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Takahashi K, Ito H, Hashimoto M, Mita K, Asakawa H, Hayashi T, Fujino K. Does antithrombotic therapy improve survival with colorectal cancer? World J Surg Oncol 2017; 15:161. [PMID: 28836988 PMCID: PMC5571652 DOI: 10.1186/s12957-017-1235-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 08/05/2017] [Indexed: 12/21/2022] Open
Abstract
Background The study aimed to evaluate the prognosis for patients with colorectal cancer who underwent surgery while receiving antithrombotic therapy (ATT) across all disease stages and for patients at disease stages 0–III. Methods This retrospective cohort study included 710 Japanese patients who underwent surgery for colorectal cancer between January 2009 and November 2015 at our institution. Approximately 35% of these patients received ATT. Of these, 199 (28.0%) received antiplatelet therapy, and 76 (10.7%) received anticoagulant therapy. We investigated the prognosis among patients with colorectal cancer receiving ATT, antiplatelet therapy, or anticoagulant therapy in all-stage and stage 0–III cancers. Results For all disease stages combined, no benefit was observed for ATT, antiplatelet therapy, and anticoagulant therapy groups in the overall survival rates (ATT: 87.8 vs. 78.4%, P = 0.23; antiplatelet therapy: 87.8 vs. 78.6%, P = 0.25; and anticoagulant therapy: 92.2 vs. 80.2%, P = 0.26). However, overall survival rates of patients with stage 0–III colorectal cancer undergoing ATT, antiplatelet therapy, and anticoagulant therapy significantly improved. (ATT: 98.5 vs. 92.7%, P = 0.01; antiplatelet therapy: 98.3 vs. 91.1%, P = 0.02; and anticoagulant therapy: 100 vs. 92.1%, P = 0.00). Conclusion Receiving ATT significantly improves overall survival rates in patients with stage 0–III colorectal cancer.
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Affiliation(s)
- Kodai Takahashi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan.
| | - Hideto Ito
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Masatoshi Hashimoto
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Hideki Asakawa
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Takashi Hayashi
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
| | - Keiichi Fujino
- Department of Surgery, New-Tokyo Hospital, 1271 Wanagaya, Matsudo-city, Chiba, 270-2232, Japan
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Murphy C, Turner N, Wong HL, Sinnathamby M, Tie J, Lee B, Desai J, Skinner I, Christie M, Hutchinson R, Lunke S, Waring P, Gibbs P, Tran B. Examining the impact of regular aspirin use and PIK3CA mutations on survival in stage 2 colon cancer. Intern Med J 2017; 47:88-98. [PMID: 27800646 DOI: 10.1111/imj.13312] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIM Data suggest aspirin improves survival in colorectal cancer (CRC) harbouring PIK3CA mutations. The impact of aspirin is thought predominantly to be through an anti-inflammatory effect. The aim of this study is to explore the effect of aspirin use on survival in a real-world cohort of stage 2 colon cancer (CC) patients. METHODS A prospective CRC database identified patients diagnosed with stage 2 CC between 2000 and 2011. PIK3CA mutation status was determined by next generation sequencing. Neutrophil-lymphocyte ratio greater than 5 at diagnosis represented systemic inflammation. Chart review was used to record regular aspirin use at diagnosis. Clinico-pathological features and survival data were available. Survival analyses used the Cox proportional hazards method. RESULTS Of 488 patients with stage 2 CC, 95 patients were aspirin users and 70 patients had PIK3CA mutations. Aspirin users were more likely to be older (median: 76.4 years vs 68.3 years, P < 0.001), to be less fit (American Society of Anaesthetists Score 3-4: 58% vs 31%, P < 0.001) and to have systemic inflammation (neutrophil-lymphocyte ratio > 5: 39% vs 27%, P = 0.027). Regular aspirin use did not significantly improve recurrence-free survival. In the PIK3CA mutated group, there was a trend towards improved recurrence-free survival (hazard ratio: 0.45, P = 0.42). CONCLUSIONS Our study did not demonstrate a significant survival advantage from aspirin use in stage 2 PIK3CA mutated CC. The 'real-world' nature of our cohort and the subsequent uncontrolled differences in age and fitness in aspirin users are likely to have contributed to this result. Defining the true impact of aspirin in CRC requires prospective randomised clinical trials.
