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Han SZ, Wang R, Wen KM. Delayed diagnosis of ascending colon mucinous adenocarcinoma with local abscess as primary manifestation: Report of three cases. World J Clin Cases 2021; 9:7901-7908. [PMID: 34621844 PMCID: PMC8462249 DOI: 10.12998/wjcc.v9.i26.7901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal mucinous adenocarcinoma is a distinct subtype of colorectal adenocarcinoma that is not sensitive to chemotherapy and radiotherapy, and its prognosis is worse than that of nonmucinous adenocarcinoma. Early diagnosis and aggressive surgical treatment may be the key to improving the prognosis of patients. Ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess caused by non-intestinal perforation has never been reported. Moreover, since the lumen of the ascending colon is large, and early stage ascending colon cancer lacks typical clinical manifestations, the diagnosis may be delayed easily. We herein report three cases of delayed diagnosis of colorectal mucinous adenocarcinoma.
CASE SUMMARY We present three patients (two females and one male) with mucinous ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess (the right area of the lumbar spine, right groin, and lower right abdomen) caused by non-intestinal perforation. At the initial clinical visit, the common causes of those abscesses, including spinal tuberculosis and urinary tract infection, were excluded. The treatment of the abscess was through an incision and drainage. However, the source of the abscess was not made clear, which led to an abscess recurrence and a delayed diagnosis of colorectal mucinous adenocarcinoma. After the patients were referred to our hospital, a definitive diagnosis of ascending colon mucinous adenocarcinoma was made with the help of tumor markers and colonoscopic findings. Because of the delayed diagnosis of the disease, two patients (case 1 and case 2) missed the chance of surgery due to disease progression and died in a short follow-up period. Only case 3 underwent radical surgery for the tumor in the right colon and partial abdominal wall resection and achieved a better prognosis.
CONCLUSION Abscesses in the right area of the lumbar spine, right groin, or right lower quadrant caused by non-intestinal perforation as the primary clinical manifestation of ascending colon mucinous adenocarcinoma are extremely rare. Mucinous adenocarcinoma of the ascending colon may be one of the causes of such abscesses. Performing colonoscopy as soon as possible is of great significance in the diagnosis and treatment of the disease.
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Affiliation(s)
- Shang-Zhi Han
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Rong Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Kun-Ming Wen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Chen Y, Hou W, Zhong M, Wu B. Comprehensive Proteomic Analysis of Colon Cancer Tissue Revealed the Reason for the Worse Prognosis of Right-Sided Colon Cancer and Mucinous Colon Cancer at the Protein Level. Curr Oncol 2021; 28:3554-3572. [PMID: 34590603 PMCID: PMC8482240 DOI: 10.3390/curroncol28050305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022] Open
Abstract
To clarify the molecular mechanisms underlying the poor prognosis of right-sided and mucinous colon cancer at the proteomic level. A tandem mass tag-proteomics approach was used to identify differentially expressed proteins (DEPs) in colon carcinoma tissues from different locations and with different histological types to reveal the underlying mechanisms of these differences at the protein level. In additional, the DEPs were analyzed using bioinformatics methods. The proteomics profiles among colon cancers with different tumor locations and histological types were dramatically distinguished. In terms of tumor locations, the right-sided carcinoma specific DEPs may promote the tumor progression via activating inflammation, metastasis associated pathways. When referring to histological types, the mucinous colon cancers perhaps increased the invasion and metastasis through distinct mechanisms in different tumor locations. For mucinous cancer located in right-sided colon, the mucinous specific DEPs were mainly associated with ECM-related remodeling and the IL-17 signal pathway. For mucinous cancer located in left-sided colon, the mucinous specific DEPs showed a strong relationship with ACE2/Ang-(1–7)/MasR axis. The proteomics profiles of colon cancers showed distinct differences related to locations and histological types. These results suggested a distinct mechanism underlying the diverse subtypes of colon cancers.
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Affiliation(s)
- Yanyu Chen
- State Key Laboratory of Medical Molecular Biology & Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing 100730, China;
| | - Wenyun Hou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (W.H.); (M.Z.)
| | - Miner Zhong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (W.H.); (M.Z.)
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (W.H.); (M.Z.)
- Correspondence: ; Tel.: +86-010-69156470
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Zaborowski AM, Abdile A, Adamina M, Aigner F, d'Allens L, Allmer C, Álvarez A, Anula R, Andric M, Atallah S, Bach S, Bala M, Barussaud M, Bausys A, Bebington B, Beggs A, Bellolio F, Bennett MR, Berdinskikh A, Bevan V, Biondo S, Bislenghi G, Bludau M, Boutall A, Brouwer N, Brown C, Bruns C, Buchanan DD, Buchwald P, Burger JWA, Burlov N, Campanelli M, Capdepont M, Carvello M, Chew HH, Christoforidis D, Clark D, Climent M, Cologne KG, Contreras T, Croner R, Daniels IR, Dapri G, Davies J, Delrio P, Denost Q, Deutsch M, Dias A, D'Hoore A, Drozdov E, Duek D, Dunlop M, Dziki A, Edmundson A, Efetov S, El-Hussuna A, Elliot B, Emile S, Espin E, Evans M, Faes S, Faiz O, Fleming F, Foppa C, Fowler G, Frasson M, Figueiredo N, Forgan T, Frizelle F, Gadaev S, Gellona J, Glyn T, Gong J, Goran B, Greenwood E, Guren MG, Guillon S, Gutlic I, Hahnloser D, Hampel H, Hanly A, Hasegawa H, Iversen LH, Hill A, Hill J, Hoch J, Hoffmeister M, Hompes R, Hurtado L, Iaquinandi F, Imbrasaite U, Islam R, Jafari MD, Kanemitsu Y, Karachun A, Karimuddin AA, Keller DS, Kelly J, Kennelly R, Khrykov G, Kocian P, Koh C, Kok N, Knight KA, Knol J, Kontovounisios C, Korner H, Krivokapic Z, Kronberger I, Kroon HM, Kryzauskas M, Kural S, Kusters M, Lakkis Z, Lankov T, Larson D, Lázár G, Lee KY, Lee SH, Lefèvre JH, Lepisto A, Lieu C, Loi L, Lynch C, Maillou-Martinaud H, Maroli A, Martin S, Martling A, Matzel KE, Mayol J, McDermott F, Meurette G, Millan M, Mitteregger M, Moiseenko A, Monson JRT, Morarasu S, Moritani K, Möslein G, Munini M, Nahas C, Nahas S, Negoi I, Novikova A, Ocares M, Okabayashi K, Olkina A, Oñate-Ocaña L, Otero J, Ozen C, Pace U, São Julião GP, Panaiotti L, Panis Y, Papamichael D, Park J, Patel S, Patrón Uriburu JC, Pera M, Perez RO, Petrov A, Pfeffer F, Phang PT, Poskus T, Pringle H, Proud D, Raguz I, Rama N, Rasheed S, Raval MJ, Rega D, Reissfelder C, Reyes Meneses JC, Ris F, Riss S, Rodriguez-Zentner H, Roxburgh CS, Saklani A, Salido AJ, Sammour T, Saraste D, Schneider M, Seishima R, Sekulic A, Seppala T, Sheahan K, Shine R, Shlomina A, Sica GS, Singnomklao T, Siragusa L, Smart N, Solis A, Spinelli A, Staiger RD, Stamos MJ, Steele S, Sunderland M, Tan KK, Tanis PJ, Tekkis P, Teklay B, Tengku S, Jiménez-Toscano M, Tsarkov P, Turina M, Ulrich A, Vailati BB, van Harten M, Verhoef C, Warrier S, Wexner S, de Wilt H, Weinberg BA, Wells C, Wolthuis A, Xynos E, You N, Zakharenko A, Zeballos J, Winter DC. Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surg 2021; 156:865-874. [PMID: 34190968 DOI: 10.1001/jamasurg.2021.2380] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Observations Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. Conclusions and Relevance The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.
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Affiliation(s)
| | - Ahmed Abdile
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Michel Adamina
- Department of Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Felix Aigner
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Laura d'Allens
- Department of Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Caterina Allmer
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Andrea Álvarez
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Rocio Anula
- Department of Surgery, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - Mihailo Andric
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Sam Atallah
- Department of Colorectal Surgery, AdventHealth, Orlando, Florida
| | - Simon Bach
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Miklosh Bala
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marie Barussaud
- Department of Surgery, University Hospital Poitiers, Poitiers, France
| | - Augustinas Bausys
- Department of Surgery, National Cancer Institute, Vilnius, Lithuania
| | - Brendan Bebington
- Department of Surgery, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
| | - Andrew Beggs
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Felipe Bellolio
- Department of Digestive Surgery, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | - Anton Berdinskikh
- Department of Surgery, St-Petersburg Clinical Scientific and Practical Centre, St Petersburg, Russia
| | - Vicki Bevan
- Department of Surgery, Morriston Hospital, Swansea, Wales, United Kingdom
| | - Sebastiano Biondo
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain
| | | | - Marc Bludau
- Department of Surgery, University Hospital Cologne, Cologne, Germany
| | - Adam Boutall
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Nelleke Brouwer
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl Brown
- Department of Surgery, St Paul's Hospital, the University of British Columbia, Vancouver, British Columbia, Canada
| | - Christiane Bruns
- Department of Surgery, University Hospital Cologne, Cologne, Germany
| | - Daniel D Buchanan
- Department of Clinical Pathology, the University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | | | - Nikita Burlov
- Department of Surgery, Leningrad Regional Clinical Oncology Dispensary, Leningrad, Russia
| | | | - Maylis Capdepont
- Department of Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Michele Carvello
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hwee-Hoon Chew
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | | | - David Clark
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Marta Climent
- Department of Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Kyle G Cologne
- Department of Surgery, Keck Hospital, University of Southern California, Los Angeles
| | - Tomas Contreras
- Department of Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Roland Croner
- Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Ian R Daniels
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Giovanni Dapri
- Department of Surgery, St-Pierre University Hospital, Brussels, Belgium
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Paolo Delrio
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, Italy
| | - Quentin Denost
- Department of Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Michael Deutsch
- Department of Surgery, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Andre Dias
- Department of Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | | | - Evgeniy Drozdov
- Department of Surgery, Siberian State Medical University, Tomsk, Russia
| | - Daniel Duek
- Department of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Malcolm Dunlop
- Department of Surgery, Western General Hospital, Edinburgh, United Kingdom
| | - Adam Dziki
- Department of Surgery, Military Medical Academy University Teaching Hospital, Łódź, Poland
| | - Aleksandra Edmundson
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sergey Efetov
- Department of Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alaa El-Hussuna
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Brodie Elliot
- Department of Surgery, Whangarei Hospital, Whangarei, New Zealand
| | - Sameh Emile
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Eloy Espin
- Colorectal Surgery Unit, General Surgery Service, Hospital Vall de Hebron, Barcelona, Spain
| | - Martyn Evans
- Department of Surgery, Morriston Hospital, Swansea, Wales, United Kingdom
| | - Seraina Faes
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Omar Faiz
- Department of Surgery, St Mark's Hospital, London, United Kingdom
| | - Fergal Fleming
- Department of Surgery, University of Rochester, New York
| | - Caterina Foppa
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - George Fowler
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Matteo Frasson
- Department of Surgery, University Hospital La Fe, Valencia, Spain
| | - Nuno Figueiredo
- Department of Surgery, Champalimaud Clinical Centre, Lisbon, Portugal
| | - Tim Forgan
- Department of Surgery, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Frank Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Shamil Gadaev
- Fourth Coloproctology Department, St Petersburg Oncology Center, St Petersburg, Russia
| | - Jose Gellona
- Department of Colorectal Surgery, Clínica Santa María, Santiago, Chile
- Department of Colorectal Surgery, Hospital Militar de Santiago, Le Reina, Chile
| | - Tamara Glyn
- Department of Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Jianping Gong
- Department of Surgery, Tongji Hospital, Wuhan, China
| | - Barisic Goran
- Department of Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Emma Greenwood
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Stephanie Guillon
- Department of Surgery, Bordeaux University Hospital, Bordeaux, France
| | - Ida Gutlic
- Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - Dieter Hahnloser
- Department of Visceral Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Heather Hampel
- Division of Human Genetics, The Ohio State University Comprehensive Cancer Center, Columbus
| | - Ann Hanly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Hirotoshi Hasegawa
- Department of Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | | | - Andrew Hill
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - James Hill
- Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jiri Hoch
- Department of Surgery, Motol University Hospital, Prague, Czech Republic
| | | | - Roel Hompes
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Luis Hurtado
- Department of Surgery, University Hospital La Fe, Valencia, Spain
| | | | | | - Rumana Islam
- Department of Surgery, Austin Hospital, Melbourne, Australia
| | | | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Aleksei Karachun
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Ahmer A Karimuddin
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento
| | - Justin Kelly
- Advent Health Colorectal Surgery, Orlando, Florida
| | - Rory Kennelly
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Gleb Khrykov
- Department of Surgery, Leningrad Regional Clinical Oncology Dispensary, Leningrad, Russia
| | - Peter Kocian
- Department of Surgery, Motol University Hospital, Prague, Czech Republic
| | - Cherry Koh
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neils Kok
- Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Joep Knol
- Department of Surgery, Ziekenhuis Oost-Limburg, Belgium
| | | | - Hartwig Korner
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Zoran Krivokapic
- Department of Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Hidde Maarten Kroon
- Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Said Kural
- School of Medicine, Uludag University, Bursa, Turkey
| | - Miranda Kusters
- Department of Surgery, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Zaher Lakkis
- Department of Surgery, University Hospital Besançon, Besançon, France
| | - Timur Lankov
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Dave Larson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - Kai-Yin Lee
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Suk Hwan Lee
- Kyung Here University Hospital at Gangdong, Seoul, South Korea
| | - Jérémie H Lefèvre
- Sorbonne Université, Department of Digestive Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Paris, France
| | - Anna Lepisto
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Christopher Lieu
- Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora
| | - Lynette Loi
- University of Glasgow, Glasgow, United Kingdom
| | - Craig Lynch
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | | | - Annalisa Maroli
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sean Martin
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Anna Martling
- Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Klaus E Matzel
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Julio Mayol
- Department of Surgery, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - Frank McDermott
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | | | - Monica Millan
- Department of Surgery, La Fe University Hospital, Valencia, Spain
| | - Martin Mitteregger
- Department of Surgery, Barmherzige Brüder Krankenhaus Graz, Graz, Austria
| | - Andrei Moiseenko
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - John R T Monson
- AdventHealth Medical Group Colorectal Surgery, AdventHealth, Orlando, Florida
| | - Stefan Morarasu
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Gabriela Möslein
- Department for Hereditary Tumors, Evangelisches Krankenhaus Bethesda, Duisburg, Germany
| | - Martino Munini
- Department of Surgery, Lugano Regional Hospital, Lugano, Switzerland
| | - Caio Nahas
- Department of Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Sergio Nahas
