51
|
Dickson EA, Keeler BD, Ng O, Kumar A, Brookes MJ, Acheson AG. Preoperative intravenous iron therapy and survival after colorectal cancer surgery: long-term results from the IVICA randomised controlled trial. Colorectal Dis 2020; 22:2018-2027. [PMID: 32871616 DOI: 10.1111/codi.15342] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023]
Abstract
AIM Preoperative iron is frequently used for the correction of anaemia in colorectal cancer surgery. However, enteral iron intake may promote tumour growth and progression which could influence cancer recurrence and patient survival. We explore the long-term outcomes of patients receiving either oral or intravenous iron replacement therapy as part of a previous randomized controlled trial. METHODS The IVICA trial randomized anaemic colorectal cancer patients to receive either oral (OI, control) or intravenous (IVI, treatment) iron prior to their elective operation. Follow-up analysis of all patients recruited to this multicentre trial who underwent surgical resection with curative intent was performed. Kaplan-Meier survival estimates and Cox proportional hazard models were used to compare groups. A pooled group multivariable analysis comparing patients who achieved resolution of anaemia preoperatively to those who did not was also undertaken. RESULTS In all, 110 of the 116 patients previously enrolled were eligible for analysis (OI n = 56, IVI n = 54). Median overall follow-up duration was 61 months (interquartile range 46-67). No significant difference in 5-year overall survival (hazard ratio (HR) 1.22, 95% CI 0.65-2.28, P = 0.522) or disease-free survival (HR 1.08, 95% CI 0.61-1.92, P = 0.79) was observed between OI and IVI. A pooled analysis of treatment groups found that preoperative resolution of anaemia led to improved 5-year overall survival on multivariable analysis (HR 3.38, 95% CI 1.07-11.56, P = 0.044). CONCLUSION We recommend IVI for the preoperative correction of anaemia. Route of iron therapy did not significantly influence survival. Preoperative anaemia correction may lead to an overall survival advantage following elective colorectal cancer surgery.
Collapse
Affiliation(s)
- E A Dickson
- National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - B D Keeler
- Milton Keynes University Hospitals NHS Foundation Trust, Milton Keynes, UK
| | - O Ng
- Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - A Kumar
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - M J Brookes
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - A G Acheson
- National Institute for Health Research Biomedical Research Centre in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
52
|
Lees JG, White D, Keating BA, Barkl-Luke ME, Makker PGS, Goldstein D, Moalem-Taylor G. Oxaliplatin-induced haematological toxicity and splenomegaly in mice. PLoS One 2020; 15:e0238164. [PMID: 32877416 PMCID: PMC7467301 DOI: 10.1371/journal.pone.0238164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Haematological toxicities occur in patients receiving oxaliplatin. Mild anaemia (grade 1-2) is a common side effect and approximately 90% of recipients develop measurable spleen enlargement. Although generally asymptomatic, oxaliplatin-induced splenomegaly is independently associated with complications following liver resection for colorectal liver metastasis and separately with poorer patient outcomes. Here, we investigated oxaliplatin-induced haematological toxicities and splenomegaly in mice treated with escalating dosages comparable to those prescribed to colorectal cancer patients. METHODS Blood was analysed, and smears assessed using Wright-Giemsa staining. Paw coloration was quantified as a marker of anaemia. Spleen weight and morphology were assessed for abnormalities relating to splenomegaly and a flow cytometry and multiplex cytokine array assessment was performed on splenocytes. The liver was assessed for sinusoidal obstructive syndrome. RESULTS Blood analysis showed dose dependent decreases in white and red blood cell counts, and significant changes in haematological indices. Front and hind paws exhibited dose dependent and dramatic discoloration indicative of anaemia. Spleen weight was significantly increased indicating splenomegaly, and red pulp tissue exhibited substantial dysplasia. Cytokines and chemokines within the spleen were significantly affected with temporal upregulation of IL-6, IL-1α and G-CSF and downregulation of IL-1β, IL-12p40, MIP-1β, IL-2 and RANTES. Flow cytometric analysis demonstrated alterations in splenocyte populations, including a significant reduction in CD45+ cells. Histological staining of the liver showed no evidence of sinusoidal obstructive syndrome but there were signs suggestive of extramedullary haematopoiesis. CONCLUSION Chronic oxaliplatin treatment dose dependently induced haematological toxicity and splenomegaly characterised by numerous physiological and morphological changes, which occurred independently of sinusoidal obstructive syndrome.
Collapse
Affiliation(s)
- Justin G. Lees
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
- * E-mail: (GM-T); (JGL)
| | - Daniel White
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Brooke A. Keating
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Mallory E. Barkl-Luke
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Preet G. S. Makker
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - David Goldstein
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Gila Moalem-Taylor
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
- * E-mail: (GM-T); (JGL)
| |
Collapse
|
53
|
Rodrigues D, Simões J, Teixeira L, Aires F, Fernandes C, Rey C, Sarmento C, Marques M. Baseline anaemia increases locally advanced rectal cancer mortality in older patients undergoing preoperative chemoradiation. Support Care Cancer 2020; 29:1403-1411. [PMID: 32666216 DOI: 10.1007/s00520-020-05618-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/07/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE The median diagnosis age of rectal cancer (RC) is 70 years old. The standard of care for locally advanced RC (LARC) is preoperative chemoradiation (CRT) followed by surgery. Anaemia is a frequent condition in older patients but is not a pure consequence of ageing. METHODS The patients aged 65 years or over, with clinical stage II/III LARC, and treated with preoperative concurrent CRT were retrospectively reviewed. Baseline haemoglobin (Hb) levels were collected. RESULTS One hundred and seven patients enrolled in this study, but 17 were excluded in relation with treatment disruption. Fifty-seven (63.3%) males and 33 (36.7%) females completed preoperative CRT whose median age at diagnosis was 73. Twenty-five (27.8%) patients presented with anaemia at rectal cancer diagnosis, and median Hb was 13.5 g/dL (IQR = 1.45) and 11.2 g/dL (IQR = 1.35), for non-anaemic and anaemic patients, respectively. For the enrolled older population, only 2 patients reported acute grade 3 toxicity. Baseline anaemia tended to decrease the LARC-free interval and was associated with a significantly higher hazard of all-cause and LARC mortality, approximately 5 times (HR = 5.25; 95% CI 1.48-18.66) and 10 times (HR = 10.09; 95% CI 2.40-42.48), respectively. Patients older than 75 presented a significantly negative impact on overall survival (OS) and LARC-specific survival (HR = 6.20, 95% CI 2.00-19.22; and HR = 7.61, 95% CI 2.08-27.87, respectively). Conversely, no significant impact was found for age-adjusted Charlson comorbidity index on OS, LARC-specific survival and LARC-free interval. CONCLUSIONS Overall and LARC-specific survival were significantly lower for the baseline anaemic older patients and for those aged 75 years or over.