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Affiliation(s)
- Caitlin Murphy
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia
| | - Natalie Turner
- Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Hui-Li Wong
- Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Mathu Sinnathamby
- Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeanne Tie
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.,Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Belinda Lee
- Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jayesh Desai
- Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Iain Skinner
- Colorectal Unit, Department of Surgery, Western Health, Melbourne, Victoria, Australia
| | - Michael Christie
- Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ryan Hutchinson
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sebastian Lunke
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul Waring
- Centre for Translational Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.,Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ben Tran
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.,Colorectal Translational Oncology Group, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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153
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Hua X, Phipps AI, Burnett-Hartman AN, Adams SV, Hardikar S, Cohen SA, Kocarnik JM, Ahnen DJ, Lindor NM, Baron JA, Newcomb PA. Timing of Aspirin and Other Nonsteroidal Anti-Inflammatory Drug Use Among Patients With Colorectal Cancer in Relation to Tumor Markers and Survival. J Clin Oncol 2017; 35:2806-2813. [PMID: 28617623 PMCID: PMC5562174 DOI: 10.1200/jco.2017.72.3569] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Regular use of aspirin is associated with improved survival for patients with colorectal cancer (CRC). However, the timing of and the subtype of CRC that would benefit the most from using aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in relation to survival is unclear. Patients and Methods In all, 2,419 patients age 18 to 74 years with incident invasive CRC who were diagnosed from 1997 to 2008 were identified from population-based cancer registries in the United States, Canada, and Australia. Detailed epidemiologic questionnaires were administered at study enrollment and at 5-year follow-up. Survival outcomes were completed through linkage to national death registries. BRAF- and KRAS-mutation status, microsatellite instability, and CpG island methylator phenotype were also evaluated. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for overall survival (OS) and CRC-specific survival. Results After a median of 10.8 years of follow-up since diagnosis, 381 deaths (100 as a result of CRC) were observed. Compared with nonusers, postdiagnostic aspirin-only users had more favorable OS (HR, 0.75; 95% CI, 0.59 to 0.95) and CRC-specific survival (HR, 0.44; 95% CI, 0.25 to 0.71), especially among those who initiated aspirin use (OS: HR, 0.64; 95% CI, 0.47 to 0.86; CRC-specific survival: HR, 0.40; 95% CI, 0.20 to 0.80). The association between any NSAID use after diagnosis and OS differed significantly by KRAS-mutation status ( Pinteraction = .01). Use of any NSAID after diagnosis was associated with improved OS only among participants with KRAS wild-type tumors (HR, 0.60; 95% CI, 0.46 to 0.80) but not among those with KRAS-mutant tumors (HR, 1.24; 95% CI, 0.78 to 1.96). Conclusion Among long-term CRC survivors, regular use of NSAIDs after CRC diagnosis was significantly associated with improved survival in individuals with KRAS wild-type tumors.
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Affiliation(s)
- Xinwei Hua
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Amanda I. Phipps
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Andrea N. Burnett-Hartman
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Scott V. Adams
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Sheetal Hardikar
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Stacey A. Cohen
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Jonathan M. Kocarnik
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Dennis J. Ahnen
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Noralane M. Lindor
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - John A. Baron
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
| | - Polly A. Newcomb
- Xinwei Hua, Amanda I. Phipps, Andrea N. Burnett-Hartman, Scott V. Adams, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, Fred Hutchinson Cancer Research Center; Xinwei Hua, Amanda I. Phipps, Sheetal Hardikar, Stacey A. Cohen, Jonathan M. Kocarnik, and Polly A. Newcomb, University of Washington, Seattle, WA; Andrea N. Burnett-Hartman, Kaiser Permanente Colorado Institute for Health Research; Dennis J. Ahnen, University of Colorado School of Medicine, and Gastroenterology of the Rockies, Denver, CO; Noralane M. Lindor, Mayo Clinic, Scottsdale, AZ; and John A. Baron, University of North Carolina, Chapel Hill, NC
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Abstract
PURPOSE Colorectal cancer (CRC) is the third most common cancer diagnosed in men and women in the United States. Given the availability of effective screening, most tumors are found early enough to offer patients substantial long-term survival. Thus there is a resulting significant population of CRC survivors for whom modifiable risk factors for recurrence and survival would be of interest. METHODS We conducted a population-based retrospective cohort study among patients enrolled in 2 large Midwestern health plans for which claims data, including pharmacy fill data, and medical record data were available. Men and women who were 40 years of age or older at the time of CRC diagnosis with disease less than stage IV and no history of Crohn disease, ulcerative colitis, and irritable bowel syndrome were included. CRC cases diagnosed between January 1, 1990 and December 31, 2000 were included if they met the inclusion criteria. Adjusted Cox proportional hazard models were used with exposure modeled as a time-dependent covariate. We assessed progression-free survival, defined as an aggressive polyp or invasive disease, and overall survival. RESULTS After adjustment for age at diagnosis, sex, race, body mass index, stage, side of initial tumor, and tumor histology, we found that current users of nonsteroidal anti-inflammatory drugs had a 3-fold decreased risk of recurrence and a >7-fold decreased risk of death. Our results are statistically significant with P-values <0.05. CONCLUSIONS Our results suggest that current use of nonsteroidal anti-inflammatory drugs provides significant improvements in CRC outcomes.