- Department of Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Anastasia Novikova
- Department of Surgery, Pavlov First St Petersburg State Medical University's Clinic, St Petersburg, Russia
| | - Misael Ocares
- Department of Surgery, University Hospital Concepción, Concepción, Chile
| | | | - Alexandra Olkina
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Luis Oñate-Ocaña
- Department of Surgery, National Cancer Institute, Mexico City, Mexico
| | - Jaime Otero
- Department of Surgery, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Hospital Clínico San Carlos, Madrid, Spain
| | - Cihan Ozen
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Ugo Pace
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, Italy
| | | | - Lidiia Panaiotti
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Yves Panis
- Department of Surgery, Beaujon Hospital, Paris, France
| | | | - Jason Park
- Department of Surgery, St Boniface General Hospital, Winnipeg, Manitoba, Canada
| | - Swati Patel
- Department of Gastroenterology, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Miguel Pera
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - Rodrigo O Perez
- Colorectal Surgery Division, Angelita and Joaquim Gama Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Alexei Petrov
- Surgical Department of Abdominal Oncology, N. N. Petrov National Medical Research Centre of Oncology, St Petersburg, Russia
| | - Frank Pfeffer
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - P Terry Phang
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tomas Poskus
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Heather Pringle
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - David Proud
- Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Ivana Raguz
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nuno Rama
- Department of Surgery, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Shahnawaz Rasheed
- Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Manoj J Raval
- Department of Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Daniela Rega
- Colorectal Surgical Oncology, Abdominal Oncology Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale" IRCSS, Naples, Italy
| | | | | | - Frederic Ris
- Department of Surgery, University Hospital Geneva, Geneva, Switzerland
| | - Stefan Riss
- Department of Surgery, Medical University Vienna, Vienna, Austria
| | | | - Campbell S Roxburgh
- Glasgow Royal Infirmary, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | | | - Tarik Sammour
- Department of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, Australia
| | - Deborah Saraste
- Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
| | - Martin Schneider
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ryo Seishima
- Department of Surgery, Keio University, Tokyo, Japan
| | | | - Toni Seppala
- Department of Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Kieran Sheahan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Rebecca Shine
- Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Alexandra Shlomina
- Department of Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | | | - Neil Smart
- Department of Surgery, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Alejandro Solis
- Colorectal Surgery Unit, General Surgery Service, Hospital Vall de Hebron, Barcelona, Spain
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roxane D Staiger
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Scott Steele
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Ker-Kan Tan
- Department of Surgery, School of Medicine, National University of Singapore, Singapore, Singapore
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Paris Tekkis
- Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Biniam Teklay
- Department of Surgery, Åbenrå Hospital, Åbenrå, Denmark
| | | | | | - Petr Tsarkov
- Department of Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Matthias Turina
- Department of Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alexis Ulrich
- Department of Surgery, Lukas Hospital, Neuss, Germany
| | - Bruna B Vailati
- Department of Surgery, Angelita and Joaquim Gama Institute, São Paulo, Brazil
| | - Meike van Harten
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Cornelis Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Satish Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Steve Wexner
- Department of Surgery, Cleveland Clinic Florida, Weston
| | - Hans de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benjamin A Weinberg
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Cameron Wells
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | | | - Evangelos Xynos
- Department of Surgery, Creta Inter-Clinic Hospital, Heraklion, Crete, Greece
| | - Nancy You
- Department of Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Alexander Zakharenko
- Department of Surgery, Pavlov First St Petersburg State Medical University's Clinic, St Petersburg, Russia
| | | | - Des C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
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O'Connell E, Reynolds IS, Salvucci M, McNamara DA, Burke JP, Prehn JHM. Mucinous and non-mucinous colorectal cancers show differential expression of chemotherapy metabolism and resistance genes. THE PHARMACOGENOMICS JOURNAL 2021; 21:510-519. [PMID: 33731881 DOI: 10.1038/s41397-021-00229-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/22/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Abstract
Previous research has identified differences in mutation frequency in genes implicated in chemotherapy resistance between mucinous and non-mucinous colorectal cancers (CRC). We hypothesized that outcomes in mucinous and non-mucinous CRC may be influenced by expression of genes responsible for chemotherapy resistance. Gene expression data from primary tumor samples were extracted from The Cancer Genome Atlas PanCancer Atlas. The distribution of clinical, pathological, and gene expression variables was compared between 74 mucinous and 521 non-mucinous CRCs. Predictors of overall survival (OS) were assessed in a multivariate analysis. Kaplan-Meier curves were constructed to compare survival according to gene expression using the log rank test. The median expression of 5-FU-related genes TYMS, TYMP, and DYPD was significantly higher in mucinous CRC compared to non-mucinous CRC (p < 0.001, p = 0.003, p < 0.001, respectively). The median expression of oxaliplatin-related genes ATP7B and SRPK1 was significantly reduced in mucinous versus non-mucinous CRC (p = 0.004, p = 0.007, respectively). At multivariate analysis, age (odds ratio (OR) = 0.96, p < 0.001), node positive disease (OR = 0.49, p = 0.005), and metastatic disease (OR = 0.32, p < 0.001) remained significant negative predictors of OS, while high SRPK1 remained a significant positive predictor of OS (OR = 1.59, p = 0.037). Subgroup analysis of rectal cancers demonstrated high SRPK1 expression was associated with significantly longer OS compared to low SRPK1 expression (p = 0.011). This study highlights that the molecular differences in mucinous CRC and non-mucinous CRC extend to chemotherapy resistance gene expression. SRPK1 gene expression was associated with OS, with a prognostic role identified in rectal cancers.
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Affiliation(s)
- E O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - I S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - M Salvucci
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - D A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - J H M Prehn
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland. .,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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55
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Bauer F. Imaging and Diagnosis for Planning the Surgical Procedure. COLORECTAL CANCER 2021. [DOI: 10.5772/intechopen.93873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The preoperative imaging diagnosis of rectal cancer lies at the heart of oncological staging and has a crucial influence on patient management and therapy planning. Rectal cancer is common, and accurate preoperative staging of tumors using high-resolution magnetic resonance imaging (MRI) is a crucial part of modern multidisciplinary team management (MDT). Indeed, rectal MRI has the ability to accurately evaluate a number of important findings that maBay impact patient management, including distance of the tumor to the mesorectal fascia, presence of lymph nodes, presence of extramural vascular invasion (EMVI), and involvement of the anterior peritoneal reflection/peritoneum and the sphincter complex. Many of these findings are difficult to assess in non-expert hands. In this chapter, we present currently used staging modalities with focus on MRI, including optimization of imaging techniques, tumor staging, interpretation help as well as essentials for reporting.
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Advances in radiological staging of colorectal cancer. Clin Radiol 2021; 76:879-888. [PMID: 34243943 DOI: 10.1016/j.crad.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
The role of imaging in clinically staging colorectal cancer has grown substantially in the 21st century with more widespread availability of multi-row detector computed tomography (CT), high-resolution magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI), and integrated positron-emission tomography (PET)/CT. In contrast to staging many other cancers, increasing colorectal cancer stage does not highly correlate with survival. As has been the case previously, clinical practice incorporates advances in staging and it is used to guide therapy before adoption into international staging guidelines. Emerging imaging techniques show promise to become part of future staging standards.
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Mucinous Adenocarcinoma Predicts Poor Response and Prognosis in Patients With Locally Advanced Rectal Cancer: A Pooled Analysis of Individual Participant Data From 3 Prospective Studies. Clin Colorectal Cancer 2021; 20:e240-e248. [PMID: 34334298 DOI: 10.1016/j.clcc.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the predictive implications and prognosis of mucinous adenocarcinoma (MAC) in locally advanced rectal cancer (LARC) with intensified neoadjuvant treatment. METHODS Individual patient data of LARC patients from 3 prospective clinical trials was analyzed. Neoadjuvant treatment regimens comprised chemoradiotherapy (CRT) with fluorouracil (5-FU) or mFOLFOX6, neoadjuvant chemotherapy alone with mFOLFOX6 or mFOLFOXIRI. The postoperative pathological result, local recurrence and disease-free survival (DFS) were retrospectively analyzed in patients with MAC and adenocarcinoma (AC) with neoadjuvant treatment. RESULTS Totally, 743 patients were recruited, with 620 patients eligible for analysis. Fifty-three (8.5%) patients were MAC. The pathological complete response (pCR) rate and tumor downstaging rate (ypStage 0-I) between MAC and AC patients was 7.5% vs. 22.0% (P = .01) and 20.8% vs. 48.7% (P < .001), respectively. Among patients receiving preoperative CRT with 5FU or mFOLFOX6, the pCR rate and tumor downstaging rate between MAC and AC patients was 11.1% vs. 27.3% (P = .03) and 23.7% vs. 52.6% (P = .001), respectively. Regarding neoadjuvant chemotherapy alone with mFOLFOX6 or mFOLFOXIRI, the pCR rate and tumor downstaging rate was 0 vs.13.2% (P = .11) and 11.8% vs. 42.5% (P = .03) between MAC and AC group, respectively. With the median follow-up time of 38.9 months, the 3-year DFS and 3-year locoregional recurrence rate was 58.4% vs. 77.6% (P = .02) and 26.0% vs. 5.7% (P = .001) in the MAC and AC group, respectively. MAC (hazard ratio [HR] 1.85, 95% confidence interval [CI], 1.15-2.98), PNI (HR 3.23, 95% CI, 1.85-5.72) and LVI (HR 2.04, 95% CI, 1.02-4.08) were independent prognosis factors and were associated with worse DFS. CONCLUSIONS Patients with MAC of the rectum are associated with a lower pCR rate and tumor downstaging rate, higher incidence of local recurrence, and poorer DFS with neoadjuvant treatment.
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Reynolds IS, O'Connell E, Fichtner M, Blümel A, Mason SE, Kinross J, McNamara DA, Kay EW, O'Connor DP, Das S, Burke JP, Prehn JHM. An Insight Into the Driver Mutations and Molecular Mechanisms Underlying Mucinous Adenocarcinoma of the Rectum. Dis Colon Rectum 2021; 64:677-688. [PMID: 33955407 DOI: 10.1097/dcr.0000000000001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mucinous adenocarcinoma of the rectum accounts for 10% of all rectal cancers and has an impaired response to neoadjuvant chemoradiotherapy and worse overall survival. To date, insufficient genomic research has been performed on this histological subtype. OBJECTIVE This study aims to define the mismatch repair deficiency rate and the driver mutations underpinning mucinous adenocarcinoma of the rectum and to compare it with rectal adenocarcinoma not otherwise specified. DESIGN Immunohistochemistry and sequencing were performed on tumor samples from our tumor biobank. SETTINGS This study was conducted across 2 tertiary referral centers. PATIENTS Patients with mucinous adenocarcinoma and rectal adenocarcinoma not otherwise specified who underwent rectal resection between 2008 and 2018 were included. MAIN OUTCOME MEASURES Mismatch repair status was performed by immunohistochemical staining. Mutations in the panel of oncogenes and tumor suppressor genes were determined by sequencing on the MiSeq V3 platform. RESULTS The study included 33 patients with mucinous adenocarcinoma of the rectum and 100 patients with rectal adenocarcinoma not otherwise specified. Those with mucinous adenocarcinoma had a mismatch repair deficiency rate of 12.1% compared to 2.0% in the adenocarcinoma not otherwise specified cohort (p = 0.04). Mucinous adenocarcinoma and adenocarcinoma not otherwise specified rectal tumors had similar mutation frequencies in most oncogenes and tumor suppressor genes. No difference was found in the KRAS mutation rate (50.0% vs 37.1%, p = 0.29) or BRAF mutation rate (6.7% vs 3.1%, p = 0.34) between the cohorts. No difference was found between the cohorts regarding recurrence-free (p = 0.29) or overall survival (p = 0.14). LIMITATIONS The major limitations of this study were the use of formalin-fixed, paraffin-embedded tissue over fresh-frozen tissue and the small number of patients included, in particular, in the mucinous rectal cohort. CONCLUSIONS Most mucinous rectal tumors develop and progress along the chromosomal instability pathway. Further research in the form of transcriptomics, proteomics, and analysis of the effects of the mucin barrier may yield valuable insights into the mechanisms of resistance to chemoradiotherapy in this cohort. See Video Abstract at http://links.lww.com/DCR/B464. UNA PERCEPCIN SOBRE MUTACIONES IMPULSORAS Y MECANISMOS MOLECULARES SUBYACENTES AL ADENOCARCINOMA MUCINOSO DEL RECTO ANTECEDENTES:El adenocarcinoma mucinoso del recto, representa el 10% de todos los cánceres rectales y tiene una respuesta deficiente a la quimioradioterapia neoadyuvante y una peor supervivencia en general. A la fecha, se han realizado muy pocas investigaciones genómicas sobre este subtipo histológico.OBJETIVO:Definir la tasa de deficiencia en la reparación de desajustes y mutaciones impulsoras, que sustentan el adenocarcinoma mucinoso del recto y compararlo con el adenocarcinoma rectal no especificado de otra manera.DISEÑO:Se realizaron inmunohistoquímica y secuenciación en muestras tumorales de nuestro biobanco de tumores.AJUSTE:El estudio se realizó en dos centros de referencia terciarios.PACIENTES:Se incluyeron pacientes con adenocarcinoma mucinoso y adenocarcinoma no especificado de otra manera, sometidos a resección rectal entre 2008 y 2018.PRINCIPALES MEDIDAS DE RESULTADO:El estado de reparación de desajustes se realizó mediante tinción inmunohistoquímica. Las mutaciones en el panel de oncogenes y genes supresores de tumores, se determinaron mediante secuenciación en la plataforma MiSeq V3.RESULTADOS:El estudio incluyó a 33 pacientes con adenocarcinoma mucinoso del recto y 100 pacientes con adenocarcinoma del recto no especificado de otra manera. Aquellos con adenocarcinoma mucinoso, tenían una tasa de deficiencia de reparación de desajustes del 12,1% en comparación con el 2,0% en la cohorte de adenocarcinoma no especificado de otra manera (p = 0,04). El adenocarcinoma mucinoso y el adenocarcinoma no especificado de otra manera, tuvieron frecuencias de mutación similares en la mayoría de los oncogenes y genes supresores de tumores. No se encontraron diferencias en la tasa de mutación de KRAS (50,0% frente a 37,1%, p = 0,29) o la tasa de mutación de BRAF (6,7% frente a 3,1%, p = 0,34) entre las cohortes. No se encontraron diferencias entre las cohortes con respecto a la supervivencia libre de recurrencia (p = 0,29) o la supervivencia global (p = 0,14).LIMITACIONES:Las mayores limitaciones de este estudio, fueron el uso de tejido embebido en parafina y fijado con formalina, sobre el tejido fresco congelado y el pequeño número de pacientes incluidos, particularmente en la cohorte mucinoso rectal.CONCLUSIONES:La mayoría de los tumores rectales mucinosos se desarrollan y progresan a lo largo de la vía de inestabilidad cromosómica. La investigación adicional en forma transcriptómica, proteómica y análisis de los efectos de la barrera de la mucina, puede proporcionar información valiosa sobre los mecanismos de resistencia a la quimioradioterapia, en esta cohorte. Consulte Video Resumen en http://links.lww.com/DCR/B464.