Collapse
Affiliation(s)
- Darlene Rodrigues
- Department of Radiotherapy, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal.
| | - Joana Simões
- Department of Medical Oncology, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal
| | - Laetitia Teixeira
- Departamento de Estudo de Populações, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal.,CINTESIS, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Rua de Jorge Viterbo Ferreira, n° 228, 4050-313, Porto, Portugal.,EPIUnit Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600, Porto, Portugal
| | - Fátima Aires
- Department of Radiotherapy, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal
| | - Catarina Fernandes
- Department of Medical Oncology, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal
| | - Cármen Rey
- Department of Medical Oncology, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal
| | - Cristina Sarmento
- Department of Medical Oncology, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal
| | - Margarida Marques
- Department of Radiotherapy, Centro Hospitalar Universitário de São João, E.P.E., 4200-319, Porto, Portugal
| |
Collapse
|
54
|
Tehori O, Livovsky DM, Goldin E, Koslowsky B. The severity of anemia does not correlate with the risk of gastrointestinal cancer in subsequent evaluation. Scand J Gastroenterol 2020; 55:819-823. [PMID: 32568557 DOI: 10.1080/00365521.2020.1779804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Iron deficiency anemia (IDA) is a risk factor for gastrointestinal (GI) malignancies. Little is known regarding the correlation between the depth of anemia and the risk for GI malignancy. The aim of this study was to test the hypothesis that very low hemoglobin levels pose an additional risk compared to low hemoglobin levels.Methods: Patients 40-70 years old, presenting to the ER with IDA during years 2016-2017 were retrospectively analyzed. Comparison was performed between two groups, one with a very low hemoglobin level (below 8 g/dL) and the other a low hemoglobin level (between 8-10 g/dL).Results: 1020 patients were analyzed, and 107 fulfilled the inclusion criteria. Seventy-five patients (70%) were in the very low hemoglobin group and 21 patients (19.6%) were diagnosed with a new GI malignancy. Mean age was 56, 49 (45%) were females, and 68 (63%) underwent esophagogastroduodenoscopy (EGD) or/and colonoscopy during the index hospitalization. The median hemoglobin and MCV were 7.3 G/dL, and 73 fL, respectively. New malignancies were found in 15/75 (20%) and 6/32 (19%) of patients with very low and low hemoglobin levels, respectively (p = .88). GI malignancies were more commonly found in females compared to males, 14 (29%) vs. 7 (12%), p = .032, respectively. The right colon was the most common site for malignancy. Active GI bleeding was not a risk factor for GI malignancy.Conclusions: Very low hemoglobin levels and overt GI bleeding do not pose an additional risk factor for GI malignancy, compared to low hemoglobin levels and no overt GI bleeding.
Collapse
Affiliation(s)
- Omer Tehori
- Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University Medical School, Jerusalem, Israel
| | - Dan M Livovsky
- Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University Medical School, Jerusalem, Israel
| | - Eran Goldin
- Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University Medical School, Jerusalem, Israel
| | - Benjamin Koslowsky
- Shaare-Zedek Medical Center, Digestive Diseases Institute, Hebrew University Medical School, Jerusalem, Israel
| |
Collapse
|
55
|
Borsetto D, Polesel J, Tirelli G, Menegaldo A, Baggio V, Gava A, Nankivell P, Pracy P, Fussey J, Boscolo-Rizzo P. Pretreatment High MCV as Adverse Prognostic Marker in Nonanemic Patients with Head and Neck Cancer. Laryngoscope 2020; 131:E836-E845. [PMID: 32589769 DOI: 10.1002/lary.28882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/12/2020] [Accepted: 05/30/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Mean corpuscular volume (MCV) has been shown in to be a reliable prognostic marker in other cancers; however, no evidence exists on its use in head and neck squamous cell carcinoma (HNSCC). This study aimed to investigate the association between MCV, hemoglobin, platelet count and albumin concentration, and survival in stage III/IVA-B HNSCC treated with concurrent chemoradiotherapy. STUDY DESIGN Retrospective cohort study. METHODS In this multicenter retrospective study, we analyzed MCV, platelet count, hemoglobin concentration, and albumin concentration in peripheral blood samples from 260 patients with HNSCC undergoing organ preservation treatment with curative intent at the time of diagnosis. We then analyzed survival outcomes after accounting for confounders using multivariate analysis. RESULTS After adjustment for potential confounders, patients with low hemoglobin had a 3.3-fold higher risk of death (95% confidence interval [CI]: 2.26-4.81) than those with normal hemoglobin. Patients with an elevated MCV had a 1.54-fold higher risk of death (95% CI: 1.06-2.24), independent of site, stage, and human papillomavirus status. Interestingly, the effect of MCV on overall and progression-free survival was limited to those with a normal pretreatment hemoglobin. We identified no associations between pretreatment platelet count or albumin concentration and survival. CONCLUSION These findings suggest that pretreatment anemia and macrocytosis are independent predictors of lower overall and progression-free survival in HNSCC patients undergoing organ preservation treatment. LEVEL OF EVIDENCE III Laryngoscope, 131:E836-E843, 2021.
Collapse
Affiliation(s)
- Daniele Borsetto
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Anna Menegaldo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Vittorio Baggio
- Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy
| | - Alessandro Gava
- Department of Radiation Oncology, Treviso Regional Hospital, Treviso, Italy
| | - Paul Nankivell
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK.,Institue of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Paul Pracy
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Jonathan Fussey
- Department of ENT/Head and Neck Surgery, Queen Elizabeth University Hospital Birmingham, Birmingham, UK
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| |
Collapse
|
56
|
Sirniö P, Väyrynen JP, Mutt SJ, Herzig KH, Walkowiak J, Klintrup K, Mäkelä J, Karttunen TJ, Mäkinen MJ, Tuomisto A. Systemic inflammation is associated with circulating cell death released keratin 18 fragments in colorectal cancer. Oncoimmunology 2020; 9:1783046. [PMID: 32923147 PMCID: PMC7458668 DOI: 10.1080/2162402x.2020.1783046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Systemic inflammation is a stage-independent marker of poor prognosis in colorectal cancer (CRC), activated in a complex, multifactorial process. It has been proposed that one of the main factors driving systemic inflammation may be tumor necrosis. Keratin 18 (KRT18) fragments are released from dead cells and their serum levels are markers for apoptotic and necrotic cell death. In CRC, high KRT18 levels associate with advanced disease, but their relationship with tumor necrosis and systemic inflammation is unknown. In this study, serum total soluble KRT18 (tKRT18) and apoptosis-related, caspase-cleaved fragment (aKRT18) levels were measured preoperatively from 328 CRC patients, and their difference was calculated to assess necrosis related KRT18 (nKRT18) levels. The relationships of these markers with tumor necrosis, clinicopathologic features, systemic inflammation markers (C-reactive protein, albumin, and 13 cytokines), and survival were analyzed. High serum tKRT18, aKRT18, and nKRT18 levels showed association with a higher extent of tumor necrosis, distant metastasis, and increased levels of several markers of systemic inflammation, including CXCL8. High serum tKRT18 (multivariable HR 1.94, 95% CI 1.28-2.95, p = .002) and nKRT18 (multivariable HR 1.87, 95% CI 1.24-2.82, p = .003) levels were associated with poor overall survival independent of potential confounding factors. Our results show that tumor necrosis in CRC contributes to serum levels of KRT18 fragments, and both necrosis and KRT18 levels associate with systemic inflammation. Moreover, we show that serum tKRT18 and nKRT18 levels have independent prognostic value in CRC. Our observations confirm the link between cell death and systemic inflammation.
