplemented parenteral nutrition is beneficial to chemotherapy in gastrointestinal neoplasm patients. The aim of this study was to prospectively evaluate the effect of parenteral nutrition with alanyl-glutamine dipeptide on gastrointestinal neoplasm patients receiving chemotherapy.

METHODS

This study was a prospective, randomized double-blind clinical trial. Seventy-two patients were randomly divided into study group and control group (each group had 36 patients). The side effects during chemotherapy were observed. Serum albumin, serum pre-albumin, IgG, IgA, IgM, C3, C4 level were measured before chemotherapy and on day 4 and day 8 after chemotherapy. Nitrogen balance was also calculated simultaneously.

RESULTS

(1) Less side effects during chemotherapy in study group were revealed compared to those in control group (P<0.05). (2) Serum albumin and pre-albumin levels were both decreased in the two groups on day 4 after chemotherapy, and were markedly decreased in control group on day 8 after chemotherapy (P<0.05). (3) IgG, IgM, IgA levels were all decreased compared with the test results before chemotherapy on day 4 after chemotherapy in two groups, and were significantly decreased in control group on day 8 after chemotherapy (P<0.05). C3 and C4 levels were higher in study group compared with control group on day 8 after chemotherapy (P<0.05). (4) Nitrogen balance in study group was better than that in control group (P<0.05) on day 8 after chemotherapy.

CONCLUSIONS

Alanyl-glutamine dipeptide is beneficial to chemotherapy in gastrointestinal neoplasm patients. It could reduce the side effects of chemotherapy, which helps to improve the nutritional status, the immune function and the survival quality of patients during chemotherapy.

Prognostic effect of perioperative change of serum carcinoembryonic antigen level: a useful tool for detection of systemic recurrence in rectal cancer

BACKGROUND

The prognosis of patients even with the same stage of rectal cancer varies widely. We analyzed the capability of perioperative change of serum carcinoembryonic antigen (CEA) level for predicting recurrence and survival in rectal cancer patients.

METHODS

We reviewed 631 patients who underwent potentially curative resection for stage II or III rectal cancer. Patients were categorized into three groups according to their serum CEA concentrations on the seventh day before and on the seventh day after surgery: group A, normal CEA level (<or=5 ng/mL) in both periods; group B, increased preoperative and normal postoperative CEA; and group C, continuously increased CEA in both periods. The prognostic relevance of the CEA group was investigated by analyses of recurrence patterns and survival.

RESULTS

Stage III patients showed higher systemic recurrence (P = .001) and worse 5-year survival rates (P < .0001) for group C than for groups A and B. On multivariate analysis, the CEA group was a significant predictor for recurrence (P < .001; relative risk, 2.740; 95% confidence interval, 1.677-4.476) and survival (P = .001; relative risk, 2.174; 95% confidence interval, 1.556-3.308).

CONCLUSIONS

The perioperative serum CEA change was a useful prognostic indicator to predict for systemic recurrence and survival in stage III rectal cancer patients.

Serum CEA as a predictor for the response to preoperative chemoradiation in rectal cancer

BACKGROUND AND OBJECTIVES

Recent data suggest that good responders to preoperative chemoradiation (CRT) have a favorable prognosis in rectal cancer patients. The aim of this study was to investigate the predictive value of serum carcinoembryonic antigen (CEA) levels for the tumor response to preoperative CRT in rectal cancer patients.

METHODS

The study comprised 141 rectal adenocarcinoma patients who underwent preoperative radiotherapy with 5-fluorouracil (FU) based chemotherapy, followed by radical surgery. The staging workup was consisted of endorectal ultrasound, abdominopelvic computed tomography scan, or magnetic resonance imaging. The outcome parameters were cancer-specific survival and disease-free survival. Pre-CRT clinicopathologic features, including age, gender, location of the tumor, clinical tumor (cT) classification, clinical nodal (cN) classification, and serum CEA levels were investigated as possible predictors for the response to preoperative CRT.