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Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emer O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Fichtner
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anna Blümel
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sam E Mason
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - James Kinross
- Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine W Kay
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Darran P O'Connor
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sudipto Das
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Jochen H M Prehn
- Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Li Z, Li S, Zang S, Ma X, Chen F, Xia Y, Chen L, Shen F, Lu Y, Lu J. Predicting Treatment Response to Neoadjuvant Chemoradiotherapy in Rectal Mucinous Adenocarcinoma Using an MRI-Based Radiomics Nomogram. Front Oncol 2021; 11:671636. [PMID: 34109121 PMCID: PMC8181148 DOI: 10.3389/fonc.2021.671636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To build and validate an MRI-based radiomics nomogram to predict the therapeutic response to neoadjuvant chemoradiotherapy (nCRT) in rectal mucinous adenocarcinoma (RMAC). Methods Totally, 92 individuals with pathologically confirmed RMAC administered surgical resection upon nCRT in two different centers were assessed retrospectively (training set, n = 52, validation set, n = 40). Rectal MRI was performed pre-nCRT. Radiomics parameters were obtained from high-resolution T2-weighted images and selected to construct a radiomics signature. Then, radiomics nomogram construction integrated patient variables and the radiomics signature. The resulting radiomics nomogram was utilized to assess the tumor regression grade (TRG). Diagnostic performance was determined by generating receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Results Six optimal features related to TRG were obtained to construct a radiomics signature. The nomogram combining the radiomics signature with age and mucin deposit outperformed the radiomics signature alone in the training (AUC, 0.950 vs 0.843, p < 0.05) and validation (AUC, 0.868 vs 0.719, p < 0.05) cohorts. DCA demonstrated a clinical utility for the radiomics nomogram model. Conclusions The established quantitative MRI-based radiomics nomogram is effective in predicting treatment response to neoadjuvant therapy in patients with RMAC.
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Affiliation(s)
- Zhihui Li
- Department of Radiology, RuiJin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuai Li
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Shuqin Zang
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Xiaolu Ma
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Fangying Chen
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Yuwei Xia
- Scientific Research Department, Huiying Medical Technology Co., Ltd, Beijing, China
| | - Liuping Chen
- Department of Radiology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fu Shen
- Department of Radiology, Changhai Hospital, Shanghai, China
| | - Yong Lu
- Department of Radiology, RuiJin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Shanghai, China
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Gu Y, Zhang L, Yang H, Zhuang J, Sun Z, Guo J, Guan M. Nanosecond pulsed electric fields impair viability and mucin expression in mucinous colorectal carcinoma cell. Bioelectrochemistry 2021; 141:107844. [PMID: 34052542 DOI: 10.1016/j.bioelechem.2021.107844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022]
Abstract
Nanosecond pulsed electric fields (nsPEFs) are a non-thermal technology that can induce a myriad of biological responses and changes in cellular physiology. nsPEFs have gained significant attention as a novel cancer therapy. However, studies investigating the application of nsPEF in mucinous carcinomas are scarce. In this study, we explored several biological responses in two mucinous colorectal adenocarcinoma cell lines, LS 174T and HT-29, to nsPEF treatment. We determined the overall cell survival and viability rates following nsPEF treatment using CCK-8 and colony formation assays. We measured the intracellular effects of nsPEF treatment by analyzing cell cycle distribution, cell apoptosis and mitochondrial potential. We also analyzed mucin production at both mRNA and protein levels. Our results showed that nsPEF treatment significantly reduced mucinous cell viability in a dose-dependent manner. nsPEF treatment increased cell cycles arrest at G0/G1 while the proportion of G2/M cells gradually decreased. Cell apoptosis increased following nsPEF treatment with a clear loss in mitochondrial membrane potential. Furthermore, the protein expression of functional mucin family members decreased after nsPEF treatment. In conclusion, nsPEF treatment reduced MCRC cell viability, cell proliferation, and mucin protein production while promoted apoptosis. Our work is a pilot study that projects some insights into the potential clinical applications of nsPEFs in treating mucinous colorectal carcinoma.
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Affiliation(s)
- Yiran Gu
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, Jiangsu, China; School of Life Science, Shanghai University, Shanghai 200444, China
| | - Long Zhang
- State Key Laboratory of Solid-State Lighting Research Center of Light for Health, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, Jiangsu, China
| | - Hua Yang
- Department of General Surgery, Zhongshan Hospital (South Branch), Fudan University, Shanghai 200083, China
| | - Jie Zhuang
- State Key Laboratory of Solid-State Lighting Research Center of Light for Health, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, Jiangsu, China
| | - Zhenglong Sun
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming 650500, China
| | - Jinsong Guo
- State Key Laboratory of Solid-State Lighting Research Center of Light for Health, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, Jiangsu, China
| | - Miao Guan
- School of Life Science and Technology, Kunming University of Science and Technology, Kunming 650500, China
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Zhao Q, Wan L, Zou S, Zhang C, E T, Yang Y, Ye F, Zhao X, Ouyang H, Zhang H. Prognostic risk factors and survival models for T3 locally advanced rectal cancer: what can we learn from the baseline MRI? Eur Radiol 2021; 31:4739-4750. [PMID: 34003351 DOI: 10.1007/s00330-021-08045-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/07/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the baseline MRI characteristics for predicting survival outcomes and construct survival models for risk stratification to facilitate personalized treatment and follow-up strategies in patients with MRI-defined T3 (mrT3) locally advanced rectal cancer (LARC). METHODS We retrospectively reviewed 256 mrT3 LARC patients evaluated between 2008 and 2012 in our institution, with an average follow-up period of 6.8 ± 1.2 years. The baseline MRI characteristics, clinical data, and follow-up information were evaluated. The patients were randomized into a training cohort (TC, 186 patients) and validation cohort (VC, 70 patients). The TC dataset was used to develop multivariate nomograms for disease-free survival (DFS) and overall survival (OS), while the VC dataset was used for independent validation of the models. Harrell concordance (C) indices and Hosmer-Lemeshow calibration were used to evaluate the performances of the models. RESULTS Baseline mrT3 substage, extramural venous invasion (EMVI) grading, mucinous adenocarcinoma, mesorectal fascia involvement, elevated pretreatment carcinoembryonic antigen level, and neoadjuvant chemoradiotherapy (NCRT) were independent predictors of DFS. T3 substage, EMVI grading, and NCRT were also independent predictors of OS. The nomograms constructed permitted the individualized prediction of 3-year and 5-year DFS and 5-year OS with high discrimination (C-index range, 0.833-0.892) and good calibration in the TC and VC. CONCLUSIONS We have identified baseline MRI characteristics that help independently predict survival outcomes in patients with mrT3 LARC. The survival models based on these characteristics allow for the individualized pretreatment risk stratification in patients with mrT3 LARC. KEY POINTS • Baseline MRI characteristics can independently stratify risk and predict survival outcomes in patients with mrT3 LARC. • The nomograms built using selected baseline MRI characteristics facilitate the individualized pretreatment risk stratification and help with clinical decision-making in patients with mrT3 LARC. • MR-defined risk factors should, therefore, be carefully reported in the baseline MRI evaluation.
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Affiliation(s)
- Qing Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lijuan Wan
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuangmei Zou
- Department of Diagnostic Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Chongda Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tuya E
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yang Yang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Feng Ye
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Han Ouyang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hongmei Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Zhou S, Jiang Y, Pei W, Zhou H, Liang J, Zhou Z. Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients: A retrospective study of its safety and indications. J Surg Oncol 2021; 124:354-360. [PMID: 33882149 DOI: 10.1002/jso.26509] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/18/2021] [Accepted: 04/11/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES There is no consensus on the safety and indications of lateral pelvic lymph node dissection (LPND) for patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT). METHODS We retrospectively analyzed 151 patients who underwent total mesorectal excision (TME) + LPND and divided them into two groups: nCRT group (n = 73) and non-nCRT group (n = 78). RESULTS Thirty-one (20.5%) patients had LPNM by pathology. The operative time was significantly longer in the nCRT group (291.9 vs. 237.0 min, p < 0.001); however, the two groups had comparable intraoperative blood loss (87.3 vs. 78.9 ml, p = 0.607) and morbidity (19.2% vs. 15.7%, p = 0.537). Additionally, in the nCRT group, multivariate logistic regression analysis showed that poor/mucinous/signet adenocarcinoma (odds ratio [OR] = 6.65, 95% confidence interval [CI] = 1.03-43.03, p = 0.047) and post-nCRT LPN size ≥7 mm (OR = 26.67, 95% CI = 2.87-247.91, p = 0.004) were independent risk factors for pathological LPNM. CONCLUSION nCRT before TME + LPND is safe and feasible with a comparably low mortality and acceptable morbidity. Poor/mucinous/signet adenocarcinoma and post-nCRT LPN size ≥7 mm were independent predictive factors of pathological LPNM after nCRT for rectal cancer patients with clinical LPNM, and patients with these characteristics should consider LPND after nCRT.
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Affiliation(s)
- Sicheng Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yujuan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Pei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixiang Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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O'Connell E, Salvucci M, Reynolds IS, McNamara DA, Burke JP, Prehn JHM. Mucinous Colorectal Cancer is Associated With Expression of the TIM-3 Immune Checkpoint Independently of Microsatellite Instability (MSI) Status. Ann Surg Oncol 2021; 28:7999-8006. [PMID: 33876348 DOI: 10.1245/s10434-021-09873-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immune checkpoint inhibition has demonstrated success in overcoming tumor-mediated immune suppression in several types of cancer. However, its clinical use is limited to a small subset of colorectal cancer (CRC) patients, and response is highly variable between CRC subtypes. This study aimed to determine the profile of immune checkpoints and factors associated with immune checkpoint inhibitor response in mucinous CRC. METHODS Gene expression data from CRC was extracted from the TCGA PanCanAtlas data-freeze release. Gene expression data were reported as batch-corrected and normalized RNA expression derived from RNA-Seq quantification. Clinical, pathologic, and transcriptomic data were compared between mucinous and non-mucinous CRC cohorts. RESULTS The 557 cases of CRC eligible for inclusion in this study comprised 486 cases of non-mucinous CRC (87.3 %) and 71 cases of mucinous CRC (12.7 %). High correlation was observed in the expression of the included immune checkpoints. Significantly higher expression of programmed cell death protein 1 ligand (PD-L1) and T cell immunoglobulin and mucin domain 3 (TIM-3) was observed in mucinous CRC than in non-mucinous CRC. In a multiple regression model, significant contributors to the prediction of TIM-3 gene expression were microsatellite instability (MSI) (unstandardized regression coefficient [B] = 1.223; p < 0.001), stage (American Joint Committee on Cancer [AJCC] 2; B = 0.423; p < 0.05), and mucinous status (B = 0.591; p < 0.01). CONCLUSION Expression of TIM-3, an emerging immune checkpoint inhibition target, was significantly higher in mucinous CRC, and expression was predicted by mucinous status independently of MSI. These findings should prompt investigation of immune checkpoint signaling in the mucinous tumor microenvironment to clarify the potential for immune checkpoint inhibition in mucinous CRC.
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Affiliation(s)
- Emer O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Manuela Salvucci
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Jochen H M Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland. .,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland.