Collapse
Affiliation(s)
- Päivi Sirniö
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90014, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland
| | - Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90014, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shivaprakash J Mutt
- Research Unit of Biomedicine and Biocenter Oulu, Department of Physiology, University of Oulu, Oulu 90014, Finland
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine and Biocenter Oulu, Department of Physiology, University of Oulu, Oulu 90014, Finland.,Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Jaroslaw Walkowiak
- Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, Poznan, Poland
| | - Kai Klintrup
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland.,Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, Oulu, Finland
| | - Jyrki Mäkelä
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland.,Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, Oulu, Finland
| | - Tuomo J Karttunen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90014, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90014, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland
| | - Anne Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90014, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90029, Finland
| |
Collapse
|
57
|
McSorley ST, Anderson JH, Whittle T, Roxburgh CS, Horgan PG, McMillan DC, Steele CW. The impact of preoperative systemic inflammation on the efficacy of intravenous iron infusion to correct anaemia prior to surgery for colorectal cancer. Perioper Med (Lond) 2020; 9:17. [PMID: 32537137 PMCID: PMC7288411 DOI: 10.1186/s13741-020-00146-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/01/2020] [Indexed: 02/06/2023] Open
Abstract
Aim Intravenous iron is increasingly used prior to surgery for colorectal cancer (CRC) to correct iron deficiency anaemia and reduce blood transfusion. Its utility in functional iron deficiency (FID) or anaemia of inflammation is less clear. This observational study examined post-iron infusion changes in haemoglobin (Hb) based on grouping by C-reactive protein (CRP) and ferritin. Methods Anaemic (M:Hb < 130 mg/L, F:Hb < 120 mg/L) patients with CRC receiving iron infusion, within a preoperative anaemia detection and correction protocol, at a single centre between 2016 and 2019 were included. Patients were grouped by iron deficiency (ferritin < 30 μg/L and CRP ≤ 5 mg/L, n = 18), FID (ferritin < 30 μg/L and CRP > 5 mg/L, n = 17), anaemia of inflammation (ferritin ≥ 30 μg/L and CRP > 5 mg/L, n = 6), and anaemia of other causes (ferritin ≥ 30 μg/L and CRP ≤ 5 mg/L, n = 6). Median change in Hb and postoperative day (POD) 1 Hb was compared by Kruskal-Wallis test. Results Iron-deficient patients had the greatest increase in Hb after infusion (24 mg/L), highest POD 1 Hb (108 mg/L), and required no blood transfusions. Patients with FID had the second greatest increase in Hb (15 mg/L) and second highest POD 1 Hb (103 mg/L). Those with anaemia of inflammation had little increase in Hb after infusion (3 mg/L) and lower POD 1 Hb (102 mg/L) than either iron-deficient group. Those without iron deficiency showed a decrease in haemoglobin after infusion (- 5 mg/L) and lowest POD 1 Hb (95 mg/L). Conclusions Preoperative intravenous iron is less efficacious in patients with anaemia of inflammation and FID undergoing surgery for CRC, compared with true iron deficiency. Further understanding of the role of perioperative iron infusions is required for maximum gain from therapy.
Collapse
Affiliation(s)
- Stephen T McSorley
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| | - John H Anderson
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| | - Thomas Whittle
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| | - Campbell S Roxburgh
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| | - Paul G Horgan
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| | - Donald C McMillan
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| | - Colin W Steele
- School of Medicine and Dentistry, University Department of Surgery, Academic Unit of Surgery, Glasgow Royal Infirmary, University of Glasgow, Level 2, New Lister Building, Alexandra Parade, Glasgow, G4 0SF UK
| |
Collapse
|
58
|
Platelet and hemoglobin count at diagnosis are associated with survival in African American and Caucasian patients with colorectal cancer. Cancer Epidemiol 2020; 67:101746. [PMID: 32521488 DOI: 10.1016/j.canep.2020.101746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND African Americans (AAs) compared to Caucasian Americans (CAs) with colorectal cancer (CRC) have lower stage-specific survival. CRC patients often present with several hematopathologies (such as thrombocytosis, thrombocytopenia, anemia) at diagnosis, which is associated with poorer survival. However, whether these measures impact the racial disparity in survival is not known. METHODS The study population was composed of 581 histologically confirmed CRCs at the Medical University of South Carolina (393 CA, 188 AA) diagnosed between 01/01/2000 and 06/30/2013. We used Cox proportional hazards regression to estimate the association between thrombocytosis, thrombocytopenia, or anemia at diagnosis and risk of death by race. This analysis was adjusted for age, sex, stage and first-line treatment. RESULTS In all patients combined, thrombocytosis, thrombocytopenia, and anemia (vs. the normal ranges) were associated with significantly higher risks of death. In the race-specific analyses, AAs (HR 2.51 [95 % CI: 1.52-4.15]) vs. CAs (HR 1.15 [95 % CI: 0.75-1.75]) with thrombocytosis compared to normal had a higher risk of death (p for difference = 0.03). CONCLUSIONS Abnormal thrombocyte and hemoglobin levels at diagnosis were associated with poorer survival. AAs compared to CAs with elevated platelets at diagnosis had a higher risk of death. Our study is the first to examine the role of race, hematologic measures at diagnosis, and risk of death in colorectal cancer patients. These results suggest that the racial differences in the immune response may contribute to the racial disparity in survival.
Collapse
|
59
|
Li Y, Wu H, Xing C, Hu X, Zhang F, Peng Y, Li Z, Lu T. Prognostic evaluation of colorectal cancer using three new comprehensive indexes related to infection, anemia and coagulation derived from peripheral blood. J Cancer 2020; 11:3834-3845. [PMID: 32328188 PMCID: PMC7171501 DOI: 10.7150/jca.42409] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Many indicators of peripheral blood in routine blood test (BRT) results of colorectal cancer (CRC) patients are related to prognosis. Currently, indexes such as NLR (Neutrophil-to- Lymphocyte Ratio), PLR (Platelet-to-Lymphocyte Ratio) and LMR (Lymphocyte-to-Monocyte ratio) evaluate the survival risk of patients by assessing the inflammatory - immune status of CRCs. These indexes are more comprehensive and accurate than independent estimates. We hope to design more effective indexes through fully considering the correlation and significance between BRT indicators and prognosis, so as to play a guiding role in clinical malignant estimation of CRCs. Methods: 701 CRCs in training set and 256 CRCs in test set were included in the study samples, and their clinical data, tumor pathology results and peripheral blood routine results were collected. The prognosis, progression, and survival status of all patients were determined after follow-up. Above data were used for statistical analysis and designing new indexes. Results: It was found that high NE, MONO, RDW-CV/SD and PLT in peripheral blood indicated poor prognosis of DFS and OS. Conversely, CRCs with postoperative tumor progression or death had lower LY, EO, RBC, HGB, HCT, MCV, MCH, MCHC, PDW, and P-LCR. IRR, ARR and CRR related to infection, anemia and coagulation were designed respectively using the largest AUC indicators (P<0.05) selected by ROC curve. The formula: IRR= (NE*MONO)/(LY*EO); ARR= (HGB*MCHC)/RDW-CV; CRR=PLT/PDW. Results of Kaplan‑Meier survival analysis and multivariate COX proportional hazard analysis adjusted for age, gender, TNM stage, infiltration, adhesion showed IRR, ARR, CRR were all able to be used as the evaluation standard of survival of CRC. The result was also authenticated in the test set. Conclusion: We designed three different prognostic indexes of colorectal cancer, IRR, ARR and CRR, which could be used as risk indicators of CRC prognosis, tumor progression and survival.
Collapse
Affiliation(s)
- Yalun Li
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Huizhe Wu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Chengzhong Xing
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Xiaoyun Hu
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, Liaoning, China
| | - Fangxiao Zhang
- Department of Intensive Care Unit, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yangjie Peng
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Zeyu Li
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| | - Tingting Lu
- Department of Anorectal Surgery, First Affiliated Hospital of China Medical University , Shenyang, Liaoning, China
| |
Collapse
|
60
|
FIT negative cancers: A right-sided problem? Implications for screening and whether iron deficiency anaemia has a role to play. Surgeon 2020; 19:27-32. [PMID: 32199773 DOI: 10.1016/j.surge.2020.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/18/2020] [Accepted: 02/21/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Faecal Immunohistochemistry Testing (FIT) is recommended as an adjunct to guide referrals from Primary Care for individuals without rectal bleeding, who do not meet the suspected cancer pathway referral guidelines. It has largely replaced Faecal Occult Blood Testing. AIMS To assess the specificity of FIT. To understand the characteristics of FIT negative cancer patients and whether they have predominantly right sided cancers. Evaluating the efficacy of FIT and Iron deficiency anaemia in combination to capture patients with colorectal cancers. METHODS A study of 1000 symptomatic patients, undergoing FIT by Clinicians during the 'Digital rectal examination'. Inclusion criteria; all patients referred via our cancer referral pathway. FIT positivity was set at 10 μg g of faeces. RESULTS There were 7 FIT negative cancers in this cohort; 1 was a lymphoma and the other 6 were caecal adenocarcinomas. 5 were anaemic. The positive predictive value of IDA was 34% compared with 'other symptoms'; 18%. The negative predictive value of FIT was 99.05% in this cohort. Specificity for FIT was 86.9% (CI 96%). CONCLUSION Two separate referral pathways for IDA and FIT positive tests, would have captured all patients except 2; the lymphoma and 1 advanced caecal adenocarcinoma. FIT is an excellent triage tool prior to colonoscopy however capturing right sided disease remains a weak point. Multivariate analysis of patients in addition to IDA and FIT should improve capture of this subgroup.