RESULTS

Pathologic complete or near complete responses (good responders, GR) occurred in 26 (19%) patients, while partial or no response (poor responders, PR) occurred in the remaining 115 (81%) patients. GR showed better cancer-specific survival (P = 0.028) and disease-free survival rates (P = 0.011) than PR. Univariate analysis revealed that positive cN and elevated (>5 ng/ml) pre-CRT serum CEA levels are associated with poor tumor response to preoperative CRT. Using logistic regression analysis, elevated pre-CRT serum CEA levels were the only significant predictor for the poor response to CRT (Odd ratio = 2.876, 95% confidence interval = 1.04-7.46, P = 0.041).

CONCLUSIONS

Our data suggest that elevated pre-CRT serum CEA levels are associated with poor tumor response to CRT. Therefore, pre-CRT serum CEA levels provide useful information about tumor response to preoperative CRT in rectal cancer patients.

Altered plasma matrix metalloproteinase-9/tissue metalloproteinase-1 concentration during the early postoperative period in patients with colorectal cancer

BACKGROUND

The authors have previously demonstrated that insulin-like growth factor binding protein-3 (IGFBP-3) is depleted in plasma for 1 to 3 days after major open surgery (OS), but not after laparoscopic surgery (LS). After surgery, IGFP-3 cleavage occurs rapidly and is likely attributable to altered plasma proteolytic activity. This study aimed to assess plasma proteolysis after both open and closed colorectal resection and, if possible, to identify a protease/protease inhibitor system affected by surgery.

METHODS

Plasma from 88 patients with colorectal cancer (stages I-III) who underwent resection was obtained preoperatively (pre-OP) and on postoperative days (POD) 1 to 3. Plasma proteolytic activity was assessed via zymography. On the basis of the results, specific protease and protease inhibitor concentrations were next measured via enzyme-linked immunoassay (ELISA). Statistical analysis was performed using Wilcoxon's test.

RESULTS

Early after surgery, zymography showed a predominant band representing a 92-kDa gelatinase corresponding to a proform of matrix metalloproteinase-9 (MMP-9), a protease known to cleave IGFBP-3. In OS patients, the mean concentration of plasma MMP-9 was significantly higher on POD 1 than at pre-OP (p < 0.003). On POD 2 and 3, no differences were noted. In the LS group, the mean levels of MMP-9 before and after surgery were comparable. The levels of a natural MMP-9 inhibitor, tissue inhibitor of metalloproteinase-1 (TIMP-1), also were measured. In the OS group, the level of TIMP-1 was significantly higher on POD 1 (p < 0.0003) and POD 2 (p < 0.01) and 3 (p < 0.01) than at pre-OP. In the LS group, a smaller but significant increase in TIMP-1 levels was found between the pre-OP sample and the POD 1 (p < 0.01) and POD 2 (p < 0.01) samples. No difference was noted on POD 3 (p = 0.1).

CONCLUSIONS

Open surgery, but not laparoscopic surgery, is accompanied by a short-lived significant increase in MMP-9 levels, which likely accounts for the decrease in IGFBP-3 levels observed after OS. The transitory nature of MMP-9 imbalance may be attributable to the increase in TIMP-1 levels postoperatively.

A carcinoembryonic antigen-secreting adenocarcinoma arising in tailgut cyst: clinical implications of carcinoembryonic antigen

Tailgut cysts (TGCs) are rare congenital cysts that occur in the retrorectal or presacral spaces. Although most tailgut cysts have been reported as benign, there have been at least 9 cases associated with malignant change. We report herein on an unusual case of a 40-year-old woman with a carcinoembryonic antigen (CEA)-producing adenocarcinoma arising within a TGC who underwent surgical resection and local radiation therapy. Despite the complete resection, metastatic adenocarcinoma developed five months after surgery. CEA-producing adenocarcinoma from a TGC is extremely rare and only two cases, including this case, have been reported in the English medical literature. Besides CEA, the serum levels of CA 19-9 became markedly elevated in this patient. Given that the serum CEA level decreased to the normal range after complete resection of tumor and that the tumor recurrence was associated with a rebound of the CEA serum level, our case shows that serial measurements of serum CEA can be used for treatment planning and for assessing the patient's treatment response for this rare disease.