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Zhou YW, Xia RL, Chen YY, Ma XL, Liu JY. Clinical features, treatment, and prognosis of different histological types of primary small bowel adenocarcinoma: A propensity score matching analysis based on the SEER database. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2108-2118. [PMID: 33849741 DOI: 10.1016/j.ejso.2021.03.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/19/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE This aim of this study was to provide a comprehensive understanding of the clinical characteristics, treatment, and prognosis of patients with small bowel adenocarcinoma (SBA), mucinous small bowel adenocarcinoma (MSBA), and signet ring cell carcinoma of the small bowel (SRCSB). METHODS Information on patients with SBA, MSBA, and SRCSB (2004-2015) was obtained from the Surveillance, Epidemiology and End Results (SEER) database. Cox proportional hazards models and Kaplan-Meier curves were used for the survival analyses. Propensity-score matching (PSM) was implemented to determine the differences among these tumors. RESULTS In all, 3697 patients with SBA (n = 3196), MSBA (n = 325) and SRCSB (n = 176) were ultimately eligible for this study. Poor differentiation, local invasion, and lymph node metastasis were more likely to be observed in SRCSB than in SBA and MSBA. Surgery was the most common treatment modality in all groups. The prognosis of SBA was similar to that of MSBA, but better than that of SRCSB in both unmatched and matched cohorts. M stage, surgery, and chemotherapy were identified as independent predictors of survival in all patients. Surgery and chemotherapy could significantly improve outcomes in all groups before and after PSM. Radiotherapy was associated with a survival benefit in patients with SBA, but this trend was not maintained after PSM. Survival advantages of SBA and MSBA were remarkable in the stratified analysis of surgery after PSM. CONCLUSION Patients with SRCSB had the worst prognosis among all histological types examined. However, surgery and chemotherapy could improve patients survival, regardless of histological type.
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Affiliation(s)
- Yu-Wen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Ruo-Lan Xia
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Yue-Yun Chen
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Xue-Lei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Ji-Yan Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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O’Connell E, Reynolds IS, McNamara DA, Burke JP, Prehn JHM. Resistance to Cell Death in Mucinous Colorectal Cancer-A Review. Cancers (Basel) 2021; 13:cancers13061389. [PMID: 33808549 PMCID: PMC8003305 DOI: 10.3390/cancers13061389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/07/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
Mucinous colorectal cancer (CRC) is estimated to occur in approximately 10-15% of CRC cases and is characterized by abundant extracellular mucin. Mucinous CRC is frequently associated with resistance to apoptosis. Inferior prognosis is observed in mucinous CRC, particularly in rectal cancer and metastatic cases. Mucins are heavily glycosylated secretory or transmembrane proteins that participate in protection of the colonic epithelium. MUC2 overexpression is a hallmark of mucinous CRCs. Mucinous CRC is associated with KRAS and BRAF mutation, microsatellite instability and the CpG island methylator phenotype. Mutations of the APC gene and p53 mutations which are characteristic non-mucinous colorectal adenocarcinoma are less common in mucinous CRC. Both physical and anti-apoptotic properties of mucin provide mechanisms for resistance to cell death. Mucin glycoproteins are associated with decreased expression of pro-apoptotic proteins, increased expression of anti-apoptotic proteins and increased cell survival signaling. The role for BCL-2 proteins, including BCL-XL, in preventing apoptosis in mucinous CRC has been explored to a limited extent. Additional mechanisms opposing cell death include altered death receptor expression and altered mutation rates in genes responsible for chemotherapy resistance. The roles of alternate cell death programs including necroptosis and pyroptosis are not well understood in mucinous CRC. While the presence of MUC2 is associated with an immunosuppressive environment, the tumor immune environment of mucinous CRC and the role of immune-mediated tumor cell death likewise require further investigation. Improved understanding of cell death mechanisms in mucinous CRC may allow modification of currently used regimens and facilitate targeted treatment.
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Affiliation(s)
- Emer O’Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ian S. Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Deborah A. McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - John P. Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin 9, Ireland; (E.O.); (I.S.R.); (D.A.M.); (J.P.B.)
| | - Jochen H. M. Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Correspondence:
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Reynolds IS, Cromwell PM, Hoti E. Clinicopathological characteristics and survival outcomes for patients with mucinous colorectal cancer liver metastases undergoing hepatic resection: A systematic review and meta-analysis. Am J Surg 2021; 222:529-535. [PMID: 33750573 DOI: 10.1016/j.amjsurg.2021.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mucinous adenocarcinoma represents a distinct histological subtype of colorectal cancer. To date there has been limited data available for patients with colorectal cancer liver metastases (CRCLM) derived from mucinous adenocarcinoma. This systematic review and meta-analysis aims to provide data on the clinicopathological and survival outcomes of this cohort. METHODS Databases were searched for studies comparing clinicopathological and survival outcomes between patients with mucinous CRCLM and CRCLM from adenocarcinoma not otherwise specified who underwent liver resection. A random-effects model was used for analysis. RESULTS Eight studies describing 9157 patients were included. Mucinous CRCLM were positively associated with colon tumors (OR 1⋅64, P = 0⋅01), T3/T4 tumors (OR 1⋅58, P = 0⋅02), node positive tumors (OR 1⋅55, P = 0⋅005). The review also identified a trend towards worse overall survival in patients with mucinous CRCLM. CONCLUSIONS Despite the distinct clinicopathological characteristics and impaired long term outcomes of mucinous CRCLM, resection should remain the gold standard where possible.
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Affiliation(s)
- Ian S Reynolds
- Department of Surgery, St Michael's Hospital, Co Dublin, Ireland; Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin 4, Ireland.
| | - Paul M Cromwell
- Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | - Emir Hoti
- Department of Surgery, St Michael's Hospital, Co Dublin, Ireland; Department of Hepatobiliary and Liver Transplant Surgery, St Vincent's University Hospital, Dublin 4, Ireland
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Fischer J, Eglinton TW, Richards SJ, Frizelle FA. Predicting pathological response to chemoradiotherapy for rectal cancer: a systematic review. Expert Rev Anticancer Ther 2021; 21:489-500. [PMID: 33356679 DOI: 10.1080/14737140.2021.1868992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Pathological complete response (pCR) rates of approximately 20% following neoadjuvant long-course chemoradiotherapy for rectal cancer have given rise to non-operative or watch-and-wait (W&W) management. To improve outcomes there has been significant research into predictors of response. The goal is to optimize selection for W&W, avoid chemoradiotherapy in those who won't benefit and improve treatment to maximize the clinical complete response (cCR) rate and the number of patients who can be considered for W&W.Areas covered: A systematic review of articles published 2008-2018 and indexed in PubMed, Embase or Medline was performed to identify predictors of pathological response (including pCR and recognized tumor regression grades) to fluoropyrimidine-based chemoradiotherapy in patients who underwent total mesorectal excision for rectal cancer. Evidence for clinical, biomarker and radiological predictors is discussed as well as potential future directions.Expert opinion: Our current ability to predict the response to chemoradiotherapy for rectal cancer is very limited. cCR of 40% has been achieved with total neoadjuvant therapy. If neoadjuvant treatment for rectal cancer continues to improve it is possible that the treatment for rectal cancer may eventually parallel that of anal squamous cell carcinoma, with surgery reserved for the minority of patients who don't respond to chemoradiotherapy.
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Affiliation(s)
- Jesse Fischer
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, North Shore Hospital, Auckland, New Zealand
| | - Tim W Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Simon Jg Richards
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Australia
| | - Frank A Frizelle
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
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A Comprehensive Evaluation of Associations Between Routinely Collected Staging Information and The Response to (Chemo)Radiotherapy in Rectal Cancer. Cancers (Basel) 2020; 13:cancers13010016. [PMID: 33375133 PMCID: PMC7792936 DOI: 10.3390/cancers13010016] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/17/2020] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Rectal cancer patients are often treated with radiotherapy, either alone or combined with chemotherapy, prior to surgery to enable radical surgery on a non-resectable tumor or to lower the recurrence risk. For some patients, the tumor disappears completely after preoperative treatment, while others experience little or no benefit. Accurate prediction of therapy response before treatment is of great importance for a personalized treatment approach and intentional organ preservation. We performed a comprehensive evaluation of the predictive capacity of all routinely collected staging information at diagnosis in a population-based, completely staged patient material of 383 patients representing a real-life clinical situation. Size or stage of the rectal tumor were independent predictors of excellent response irrespective of preoperative treatment, with small/early-stage tumors being significantly more likely to reach a complete response. Levels of the tumor marker carcinoembryonic antigen (CEA) above upper normal limit halved the chance of response. Abstract Radiotherapy (RT) or chemoradiotherapy (CRT) are frequently used in rectal cancer, sometimes resulting in complete tumor remission (CR). The predictive capacity of all clinical factors, laboratory values and magnetic resonance imaging parameters performed in routine staging was evaluated to understand what determines an excellent response to RT/CRT. A population-based cohort of 383 patients treated with short-course RT (5 × 5 Gy in one week, scRT), CRT, or scRT with chemotherapy (scRT+CT) and having either had a delay to surgery or been entered into a watch-and-wait program were included. Complete staging according to guidelines was performed and associations between investigated variables and CR rates were analyzed in univariate and multivariate analyses. In total, 17% achieved pathological or clinical CR, more often after scRT+CT and CRT than after scRT (27%, 18% and 8%, respectively, p < 0.001). Factors independently associated with CR included clinical tumor stage, small tumor size (<3 cm), tumor level, and low CEA-value (<3.8 μg/L). Size or stage of the rectal tumor were associated with excellent response in all therapy groups, with small or early stage tumors being significantly more likely to reach CR (p = 0.01 (scRT), p = 0.01 (CRT) and p = 0.02 (scRT+CT). Elevated level of carcinoembryonic antigen (CEA) halved the chance of response. Extramural vascular invasion (EMVI) and mucinous character may indicate less response to RT alone.
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PET/MRI Characterization of Mucinous Versus Nonmucinous Components of Rectal Adenocarcinoma: A Comparison of Tumor Metabolism and Cellularity. AJR Am J Roentgenol 2020; 216:376-383. [PMID: 33295813 DOI: 10.2214/ajr.19.22627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate whether FDG PET/MRI can be used to differentiate the mucinous from the nonmucinous components of primary rectal tumors and to compare the glycolytic metabolism on PET with tumor cellularity on DWI in both components. SUBJECTS AND METHODS. Ninety-nine patients who underwent FDG PET/MRI for staging of primary rectal cancer were included in this prospective analysis. MRI depicted the mucin component through the tumor volume. Separate volumes of interest were drawn on both mucinous and nonmucinous components and propagated to PET and apparent diffusion coefficient (ADC) mapping. Maximum and mean standardized uptake values (SUVmax, SUVmean) and maximum, mean, and minimum ADC values (ADCmax, ADCmean, ADCmin) were recorded and compared between areas with mucinous and nonmucinous components. Whole-body PET/MRI was also used to evaluate for the presence of distant metastases. Nonparametric testing was used to compare the two groups of patients: those with tumors with a mucinous component and those with tumors without a mucinous component. Logistic regression analysis was performed to calculate the association risk between mucinous component and metastatic disease. RESULTS. Seventeen patients (17.2%) had a mucinous component within the tumor on T2-weighted MRI. Most of these patients had advanced disease, the mucinous component tumors being in significantly higher T categories than the tumors without a mucinous component (88.2% vs 61.0%; p = 0.032). SUVmax (7.4 vs 16.7; p = 0.002) and SUVmean (5.4 vs 13.4; p = 0.001) were significantly lower in tumors with a mucinous component than in those without a mucinous component. Tumor ADC measurements were not different between tumors with and those without a mucinous component (ADCmean, 1.4 vs 1.6; p = 0.361). There was no association between presence of a mucinous component within the primary rectal tumor and presence of synchronous metastases (odds ratio, 1.1 [0.4-3.0]; p = 0.904). Moreover, the occurrence of metastases in patients with mucinous component tumors (7/17 [41.2%]) was not different from that in patients with tumors without a mucinous component (28/82 [34.1%]) (p = 0.887). CONCLUSION. PET/MRI can be used to differentiate the mucinous and nonmucinous components within primary rectal adenocarcinoma on the basis of metabolic status. The FDG uptake is significantly lower in the mucinous component, but tumor cellularity based on MRI and DWI findings is not. Despite being associated with a higher T category in the sample of patients in this study, the presence of a mucinous component seems not to be associated with increased risk of synchronous metastases.
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Cao W, Zou Q, Zhao Y, Zhou J, Li W, Ren D, Meng X, Hu B, Zhou Z. Application of liver acquisition with volume acceleration enhanced sequence in improving the accuracy of reassessing organ-invasive rectal mucinous adenocarcinoma after chemoradiation. Eur J Radiol 2020; 133:109368. [PMID: 33207287 DOI: 10.1016/j.ejrad.2020.109368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore the ability of liver acquisition with volume acceleration contrast-enhanced sequence (LAVA-ce) to improve the accuracy of reassessing adjacent organ involvement by rectal mucinous adenocarcinoma (MC) after neoadjuvant therapy (NAT). METHODS This study retrospectively enrolled twenty-five patients with MC who underwent pre- and post-NAT MRI, were staged as T4b using pre-NAT T2 weighted imaging, received NAT and underwent radical resection. All MR images were divided into two schemes, T2 weighted plus diffusion weighted imaging (T2Dw protocol) and plus LAVA-ce (T2DwLce protocol). All patients were scored on a 0-4 scale to reassess organ-invasive mucus components. Postoperative pathology was used to identify the involvement of surrounding organs (ypT4b). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the consistency of the results with pathology after adding fs-CE sequence. RESULTS Among 25 MC patients (15 males and 10 females, aged 21-89 years), 21 were restaged as yT4b after NAT by using T2Dw, with an accuracy of 44.0 % (11/25), which was lower than the accuracy of staging patients with non-mucinous rectal adenocarcinoma (94.1 %, 96/102). The accuracy of MC restaging was improved by using T2DwLce (23/25). The AUC of T2DwLce was 0.857 (95 % CI, 0.660∼0.964), which was higher than that of T2Dw (AUC, 0.611 [95 % CI, 0.397∼0.798]) (P = 0.019). CONCLUSION The LAVA-ce sequence can improve the accuracy of reevaluation and should be included in the MRI protocol for MC patients.