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155
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Voorneveld PW, Reimers MS, Bastiaannet E, Jacobs RJ, van Eijk R, Zanders MMJ, Herings RMC, van Herk-Sukel MPP, Kodach LL, van Wezel T, Kuppen PJK, Morreau H, van de Velde CJH, Hardwick JCH, Liefers GJ. Statin Use After Diagnosis of Colon Cancer and Patient Survival. Gastroenterology 2017; 153:470-479.e4. [PMID: 28512021 DOI: 10.1053/j.gastro.2017.05.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Statin use has been associated with a reduced incidence of colorectal cancer and might also affect survival of patients diagnosed with colon cancer. Statins are believed to inhibit Ras signaling and may also activate the bone morphogenetic protein (BMP) signaling pathway in colorectal cancer cells. We investigated the effects of statins on overall survival of patients with a diagnosis of colon cancer, and whether their effects were associated with changes in KRAS or the BMP signaling pathways. METHODS Data were derived from the PHARMO database network (Netherlands) and linked to patients diagnosed with colon cancer from 2002 through 2007, listed in the Eindhoven Cancer Registry. We obtained information on causes of death from statistics Netherlands. We constructed a tissue microarray of 999 colon cancer specimens from patients who underwent surgical resection from 2002 through 2008. Survival was analyzed with statin user status after diagnosis as a time-dependent covariate. Multivariable Poisson regression survival models and Cox analyses were used to study the effect of statins on survival. Tumor tissues were analyzed by immunohistochemistry for levels of SMAD4, BMPR1A, BMPR1B, and BMPR2 proteins. Tumor tissues were considered to have intact BMP signaling if they contained SMAD4 plus BMPR1A, BMPR1B, or BMPR2. DNA was isolated from tumor tissues and analyzed by quantitative polymerase chain reaction to detect mutations in KRAS. The primary outcome measures were overall mortality and cancer-specific mortality. RESULTS In this cohort, 21.0% of the patients (210/999) were defined as statin users after diagnosis of colon cancer. Statin use after diagnosis was significantly associated with reduced risk of death from any cause (adjusted relative risk [RR], 0.67; 95% confidence interval [CI], 0.51-0.87; P = .003) and death from cancer (adjusted RR, 0.66; 95% CI, 0.49-0.89; P = .007). Statin use after diagnosis was associated with reduced risk of death from any cause or from cancer for patients whose tumors had intact BMP signaling (adjusted RR, 0.39; 95% CI, 0.22-0.68; P = .001), but not for patients whose tumors did not have BMP signaling (adjusted RR, 0.81; 95% CI, 0.55-1.21; P = .106; P < .0001 for the interaction). Statin use after diagnosis was not associated with reduced risk of death from any cause or from cancer for patients whose tumors did not contain KRAS mutations (adjusted RR, 0.81; 95% CI, 0.56-1.18; P = .273) or whose tumors did have KRAS mutations (adjusted RR, 0.59; 95% CI 0.35-1.03; P = .062; P = .90 for the interaction). CONCLUSIONS In an analysis of 999 patients with a diagnosis of colon cancer, we associated statin with reduced risk of death from any cause or from cancer. The benefit of statin use is greater for patients whose tumors have intact BMP signaling, independent of KRAS mutation status. Randomized controlled trials are required to confirm these results.