Adjuvant radiochemotherapy of stage II and III rectal adenocarcinoma: role of CEA and CA 19-9

BACKGROUND

This analysis was undertaken to evaluate the impact of pre-radiotherapy CEA and CA 19-9 values on clinical outcome of locally advanced rectal cancer.

PATIENTS AND METHODS

Retrospective data were collected from patients (n=203) with UICC stage II and III rectal adenocarcinomas, who underwent low anterior or abdominoperineal resection and received post-operative or pre-operative radiochemotherapy from January 1989 until July 2002. The rates of survival and distant and local recurrences were evaluated using Kaplan-Meier survival analysis, Log-rank test and Cox's proportional hazards (median follow-up 8 years). Multivariate analysis was used to assess the prognostic value of CEA and CA 19-9.

RESULTS

The 5-year actuarial rates for patients with normal (n =118) and elevated (n=88) CEA values were as follows: overall survival 62.4% and 32.0% (p<0.001), local control 73.5% and 55.0% (p=0.007), and absence of distant metastasis 83.3% and 88.0% (n.s.), respectively. Similar results were obtained for patients with normal (n=82) and elevated (n = 10) CA 19-9 values: overall survival 60.7% and 14.0% (p=0.007), local control 83.7% and 80.0% (n.s.), and absence of distant metastasis 64.9% and 75.0% (n.s.), respectively. After adjustment for TNM stage, sex, age, LDH, tumor site and grading, the elevation of CEA proved to be an independent prognostic factor for overall survival (relative risk of 1.01 per ng/ml, CI 1.002 - 1.01; p=0.005).

CONCLUSION

This study confirmed the prognostic value of pre-radiotherapy CEA and CA 19-9 in patients with stage II or III rectal carcinoma.

Risk of colorectal neoplasm in patients with acromegaly and its relationship with serum growth hormone levels

OBJECTIVES

Acromegalics have been reported to be at an increased risk of colorectal neoplasm. However, the magnitude of the risk is still controversial and the mechanism has not been fully investigated. In this study, we attempted to determine the magnitude of the association between acromegaly and colorectal lesions after taking into account age, gender, smoking status, and treatment status. In addition, we assessed the relationship between colorectal lesions and serum growth hormone (GH) levels in acromegalics.

METHODS

We conducted a case-control study by using 19 consecutive untreated patients (male:female = 11:8) who were newly diagnosed with acromegaly between 1990 and 2000. All patients underwent colonoscopy and received a histological diagnosis of colorectal lesions. Prevalence of hyperplastic polyp, adenoma, and carcinoma were compared with the prevalence in 76 controls matched for gender, age, and smoking status. Serum GH levels were compared between acromegalic patients with and without each type of colorectal lesion.

RESULTS

The prevalence of hyperplastic polyp, adenoma, and carcinoma were significantly higher in the acromegalic patients compared to the controls (p < 0.05, odds ratios; 8.3, 4.2, and 9.8, respectively). In acromegalics, the presence of hyperplastic polyps and carcinomas were significantly associated with higher serum GH levels after adjusting for the other lesions and age (p < 0.05).

CONCLUSIONS

After controlling for age, gender, smoking status, and treatment status, acromegaly was associated with significantly higher prevalence of colorectal hyperplastic polyp, adenoma, and carcinoma. High serum GH levels may be associated with the presence of hyperplastic polyp and carcinoma.

[Relationship of serum level of dihydropyrimidine dehydrogenase and serum concentration of 5-fluorouracil to treatment response and adverse events in colorectal cancer patients]

BACKGROUND & OBJECTIVE

Toxicities and response are different when patients with advanced colorectal cancer were treated with standard FOLFOX6 regimen. Serum level of dihydropyrimidine dehydrogenase (DPD) relates to efficacy and toxicities of chemotherapy containing 5-fluorouracil (5-FU). This study was to explore relationship of DPD to serum concentration of 5-FU in colorectal cancer patients treated with FOLFOX6 regimen, and their correlation to treatment response and adverse events.

METHODS

Serum level of DPD in 72 patients with colorectal cancer was detected by high-performance liquid chromatography (HPLC) before chemotherapy. Serum concentration of 5-FU at steady state was detected by HPLC after patients received FOLFOX6 regimen. Treatment response and adverse events in the patients were assessed.