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Affiliation(s)
- Wuteng Cao
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Qi Zou
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Yandong Zhao
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Pathology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Jie Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Wenli Li
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Donglin Ren
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Xiaochun Meng
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
| | - Bang Hu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.
| | - Zhiyang Zhou
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
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Yu F, Huang L, Shen F, Wu S, Chen J. Prognostic implications of mucinous histology in stage III colon cancer with the receipt of adjuvant chemotherapy. J Gastrointest Oncol 2020; 11:858-869. [PMID: 33209482 DOI: 10.21037/jgo-20-160] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background There is still a debate about the survival benefit of chemotherapy in stage III mucinous colon cancer, we then conduct a comprehensive assessment of the efficacy of adjuvant chemotherapy in this population. Methods The data used in the current study were extracted from the Surveillance, Epidemiology and End Results (SEER) database. Chi-squared (χ2) test was used to compared patient characteristics according to the histology. The outcome of the survival analysis used in the current study was cancer-specific survival (CSS). Univariable and multivariable analyses were carried out using the Cox proportional hazards regression models to evaluate the prognostic characteristics associated with CSS of colon cancer. And the risks of mortality were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). Results A total of 68,976 patients diagnosed with stage III colon cancer were included in our analyses, including mucinous adenocarcinoma (MAC, N=6,592) and non-mucinous adenocarcinoma (NMA, N=62,384). In NMA, the receipt of chemotherapy had 46.0% independently decreased risk of colon cancer-specific mortality compared to non-chemotherapy group (HR =0.540, 95% CI: 0.523-0.558, P<0.001). In MAC, the receipt of chemotherapy had 37.7% independently decreased risk of colon cancer-specific mortality compared to non-chemotherapy group (HR =0.623, 95% CI: 0.566-0.685, P<0.001). Conclusions MAC was associated with worse prognosis and was less responsive to chemotherapy compared with NMA in stage III colon cancer. However, stage III mucinous colon cancer still need to be treated with chemotherapy because of the significant survival benefit and specialized treatment plans for MAC were quite necessary in the future.
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Affiliation(s)
- Feng Yu
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Luqiao Huang
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Feng Shen
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Shuang Wu
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jian Chen
- Department of Gastrointestinal Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Engel RM, Oliva K, Koulis C, Yap R, McMurrick PJ. Predictive factors of complete pathological response in patients with locally advanced rectal cancer. Int J Colorectal Dis 2020; 35:1759-1767. [PMID: 32474708 DOI: 10.1007/s00384-020-03633-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Patients with locally advanced rectal cancer who achieve pathologic complete response (pCR) following neoadjuvant therapy have better long-term outcomes and could be spared from the perioperative and long-term morbidity of rectal resection. The aim of this study was to identify factors that predict the ability to achieve pCR at completion of conventional neoadjuvant therapy, therefore determining their suitability for non-surgical management. METHODS A retrospective analysis was performed on data obtained from a prospectively maintained colorectal neoplasia database. Patients treated for biopsy-proven primary rectal adenocarcinoma between January 1, 2010, and February 28, 2018, who received neoadjuvant radiotherapy or chemoradiotherapy and had undergone surgical resection, were included in this study. Five-year oncologic outcome data was also obtained for 144 patients. Clinicopathological tumour characteristics and treatment regimens were analysed for correlation to clinical outcome. RESULTS Three hundred fifty-four patients met inclusion criteria for this study. We identified significant differences between patients achieving a pCR and those that did not for tumour type (adenocarcinoma vs. mucinous/signet ring; p = 0.008), pre-treatment serum CEA level (</≥ 2.5 μg/L; p = 0.003), neoadjuvant therapy type (short-course radiotherapy and long-course chemoradiotherapy; p = 0.008) and preoperative lymph node status (node-negative versus node-positive disease; p = 0.031). Additionally, this is the first report to our knowledge to identify a significant correlation with pCR and the degree of tumour fixity (mobile vs. fixed/tethered; p = 0.038). CONCLUSIONS This retrospective analysis identified factors that significantly impact a patients' ability to achieve a pCR, which may prove useful for prospectively selecting patients suitable for non-surgical management of disease.
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Affiliation(s)
- Rebekah M Engel
- Cabrini Monash University Department of Surgery, Cabrini Health, Malvern, VIC, 3144, Australia.
- Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, 3800, Australia.
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute, Monash University, Wellington Road, Clayton, VIC, 3800, Australia.
| | - Karen Oliva
- Cabrini Monash University Department of Surgery, Cabrini Health, Malvern, VIC, 3144, Australia
| | - Christine Koulis
- Cabrini Monash University Department of Surgery, Cabrini Health, Malvern, VIC, 3144, Australia
| | - Raymond Yap
- Cabrini Monash University Department of Surgery, Cabrini Health, Malvern, VIC, 3144, Australia
| | - Paul J McMurrick
- Cabrini Monash University Department of Surgery, Cabrini Health, Malvern, VIC, 3144, Australia
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Hlaváč V, Holý P, Souček P. Pharmacogenomics to Predict Tumor Therapy Response: A Focus on ATP-Binding Cassette Transporters and Cytochromes P450. J Pers Med 2020; 10:jpm10030108. [PMID: 32872162 PMCID: PMC7565825 DOI: 10.3390/jpm10030108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
Pharmacogenomics is an evolving tool of precision medicine. Recently, due to the introduction of next-generation sequencing and projects generating "Big Data", a plethora of new genetic variants in pharmacogenes have been discovered. Cancer resistance is a major complication often preventing successful anticancer treatments. Pharmacogenomics of both somatic mutations in tumor cells and germline variants may help optimize targeted treatments and improve the response to conventional oncological therapy. In addition, integrative approaches combining copy number variations and long noncoding RNA profiling with germline and somatic variations seem to be a promising approach as well. In pharmacology, expression and enzyme activity are traditionally the more studied aspects of ATP-binding cassette transporters and cytochromes P450. In this review, we briefly introduce the field of pharmacogenomics and the advancements driven by next-generation sequencing and outline the possible roles of genetic variation in the two large pharmacogene superfamilies. Although the evidence needs further substantiation, somatic and copy number variants as well as rare variants and common polymorphisms in these genes could all affect response to cancer therapy. Regulation by long noncoding RNAs has also been shown to play a role. However, in all these areas, more comprehensive studies on larger sets of patients are needed.
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Affiliation(s)
- Viktor Hlaváč
- Toxicogenomics Unit, National Institute of Public Health, 100 00 Prague, Czech Republic; (P.H.); (P.S.)
- Laboratory of Pharmacogenomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 306 05 Pilsen, Czech Republic
- Correspondence: ; Tel.: +420-267082681; Fax: +420-267311236
| | - Petr Holý
- Toxicogenomics Unit, National Institute of Public Health, 100 00 Prague, Czech Republic; (P.H.); (P.S.)
- Laboratory of Pharmacogenomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 306 05 Pilsen, Czech Republic
- Third Faculty of Medicine, Charles University, 100 00 Prague, Czech Republic
| | - Pavel Souček
- Toxicogenomics Unit, National Institute of Public Health, 100 00 Prague, Czech Republic; (P.H.); (P.S.)
- Laboratory of Pharmacogenomics, Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 306 05 Pilsen, Czech Republic
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74
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Reynolds IS, Thomas V, O'Connell E, Fichtner M, McNamara DA, Kay EW, Prehn JHM, Burke JP, Furney SJ. Mucinous Adenocarcinoma of the Rectum: A Whole Genome Sequencing Study. Front Oncol 2020; 10:1682. [PMID: 32984045 PMCID: PMC7479243 DOI: 10.3389/fonc.2020.01682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/29/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Mucinous adenocarcinoma of the rectum is an infrequently encountered histological subtype that is associated with an impaired response to chemoradiotherapy and a worse overall prognosis. A genomic profile analysis of mucinous rectal tumors has not yet been performed. The aim of this study was to comprehensively describe the burden of somatic mutations and copy number variation as well as perform mutational signature and microbial analysis of an in-house collected cohort of mucinous adenocarcinoma of the rectum. Methods Genomic DNA was extracted from 10 cases of mucinous rectal cancer and matched normal tissue. Whole genome sequencing (WGS) was carried out on these 10 cases and a comprehensive bioinformatic analysis was undertaken. Results The average number of SNVs, InDels and SVs in the cohort was 16,600, 1,855, and 120, respectively. A single case was MSI-H. KRAS mutations were found in 70% of cases while TP53 was mutated in only 40% of cases. CNA gain was identified on chromosomes 7, 8, 12, 13, and 20 while CNA loss was found on chromosomes 4, 8, 17, and 18 corresponding to oncogenes and tumor suppressor genes, respectively. Overall mucinous rectal cancers are more likely to be MSI-H and to have KRAS, BRAF, and PIK3CA mutations when compared to rectal adenocarcinoma NOS. Microbial analysis demonstrated an abundance of Fusobacterium nucleatum in tumor samples compared to normal tissue. Conclusion This study provides a detailed WGS analysis of 10 cases of mucinous rectal cancer. It demonstrates an important lesson in tumor biology in that histologically similar tumors can have extensive differences at the genomic level. This study is relevant as it raises important questions about the relationship between bacteria and malignancy.
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Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Valentina Thomas
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Genomic Oncology Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emer O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Fichtner
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine W Kay
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Jochen H M Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Simon J Furney
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Genomic Oncology Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
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75
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Cao W, Wu L, Zhao Y, Zhou J, Li W, Wang X, Xu J, Zhou Z, Liang C. A New MRI-Defined Biomarker for Rectal Mucinous Adenocarcinoma: Mucin Pool Patterns in Determining the Efficacy of Neoadjuvant Therapy. Front Oncol 2020; 10:1425. [PMID: 32974154 PMCID: PMC7468516 DOI: 10.3389/fonc.2020.01425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022] Open
Abstract
Background and Aim: This work aims to study the relationship between MRI-defined mucin pool (MP) patterns prior to treatment and the efficacy of neoadjuvant therapy (NAT) in locally advanced rectal mucinous adenocarcinoma (RMAC). Methods: This retrospective study included 278 RMAC patients evaluated between January 2012 and January 2019. After having been trained by using 118 cases with postoperative pathological images, radiologists distinguished MRI-defined MP status as mixed type (MTMP) and separate type (STMP) in a NAT cohort (160 patients) in addition to tumor characteristics, invasion of mesorectal facia, and nodal status. Reader reproducibility was determined using the κ coefficient. The main outcome was the accuracy of MP dichotomy in predicting whether patients had tumor responsiveness or not. Results: Among 278 cases, MTMP and STMP accounted for 49.6 and 50.4% of MPs, respectively. A total of 72 patients received neoadjuvant chemoradiotherapy and 88 received chemotherapy. The tumor responsiveness rate in the chemoradiotherapy group was higher than that in the chemotherapy group (58.3 vs. 21.6%, P < 0.001). In the chemotherapy group, the tumor responsiveness rate in patients with MTMPs was lower than that in patients with STMPs (4.9 vs. 25.5%, P = 0.002). The baseline MRI-defined MTMP was associated with lower responsiveness rates after NAT in the chemotherapy group (odds ratio, 11.050, with 95% CI, 2.368–51.571, P = 0.002). Conclusions: MP dichotomy can be reliably evaluated by using MRI. In the chemotherapy group, MTMP may be a dependent predictor to indicate a lower likelihood of tumor responsiveness after NAT.
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Affiliation(s)
- Wuteng Cao
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Lei Wu
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yandong Zhao
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Jie Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Wenli Li
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Xinhua Wang
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Jianbo Xu
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China
| | - Zhiyang Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, China.,Guangzhou Universal Medical Imaging Diagnostic Center, Guangzhou, China
| | - Changhong Liang
- School of Medicine, South China University of Technology, Guangzhou, China.,Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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76
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Childs DD, Rocha Lima CMSP, Zhou Y. Mucin-Containing Rectal Cancer: A Review of Unique Imaging, Pathology, and Therapeutic Response Features. Semin Roentgenol 2020; 56:186-200. [PMID: 33858645 DOI: 10.1053/j.ro.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David D Childs
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC.
| | | | - Yi Zhou
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC
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77
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Development of the 'PREDICT' score through a systematic review and meta-analysis of the predictive parameters for locoregional recurrence after total mesorectal excision. Updates Surg 2020; 73:35-46. [PMID: 32734579 DOI: 10.1007/s13304-020-00853-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: 05/07/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite robust management techniques, locoregional recurrence rates of rectal cancer are still significant. Although offering intensive follow-up has been shown to be beneficial in the early detection, it can be resource consuming. Having a robust knowledge of risk factors of locoregional recurrence will help in identification of patients who actually need intensive follow-up programs. This review aimed to identify the factors that can predict locoregional recurrence after Total mesorectal excision (TME). METHODS We systematically reviewed PubMed, Scopus and Cochrane for relevant articles with no date restrictions while language was restricted to English. We only included articles that had either provided Hazards ratio (HR)/odds ratio (OR) or provided enough data that allowed calculation of HR/OR specifically for rectal cancer. Articles were deemed eligible if they included patients undergoing (TME). RESULTS Seventeen studies (18,605 patients) published between 2002 and 2019 were included. A total of 699 patients developed locoregional recurrence at a median time of 25.2 months after surgery. There were eight significant predictors evaluated by more than one study; T3-T4 stage, circumferential resection margin, lymphovascular invasion, mucinous histology, N1-N2 stage, positive distal resection margin, Tumor < 5 cm from anal verge, and lack of neoadjuvant radiotherapy. A scoring system was developed based on the weight and pooled OR/HR of each predictor. CONCLUSION Using predictive factors identified in our review in context of scoring system may help in the early detection of locoregional recurrence after TME. This may help in tailoring the application of intensive follow-up programs.