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Affiliation(s)
- Philip W Voorneveld
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, the Netherlands
| | - Marlies S Reimers
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, the Netherlands; Department of Gerontology & Geriatrics, Leiden University Medical Center, the Netherlands
| | - Rutger J Jacobs
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, the Netherlands
| | - Ronald van Eijk
- Department of Pathology, Leiden University Medical Center, the Netherlands
| | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, the Netherlands
| | | | - Liudmila L Kodach
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, the Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, the Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, the Netherlands
| | | | - James C H Hardwick
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, the Netherlands.
| | - Gerrit Jan Liefers
- Department of Surgery, Leiden University Medical Center, the Netherlands
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156
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Cuzick J. Preventive therapy for cancer. Lancet Oncol 2017; 18:e472-e482. [PMID: 28759386 DOI: 10.1016/s1470-2045(17)30536-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/08/2016] [Accepted: 12/22/2016] [Indexed: 12/14/2022]
Abstract
Therapeutic cancer prevention is a developing area that can gain a lot from the successes in the prevention of cardiovascular diseases. Although weight control and physical activity are important in the prevention of both diseases, several other preventive measures exist. Low-dose aspirin for cancer prevention is often cited as the most important approach in terms of population benefit, and should be offered to those older than 50 years of age without hypertension or risk factors for gastrointestinal bleeding. Universal vaccination against the human papillomavirus, ideally with the nine-valent vaccine, also offers substantial benefits for the whole population if given before infection occurs (ie, typically at age 12-14 years). Other therapies, such as anti-oestrogen drugs for breast cancer prevention, should be targeted to high-risk groups to maintain a favourable benefit-risk ratio. Better algorithms for identification and improved platforms to reach these groups, such as during a screening visit, remain a key priority to allow existing knowledge to inform public health. Many other promising compounds have been identified, often as components of food, but results suggesting increased disease incidence with β carotene and vitamin E administration indicate that such treatments need rigorous evaluation before acceptance.
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Affiliation(s)
- Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
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157
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Elaskalani O, Berndt MC, Falasca M, Metharom P. Targeting Platelets for the Treatment of Cancer. Cancers (Basel) 2017; 9:E94. [PMID: 28737696 PMCID: PMC5532630 DOI: 10.3390/cancers9070094] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022] Open
Abstract
The majority of cancer-associated mortality results from the ability of tumour cells to metastasise leading to multifunctional organ failure and death. Disseminated tumour cells in the blood circulation are faced with major challenges such as rheological shear stresses and cell-mediated cytotoxicity mediated by natural killer cells. Nevertheless, circulating tumour cells with metastatic ability appear equipped to exploit host cells to aid their survival. Despite the long interest in targeting tumour-associated host cells such as platelets for cancer treatment, the clinical benefit of this strategy is still under question. In this review, we provide a summary of the latest mechanistic and clinical evidence to evaluate the validity of targeting platelets in cancer.
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Affiliation(s)
- Omar Elaskalani
- Faculty of Health Sciences, Curtin University, Perth 6100, Australia.
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth 6100, Australia.
| | - Michael C Berndt
- Faculty of Health Sciences, Curtin University, Perth 6100, Australia.
| | - Marco Falasca
- Faculty of Health Sciences, Curtin University, Perth 6100, Australia.
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth 6100, Australia.
- School of Biomedical Sciences, Curtin University, Perth 6100, Australia.
| | - Pat Metharom
- Faculty of Health Sciences, Curtin University, Perth 6100, Australia.
- Curtin Health Innovation Research Institute (CHIRI), Curtin University, Perth 6100, Australia.