RESULTS

Serum levels of DPD were normally distributed in 72 patients (ranged 1.55-5.94), while serum concentrations of 5-FU at steady state were not (ranged 141.1-1 741.9 microg/L). Serum level of DPD was negatively correlated with serum concentration of 5-FU (r=-0.460, P < 0.01). Occurrence of adverse events was lower when 5-FU concentration was less than 600 microg/L than when 5-FU concentration was more than 600 microg/L (P < 0.05). The mean serum concentration of 5-FU was significantly higher in patients with complete response and partial response than in patients with steady disease, and progressive disease (513.9 microg/L vs. 409.8 microg/L, and 259.3 microg/L, P < 0.05). Serum level of DPD was lower in patients suffered oral mucositis and diarrhea of grade II-IV than in patients suffered oral mucositis and diarrhea of grade 0-I (P=0.016, P=0.047). Serum level of DPD had no relation with treatment response of the patients (r=0.312, P=0.078).

CONCLUSIONS

DPD level and serum 5-FU concentration vary a lot among patients with colorectal cancer. DPD level negatively correlates with serum 5-FU concentration. Serum concentration of 5-FU correlates with treatment effect and toxicities.

Preoperative plasma soluble urokinase plasminogen activator receptor as a prognostic marker in rectal cancer patients. An EORTC-Receptor and Biomarker Group collaboration

BACKGROUND AND AIMS

Since approximately 30% of patients with Dukes' stage B colorectal cancer will experience disease recurrence within five years of primary treatment, current staging of patients with early colorectal cancer apparently fails to adequately predict patient outcome. It has previously been shown that the preoperative plasma concentration of soluble urokinase plasminogen activator receptor (suPAR) is associated with the survival of patients with early colorectal cancer. In this study we sought to confirm the independent prognostic value of suPAR in rectal cancer.

METHODS

suPAR was retrospectively determined by two different versions of a suPAR ELISA in preoperatively collected plasma samples from a Swedish (n = 354) and a Danish (n = 255) cohort of rectal cancer patients.

RESULTS

In both cohorts the suPAR concentration was significantly higher in Dukes' stage D patients than in Dukes' stage A-C patients (p < 0.0001). Among Dukes' stage A-C patients, no differences in median suPAR values were seen. In univariate analysis, continuous suPAR was found to be associated with survival (p < 0.0001 in both cohorts). Of particular interest was that similar results were obtained for Dukes' stage A and B patients when analyzed separately. In multivariate analysis, continuous suPAR was found in both cohorts to be independent of Dukes' stage.

CONCLUSIONS

This study confirms that the preoperative concentration of plasma suPAR contains independent prognostic information on patients with rectal cancer. This result was independent of the two different versions of an in-house suPAR ELISA used to perform the analyses. The next step in the evaluation of suPAR as a prognostic parameter in rectal cancer will be to launch an appropriately dimensioned prospective study where the benefit of applying preoperative plasma suPAR measurement to clinical decision-making regarding adjuvant therapy is assessed.

Postoperative infections in colorectal cancer patients

BACKGROUND/AIMS

Colorectal surgery is associated with some of the highest rates of infective complications, and especially surgical site infections. It has recently been reported that postoperative infection in colorectal cancer surgery increases the risk of recurrence. The aim of this study was to analyze factors associated with the occurrence of postoperative infections in patients with colorectal cancer.

METHODOLOGY

A total of 81 patients operated for colorectal cancer was included. Patients' characteristics and postoperative course were recorded and analyzed.

RESULTS

Patients with tumors located in the rectum had significantly higher rate of postoperative infectious complications compared to patients with tumors located in the colon (p=0.002). In a logistic regression model, among all evaluated predictors, only preoperative hemoglobin concentration was found to be an independent significant predictor of postoperative infection (p=0.01).

CONCLUSIONS

Preoperative anemia was found to be significant independent predictor of postoperative infection. Meticulous surgical technique with minimal blood loss is an important means of reduction of postoperative infections in colorectal surgery.