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78
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Dang Y, Gao H, Huang S, Qi T. Clinical complete regression after local radiotherapy combined with chemotherapy for stage IV rectal cancer: A case report. Mol Clin Oncol 2020; 13:186-190. [PMID: 32714544 DOI: 10.3892/mco.2020.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/09/2020] [Indexed: 11/06/2022] Open
Abstract
Colorectal cancer is the fourth most common type of cancer worldwide with about 0.8 million new cases annually. Improving patient survival remains a challenge for clinicians. Observation waiting method provides improved quality of life compared with direct surgery. This case report suggested that colorectal cancer patients could choose active observation waiting method for treatment. A 59-year-old male patient, with rectal bleeding and an Eastern Cooperative Oncology Group (ECOG) performance status score of 0, was admitted to the hospital due to increased fecal blood volume. The electronic colonoscopy revealed multiple polyps in colon and rectum, whereas the pathological biopsy indicated poorly differentiated rectal adenocarcinoma. The clinical stage was defined as T3N2M1a according to the TNM classification of the American Joint Committee on Cancer (AJCC) staging manual (version 8). In addition, positron emission tomography/computed tomography (PET/CT) examination showed non-regional lymph node metastasis (subclavian). Subsequently, the expression of PD-L1 (-), NRAS (-), KRAS (-), HRAS (-), BRAF (-) (-, negative) and the microsatellite stability (MSS) were detected in the rectal cancer lesion using molecular pathological examination. Patients with primary rectal cancer and pelvic lymph node metastasis were treated with three-dimensional conformal radiotherapy (3D-CRT; dose, 60 Gy/30 Fr) and XELOX chemotherapy (200 mg oxaliplatin at day 1 plus 1.5 g capecitabine twice a day from day 1-14 for a total of 5 cycles). PET/CT scan revealed that the metabolism levels of the lesion returned to normal. In addition, the routine re-examination showed progressive improvement of tumor lesions. Until recently, the carcinoembryonic antigen (CEA) level of the male patient has been within normal range. The observation waiting method rather than the direct sequential surgical resection of the primary lesion in patients with advanced rectal cancer who achieved complete clinical remission (CCR) may provide a novel treatment method for rectal cancer. Thus, overall survival (OS) and quality of survival (QoS) differences between the two strategies need to be further verified by multicenter clinical trials.
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Affiliation(s)
- Yazheng Dang
- Department of Radiation Oncology, 986 Hospital of People's Liberation Army Air Force, Xi'an, Shaanxi 710054, P.R. China
| | - Hongxiang Gao
- Department of Oncology, Chang An Hospital, Xi'an, Shaanxi 710018, P.R. China
| | - Shigao Huang
- Cancer Center, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR 999078, P.R. China.,Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR 999078, P.R. China
| | - Tao Qi
- Department of Radiation Oncology, 986 Hospital of People's Liberation Army Air Force, Xi'an, Shaanxi 710054, P.R. China
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79
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Lalwani N, Bates DDB, Arif-Tiwari H, Khandelwal A, Korngold E, Lockhart M. Baseline MR Staging of Rectal Cancer: A Practical Approach. Semin Roentgenol 2020; 56:164-176. [PMID: 33858643 DOI: 10.1053/j.ro.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As therapeutic options to treat rectal cancers have advanced over the last several decades, MRI has become the standard of care for baseline local tumor and nodal staging of rectal cancers. An understanding of the technique, anatomy, tumor appearance, and elements of staging on MRI is essential to provide prognostic information and to guide neoadjuvant chemoradiation and surgical treatment. We provide a framework for imaging the rectum on MRI followed by a practical case-based approach to interpretation of pre-treatment MRI of the rectum in evaluation of rectal cancers, with examples and illustrations of the range of local tumor (T) stage and nodal (N) disease involvement. This approach can be paired with standardized reporting templates to support clear, accurate and clinically relevant imaging assessment of rectal cancers.
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Affiliation(s)
- Neeraj Lalwani
- Virginia Commonwealth University School of Medicine and VCU Health, Richmond, VA.
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Mark Lockhart
- The University of Alabama at Birmingham, Department of Radiology, Birmingham, AL
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80
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Yuan Z, Frazer M, Ahmed KA, Naqvi SMH, Schell MJ, Felder S, Sanchez J, Dessureault S, Imanirad I, Kim RD, Torres-Roca JF, Hoffe SE, Frakes JM. Modeling precision genomic-based radiation dose response in rectal cancer. Future Oncol 2020; 16:2411-2420. [PMID: 32686956 DOI: 10.2217/fon-2020-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Genomic-based risk stratification to personalize radiation dose in rectal cancer. Patients & methods: We modeled genomic-based radiation dose response using the previously validated radiosensitivity index (RSI) and the clinically actionable genomic-adjusted radiation dose. Results: RSI of rectal cancer ranged from 0.19 to 0.81 in a bimodal distribution. A pathologic complete response rate of 21% was achieved in tumors with an RSI <0.31 at a minimal genomic-adjusted radiation dose of 29.76 when modeling RxRSI to the commonly prescribed physical dose of 50 Gy. RxRSI-based dose escalation to 55 Gy in tumors with an RSI of 0.31-0.34 could increase pathologic complete response by 10%. Conclusion: This study provides a theoretical platform for development of an RxRSI-based prospective trial in rectal cancer.
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Affiliation(s)
- Zhigang Yuan
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Marissa Frazer
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Syeda Mahrukh Hussnain Naqvi
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Michael J Schell
- Department of Biostatistics & Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Seth Felder
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Julian Sanchez
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Sophie Dessureault
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Iman Imanirad
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Richard D Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Javier F Torres-Roca
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Sarah E Hoffe
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Jessica M Frakes
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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81
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De Mattia E, Roncato R, Palazzari E, Toffoli G, Cecchin E. Germline and Somatic Pharmacogenomics to Refine Rectal Cancer Patients Selection for Neo-Adjuvant Chemoradiotherapy. Front Pharmacol 2020; 11:897. [PMID: 32625092 PMCID: PMC7311751 DOI: 10.3389/fphar.2020.00897] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/02/2020] [Indexed: 12/25/2022] Open
Abstract
Neoadjuvant chemoradiotherapy (nCRT) followed by radical surgery is the standard of care for patients with Locally Advanced Rectal Cancer (LARC). Current selection for nCRT is based on clinical criteria regardless of any molecular marker. Pharmacogenomics may be a useful strategy to personalize and optimize nCRT in LARC. This review aims to summarize the most recent and relevant findings about the role of germline and somatic pharmacogenomics in the prediction of nCRT outcome in patients with LARC, discussing the state of the art of their application in the clinical practice. A systematic literature search of the PubMed database was completed to identify relevant English-language papers published up to January 2020. The chemotherapeutic backbone of nCRT is represented by fluoropyrimidines, mainly metabolized by DPD (Dihydro-Pyrimidine Dehydrogenase, DPYD). The clinical impact of testing DPYD*2A, DPYD*13, c.2846A > T and c.1236G > A-HapB3 before a fluoropyrimidines administration to increase treatment safety is widely acknowledged. Other relevant target genes are TYMS (Thymidylate Synthase) and MTHFR (Methylene-Tetrahydro-Folate Reductase), whose polymorphisms were mainly studied as potential markers of treatment efficacy in LARC. A pivotal role of a TYMS polymorphism in the gene promoter region (rs34743033) was reported and was pioneeringly used to guide nCRT treatment in a phase II study. The pharmacogenomic analysis of other pathways mostly involved in the cellular response to radiation damage, as the DNA repair and the activation of the inflammatory cascade, provided less consistent results. A high rate of somatic mutation in genes belonging to PI3K (Phosphatidyl-Inositol 3-Kinase) and MAPK (Mitogen-Activated Protein Kinase) pathways, as BRAF (V-raf murine sarcoma viral oncogene homolog B1), KRAS (Kirsten Rat Sarcoma viral oncogene homolog), NRAS (Neuroblastoma RAS viral (v-ras) oncogene homolog), PIK3CA (Phosphatidyl-Inositol-4,5-bisphosphate 3-Kinase, Catalytic Subunit Alpha), as well as TP53 (Tumor Protein 53) was reported in LARC. Their pharmacogenomic role, already defined in colorectal cancer, is under investigation in LARC with promising results concerning specific somatic mutations in KRAS and TP53, as predictors of tumor response and prognosis. The availability of circulating tumor DNA in plasma may also represent an opportunity to monitor somatic mutations in course of therapy.
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Affiliation(s)
- Elena De Mattia
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Rossana Roncato
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Elisa Palazzari
- Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Giuseppe Toffoli
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Erika Cecchin
- Clinical and Experimental Pharmacology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
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82
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Chen J, Zhou L, Gao J, Lu T, Wang J, Wu H, Liang Z. Clinicopathological Characteristics and Mutation Spectrum of Colorectal Adenocarcinoma With Mucinous Component in a Chinese Cohort: Comparison With Classical Adenocarcinoma. Front Oncol 2020; 10:917. [PMID: 32582557 PMCID: PMC7296099 DOI: 10.3389/fonc.2020.00917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Colorectal adenocarcinoma with mucinous component (AWMC) is a special entity of colorectal cancer. The study is aimed at analyzing the clinicopathological characteristics, mutation spectrum, and prognosis of AWMC and comparing it with classical adenocarcinoma (AC) in a Chinese cohort. Methods: One hundred eight AMWC and 204 AC patients were included. Targeted next-generation sequencing (NGS) was performed on formalin-fixed paraffin-embedded (FFPE) tissues. AWMC was further divided into two groups: AWMC with signet ring cell component and AWMC without signet ring cell component. Clinicopathological features, mismatch repair protein (MMR) status, genetic alterations, and survival outcomes were analyzed after tumor location was taken into consideration. Results: AWMC had larger tumor size (p = 0.014) and showed predilection for proximal colon (p < 0.001) compared with AC. Regardless of primary sites, AWMC was associated with less metastasis (p < 0.001) and earlier AJCC stage (p < 0.001). Mismatch repair protein deficiency (dMMR) was more commonly detected in AWMC than in AC for right-sided colon (p < 0.001), but the difference was not significant for left-sided colon (p = 0.081). The five most commonly mutated genes in AWMC were KRAS (45.4%), TP53 (39.8%), APC (22.2%), PIK3CA (22.2%), and SMAD4 (10.2%). AWMC showed a significantly lower mutation rate of TP53 than AC, both in right-sided colon and in left-sided colon (p < 0.001 and p = 0.033, respectively). In left-sided colon, AWMC with signet ring cell component had a significantly smaller size than tumors with signet ring cell component (p = 0.034). No dMMR cases were detected in AWMC with signet ring cell component (n = 7). Moreover, AWMC with signet ring cell component had a significantly lower KRAS mutation rate than AWMC without signet ring cell component, both in right-sided colon and in left-sided colon (p = 0.036 and p = 0.012, respectively). The disease-specific survival (DSS) for AWMC and AC were not statistically different (p = 0.0587). Multivariate analysis showed that AWMC was not an independent predictor of prognosis. Conclusion: Regardless of primary sites, AWMC demonstrates less metastasis, earlier stages, more frequent dMMR, and lower TP53 mutation rate than AC. Our results indicate that different molecular pathogenesis might underlie mucinous morphology in colorectal carcinoma. Mucinous component is not an independent factor of outcome.
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Affiliation(s)
- Jingci Chen
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangrui Zhou
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Gao
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Lu
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyong Liang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chang J, Liu ZS, Song DF, Li M, Zhang S, Zhao K, Guan YT, Ren HL, Li YS, Zhou Y, Liu XL, Lu SY, Hu P. Cholecystokinin type 2 receptor in colorectal cancer: diagnostic and therapeutic target. J Cancer Res Clin Oncol 2020; 146:2205-2217. [PMID: 32488497 DOI: 10.1007/s00432-020-03273-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/23/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Cholecystokinin type 2 receptor (CCK2R), which mediates the action of gastrin and cholecystokinin (CCK), has been demonstrated to promote the proliferation of colorectal cancer (CRC). A number of studies showed that CCK2R overexpressed in gastric cancer and pancreatic cancer but few in CRC. The correlation between CCK2R expression and clinicopathological characteristics is also not clear. METHODS This study investigated CCK2R expression in a wide range of cell lines and clinical CRC samples, and explored expression pattern and prognostic value of CCK2R in relation to clinicopathological parameters. The location and expression levels of CCK2R were measured by immunocytochemical (ICC), qRT-PCR and Western blot. The druggability and antineoplastic effects of CCK2R as a therapeutic target were investigated using an anti-CCK2R targeting recombinant toxin named rCCK8PE38 by CCK-8 assay. RESULTS Compared with paracarcinoma tissues, tumor samples showed overexpression of CCK2R (p = 0.028) including both CRC tissue and plasma samples, with plasma detection showing a significant indication for CCK2R evaluation. Aberrant expression correlated significantly with histological type (p = 0.032) and p53 status (p < 0.01), and patients with CCK2R overexpression had significantly lower disease-free survival. Application of rCCK8PE38 demonstrated the specificity and druggability of CCK2R as a therapeutic target, providing a strategy for clinical case screening of drugs targeting CCK2R. CONCLUSION This study highlighted the aberrant expression and clinical correlation of CCK2R and reveals its diagnostic, prognostic and treatment value in CRC. We hypothesize that CCK2R serve as a target for the diagnosis and treatment of this cancer.
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Affiliation(s)
- Jiang Chang
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Zeng-Shan Liu
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - De-Feng Song
- China-Japan Union Hospital, Xian Tai Da Jie 126, Changchun, 130033, China
| | - Meng Li
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Song Zhang
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Ke Zhao
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Yu-Ting Guan
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Hong-Lin Ren
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Yan-Song Li
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Yu Zhou
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China
| | - Xi-Lin Liu
- China-Japan Union Hospital, Xian Tai Da Jie 126, Changchun, 130033, China.
| | - Shi-Ying Lu
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China. .,Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China.
| | - Pan Hu
- Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, College of Veterinary Medicine, Double-First Class Discipline of Human-Animal Medicine, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China. .,Key Laboratory of Zoonosis Research, Ministry of Education/Institute of Zoonosis, Jilin University, Xi An Da Lu 5333, Changchun, 130062, China.