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158
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Kim SA, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Aspirin use and head and neck cancer survival: an observational study of 11,623 person-years follow-up. Int J Clin Oncol 2017; 23:52-58. [DOI: 10.1007/s10147-017-1165-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/13/2017] [Indexed: 11/25/2022]
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159
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Brasky TM, Felix AS, Cohn DE, McMeekin DS, Mutch DG, Creasman WT, Thaker PH, Walker JL, Moore RG, Lele SB, Guntupalli SR, Downs LS, Nagel CI, Boggess JF, Pearl ML, Ioffe OB, Park KJ, Ali S, Brinton LA. Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence. J Natl Cancer Inst 2017; 109:1-10. [PMID: 28376204 DOI: 10.1093/jnci/djw251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022] Open
Abstract
Background Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients. Methods Study subjects comprised 4374 participants of the NRG Oncology/Gynecology Oncology Group 210 Study with endometrial carcinoma who completed a presurgical questionnaire that assessed history of regular prediagnostic NSAID use and endometrial cancer risk factors. Recurrences, vital status, and causes of death were obtained from medical records and cancer registries. Fine-Gray semiproportional hazards regression estimated adjusted subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations of NSAID use with endometrial carcinoma-specific mortality and recurrence. Models were stratified by endometrial carcinoma type (ie, type I [endometrioid] vs type II [serous, clear cell, or carcinosarcoma]) and histology. Results Five hundred fifty endometrial carcinoma-specific deaths and 737 recurrences occurred during a median of five years of follow-up. NSAID use was associated with 66% (HR = 1.66, 95% CI = 1.21 to 2.30) increased endometrial carcinoma-specific mortality among women with type I cancers. Associations were statistically significant for former and current users, and strongest among former users who used NSAIDs for 10 years or longer (HR = 2.23, 95% CI = 1.19 to 4.18, two-sided P trend = .01). NSAID use was not associated with recurrence or endometrial carcinoma-specific mortality among women with type II tumors. Conclusions In this study, use of NSAIDs was associated with increased endometrial carcinoma-specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted.
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Affiliation(s)
- Theodore M Brasky
- Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- College of Medicine, and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.,Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA
| | - D Scott McMeekin
- Stephenson Oklahoma Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma, USA
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, Case Western Reserve University, Cleveland, OH, USA
| | - John F Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC, USA
| | - Michael L Pearl
- Gynecologic Oncology, State University of New York at Stonybrook, Stonybrook, NY , USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shamshad Ali
- NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Kato I, Lane D, Womack CR, Bock CH, Hou L, Lin JH, Wu C, Beebe Dimmer J, Simon MS. Interaction between Nonsteroidal Anti-inflammatory Drugs and Low-fat Dietary Intervention on Colorectal Cancer Incidence; the Women's Health Initiative (WHI) Dietary Modification Trial. J Am Coll Nutr 2017; 36:462-469. [PMID: 28682183 DOI: 10.1080/07315724.2017.1321505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Women's Health Initiative (WHI) Dietary Modification (DM) trial did not show that reductions in dietary fat accompanied by increases in vegetable and fruit consumption decrease the incidence of colorectal cancer. Secondary analyses suggested that aspirin use may modify the intervention effects of DM on colorectal cancer development, although a recent reanalysis including the postintervention period confirmed no main effect of the intervention on reducing colorectal cancer incidence Methods: We analyzed data from 48,834 postmenopausal women who were randomized into the low-fat DM (N = 19,540) or comparison (N = 29,294) group for an average 8.1 years and followed for an additional 9.4 years through August 31, 2014. Exposure to specific class(es) or strength(s) of nonsteroidal anti-inflammatory drugs (NSAIDs) was modeled at baseline and as time-dependent use through the 9-year clinic visit. A Cox proportional hazard model was employed to assess the association of the DM, medication use, and their interaction with colorectal cancer events. RESULTS A total of 906 incident cases of colorectal cancer were identified during the intervention and postintervention periods. By both exposure models, we found that colorectal cancer incidence was not different in the DM from the comparison group among any type of NSAID users. None of the interactions with any category of NSAID use was statistically significant; however there was most modest evidence for an interaction (p = 0.07) with aspirin use at baseline (hazard ratio [HR] = 0.81, 95% confidence interval [CI], 0.60-1.11 for users; HR = 1.12, 95% CI, 0.97-1.30 for nonusers). Strength and duration of aspirin use at baseline did not alter the associations. CONCLUSION Extended follow-up of women in the WHI DM trial did not confirm combined protective effects of aspirin and low-fat diet on colorectal cancer risk among the postmenopausal women.