A phase I-II, dose-escalating trial of ZD9331 in combination with irinotecan (CPT11) in previously pretreated metastatic colorectal cancer patients

BACKGROUND

To establish the recommended dose (RD) of the thymidylate-synthase inhibitor ZD9331 administered with irinotecan (CPT-11) in patients with pretreated metastatic colorectal cancer, and to assess toxicity profile, pharmacokinetics (PK), and anti-tumor activity in a phase I/II open, multicenter, intrapatient chemotherapy dose escalating trial.

PATIENTS AND METHODS

Twenty-one patients who failed first-line therapy (5-fluorouracil/leucovorin +/- oxaliplatin) received every 2 weeks CPT-11 180 mg/m2 D1, followed by ZD9331 30-minute infusion D2 at three dose levels: 90, 120 and 150 mg/m2.

RESULTS

RD of ZD9331 was established at 90 mg/m2 for the first two cycles, with possibility to escalate at 120 mg/m2 according to safety evaluation. Grade 3-4 toxicities were neutropenia (67% of patients), grade 3 vomiting (14%), grade 3 nausea (10%) and grade 3 diarrhea (5%). ZD9331 dose level does not affect the PK of CPT-11 or SN-38. Tumor growth control (PR + SD) was achieved for 14 (66.7%) patients. Median time to progression was 6 months, and median survival was 8.4 months.

CONCLUSION

ZD9331 90 mg/m2 combined with CPT-11 180 mg/m2 may be a viable option for treatment of metastatic colorectal cancer, with possible escalation to 120 mg/m2 of ZD9331 according to safety evaluation.

Biochemical signs of impaired cobalamin status during and after radiotherapy for rectal cancer

PURPOSE

The aim of the study was to investigate whether pelvic radiotherapy for rectal cancer had a negative impact on cobalamin status.

METHODS AND MATERIALS

Consecutive patients receiving pelvic radiotherapy (50 Gy) for rectal cancer were evaluated prospectively (n = 54). Serum cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine (tHcy) were measured at start and end of radiotherapy, at follow-up 4-6 weeks and 1 year (n = 23) after radiotherapy.

RESULTS

Mean serum cobalamin decreased from 306 pmol/L before treatment to 267 pmol/L at the end of radiotherapy (p < 0.001), 247 pmol/L 4-6 weeks after radiotherapy (p < 0.001), and 249 pmol/L 1 year after radiotherapy (p = 0.02). Mean serum MMA was 0.16 micromol/L pretreatment, 0.17 micromol/L at the end of radiotherapy (n.s.), and increased to 0.19 micromol/L after 4-6 weeks (p = 0.007), and to 0.21 micromol/L after 1 year (p < 0.001). There was no change in serum tHcy. Mean serum holoTC was reduced from 111 pmol/L pretreatment to 93 pmol/L 4-6 weeks after radiotherapy (p = 0.002).

CONCLUSIONS

The data suggest rapid and persistent decrease in cobalamin status after radiotherapy for rectal cancer, as reflected by reduced serum cobalamin combined with increased serum MMA. This observation, though modest, may motivate routine monitoring of cobalamin status at follow-up after radiotherapy.

Hematogenous rectal metastasis 20 years after removal of epithelial ovarian cancer

BACKGROUND

Rectal tumors are rarely metastatic. Moreover, hematogenous spread is rare in ovarian cancer whose dissemination frequently occurs through peritoneal or lymphatic ways.

CASE

A 55-year-old female presented with a rectal metastasis that appeared 20 years after the treatment of a primary clear cell carcinoma of the ovary. The cytokeratin 7 positive/cytokeratin 20 negative immunophenotype assessed the ovarian origin of the rectal tumor. Because of the integrity of the rectal serosa and the uninvolved mesenteric lymph nodes, we hypothesize our rectal metastasis to come from the hematogenous way.

CONCLUSION

This is the first reported case of hematogenous rectal metastasis in epithelial ovarian carcinoma and that, with so late delay.

Increased activity of the mannan-binding lectin complement activation pathway in patients with colorectal cancer

BACKGROUND

Postoperative bacterial infectious complications are frequent in patients with colorectal cancer (CRC), with subsequent increased recurrence rates and poor prognosis. Deficiency of the mannan-binding lectin (MBL) complement activation pathway may cause increased risk of infection in certain patient groups. It is hypothesized that a deficient MBL pathway might be more frequent among patients with CRC than in healthy individuals. The MBL pathway was therefore evaluated in serum obtained preoperatively from 193 patients with primary CRC and in serum from 150 healthy volunteers.