Collapse
|
61
|
Aro R, Mäkäräinen-Uhlbäck E, Ämmälä N, Rautio T, Ohtonen P, Saarnio J, Meriläinen S. The impact of sarcopenia and myosteatosis on postoperative outcomes and 5-year survival in curatively operated colorectal cancer patients - A retrospective register study. Eur J Surg Oncol 2020; 46:1656-1662. [PMID: 32224072 DOI: 10.1016/j.ejso.2020.03.206] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/23/2020] [Accepted: 03/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate whether sarcopenia or myosteatosis have an impact on short- and long-term results in patients who were surgically treated for colorectal cancer. METHODS During 2007-2011 curatively treated colorectal cancer patients (n = 348) were included in the study. Clinical data was collected retrospectively from patient registers. Skeletal muscle mass was measured at the L3 level via venous-phase computed tomography and patients were divided into sarcopenic and non-sarcopenic and into myosteatotic and non-myosteatotic. Postoperative morbidity and mortality were analysed in these groups. RESULTS Sarcopenia was found in 208 patients (59.8%) and myosteatosis was found in 108 patients (31.2%). Sarcopenia was associated with increased risk of postoperative pneumonia (6.7% vs. 1.4%, p = 0.021). Sarcopenic colon cancer patients had higher rate of cardiorespiratory complications than non-sarcopenic (6.3% vs. 0.0%, p = 0.023) and sarcopenic rectum cancer patients had more often pneumonia than non-sarcopenic (8.5% vs. 0.0%, p = 0.041). Discharge to home was less common in myosteatotic patients than in non-myosteatotic patients (47.7% vs. 76.9%, p < 0.001) and also in sarcopenic patients than in non-sarcopenic patients (62.7% vs. 75.5%, p = 0.013). Myosteatotic patients had decreased overall survival according to a Kaplan-Meier analysis (p = 0.002) and in the multivariable-adjusted Cox model (HR = 1.6, p = 0.034). CONCLUSIONS Sarcopenia increases the pneumonia and cardiorespiratory complication rates. Sarcopenia and myosteatosis predicts the need for institutional care after colorectal cancer surgery. Sarcopenia and myosteatosis seem to be negative factors for colorectal cancer patients' survival. Myosteatosis is an independent risk factor for poor overall 5-year survival.
Collapse
Affiliation(s)
- Raila Aro
- Department of Surgery, Oulu University Hospital, Oulu, Finland; Division of Operative Care and Medical Research Center, Oulu University Hospital and University of Oulu, Finland.
| | - Elisa Mäkäräinen-Uhlbäck
- Department of Surgery, Oulu University Hospital, Oulu, Finland; Division of Operative Care and Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - Noora Ämmälä
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, Oulu University Hospital, Oulu, Finland; Division of Operative Care and Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - Pasi Ohtonen
- Department of Surgery, Oulu University Hospital, Oulu, Finland; Division of Operative Care and Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - Juha Saarnio
- Department of Surgery, Oulu University Hospital, Oulu, Finland; Division of Operative Care and Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| | - Sanna Meriläinen
- Department of Surgery, Oulu University Hospital, Oulu, Finland; Division of Operative Care and Medical Research Center, Oulu University Hospital and University of Oulu, Finland
| |
Collapse
|
62
|
Wu F, Yang S, Tang X, Liu W, Chen H, Gao H. Prognostic value of baseline hemoglobin-to-red blood cell distribution width ratio in small cell lung cancer: A retrospective analysis. Thorac Cancer 2020; 11:888-897. [PMID: 32087605 PMCID: PMC7113058 DOI: 10.1111/1759-7714.13330] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to investigate the prognostic value of baseline hemoglobin‐to‐red blood cell distribution width ratio (HRR) in patients with small cell lung cancer (SCLC). Methods We retrospectively analyzed the medical records of patients with newly diagnosed SCLC who had received first‐line chemotherapy at the Department of Pulmonary Oncology of the PLA 307 Hospital between January 2008 and October 2018. The optimal cutoff value of the continuous variables was determined using the X‐tile software. Univariate and multivariate analyses were conducted using Cox proportional hazard models. The Kaplan‐Meier method was used for survival analysis, with differences tested using the log‐rank test. Results A total of 146 patients were included. The cutoff value for HRR was determined as 0.985. Statistically significant differences were observed in sex, smoking history, stage, radiotherapy combination, neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, hemoglobin, and red blood cell distribution width between the high and low HRR groups. The median overall survival (OS) was nine and 17.5 months in the low and high HRR groups, respectively (P < 0.001). The median progression‐free survival (PFS) was five and 8.5 months, respectively (P < 0.001). Univariate and multivariate analyses showed low HRR to be an independent predictor of a poor prognosis for OS (hazard ratio = 3.782; 95% confidence interval, 2.151–6.652; P < 0.001) and PFS (hazard ratio = 2.112; 95% confidence interval, 1.195–3.733; P = 0.01) in SCLC. Conclusion Low HRR was associated with poorer OS and PFS in patients with SCLC and can be a potentially valuable prognostic factor for these patients. Key points The prognostic value of the baseline hemoglobin‐to‐red blood cell distribution width ratio was evaluated in patients with small cell lung cancer. In this population, this ratio was an independent predictor of overall survival and progression‐free survival. This ratio, an inexpensive and routine parameter, can be used as a prognostic factor in small cell lung cancer.
Collapse
Affiliation(s)
- Fangfang Wu
- PLA 307 Clinical College, Anhui Medical University, Beijing, China.,Department of Pulmonary Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shaoxing Yang
- Department of Pulmonary Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiuhua Tang
- Department of Pulmonary Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wenjing Liu
- Department of Pulmonary Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Haoran Chen
- Department of Pulmonary Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongjun Gao
- PLA 307 Clinical College, Anhui Medical University, Beijing, China.,Department of Pulmonary Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
63
|
Darbà J, Marsà A. Results after 10 years of colorectal cancer screenings in Spain: Hospital incidence and in-hospital mortality (2011-2016). PLoS One 2020; 15:e0228795. [PMID: 32040530 PMCID: PMC7010253 DOI: 10.1371/journal.pone.0228795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background Colorectal cancer incidence in Spain increased considerably between the early nineties and 2010. To reverse this tendency, screenings were progressively implemented starting the year 2001, targeting the population aged 50 to 69 years. Objectives This study aimed to update colorectal cancer incidence and mortality trends in Spain and provide a detailed analysis of disease management and risk factors involved in in-hospital mortality. Methods To this aim, anonymised primary and specialised care admission records from 2011 to 2016 were extracted from a Spanish claims database representative of all Spanish regions. Results Primary care files from 37,317 patients and specialised care files from 192,048 patients were obtained, in which males represented the 56.17% and 60.70% of patients respectively. In-hospital mortality rate was 10.07% and remained stable during the study period, similarly to colorectal cancer incidence within the hospitalised population, which was 106 per 10,000 patients. Patients deceased during the hospitalisation presented an increased presence of metastatic tumours. Mean length of hospital stay decreased significantly over the study period from 13.43 days to 11.67 days (p<0.001), similarly to patients’ 30-day readmission rate, which registered a decrease from the 15.29% to 13.58% (p<0.001). In consequence, the direct medical cost measured per patient, of €10,992, decreased over time. The implementation of colorectal cancer screening programmes caused a significant decrease in the number of new diagnoses in patients aged 75 to 79 years that may be attributable to the implementation of colorectal cancer screening programmes; however, in-hospital mortality was not reduced. Metastatic tumours and other conditions as anaemia are associated with higher in-hospital mortality rates.