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Affiliation(s)
- Ikuko Kato
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA.,b Department of Pathology , Wayne State University School of Medicine , Detroit , Michigan , USA
| | - Dorothy Lane
- c Department of Family , Population and Preventive Medicine, Stony Brook University , Stony Brook , New York , USA
| | - Catherine R Womack
- d Department of Medicine and Preventive Medicine , the University of Tennessee Health Science Center , Memphis , Tennessee , USA
| | - Cathryn H Bock
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA
| | - Lifang Hou
- e Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center Feinberg School of Medicine , Northwestern University , Evanston , Illinois , USA
| | - Jennifer H Lin
- f Janssen Pharmaceutical Inc , Titusville , New Jersey , USA
| | - Chunyuan Wu
- g Fred Hutchinson Cancer Research Center , Division of Public Health Sciences , Seattle , Washington , USA
| | - Jennifer Beebe Dimmer
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA
| | - Michael S Simon
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA
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161
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Verdoodt F, Kjaer S, Friis S. Influence of aspirin and non-aspirin NSAID use on ovarian and endometrial cancer: Summary of epidemiologic evidence of cancer risk and prognosis. Maturitas 2017; 100:1-7. [DOI: 10.1016/j.maturitas.2017.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 12/26/2022]
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Gray RT, Cantwell MM, Coleman HG, Loughrey MB, Bankhead P, McQuaid S, O'Neill RF, Arthur K, Bingham V, McGready C, Gavin AT, Cardwell CR, Johnston BT, James JA, Hamilton PW, Salto-Tellez M, Murray LJ. Evaluation of PTGS2 Expression, PIK3CA Mutation, Aspirin Use and Colon Cancer Survival in a Population-Based Cohort Study. Clin Transl Gastroenterol 2017; 8:e91. [PMID: 28448072 PMCID: PMC5543466 DOI: 10.1038/ctg.2017.18] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The association between aspirin use and improved survival after colorectal cancer diagnosis may be more pronounced in tumors that have PIK3CA mutations or high PTGS2 expression. However, the evidence of a difference in association by biomarker status lacks consistency. In this population-based colon cancer cohort study the interaction between these biomarkers, aspirin use, and survival was assessed. METHODS The cohort consisted of 740 stage II and III colon cancer patients diagnosed between 2004 and 2008. Aspirin use was determined through clinical note review. Tissue blocks were retrieved to determine immunohistochemical assessment of PTGS2 expression and the presence of PIK3CA mutations. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for colorectal cancer-specific and overall survival. RESULTS In this cohort aspirin use was associated with a 31% improvement in cancer-specific survival compared to non-use (adjusted HR=0.69, 95% CI 0.47-0.98). This effect was more pronounced in tumors with high PTGS2 expression (PTGS2-high adjusted HR=0.55, 95% CI 0.32-0.96) compared to those with low PTGS2 expression (PTGS2-low adjusted HR=1.19, 95% CI 0.68-2.07, P for interaction=0.09). The aspirin by PTGS2 interaction was significant for overall survival (PTGS2-high adjusted HR=0.64, 95% CI 0.42-0.98 vs. PTGS2-low adjusted HR=1.28, 95% CI 0.80-2.03, P for interaction=0.04). However, no interaction was observed between aspirin use and PIK3CA mutation status for colorectal cancer-specific or overall survival. CONCLUSIONS Aspirin use was associated with improved survival outcomes in this population-based cohort of colon cancer patients. This association differed according to PTGS2 expression but not PIK3CA mutation status. Limiting adjuvant aspirin trials to PIK3CA-mutant colorectal cancer may be too restrictive.