METHODS

Serum MBL concentrations and MBL/MASP activity were determined using immunofluorometric assays. The levels are presented as the median, inter-quartile range and range.

RESULTS

Serum MBL levels were significantly (P < 0.0002) increased in patients with colorectal cancer (1384 (400-2188) ng/mL) (median, inter-quartile range) compared with levels in healthy blood donors (924 (230-1476) ng/mL). Similarly, the MBL/MASP activity was significantly (P < 0.0002) increased in patients (584 (202-914) mU/mL) compared with in blood donors (319 (0-684) mU/mL). This was independent of age, gender, tumour location in the colon or rectum, and disease stages according to Dukes' classification. No statistical difference (P=0.20) in frequency of MBL deficiency was found between the patients (20%) and the donors (27%).

CONCLUSIONS

Overall, the MBL complement activation pathway is significantly increased in patients with colorectal cancer compared with healthy persons. However, similar frequencies of MBL pathway deficiency are observed in patients and healthy persons.

[Protein composition of erythrocyte membranes in patients with stomach, colon and rectal cancer]

Examinations of the protein composition of erythrocyte membrane in patients with cancer of the stomach, large intestine and rectum by using the method of disc-electrophoresis in polyacrylamide gel revealed the changing contents of protein fractions, which consisted in a lower share of high-molecular polypeptides with, simultaneously, higher quantity of low-molecular peptides. A comparison of the studied parameters of the protein spectrum of erythrocyte membrane as observed in patients with cancer of the stomach, on the one hand, and in patients with tumors of the large intestine and rectum, on the other hand, led to defining the reliable difference only for the content of the fraction-5 proteins.

[Role of tumour markers in monitoring and follow-up of colorectal cancer patients]

The authors describe the significance of colorectal cancers in public health in Hungary and at international level. This is followed by the discussion of the latest aspects of patients' monitoring and continual follow-up with special emphasis on its clinical significance. In addition to CEA, the most important tumour marker in the present clinical practice, the authors review other tumour markers that might be used in controlling cancer treatment and patients' status. The estimation of treatment effectiveness should be combined with tumour marker level determinations at regular intervals because they are capable of demonstrating the dynamics of malignant processes and, if applied in adequate combinations, indicate the presence of a recurrence or metastasis. The integration of a "tumour marker panel" into the practice of follow-up may help early cancer detection and reduce health care expenses.

Vascular endothelial growth factor assessment in different blood fractions of gastrointestinal cancer patients and healthy controls

Vascular endothelial growth factor (VEGF) is known to play a central role in tumour angiogenesis. Up to now inconclusive data have been published on the clinical-biological significance of circulating VEGF and on the most suitable blood fraction for measuring it. The aims of this pilot study were to assess VEGF in blood compartments of 16 healthy control volunteers and 56 gastrointestinal cancer patients, prospectively collected, to identify the most suitable blood fraction for the determination of VEGF and to evaluate its possible clinical-biological significance. Samples of serum (S) and plasma (P) in both sodium citrate (SC) and sodium citrate-theophylline-adenosine-dipyridamole (CTAD) were collected from venous blood. After the centrifugation and separation methods VEGF levels were detected by ELISA in: S, plasma-platelets poor (P-PP), plasma-activated platelets rich (P-APR) and blood-lysed whole (B-LW). The best differentiation between healthy control volunteers and cancer patients in VEGF level was seen for P-APRCTAD (mean value: 278 pg/ml vs 77 pg/ml; p=0.0036 by t-test). No significant correlation among the blood fractions of VEGF analysed and clinical-pathological features was found. Our data suggest that P-APRCTAD blood fraction, obtained according to well standardised conditions, could represent the most suitable compartment for the assessment of VEGF. We suggest that VEGF levels in P-APRCTAD could play a role as an angiogenic marker of malignant gastrointestinal transformation. Further studies on a larger series of patients and healthy controls with the same experimental methodological conditions are required to confirm our preliminary conclusions.