Collapse
Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
- * E-mail:
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
| |
Collapse
|
64
|
Wen-Pei C, Hsiu-Ju J. Changes in fatigue in rectal cancer patients before and after therapy: a systematic review and meta-analysis. Support Care Cancer 2020; 28:2513-2522. [PMID: 32002618 DOI: 10.1007/s00520-020-05325-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatigue is a common problem among rectal cancer patients and can affect their quality of life. This study conducted a systematic review to better understand changes in fatigue severity in rectal cancer patients before, during, and after they undergo therapy. METHODS We used preset keywords to search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and ProQuest databases for relevant studies published between 2000 and 2018, and data analysis was performed using Comprehensive Meta-Analysis (CMA) software (version 2.2.048) and SPSS software (version 19.0). In total, nine articles with complete data were included in our meta-analysis. RESULTS Fatigue conditions were compared before the start of therapy (baseline) and at 1 month (time 1), 3 months (time 2), 6 months (time 3), and 12 months (time 4) after the start of therapy. The standardized mean differences (SMDs) of the pooling effects size were 1.013 (95% confidence interval (CI) 0.217-1.810), - 0.551 (95% CI - 0.647 to - 0.456), - 0.330 (95% CI - 0.427 to - 0.233), and - 0.149 (95% CI - 0.221 to - 0.078), respectively. Subsequent analysis with a linear mixed effect model revealed that the estimate of the time variable was - 0.226 (p = 0.047), which indicates that the severity of fatigue varies over time and over the course of treatment. The results reveal that fatigue affects rectal cancer patients even before they start therapy. CONCLUSION Although fatigue worsened during the first month after cancer therapy, it gradually improved thereafter.
Collapse
Affiliation(s)
- Chang Wen-Pei
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. .,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Jen Hsiu-Ju
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
| |
Collapse
|
65
|
Stage-Specific Sensitivity of Fecal Immunochemical Tests for Detecting Colorectal Cancer: Systematic Review and Meta-Analysis. Am J Gastroenterol 2020; 115:56-69. [PMID: 31850933 PMCID: PMC6946106 DOI: 10.14309/ajg.0000000000000465] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Fecal immunochemical tests (FITs) detect the majority of colorectal cancers (CRCs), but evidence for variation in sensitivity according to the CRC stage is sparse and has not yet been systematically synthesized. Thus, our objective was to systematically review and summarize evidence on the stage-specific sensitivity of FITs. METHODS We screened PubMed, Web of Science, Embase, and the Cochrane Library from inception to June 14, 2019, for English-language articles reporting on the stage-specific sensitivity of FIT for CRC detection using colonoscopy as a reference standard. Studies reporting stage-specific sensitivities and the specificity of FIT for CRC detection were included. Summary estimates of sensitivity according to the CRC stage and study setting (screening cohorts, symptomatic/diagnostic cohorts, and case-control studies) were derived from bivariate meta-analysis. RESULTS Forty-four studies (92,447 participants including 3,034 CRC cases) were included. Pooled stage-specific sensitivities were overall very similar but suffered from high levels of imprecision because of small case numbers when calculated separately for screening cohorts, symptomatic/diagnostic cohorts, and case-control studies. Pooled sensitivities (95% confidence intervals) for all studies combined were 73% (65%-79%) for stage-I-CRCs and 80% (74%-84%), 82% (77%-87%), and 79% (70%-86%) for the detection of CRC stages II, III, and IV, respectively. Even substantially larger variation was seen in sensitivity by T-stage, with summary estimates ranging from 40% (21%-64%) for T1 to 83% (68%-91%) for T3-CRC. DISCUSSION Although FITs detect 4 of 5 CRCs at stages II-IV, the substantially lower sensitivity for stage-I-CRC and, in particular, T1 CRC indicates both need and potential for further improvement in performance for the early detection of CRC.
Collapse
|
66
|
Tuomisto AE, Mäkinen MJ, Väyrynen JP. Systemic inflammation in colorectal cancer: Underlying factors, effects, and prognostic significance. World J Gastroenterol 2019; 25:4383-4404. [PMID: 31496619 PMCID: PMC6710177 DOI: 10.3748/wjg.v25.i31.4383] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/07/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
Systemic inflammation is a marker of poor prognosis preoperatively present in around 20%-40% of colorectal cancer patients. The hallmarks of systemic inflammation include an increased production of proinflammatory cytokines and acute phase proteins that enter the circulation. While the low-level systemic inflammation is often clinically silent, its consequences are many and may ultimately lead to chronic cancer-associated wasting, cachexia. In this review, we discuss the pathogenesis of cancer-related systemic inflammation, explore the role of systemic inflammation in promoting cancer growth, escaping antitumor defense, and shifting metabolic pathways, and how these changes are related to less favorable outcome.
Collapse
Affiliation(s)
- Anne E Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90220, Finland
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90220, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90220, Finland
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90220, Finland
| | - Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, Oulu 90220, Finland
- Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, Oulu 90220, Finland
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02115, United States
| |
Collapse
|
67
|
Mizuno H, Yuasa N, Takeuchi E, Miyake H, Nagai H, Yoshioka Y, Miyata K. Blood cell markers that can predict the long-term outcomes of patients with colorectal cancer. PLoS One 2019; 14:e0220579. [PMID: 31369651 PMCID: PMC6675058 DOI: 10.1371/journal.pone.0220579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022] Open
Abstract
Objectives To identify blood cell markers that predict the long-term outcomes of patients with colorectal cancer. Methods Data from 892 stage II and III colorectal cancer patients who underwent R0 resection were included. We analyzed the correlations of the preoperative blood data, previously reported prognostic indices, and clinicopathologic factors with the long-term outcomes, such as relapse-free survival and overall survival, using univariate and multivariate analyses. Results Multivariate analysis showed that tumor location, stage, mean corpuscular volume, neutrophil-to-lymphocyte ratio, and lymphocyte-to- monocyte ratio were significantly correlated with relapse-free survival. A mean corpuscular volume ≥80.5 fL, neutrophil-to-lymphocyte ratio ≥5.5, and lymphocyte-to- monocyte ratio <3.4 had hazard ratios for disease relapse between 1.39 and 1.93. The cumulative scores of these three factors were aggregated into a laboratory prognostic score, with a maximum score at 6. The relapse-free survival and overall survival were well stratified by a laboratory prognostic score between 0–3 and 4–6, respectively, independent of the stage. Conclusion The mean corpuscular volume, neutrophil-to-lymphocyte ratio, and lymphocyte-to- monocyte ratio can serve as blood cell markers to predict the long-term outcomes of patients who underwent R0 resection for stage II/III colorectal cancer.
Collapse
Affiliation(s)
- Hironori Mizuno
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
- * E-mail:
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
| | - Eiji Takeuchi
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
| | - Kanji Miyata
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan
| |
Collapse
|
68
|
Serum enterolactone concentrations are low in colon but not in rectal cancer patients. Sci Rep 2019; 9:11209. [PMID: 31371751 PMCID: PMC6671944 DOI: 10.1038/s41598-019-47622-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 07/22/2019] [Indexed: 11/08/2022] Open
Abstract
The dietary lignan metabolite, enterolactone, has been suggested to have anti-cancer functions, and high serum enterolactone concentrations have been associated with decreased risk of breast and prostate cancers. We hypothesized that serum enterolactone concentrations as a marker of plant-based foods are associated with decreased risk in colorectal cancer (CRC). We measured serum enterolactone glucuronide and sulfate concentrations by liquid chromatography-tandem mass spectrometry in 115 CRC patients and 76 sex- and age-matched controls and analyzed the results with respect to tumor parameters, clinical parameters, and systemic inflammatory markers. Patients with colon cancer had significant lower serum enterolactone glucuronide and sulfate concentrations than controls (glucuronide: median 3.14 nM vs. 6.32 nM, P < 0.001; sulfate: median 0.13 nM vs. 0.17 nM, P = 0.002), whereas rectal cancer patients had similar enterolactone levels as controls (glucuronide: median 5.39 nM vs. 6.32 nM, P = 0.357; sulfate: median 0.19 nM vs. 0.17 nM, P = 0.452). High serum enterolactone concentrations were associated with low tumor grade, high serum creatinine levels, and concomitant diabetes. In summary, our results suggest that serum enterolactone concentrations are decreased in colon but not in rectal cancer. Further investigations are required to assess whether this reflects an altered lignan metabolism by the colon microbiome.