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Affiliation(s)
- Ronan T Gray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Marie M Cantwell
- Nutrition and Metabolism Group, Institute for Global Food Security, Queen’s University Belfast, Belfast, Northern Ireland
| | - Helen G Coleman
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Maurice B Loughrey
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Peter Bankhead
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Stephen McQuaid
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
- Northern Ireland Biobank, Queen’s University Belfast, Belfast, Northern Ireland
| | - Roisin F O'Neill
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Kenneth Arthur
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Victoria Bingham
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Claire McGready
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen’s University Belfast, Belfast, Northern Ireland
| | - Chris R Cardwell
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Brian T Johnston
- Department of Gastroenterology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Jacqueline A James
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
- Northern Ireland Biobank, Queen’s University Belfast, Belfast, Northern Ireland
| | - Peter W Hamilton
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Manuel Salto-Tellez
- Northern Ireland Molecular Pathology Laboratory, Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland
- Tissue Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland
| | - Liam J Murray
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
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An Elevated Platelet-to-Lymphocyte Ratio Predicts Poor Prognosis and Clinicopathological Characteristics in Patients with Colorectal Cancer: A Meta-Analysis. DISEASE MARKERS 2017; 2017:1053125. [PMID: 28539688 PMCID: PMC5429964 DOI: 10.1155/2017/1053125] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 04/02/2017] [Indexed: 12/19/2022]
Abstract
Background. The aims of this study were to evaluate the clinicopathological and prognostic values of platelet-to-lymphocyte ratio (PLR) in colorectal cancer (CRC). Methods. The PubMed and Embase databases and the references of relevant studies were systematically searched. This study was performed with hazard ratios (HRs) and odd ratios (ORs) with corresponding 95% confidence intervals (CIs) as effect measures. Results. Our results indicated that elevated PLR was associated with poor overall survival (HR = 1.46, 95% CI = 1.23–1.73), disease-free survival (HR = 1.64, 95% CI = 1.17–2.30), cancer-specific survival (HR = 1.30, 95% CI = 1.12–1.51), and recurrence-free survival (HR = 1.38, 95% CI = 1.09–1.74) in CRC. For the clinicopathological characteristics, our results indicated that there were differences in the rate of elevated PLR between stages III/IV and I/II groups (OR = 1.38, 95% CI = 1.01–1.88), pT3/T4 and pT1/T2 groups (OR = 1.82, 95% CI = 1.03–3.20), and poor differentiation and moderate/well differentiation (OR = 2.59, 95% CI = 1.38–4.84). Conclusions. Our results indicated that elevated PLR predicted poor prognosis and clinicopathological characteristics in CRC and PLR is a convenient and low-cost blood-derived prognostic marker for CRC.
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164
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Hamada T, Cao Y, Qian ZR, Masugi Y, Nowak JA, Yang J, Song M, Mima K, Kosumi K, Liu L, Shi Y, da Silva A, Gu M, Li W, Keum N, Zhang X, Wu K, Meyerhardt JA, Giovannucci EL, Giannakis M, Rodig SJ, Freeman GJ, Nevo D, Wang M, Chan AT, Fuchs CS, Nishihara R, Ogino S. Aspirin Use and Colorectal Cancer Survival According to Tumor CD274 (Programmed Cell Death 1 Ligand 1) Expression Status. J Clin Oncol 2017; 35:1836-1844. [PMID: 28406723 DOI: 10.1200/jco.2016.70.7547] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Blockade of the programmed cell death 1 (PDCD1, PD-1) immune checkpoint pathway can improve clinical outcomes in various malignancies. Evidence suggests that aspirin (a widely used nonsteroidal anti-inflammatory drug) not only prolongs colorectal cancer survival, but can also activate T cell-mediated antitumor immunity and synergize with immunotherapy through inhibition of prostaglandin E2 production. We hypothesized that the survival benefit associated with aspirin might be stronger in colorectal carcinoma with a lower CD274 (PDCD1 ligand 1, PD-L1) expression level that resulted in lower signaling of the immune checkpoint pathway. Patients and Methods Using data from 617 patients with rectal and colon cancer in the Nurses' Health Study and the Health Professionals Follow-Up Study, we examined the association of postdiagnosis aspirin use with patient survival in strata of tumor CD274 expression status measured by immunohistochemistry. We used multivariable Cox proportional hazards regression models to control for potential confounders, including disease stage, microsatellite instability status, CpG island methylator phenotype, long interspersed nucleotide element-1 methylation, cyclooxygenase-2 (PTGS2), and CDX2 expression, and KRAS, BRAF, and PIK3CA mutations. Results The association of postdiagnosis aspirin use with colorectal cancer-specific survival differed by CD274 expression status ( Pinteraction < .001); compared with aspirin nonusers; multivariable-adjusted hazard ratios for regular aspirin users were 0.16 (95% CI, 0.06 to 0.41) in patients with low CD274 and 1.01 (95% CI, 0.61 to 1.67) in patients with high CD274. This differential association seemed consistent in patients with microsatellite-stable or PIK3CA wild-type disease and in strata of PTGS2 expression, CDX2 expression, tumor-infiltrating lymphocytes, or prediagnosis aspirin use status. Conclusion The association of aspirin use with colorectal cancer survival is stronger in patients with CD274-low tumors than CD274-high tumors. Our findings suggest a differential antitumor effect of aspirin according to immune checkpoint status.