Distributions in CEA doubling time differ in patients with recurrent colorectal carcinomas

BACKGROUND/AIMS

Serum carcinoembryonic antigen (CEA) is often measured during follow-up of patients surgically treated for colorectal cancer. We determined characteristic findings in serum CEA concentrations or CEA doubling time (DT) depending on the different tumor distributions in colorectal cancer patients.

METHODOLOGY

Serum CEA levels were measured monthly until the patients expired in 32 colorectal cancers after operations. CEA DT was based on semilogarithmic plots of time courses of CEA concentrations.

RESULTS

In cases who were preoperatively CEA positive, the maximum serum CEA levels for proximal colon, distal colon and rectal cancers were 384.8+/-586.1 ng/mL, 1395.7+/-1954.6 ng/mL and 1343.4+/-1478.3 ng/mL, respectively. The maximum serum CEA level in cases of the proximal colon in preoperative CEA positive patients was lower than that in cases of distal colon or rectum. The average CEA DT on the proximal colon, distal colon and rectal cancers was 71.62+/-43.77 days, 31.07+/-15.98 days and 73.97+/-36.66 days, respectively. The CEA DT with distal colon cancers was also significantly shorter than that with proximal colon or rectal cancers (p<0.05, p<0.02). The CEA DT for lung metastasis was significantly longer than that for liver metastasis, locally or lymph node metastasis or multiple metastases (p<0.02, p<0.02, p<0.001).

CONCLUSIONS

CEA DT serves to predict life expectancy for patients with recurrent colorectal cancers with different tumor distributions. We propose that precise measurements of serum CEA are needed so as not to overlook recurrent tumors. Detailed follow-up after operations is necessary for such patients, that CEA DT was noted in case of distal colon cancers.

Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rectal cancer

AIM: The study of immune response of open versus laparoscopical total mesorectal excision with anal sphincter preservation in patients with rectal cancer has not been reported yet. The dissected retroperitoneal area that contacts directly with carbon dioxide is extensive in laparoscopic total mesorectal excision with anal sphincter preservation surgery. It is important to clarify whether the immune response of laparoscopic total mesorectal excision with anal sphincter preservation (LTME with ASP) in patients with rectal cancer is suppressed more severely than that of open surgery (OTME with ASP). This study was designed to compare the immune functions after laparoscopic and open total mesorectal excision with anal sphincter preservation for rectal cancer.

METHODS: This study involved 45 patients undergoing laparoscopic (n = 20) and open (n = 25) total mesorectal excisions with anal sphincter preservation for rectal cancer. Serum interleukin-2 (IL-2), interleukin-6 (IL-6), tumor necrosis factor α (TNF_α) were assayed preoperatively and on days 1 and 5 postoperatively. CD3⁺ and CD56⁺ T lymphocyte count, CD3^- and CD56⁺ natural killer cell (NK) count and immunoglobulin (IgG/IgM/IgA) were assayed preoperatively and on day 5 postoperatively. The numbers of CD3⁺ and CD56⁺ T lymphocytes and CD3^- and CD56⁺ NK cells were counted using flow cytometry. An enzyme-linked immunosorbent assay (ELISA) was used for IL-2, IL-6 and TNF_α determination. And IgG, IgM, and IgA were assayed using immunonephelometry.