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Hosseini S, Nguyen N, Mohammadianpanah M, Mirzaei S, Bananzadeh AM. Predictive Significance of Mucinous Histology on Pathologic Complete Response Rate Following Capecitabine-Based Neoadjuvant Chemoradiation in Rectal Cancer: a Comparative Study. J Gastrointest Cancer 2020; 50:716-722. [PMID: 29984382 DOI: 10.1007/s12029-018-0136-x] [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] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Currently, neoadjuvant fluoropyrimidine-based chemoradiation followed by surgery is considered the standard of care for locally advanced rectal cancer. The current study aimed to investigate the predictive significance of mucinous histology on the pathologic complete response rate following neoadjuvant chemoradiation in locally advanced rectal cancer and to propose potential new treatment protocol for this specific histology. MATERIAL AND METHOD This retrospective study was conducted on 403 patients with locally advanced (clinically T3-4 and/or N1-2) rectal adenocarcinoma who had been treated at three tertiary academic hospitals between 2010 and 2015. Among those 403 patients, 46 (11%) had mucinous rectal cancer (MRC) and 358 (89%) had non-mucinous rectal cancer (NMRC). All patients underwent neoadjuvant chemoradiation with capecitabine followed by low anterior or abdominoperineal resection. RESULTS There were 268 men and 135 women with a median age of 55 years (range, 26-82 years). Patients with MRC were younger (p = 0.002) and presented with a larger tumor size (p < 0.001) and a more advanced tumor stage (p = 0.033) compared to the ones with MNRC. In the univariate analysis, female gender (p = 0.009), distal tumor location (p = 0.035), higher tumor stage (p = 0.049), node positivity (p = 0.001), MRC histology (p = 0.017), and high pretreatment CEA level (p = 0.013) were observed to be predictive of a poor pathologic complete response. However, in the multivariate analysis, tumor stage was the single most predictive factor of response to neoadjuvant chemoradiation. CONCLUSION Mucinous adenocarcinoma is a significant predictive factor for poor pathologic complete response to neoadjuvant capecitabine-based chemoradiation in patients with locally advanced rectal cancer. New treatment modality based on biomarkers may be considered in future prospective studies because of MRC poor prognosis. Immunotherapy combined with chemotherapy and/or radiotherapy may be an attractive option because of the tumor microsatellite instability-high status.
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Affiliation(s)
- Sare Hosseini
- Cancer Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - NamPhong Nguyen
- Department of Radiation Oncology, Howard University Hospital, 2401 Georgia Avenue, NW, Room 2055, Washington, DC, 20060, USA
| | - Mohammad Mohammadianpanah
- Colorectal Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, 71936, Iran.
| | - Sepideh Mirzaei
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mohammad Bananzadeh
- Colorectal Research Center, Department of Colorectal Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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85
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Mucinous Histology, BRCA1/2 Mutations, and Elevated Tumor Mutational Burden in Colorectal Cancer. JOURNAL OF ONCOLOGY 2020; 2020:6421205. [PMID: 32377194 PMCID: PMC7196997 DOI: 10.1155/2020/6421205] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/22/2020] [Accepted: 02/08/2020] [Indexed: 12/18/2022]
Abstract
Mucinous colorectal carcinomas (MC) constitute 10% of colorectal malignancies. Recently, an increased risk of colorectal cancer has been demonstrated in germline BRCA1/2 mutation carriers. Furthermore, BRCA1/2 germline mutation carriers have exhibited a higher-than-expected frequency of MC tumors. Here, we investigate the relationship between BRCA mutations and mucinous histology in colorectal carcinoma patients, using both an existing cohort of sequenced colorectal tumors and a prospective case-control study comparing MC and conventional adenocarcinoma (AC) patients tested for BRCA mutations. We discovered that MC tumors exhibit a statistically significantly higher incidence of BRCA mutations in addition to a higher average mutation count when compared to AC tumors in the existing cohort. The strongest predictor of the mutation count was mucinous histology, independently of other variables including microsatellite instability. Contrary to our hypothesis, the first association did not recur in the prospective case-control study, likely due to our pathological definition of MC tumors and small sample size. Finally, we observed a higher tumor mutational burden (TMB) in MC tumors compared with AC tumors. We suggest that the association between MC histology, BRCA mutations, and increased TMB may open the door to the utilization of simple tests (such as histopathologic characterization) to detect patients who may benefit from immunotherapy in colorectal cancer.
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86
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Cai Z, Xie X, Chen Y, Chen Z, Cao W, Saad KSS, Zou Y, Lan P, Wu X. Risk factor analysis for inaccurate pre-operative MRI staging in rectal cancer. BMC Cancer 2020; 20:253. [PMID: 32216771 PMCID: PMC7099769 DOI: 10.1186/s12885-020-06761-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/17/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Various tumor characteristics might lead to inaccurate local MRI-defined stage of rectal cancer and the purpose of this study was to explore the clinicopathological factors that impact on the precision pre-treatment MRI-defined stage of rectal cancer. METHODS A retrospectively analysis was conducted in non-metastatic rectal cancer patients who received radical tumor resection without neoadjuvant treatment during 2007-2015 in the Sixth Affiliated Hospital of Sun Yat-sen University. Clinical T stage and N stage defined by pelvic enhanced MRI and pathological stage were compared and patients were subdivided into accurate-staging, over-staging and under-staging subgroups. Logistic regressions were used to explore risk factors for over-staging or under-staging. RESULTS Five hundred fifty-one cases of patients were collected. Among them, 109 cases (19.4%) of patients were over-T-staged and 50 cases (8.9%) were under-T-staged, while 78 cases (13.9%) were over-N-staged and 75 cases (13.3%) were under-N-staged. Logistic regression suggested that pre-operative bowel obstruction was risk factor for over-T-staging (OR = 3.120, 95%CI: 1.662-5.857, P < 0.001) as well as over-N-staging (OR = 3.494, 95%CI: 1.797-6.794, P < 0.001), while mucinous adenocarcinoma was a risk factor for under-N-staging (OR = 4.049, 95%CI: 1.876-8.772, P < 0.001). Patients with larger tumor size were at lower risk for over-T-staging (OR = 0.837, 95%CI: 0.717-0.976, P = 0.024) and higher risk for over-N-staging (OR = 1.434, 95%CI: 1.223-1.680, P < 0.001). CONCLUSION Bowel obstruction, mucinous adenocarcinoma and tumor size might have impact on the pre-operative MRI T staging or N staging of rectal cancer. Our results reminded clinicians to assess clinical stage individually in such rectal cancer patients.
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Affiliation(s)
- Zerong Cai
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Xiaoyu Xie
- Department of Oncology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yufeng Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Zexian Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Wuteng Cao
- Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Khamis Salem Saeed Saad
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Yifeng Zou
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China
| | - Xiaojian Wu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, People's Republic of China.
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Sun Y, Huang Z, Lin H, Chi P. Prognostic impact of preoperative immunonutritional status in rectal mucinous adenocarcinoma. Future Oncol 2020; 16:339-351. [PMID: 32067478 DOI: 10.2217/fon-2019-0793] [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] [Indexed: 12/24/2022] Open
Abstract
Aim: To explore the impact of preoperative the albumin-to-globulin ratio (AGR) and the prognostic nutritional index (PNI) on prognosis in rectal mucinous adenocarcinoma (MAC). Methods: A total of 128 patients were included. Results: According to the X-tile analysis, cutoff values of AGR and PNI were 1.1 and 43.8. Preoperative AGR (p = 0.041), preoperative PNI (p = 0.036) and pTNM stage (p = 0.003) were independently associated with overall survival in rectal MAC patients. Distance from the anal verge (p = 0.005), preoperative AGR (p = 0.021), preoperative PNI (p = 0.007) and pTNM stage (p < 0.001) were significantly associated with disease-free survival in rectal MAC patients. Nomograms for overall survival and disease-free survival were developed (C-index: 0.739 and 0.764). Conclusion: Preoperative AGR and PNI can act as effective predictors for survival for rectal MAC patients.
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Affiliation(s)
- Yanwu Sun
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Zhekun Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Huiming Lin
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China
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Kammar P, Chaturvedi A, Sivasanker M, de'Souza A, Engineer R, Ostwal V, Saklani A. Impact of delaying surgery after chemoradiation in rectal cancer: outcomes from a tertiary cancer centre in India. J Gastrointest Oncol 2020; 11:13-22. [PMID: 32175101 DOI: 10.21037/jgo.2019.12.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Delaying surgery after chemoradiation is one of the strategies for increasing tumor regression in rectal cancer. Tumour regression and PCR are known to have positive impact on survival. Methods It's a retrospective study of 161 patients undergoing surgery after neoadjuvant chemoradiation (NCRT) for locally advanced rectal cancer (LARC). Patients were divided into three categories based on the gap between NCRT and surgery, i.e., <8, 8-12 and >12 weeks. Tumor regression grades (TRG), sphincter preservation, post-operative morbidity-mortality and survival were evaluated. Results Sphincter preservation was significantly less in >12 weeks group compared to the other two groups (P=0.003). Intraoperative blood loss was significantly higher in >12 weeks group compared to 8-12 weeks group (P=0.001).There was no difference in major postoperative morbidity and hospital stay among the groups. There was no significant correlation between delay and TRG (P=0.644). At Median follow up of 49.5 months the projected 3-year overall survival (OS) and disease free survival (DFS) were not significantly different among the 3 groups (OS: 79.5% vs. 83.3% vs. 76.5%; P=0.849 and DFS 50.4% vs. 70.6% vs. 62%; P=0.270 respectively). Conclusions Delaying surgery by more than 12 weeks causes more blood loss but no change in morbidity or hospital stay. Increased time interval between radiation and surgery does not improve tumor regression and has no effect on survival.
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Affiliation(s)
- Praveen Kammar
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Aditi Chaturvedi
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Masillamany Sivasanker
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ashwin de'Souza
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Avanish Saklani
- Colorectal Division, GI Services, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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89
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Ge YX, Li J, Zhang JQ, Duan SF, Liu YK, Hu SD. Radiomics analysis of multicenter CT images for discriminating mucinous adenocarcinoma from nomucinous adenocarcinoma in rectal cancer and comparison with conventional CT values. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:285-297. [PMID: 32116286 DOI: 10.3233/xst-190614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the value of CT-based radiomics signature for preoperatively discriminating mucinous adenocarcinoma (MA) from nomucinous adenocarcinoma (NMA) in rectal cancer and compare with conventional CT values. METHOD A total of 225 patients with histologically confirmed MA or NMA of rectal cancer were retrospectively enrolled. Radiomics features were computed from the entire tumor volume segmented from the post-contrast phase CT images. The maximum relevance and minimum redundancy (mRMR) and LASSO regression model were performed to select the best preforming features and build the radiomics models using a training cohort of 155 cases. Then, predictive performance of the models was validated using a validation cohort of 70 cases and receiver operating characteristics (ROC) analysis method. Meanwhile, CT values in post- and pre-contrast phase, as well as their difference (D-values) of tumors in two cohorts were measured by two radiologists. ROC curves were also calculated to assess diagnostic efficacies. RESULTS One hundred and sixty-three patients were confirmed by pathology as NMA and 62 cases were MA. The radiomics signature comprised 19 selected features and showed good discrimination performance in both the training and validation cohorts. The areas under ROC curves (AUC) are 0.93 (95% confidence interval [CI]: 0.89-0.98) in training cohort and 0.93 (95% CI: 0.87-0.99) in validation cohort, respectively. Three sets of CT values of MA in pre- and post-contrast phase, and their difference (D-value) (31±7.0, 51±12.6 and 20±9.3, respectively) were lower than those of NMA (37±5.6, 69±13.3 and 32±11.7, respectively). Comparing to the radiomics signature, using three sets of conventional CT values yielded relatively low diagnostic performance with AUC of 0.84 (95% CI: 0.78-0.88), 0.75 (95% CI: 0.69-0.81) and 0.78 (95% CI: 0.72-0.83), respectively. CONCLUSION This study demonstrated that CT radiomics features could be utilized as a noninvasive biomarker to identify MA patients from NMA of rectal cancer preoperatively, which is more accurate than using the conventional CT values.
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Affiliation(s)
- Yu-Xi Ge
- Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jie Li
- Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Jun-Qin Zhang
- The First People's Hospital of Yuhang District, Hangzhou, China
| | | | - Yan-Kui Liu
- Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Shu-Dong Hu
- Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
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90
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Tchelebi LT, Romesser PB, Feuerlein S, Hoffe S, Latifi K, Felder S, Chuong MD. Magnetic Resonance Guided Radiotherapy for Rectal Cancer: Expanding Opportunities for Non-Operative Management. Cancer Control 2020; 27:1073274820969449. [PMID: 33118384 PMCID: PMC7791447 DOI: 10.1177/1073274820969449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Colorectal cancer is the third most common cancer in men and the second most common in women worldwide, and the incidence is increasing among younger patients. 30% of these malignancies arise in the rectum. Patients with rectal cancer have historically been managed with preoperative radiation, followed by radical surgery, and adjuvant chemotherapy, with permanent colostomies in up to 20% of patients. Beginning in the early 2000s, non-operative management (NOM) of rectal cancer emerged as a viable alternative to radical surgery in select patients. Efforts have been ongoing to optimize neoadjuvant therapy for rectal cancer, thereby increasing the number of patients potentially eligible to forgo radical surgery. Magnetic resonance guided radiotherapy (MRgRT) has recently emerged as a treatment modality capable of intensifying preoperative radiation therapy for rectal cancer patients. This technology may also predict which patients will achieve a complete response to preoperative therapy, thereby allowing for more appropriate selection of patients for NOM. The present work seeks to illustrate the potential role MRgRT could play in personalizing rectal cancer treatment thus expanding the role of NOM in rectal cancer.