Collapse
|
69
|
Meng S, Jian Z, Yan X, Li J, Zhang R. LncRNA SNHG6 inhibits cell proliferation and metastasis by targeting ETS1 via the PI3K/AKT/mTOR pathway in colorectal cancer. Mol Med Rep 2019; 20:2541-2548. [PMID: 31322251 PMCID: PMC6691244 DOI: 10.3892/mmr.2019.10510] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 12/28/2018] [Indexed: 02/07/2023] Open
Abstract
The term ‘long non-coding RNAs’ (lncRNAs) refers to all non-protein coding transcripts >200 nucleotides in length. Dysregulation of lncRNAs has been identified in colorectal cancer, which is one of the more serious types of cancer worldwide, third place in the mortality rates, and is associated with poor prognoses. Novel evidence suggests that lncRNAs serve an important role in regulating the development and progression of colorectal cancer. In the present study, it was demonstrated that SNHG6 expression was downregulated in colorectal cancer tissues by reverse transcription quantitative polymerase chain reaction assays; however, ETS1 expression levels were upregulated. Overexpression of SNHG6 not only inhibited the proliferation of colon cancer cells in vitro by inducing apoptosis, but also inhibited cell proliferation, invasion and migration. The overexpression of SNHG6 inhibited colon cell viability and proliferation by targeting ETS1 through the phosphoinositide 3-kinase/protein kinase B/mechanistic target of rapamycin signaling pathway. These results suggested that SNHG6 may directly suppress ETS1, which may be one of potential mechanisms through which it inhibits the viability and proliferation of colorectal cancer cells, and it provides novel insight into the carcinogenesis of colorectal cancer. In addition, it may assist in the development of a treatment approach for ETS1-activated colorectal cancer.
Collapse
Affiliation(s)
- Su Meng
- Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Zhao Jian
- Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Xiaofei Yan
- Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Jibin Li
- Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Rui Zhang
- Department of Medical Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| |
Collapse
|
70
|
Väyrynen JP, Väyrynen SA, Sirniö P, Minkkinen I, Klintrup K, Karhu T, Mäkelä J, Herzig KH, Karttunen TJ, Tuomisto A, Mäkinen MJ. Platelet count, aspirin use, and characteristics of host inflammatory responses in colorectal cancer. J Transl Med 2019; 17:199. [PMID: 31196200 PMCID: PMC6567577 DOI: 10.1186/s12967-019-1950-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/05/2019] [Indexed: 02/08/2023] Open
Abstract
Background Platelets not only contribute to hemostasis but also to the regulation of inflammatory reactions and cancer pathogenesis. We hypothesized that blood platelet count would be associated with systemic inflammation, the densities of tumor infiltrating immune cells, and survival in colorectal cancer (CRC), and these relationships could be altered by aspirin use. Methods We measured blood platelet count in a cohort of 356 CRC patients and analyzed its relationships with tumor and patient characteristics including aspirin use, markers of systemic inflammation (modified Glasgow Prognostic Score, mGPS; serum levels of CRP, albumin, and 13 cytokines), blood hemoglobin levels, five types of tumor infiltrating immune cells (CD3, CD8, FoxP3, Neutrophil elastase, mast cell tryptase), and survival. Results Platelet count inversely correlated with blood hemoglobin levels (p < 0.001) and positively correlated with serum levels of CRP and multiple cytokines including IL-1RA, IL-4, IL-6, IL-7, IL-8, IL-12, IFNγ, and PDGF-BB (p < 0.001 for all), while aspirin use was not associated with the levels of systemic inflammatory markers. High platelet count was also associated with high mGPS (p < 0.001) but did not show statistically significant multivariable adjusted associations with the densities of tumor infiltrating immune cells. Higher platelet counts were observed in higher tumor stage (p < 0.001), but platelet count or aspirin use were not associated with patient survival. Conclusions High platelet count is associated with systemic inflammation in CRC. This study could not demonstrate statistically significant associations between platelet count, aspirin use, and the densities of tumor infiltrating immune cells. Electronic supplementary material The online version of this article (10.1186/s12967-019-1950-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland. .,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland. .,Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Sara A Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Päivi Sirniö
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Ilkka Minkkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Kai Klintrup
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Surgery, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Toni Karhu
- Research Unit of Biomedicine and Biocenter of Oulu, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Jyrki Mäkelä
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Surgery, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Karl-Heinz Herzig
- Research Unit of Biomedicine and Biocenter of Oulu, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572, Poznan, Poland
| | - Tuomo J Karttunen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Anne Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Pathology, Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| |
Collapse
|
71
|
Kwon HY, Kim BR, Kim YW. Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. ACTA ACUST UNITED AC 2019; 26:e357-e366. [PMID: 31285680 DOI: 10.3747/co.26.4983] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background We investigated whether preoperative anemia and perioperative blood transfusion (pbt) are associated with overall survival and recurrence-free survival in patients with nonmetastatic colorectal cancer. Methods From 1 January 2009 to 31 December 2014, 1003 patients with primary colorectal cancer were enrolled in the study. Perioperative clinical and oncologic outcomes were analyzed based on the presence of preoperative anemia and pbt. Results Preoperative anemia was found in 468 patients (46.7%). In the anemia and no-anemia groups, pbt was performed in 44% and 15% of patients respectively. Independent predictors for pbt were preoperative anemia, higher American Society of Anesthesiologists score, laparotomy, lengthy operative time, advanced TNM stage, T4 stage, and 30-day morbidity. The use of pbt, but not preoperative anemia, was found to be an independent adverse prognostic factor for overall survival. In terms of recurrence-free survival, the presence of preoperative anemia was similarly not a significant prognostic factor, but the use of pbt was an independent factor for an unfavourable prognosis. Conclusions The use of pbt, but not preoperative anemia, was independently associated with worse overall and recurrence-free survival in nonmetastatic colorectal cancer. For better oncologic outcomes, our findings indicate a need to reduce the use of blood transfusion during the perioperative period.
Collapse
Affiliation(s)
- H Y Kwon
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| | - B R Kim
- Health Promotion Center, Wonju Severance Christian Hospital, Wonju, R.O.K.,Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| | - Y W Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, R.O.K.,Big Data Research Group, Yonsei University Wonju College of Medicine, Wonju, R.O.K
| |
Collapse
|
72
|
McSorley ST, Tham A, Jones I, Talwar D, McMillan DC. Regression Correction Equation to Adjust Serum Iron and Ferritin Concentrations Based on C-Reactive Protein and Albumin in Patients Receiving Primary and Secondary Care. J Nutr 2019; 149:877-883. [PMID: 31050746 DOI: 10.1093/jn/nxz008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/11/2018] [Accepted: 01/17/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Systemic inflammation, even at low levels, can greatly interfere with measures of iron status, making diagnosis of iron deficiency difficult. The objective of the present study was to create linear regression correction equations to adjust serum ferritin and iron concentrations based on measurements of the acute-phase proteins C-reactive protein (CRP) and albumin. METHODS Data from a cohort (1) of patients (n = 7226) in primary and secondary care who had serum ferritin, iron, CRP, and albumin measured at the same time point were examined. Linear regression coefficients were calculated for CRP and albumin with serum iron and ferritin as the outcome variables. Patients with ferritin <15 µg/L or serum iron <10 µmol/L were categorized as iron deficient. The equation was then applied to a cohort (2) of patients with colorectal cancer who had ferritin and iron measured preoperatively ( n = 356). RESULTS In cohort 1 there was a significant difference in the proportions of patients with serum ferritin <15 µg/L and serum iron <10 µmol/L, respectively, when the unadjusted (7% and 55%), adjusted based on CRP alone (13% and 26%), adjusted based on albumin alone (11% and 37%), and adjusted based on both CRP and albumin (24% and 15%) values were compared (both P < 0.001). In cohort 2 there was a significant difference in the proportions of patients with serum ferritin <15 µg/L and serum iron <10 µmol/L, respectively, when the unadjusted (28% and 66%), adjusted based on CRP alone (39% and 57%), adjusted based on albumin alone (39% and 59%), and adjusted based on both CRP and albumin (46% and 44%) values were compared (P < 0.001 and P < 0.004). CONCLUSIONS In both cohorts the greatest increase in the proportion of patients meeting definitions of iron deficiency was found when adjustment was made for both CRP and albumin together. Even low levels of inflammation had a significant effect on serum iron and ferritin values.