RESULTS: The demographic data of the two groups had no difference. The preoperative levels of CD3⁺ and CD56⁺ T lymphocyte count, CD3^- and CD56⁺ NK count, serum IgG, IgM, IgA, IL-2, IL-6 and TNF_α also had no significant difference in the two groups (P > 0.05). The CD3⁺ and CD56⁺ T lymphocyte counts had no obvious changes after surgery in laparoscopic (d = -0.79% ± 3.83%) and open (d = 0.42% ± 2.09%) groups. The CD3^- and CD56⁺ NK counts were decreased postoperatively in both laparoscopic (d = -7.23% ± 11.33%) and open (d = -9.21% ± 13.93%) groups. The differences of the determined values of serum IgG, IgM and IgA on the fifth day after operation subtracted those before operation were -2.56 ± 2.14 g/L, -252.35 ± 392.94 mg/L, -506.15 ± 912.24 mg/L in laparoscopic group, and -1.81 ± 2.10 g/L, -282.72 ± 356.75 mg/L, -252.20 ± 396.28 mg/L in open group, respectively. The levels of IL-2 were decreased after operation in both groups. However, the levels of IL-6 were decreased after laparoscopic surgery (d₁ = -23.14 ± 263.97 ng/L and d₅ = -40.08 ± 272.03 ng/L), and increased after open surgery (d₁ = 27.38 ± 129.14 ng/L and d₅ = 21.67 ± 234.31 ng/L). The TNF_α levels were not elevated after surgery in both groups. There were no significant differences in the numbers of CD3⁺ and CD56⁺ T lymphocytes and CD3^- and CD56⁺ NK cells, the levels of IgG, IgM, IgA, IL-2, IL-6 and TNF_α between the two groups (P > 0.05).

CONCLUSION: There are no differences in immune responses between the patients having laparoscopic total mesorectal excision with anal sphincter preservation and those undergone open surgery for rectal cancer.

Cellulite nécrosante périnéale révélant un adénocarcinome rectal

We report one case of rectal cancer disclosed by a perineal cellulitis in a diabetic woman. This infrequent association has a bad prognosis. Diagnosis is mainly clinical. Treatment is urgent with large spectrum antibiotic therapy, surgical debridement, colostomy and hyperbaric oxygen if available. Surgical treatment of the rectal cancer can be done immediately or delayed.

Correlation between invasiveness of colorectal tumor cells and adhesive potential under flow

BACKGROUND

Tumor cell adhesiveness is involved in metastatic dissemination, and adhesive behavior may be different under static and dynamic conditions.

MATERIALS AND METHODS

Patients undergoing primary colorectal cancer excision were tested for: i) serum concentration of sE-selectin, sICAM-1 and sVCAM-1, ii) expression of CD18, CD29d and E-cadherin on tumor cells and iii) efficiency of tumor cell adhesion to ECV304 monolayers under flow and resistance to detachment by shear.

RESULTS

Twenty out of 31 patients were free of detectable relapse 12 months later. Relapsing and non-relapsing patients had similar levels of soluble adhesion molecules. E-cadherin was detected on tumor cells from three non-relapsing patients, but no relapsing one. Unexpectedly, significant CD18 labeling was found on two relapsing patients and one non-relapsing patient. Cells from relapsing patients displayed significantly increased (p < 0.05 two-sided, p < 0.025 one-sided) capacity to adhere to test monolayers under flow.

CONCLUSION

Cancer invasion is related to tumor cell adhesiveness, and the flow chamber provides a practical way of measuring adhesive parameters with a potential value for relapse prediction.

Plasma insulin, IGF-binding proteins-1 and -2 and risk of colorectal cancer: a prospective study in northern Sweden

Chronically elevated plasma insulin levels have been postulated to increase colon cancer risk, either directly through colonic insulin receptors or indirectly through downregulation of IGFBP-1 and/or IGFBP-2, thus increasing IGF activity. Our aim was to examine the relationships of plasma insulin and IGFBPs-1 and -2 with risks of colon and rectal cancers. We conducted a case-control study nested within the prospective Northern Sweden Health and Disease Cohort. Insulin and IGFBPs were measured in prediagnostic plasma samples from 168 men and women who developed cancers of the colon (n = 110) or rectum (n = 58) and from 336 matched controls. Conditional logistic regression analyses showed no significant relationship of plasma insulin with risk of colon or rectal cancer. In subjects whose blood samples had been collected after more than 4 hr of fasting, insulin showed a moderate but still nonsignificant association with colorectal cancer risk [ORs over quartiles: 1.00, 0.70 (95% CI 0.35-1.39), 1.06 (95% CI 0.55-2.07), 1.63 (95% CI 0.82-3.24); p(trend) = 0.10]. Plasma IGFBP-1 and IGFBP-2 showed no association with risk of colon and/or rectal cancer, either in the full study population or among the fasting subjects. Our results only moderately support a possible relationship of chronic hyperinsulinemia with colon cancer risk.