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Affiliation(s)
- Leila T. Tchelebi
- Department of Radiation Oncology, Penn State College of Medicine,
Hershey, PA, USA
| | - Paul B. Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer
Center, New York, NY, USA
| | - Sebastian Feuerlein
- Department of Diagnostic Imaging and Interventional Radiology,
Moffitt Cancer Center, Tampa, FL, USA
| | - Sarah Hoffe
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL,
USA
| | - Kujtim Latifi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL,
USA
| | - Seth Felder
- Department of Gastrointestinal Oncology, Moffitt Cancer Center,
Tampa, FL, USA
| | - Michael D. Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL,
USA
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91
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Reynolds IS, O’Connell E, Fichtner M, McNamara DA, Kay EW, Prehn JHM, Furney SJ, Burke JP. Mucinous adenocarcinoma is a pharmacogenomically distinct subtype of colorectal cancer. THE PHARMACOGENOMICS JOURNAL 2019; 20:524-532. [DOI: 10.1038/s41397-019-0137-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023]
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92
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Reynolds IS, O'Connell E, Fichtner M, McNamara DA, Kay EW, Prehn JHM, Furney SJ, Burke JP. Mucinous adenocarcinoma of the colon and rectum: A genomic analysis. J Surg Oncol 2019; 120:1427-1435. [PMID: 31729037 DOI: 10.1002/jso.25764] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Mucinous adenocarcinoma is a distinct subtype of colorectal cancer (CRC) with a worse prognosis when compared with non-mucinous adenocarcinoma. The aim of this study was to compare somatic mutations and copy number alteration (CNA) between mucinous and non-mucinous CRC. METHODS Data from The Cancer Genome Atlas-colon adenocarcinoma and rectum adenocarcinoma projects were utilized. Mucinous and non-mucinous CRC were compared with regard to microsatellite status, overall mutation rate, the most frequently mutated genes, mutations in genes coding for mismatch repair (MMR) proteins and genes coding for mucin glycoproteins. CNA analysis and pathway analysis was undertaken. RESULTS Mucinous CRC was more likely to be microsatellite instability-high (MSI-H) and hypermutated. When corrected for microsatellite status the single-nucleotide variation and insertion-deletion rate was similar between the two cohorts. Mucinous adenocarcinoma was more likely to have mutations in genes coding for MMR proteins and mucin glycoproteins. Pathway analysis revealed further differences between the two histological subtypes in the cell cycle, RTK-RAS, transforming growth factor-β, and TP53 pathways. CONCLUSIONS Mucinous CRC has some distinct genomic aberrations when compared with non-mucinous adenocarcinoma, many of which are driven by the increased frequency of MSI-H tumors. These genomic aberrations may play an important part in the difference seen in response to treatment and prognosis in mucinous adenocarcinoma.
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Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emer O'Connell
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Fichtner
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine W Kay
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Jochen H M Prehn
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Simon J Furney
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland.,Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Genomic Oncology Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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93
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Abstract
In recent years, rectal MRI has become a central diagnostic tool in rectal cancer staging. Indeed, rectal MR has the ability to accurately evaluate a number of important findings that may impact patient management, including distance of the tumor to the mesorectal fascia, presence of extramural vascular invasion (EMVI), presence of lymph nodes, and involvement of the peritoneum/anterior peritoneal reflection. Many of these findings are difficult to assess in nonexpert hands. In this review, we present a practical approach for radiologists to provide high-quality interpretations at initial baseline exams, based on recent guidelines from the Society of Abdominal Radiology, Rectal and Anal Cancer Disease Focused Panel. Practical pearls and pitfalls are discussed, focusing on optimization of technique including, patient preparation and protocol recommendations, interpretation, and essentials of reporting.
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MRI morphologic and clinicopathologic characteristics for predicting outcomes in patients with locally advanced rectal cancer. Abdom Radiol (NY) 2019; 44:3652-3663. [PMID: 30456561 DOI: 10.1007/s00261-018-1828-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the value of MRI morphologic and clinicopathologic factors for predicting 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). METHOD In this retrospective study, pre- and post-neoadjuvant chemoradiotherapy (nCRT) MRI morphologic (e.g., pre-nCRT MRI-detected extramural venous invasion) and clinicopathologic variabilities (e.g., pathological complete response) were evaluated in all patients. Three-year DFS was estimated using Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between morphologic or clinicopathologic variabilities and survival outcomes. RESULTS A total of 115 patients (39 females and 76 males; median age, 54 years; age range, 28-82 years) with LARC treated with nCRT were enrolled. With a median follow-up of 48.0 months, the 3-year DFS was 79.0% for all patients. During follow-up, 18 patients died, 28 patients experienced relapse (26 distant, one local, and one both), and 69 patients were censored. MRI-detected extramural venous invasion (mrEMVI) was the only significantly independent factor of long-term survival, while HR was 2.308 (95% CI 1.151-4.629, P = 0.018) on univariate and 2.495 (95% CI 1.243-5.012, P = 0.010) on multivariate analysis. The 3-year cumulative survival rate in patients with mrEMVI negativity compared with positivity were 86.6% versus 65.0% (P = 0.015), respectively. CONCLUSION In conclusion, pre-nCRT mrEMVI status was the independent significant risk factor for long-term outcomes in LARC patients treated with nCRT, while the other morphologic and clinicopathologic characteristics were not related to the patient survival.
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95
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Raposo Rodríguez L, Fernández García N, Tovar Salazar D, Gómez Illán R, Díaz Sánchez T. Imaging findings for mucinous tumors tumortumorof the abdomen and pelvis. RADIOLOGIA 2019. [DOI: 10.1016/j.rxeng.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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96
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Zhang W, Ye YJ, Ren XW, Huang J, Shen ZL. [Detection of preoperative chemoradiotherapy sensitivity molecular characteristics of rectal cancer by transcriptome second generation sequencing]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:542-547. [PMID: 31209429 DOI: 10.19723/j.issn.1671-167x.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To detect the preoperative chemoradiotherapy sensitivity molecular characteristics of rectal cancer by transcriptome second generation sequencing. METHODS The clinicopathological data of 30 patients with locally advanced rectal cancer were collected prospectively, including 9 indicators (general conditions, imaging data before radiotherapy and chemotherapy, pathological data of biopsy before radiotherapy and chemotherapy, and tumor differentiation degree, etc.), in order to analyze the correlation between them and tumor regression grading (TRG) after radiotherapy and chemotherapy for rectal cancer. At the same time, frozen specimens of colonoscopy biopsy before neoadjuvant therapy were collected from these 30 patients, and transcriptome second-generation sequencing was performed for bioinformatics analysis to screen out the genes that might drive the radio chemotherapy sensitivity of rectal cancer. RESULTS Among the 30 patients with rectal cancer, 9 had complete pathological remission, 12 had partial remission, and 9 had poor remission. The degree of pathological TRG remission after radiotherapy and chemotherapy for rectal cancer was negatively correlated with the preoperative MRI T stage (P=0.046), and positively correlated with preoperative MRI rectal cancer extravascular invasion (EMVI) (P=0.003). Transcriptome second-generation sequencing of the obtained 217 transcripts (P<0.05) for signal pathway enrichment analysis, and multiple cell signal transduction pathways related to antigen presentation could be found. The high expression of HSPA1A, HSPA1B and EXOSC2 was positively correlated with postoperative pathological remission (P<0.05). The high expression of DNMBP, WASH8P, FAM57A, and SGSM2 was positively correlated with postoperative pathological remission (P<0.05). CONCLUSION Preoperative NMR detection of extra-tumoral vascular invasion (EMVI-positive) in patients with rectal cancer was significantly better than that of EMVI-negative patients after chemoradiotherapy. Patients with high expressions of HSPA1A, HSPA1B and EXOSC2 had poor postoperative pathological remission, while patients with high expressions of genes, such as DMNMB, WASH8P, FAM57A, and SGSM2 had good postoperative pathological remission. Based on the molecular characteristics of rectal cancer radiotherapy and chemotherapy, attempts to block or enhance the molecular pathways associated with chemosensitivity of rectal cancer, are to be made to further explore new candidate therapeutic targets that can increase the sensitivity of radiotherapy and chemotherapy for rectal cancer.
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Affiliation(s)
- W Zhang
- Department of Surgical Oncology, Peking University People's Hospital, Beijing 100044, China
| | - Y J Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China
| | - X W Ren
- Biodynamic Optical Imaging Center, School of Life Sciences, Peking University, Beijing 100871, China
| | - J Huang
- Department of Immunology, Peking University School of Basic Medical Sciences, Beijing 100191, China
| | - Z L Shen
- Department of Surgical Oncology, Peking University People's Hospital, Beijing 100044, China
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97
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Wang P, Zhou S, Zhou H, Liang J, Zhou Z. Evaluating predictive factors for determining the presence of lateral pelvic node metastasis in rectal cancer patients following neoadjuvant chemoradiotherapy. Colorectal Dis 2019; 21:791-796. [PMID: 30801862 DOI: 10.1111/codi.14595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/07/2019] [Indexed: 12/20/2022]
Abstract
AIM The need or otherwise for lateral pelvic node dissection (LPND) in rectal cancer patients with clinical lateral pelvic node metastasis (LPNM) after neoadjuvant chemoradiotherapy (nCRT) is controversial. This study was designed to explore the predictive factors for pathological LPNM in rectal cancer patients with clinical LPNM after nCRT. METHOD From January 2010 to February 2018, a consecutive series of patients with rectal cancer and clinical LPNM after nCRT who underwent total mesorectal excision and LPND were reviewed. Patient demographics, operative and pathological outcomes were collected and analysed. RESULTS A total of 76 consecutive cases were included in this study: 53 (69.7%) patients underwent unilateral LPND and 23 (30.3%) bilateral LPND. The pathological results showed that LPNM was found in 13 (17.1%) patients. Multivariate logistic regression analysis showed that the post-nCRT lateral pelvic node size ≥ 5 mm (OR = 7.67, 95% CI = 1.45-40.63, P = 0.017) and mucinous/signet-ring adenocarcinoma (OR = 4.60, 95% CI = 1.11-19.08, P = 0.035) were independent risk factors for pathological LPNM. CONCLUSION Post-nCRT lateral pelvic node size ≥ 5 mm and mucinous/signet-ring adenocarcinoma were independent predictive factors of pathological LPNM for rectal cancer patients with clinical LPNM after nCRT, and patients with these characteristics may benefit from LPND.
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Affiliation(s)
- P Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - S Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - H Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Z Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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98
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Mucin-Containing Rectal Carcinomas: Overview of Unique Clinical and Imaging Features. AJR Am J Roentgenol 2019; 213:26-34. [DOI: 10.2214/ajr.18.20864] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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99
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Yi X, Pei Q, Zhang Y, Zhu H, Wang Z, Chen C, Li Q, Long X, Tan F, Zhou Z, Liu W, Li C, Zhou Y, Song X, Li Y, Liao W, Li X, Sun L, Pei H, Zee C, Chen BT. MRI-Based Radiomics Predicts Tumor Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer. Front Oncol 2019; 9:552. [PMID: 31293979 PMCID: PMC6606732 DOI: 10.3389/fonc.2019.00552] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Conventional methods for predicting treatment response to neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) are limited. Methods: This study retrospectively recruited 134 LARC patients who underwent standard nCRT followed by total mesorectal excision surgery in our institution. Based on pre-operative axial T2-weighted images, machine learning radiomics was performed. A receiver operating characteristic (ROC) curve was performed to test the efficiencies of the predictive model. Results: Among the 134 patients, 32 (23.9%) achieved pathological complete response (pCR), 69 (51.5%) achieved a good response, and 91 (67.9%) achieved down-staging. For prediction of pCR, good-response, and down-staging, the predictive model demonstrated high classification efficiencies, with an AUC value of 0.91 (95% CI: 0.83–0.98), 0.90 (95% CI: 0.83–0.97), and 0.93 (95% CI: 0.87–0.98), respectively. Conclusion: Our machine learning radiomics model showed promise for predicting response to nCRT in patients with LARC. Our predictive model based on the commonly used T2-weighted images on pelvic Magnetic Resonance Imaging (MRI) scans has the potential to be adapted in clinical practice. Novelty and Impact Statements: Methods for predicting the response of the locally advanced rectal cancer (LARC, T3-4, or N+) to neoadjuvant chemoradiotherapy (nCRT) is lacking. In the present study, we developed a new machine learning radiomics method based on T2-weighted images. As a non-invasive tool, this method facilitates prediction performance effectively. It achieves a satisfactory overall diagnostic accuracy for predicting of pCR, good response, and down-staging show an AUC of 0.908, 0.902, and 0.930 in LARC patients, respectively.
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Affiliation(s)
- Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China.,Postdoctoral Research Workstation of Pathology and Pathophysiology, Basic Medical Sciences, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Pei
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Youming Zhang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Zhu
- Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongjie Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chen Chen
- Department of Radiology, Zhuzhou 331 Hospital, Zhuzhou, China
| | - Qingling Li
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
| | - Xueying Long
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Fengbo Tan
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhongyi Zhou
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wenxue Liu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Chenglong Li
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yuan Zhou
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Song
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqiang Li
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Lunquan Sun
- Postdoctoral Research Workstation of Pathology and Pathophysiology, Basic Medical Sciences, Xiangya Hospital, Central South University, Changsha, China
| | - Haiping Pei
- Department of General surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Chishing Zee
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
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100
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Imaging findings for mucinous tumors of the abdomen and pelvis. RADIOLOGIA 2019; 61:370-387. [PMID: 31078302 DOI: 10.1016/j.rx.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/25/2019] [Accepted: 03/15/2019] [Indexed: 11/23/2022]
Abstract
This article aims to describe the imaging findings for mucinous tumors of the abdomen and pelvis, which have a similar appearance on imaging tests regardless of the organ in which they develop. Due to the high water content of mucus, the appearance of these tumors is generally similar to that of water on ultrasonography, computed tomography, and magnetic resonance imaging. Another common feature of mucin-producing tumors is that calcifications are often present. The rupture of these lesions and accumulation of mucinous material in the peritoneal cavity gives rise to pseudomyxoma peritonei. It is important to identify mucinous tumors because they have a different prognosis and clinical course than non-mucinous tumors and require different management. Depending on their anatomic location and their imaging characteristics, the treatment approach varies from follow-up to radical surgery together with chemotherapy or radiotherapy or both.
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