Collapse
Affiliation(s)
- Stephen T McSorley
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Alexander Tham
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| | - Iain Jones
- The Scottish Trace Elements and Micronutrients Reference Laboratory, Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, UK
| | - Dinesh Talwar
- The Scottish Trace Elements and Micronutrients Reference Laboratory, Department of Clinical Biochemistry, Glasgow Royal Infirmary, Glasgow, UK
| | - Donald C McMillan
- Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow, UK
| |
Collapse
|
73
|
Normocytic anaemia is associated with systemic inflammation and poorer survival in patients with colorectal cancer treated with curative intent. Int J Colorectal Dis 2019; 34:401-408. [PMID: 30515556 DOI: 10.1007/s00384-018-3211-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The present study aimed to characterise the prevalence and prognostic impact of normocytic anaemia in patients undergoing curative treatment for colorectal cancer. METHODS All individuals invited to the first round of bowel cancer screening, diagnosed with colorectal cancer and treated with curative intent from April 2009 to March 2011 in a single health board were included. The modified Glasgow prognostic score (mGPS) was used to quantify preoperative systemic inflammation. Patients were grouped as having microcytic anaemia (Hb < 130 mg/L males, < 120 mg/L females and MCV < 80 fL), normocytic anaemia (Hb < 130 mg/L males, < 120 mg/L females and MCV 80-100 fL), or neither. RESULTS Of 395,097 patients invited to screening during the study period, 872 were diagnosed with colorectal cancer. Seven hundred seventy-seven patients had FBC measured at diagnosis, of which 78 (10%) had microcytic anaemia, and 180 (23%) normocytic anaemia. On multivariate binary logistic regression, microcytic anaemia was associated with T stage (OR 1.92, 95% CI 1.26-2.91, p = 0.002) and mGPS (OR 1.57, 95% CI 1.10-2.24, p = 0.013), while normocytic anaemia was associated with colonic tumours (OR = 2.51, 95% CI 1.10-4.01, p = 0.025), T stage (OR 1.38, 95% CI 1.05-1.81, p = 0.022), and mGPS (OR 1.52, 95% CI 1.12-2.05, p = 0.007). On univariate Cox regression, there was no significant association between microcytic anaemia and cancer specific survival (CSS) (p = 0.969). Normocytic anaemia was significantly associated with poorer CSS (HR 1.55, 95% CI 1.13-2.12, p = 0.007). CONCLUSIONS Normocytic anaemia was associated with systemic inflammation and poorer CSS. Inflammation may drive both anaemia and disease recurrence in these patients, and targeting this process may improve both.
Collapse
|
74
|
Zhang Y, Li M, Gao H, Wang B, Tongcheng X, Gao B, Yu L(L. Triacylglycerol, fatty acid, and phytochemical profiles in a new red sorghum variety (Ji Liang No. 1) and its antioxidant and anti-inflammatory properties. Food Sci Nutr 2019; 7:949-958. [PMID: 30918637 PMCID: PMC6418436 DOI: 10.1002/fsn3.886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/10/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
In this study, a new red sorghum variety (Ji Liang No. 1) was investigated for its triacylglycerol (TAG) and fatty acid profiles, carotenoid and tocopherol compositions, total phenolic, total flavonoid and phenolic acid contents, and antioxidant and anti-inflammatory properties. A total of 17 TAGs were identified in the red sorghum oil. Linoleic and oleic acids were the primary fatty acids, contributing more than 80% of the total fatty acids. β-Carotene was the primary carotenoid at a level of 26.14 μg/g. α-, γ-, and δ-tocopherols were at levels of 0.19, 4.08, and 0.10 μg/g, respectively. Moreover, acetone-water (60:40, v/v) extract of the red sorghum exhibited the greatest total phenolic content of 2.77 mg GAE/g and total flavonoid content of 5.44 mg RE/g. The extract had scavenging capacities against DPPH, ABTS +, and peroxyl radicals and suppressed LPS stimulated IL-1β, IL-6, and COX-2 mRNA expressions in a dose-dependent manner. Ferulic, p-coumaric, isoferulic, and p-hydroxybenzoic acids were found in the red sorghum, with ferulic acid as the predominant phenolic acid and mostly in an insoluble bound form. These data indicated a potential utilization of the red sorghum in health-promoting functional food or supplemental products.
Collapse
Affiliation(s)
- Yaqiong Zhang
- Beijing Advanced Innovation Center for Food Nutrition and Human HealthBeijing Technology& Business University (BTBU)BeijingChina
- Institute of Food and Nutraceutical ScienceSchool of Agriculture and BiologyShanghai Jiao Tong UniversityShanghaiChina
| | - Ming Li
- Institute of Food and Nutraceutical ScienceSchool of Agriculture and BiologyShanghai Jiao Tong UniversityShanghaiChina
| | - Hang Gao
- Institute of Food and Nutraceutical ScienceSchool of Agriculture and BiologyShanghai Jiao Tong UniversityShanghaiChina
| | - Bo Wang
- Institute of Food and Nutraceutical ScienceSchool of Agriculture and BiologyShanghai Jiao Tong UniversityShanghaiChina
| | - Xu Tongcheng
- Institute of Agro‐Food Science and TechnologyShandong Provincial Key Laboratory of Agricultural Products Deep ProcessingShandong Academy of Agricultural ScienceJinanChina
| | - Boyan Gao
- Institute of Food and Nutraceutical ScienceSchool of Agriculture and BiologyShanghai Jiao Tong UniversityShanghaiChina
| | - Liangli (Lucy) Yu
- Department of Nutrition and Food ScienceUniversity of MarylandCollege ParkMaryland
| |
Collapse
|
75
|
Quantitative data on red cell measures of iron status and their relation to the magnitude of the systemic inflammatory response and survival in patients with colorectal cancer. Eur J Surg Oncol 2019; 45:1205-1211. [PMID: 30850153 DOI: 10.1016/j.ejso.2019.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/01/2019] [Accepted: 02/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Inflammation is recognised to be associated with perturbation of serum measures of iron status. However, the impact of colorectal cancer associated host inflammation on red cell measures of iron status has not been previously quantified. METHODS Patients undergoing elective surgery with curative intent, for colorectal cancer, at a single centre between 2008 and 2017 were included (n = 824). Blood samples taken for C-reactive protein (CRP), albumin, and full blood count (FBC) allowed patients to be grouped by modified Glasgow Prognostic Score (mGPS), and anaemia subtype (haemoglobin (Hb) M < 130 mg/L and F < 120 mg/L, with microcytic anaemia being mean corpuscular volume (MCV) < 80 f/L, and normocytic anaemia with MCV 80-100 f/L). Relationships between these groupings and red cell measures iron status including Hb, MCV, mean corpuscular haemoglobin (MCH) and red cell distribution width (RDW) were examined. RESULTS The combination of increasing T stage and increasing mGPS was associated with lower Hb, lower MCV, lower MCH, higher RDW, and higher prevalence of both microcytic and normocytic anaemia (all p < 0.001). The combination of CRP >10 mg/L and albumin <35 g/L was associated with lower Hb, lower MCV, lower MCH, higher RDW, and higher prevalence of both microcytic and normocytic anaemia (all p < 0.010). At multivariate Cox regression only Hb remained significantly associated with cancer specific (HR 0.98, 95% CI 0.97-0.99, p < 0.001), and overall survival (HR 0.98, 95% CI 0.97-0.99, p = 0.001). CONCLUSIONS The presence of a host systemic inflammatory response to colorectal cancer was associated with significant perturbation of red cell measure of iron status.
Collapse
|
76
|
Tokunaga R, Nakagawa S, Miyamoto Y, Ohuchi M, Izumi D, Kosumi K, Taki K, Higashi T, Miyata T, Yoshida N, Baba H. The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer. Colorectal Dis 2019; 21:100-109. [PMID: 30230148 DOI: 10.1111/codi.14425] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/13/2018] [Indexed: 12/15/2022]
Abstract
AIM Preoperative anaemia is associated with adverse outcomes in colorectal cancer (CRC). To clarify the reason for this we aimed to comprehensively assess the association of preoperative anaemia with tumour characteristics, host systemic inflammation and nutrition status, and perioperative blood transfusion. METHOD We used an integrated database of 592 CRC patients. The association of preoperative anaemic subtype, calculated from haemoglobin and erythrocyte mean corpuscular volume levels, with patient outcome, preoperative serum data relating to systemic inflammation and nutrition and perioperative blood transfusion was analysed. RESULTS Preoperative anaemia was significantly associated with poorer overall survival and relapse-free survival (RFS); in particular microcytic anaemia had a trend to poorer RFS than other forms of anaemia (P = 0.0648). In addition, preoperative anaemia was significantly correlated with right-sided tumours, greater depth of tumour invasion, use of neoadjuvant chemotherapy, poorer prognostic nutritional index and higher modified Glasgow Prognostic Score (mGPS). Microcytic anaemia in particular had a strong association with a greater depth of tumour invasion (P = 0.0072) and higher mGPS (P = 0.0058) than other causes of anaemia. Perioperative blood transfusion for CRC patients with anaemia was associated with adverse outcomes. CONCLUSIONS Preoperative anaemia, especially microcytic anaemia, was associated with poor patient outcomes, possibly due to poor systemic inflammatory and nutritional status, and it was not improved by perioperative blood transfusion. Our data suggest that preoperative anaemia and the anaemic subtype may serve as an easily available predictor of outcome in CRC.
Collapse
Affiliation(s)
- R Tokunaga
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - S Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Y Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - M Ohuchi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - D Izumi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - K Kosumi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - K Taki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - T Higashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - T Miyata
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - N Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
77
|
Sirniö P, Väyrynen JP, Klintrup K, Mäkelä J, Karhu T, Herzig KH, Minkkinen I, Mäkinen MJ, Karttunen TJ, Tuomisto A. Alterations in serum amino-acid profile in the progression of colorectal cancer: associations with systemic inflammation, tumour stage and patient survival. Br J Cancer 2018; 120:238-246. [PMID: 30563990 PMCID: PMC6342921 DOI: 10.1038/s41416-018-0357-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/15/2018] [Accepted: 11/22/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cancer cachexia is a complex wasting syndrome affecting patients with advanced cancer, with systemic inflammation as a key component in pathogenesis. Protein degradation and release of amino acids (AAs) in skeletal muscle are stimulated in cachexia. Here, we define factors contributing to serum AA levels in colorectal cancer (CRC). METHODS Serum levels of nine AAs were characterised in 336 CRC patients and their relationships with 20 markers of systemic inflammatory reaction, clinicopathological features of cancers and patient survival were analysed. RESULTS Low serum glutamine and histidine levels and high phenylalanine levels associated with indicators of systemic inflammation, including high modified Glasgow Prognostic Score, high blood neutrophil/lymphocyte ratio and high serum levels of CRP, IL-6 and IL-8. Low levels of serum glutamine, histidine, alanine and high glycine levels also associated with advanced cancer stage and with poor cancer-specific survival in univariate analysis. CONCLUSIONS In CRC, serum AA levels are associated with systemic inflammation and disease stage. These findings may reflect muscle catabolism induced by systemic inflammation in CRC.
Collapse
Affiliation(s)
- Päivi Sirniö
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Kai Klintrup
- Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Jyrki Mäkelä
- Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Toni Karhu
- Department of Physiology, Research Unit of Biomedicine and Biocenter Oulu, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Karl-Heinz Herzig
- Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Department of Physiology, Research Unit of Biomedicine and Biocenter Oulu, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572, Poznan, Poland
| | - Ilkka Minkkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Tuomo J Karttunen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Anne Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland. .,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.
| |
Collapse
|
78
|
Sirniö P, Tuomisto A, Tervahartiala T, Sorsa T, Klintrup K, Karhu T, Herzig KH, Mäkelä J, Karttunen TJ, Salo T, Mäkinen MJ, Väyrynen JP. High-serum MMP-8 levels are associated with decreased survival and systemic inflammation in colorectal cancer. Br J Cancer 2018; 119:213-219. [PMID: 29808017 PMCID: PMC6048114 DOI: 10.1038/s41416-018-0136-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 12/20/2022] Open
Abstract
Background Matrix metalloproteinase-8 (MMP-8) is a protease mainly expressed by neutrophils that cleaves numerous substrates, including collagens and cytokines. We have previously shown that serum MMP-8 levels increase in colorectal cancer (CRC) and correlate with distant metastasis. However, short follow-up in our prospective cohort did not enable survival analyses at the time of the first publication. Methods Preoperative serum MMP-8 levels were measured by immunofluorometric assay in 271 CRC patients and related to clinicopathological parameters, markers of systemic inflammation (modified Glasgow Prognostic Score, mGPS; serum levels of C-reactive protein (CRP), albumin and 13 cytokines), the density of six types of tumour-infiltrating immune cells and survival. Results Increased MMP-8 levels associated with higher mGPS and higher serum levels of CRP and several cytokines, including IL-1ra, IL-7 and IL-8 (p < 0.001 for all). Serum MMP-8 negatively correlated with tumour-infiltrating mast cells (invasive margin: p = 0.005, tumour centre: p = 0.010). The patients with high-serum MMP-8 levels (>100 ng/mL) had poor cancer-specific survival, independent of tumour stage, grade, lymphatic invasion, patient age, BRAF VE1 immunohistochemistry, mismatch repair deficiency, Immunoscore and mGPS (multivariate HR 2.12, 95% CI 1.21–3.71, p = 0.009). Conclusions High-serum MMP-8 levels are associated with systemic inflammation and adverse outcome in CRC.
Collapse
Affiliation(s)
- Päivi Sirniö
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Anne Tuomisto
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland
| | - Kai Klintrup
- Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Toni Karhu
- Research Unit of Biomedicine and Biocenter Oulu, Department of Physiology, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Karl-Heinz Herzig
- Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Research Unit of Biomedicine and Biocenter Oulu, Department of Physiology, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Gastroenterology and Metabolism, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572, Poznan, Poland
| | - Jyrki Mäkelä
- Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Tuomo J Karttunen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Tuula Salo
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Haartmaninkatu 8, POB 63, 00014, Helsinki, Finland.,Helsinki University Hospital, 00014, Helsinki, Finland
| | - Markus J Mäkinen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland.,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland
| | - Juha P Väyrynen
- Cancer and Translational Medicine Research Unit, University of Oulu, POB 5000, 90014, Oulu, Finland. .,Oulu University Hospital and Medical Research Center Oulu, POB 21, 90029, Oulu, Finland.
| |
Collapse
|