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Affiliation(s)
- Tsuyoshi Hamada
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yin Cao
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Zhi Rong Qian
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yohei Masugi
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Jonathan A Nowak
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Juhong Yang
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Mingyang Song
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Kosuke Mima
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Keisuke Kosumi
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Li Liu
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Yan Shi
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Annacarolina da Silva
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Mancang Gu
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Wanwan Li
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - NaNa Keum
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Xuehong Zhang
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Kana Wu
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Jeffrey A Meyerhardt
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Edward L Giovannucci
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Marios Giannakis
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Scott J Rodig
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Gordon J Freeman
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Daniel Nevo
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Molin Wang
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Andrew T Chan
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Charles S Fuchs
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Reiko Nishihara
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Shuji Ogino
- Tsuyoshi Hamada, Zhi Rong Qian, Yohei Masugi, Juhong Yang, Kosuke Mima, Keisuke Kosumi, Li Liu, Yan Shi, Annacarolina da Silva, Mancang Gu, Wanwan Li, Jeffrey A. Meyerhardt, Marios Giannakis, Scott J. Rodig, Gordon J. Freeman, Charles S. Fuchs, Reiko Nishihara, and Shuji Ogino, Dana-Farber Cancer Institute and Harvard Medical School; Yin Cao, Mingyang Song, and Andrew T. Chan, Massachusetts General Hospital and Harvard Medical School; Yin Cao, Mingyang Song, Li Liu, NaNa Keum, Kana Wu, Edward L. Giovannucci, Daniel Nevo, Molin Wang, Reiko Nishihara, and Shuji Ogino, Harvard T.H. Chan School of Public Health; Jonathan A. Nowak, Xuehong Zhang, Edward L. Giovannucci, Marios Giannakis, Gordon J. Freeman, Molin Wang, Andrew T. Chan, Charles S. Fuchs, and Shuji Ogino, Brigham and Women's Hospital and Harvard Medical School, Boston; Marios Giannakis and Andrew T. Chan, Broad Institute of MIT and Harvard University, Cambridge, MA; Li Liu, Huazhong University of Science and Technology, Wuhan; Yan Shi, Chinese People's Liberation Army General Hospital, Beijing; and Mancang Gu, Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
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Koliaraki V, Pallangyo CK, Greten FR, Kollias G. Mesenchymal Cells in Colon Cancer. Gastroenterology 2017; 152:964-979. [PMID: 28111227 DOI: 10.1053/j.gastro.2016.11.049] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/17/2016] [Accepted: 11/23/2016] [Indexed: 02/07/2023]
Abstract
Mesenchymal cells in the intestine comprise a variety of cell types of diverse origins, functions, and molecular markers. They provide mechanical and structural support and have important functions during intestinal organogenesis, morphogenesis, and homeostasis. Recent studies of the human transcriptome have revealed their importance in the development of colorectal cancer, and studies from animal models have provided evidence for their roles in the pathogenesis of colitis-associated cancer and sporadic colorectal cancer. Mesenchymal cells in tumors, called cancer-associated fibroblasts, arise via activation of resident mesenchymal cell populations and the recruitment of bone marrow-derived mesenchymal stem cells and fibrocytes. Cancer-associated fibroblasts have a variety of activities that promote colon tumor development and progression; these include regulation of intestinal inflammation, epithelial proliferation, stem cell maintenance, angiogenesis, extracellular matrix remodeling, and metastasis. We review the intestinal mesenchymal cell-specific pathways that regulate these processes, with a focus on their roles in mediating interactions between inflammation and carcinogenesis. We also discuss how increasing our understanding of intestinal mesenchymal cell biology and function could lead to new strategies to identify and treat colitis-associated cancers.
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Affiliation(s)
| | - Charles K Pallangyo
- Muhimbili University of Health and Allied Sciences, School of Medicine, Dar es Salaam, Tanzania
| | - Florian R Greten
- Institute for Tumor Biology and Experimental Therapy, Georg-Speyer-Haus, Frankfurt am Main, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.
| | - George Kollias
- Biomedical Sciences Research Centre "Alexander Fleming," Vari, Greece; Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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166
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Gelsomino F, Bertolini F, Luppi G, Spallanzani A, Pettorelli E, Reggiani Bonetti L, Meduri B, Manco G, Conte P, Cascinu S. A Dose-finding and Biomarker Evaluation Phase Ib Study of Everolimus in Association With 5-Fluorouracil and Pelvic Radiotherapy as Neoadjuvant Treatment of Locally Advanced Rectal Cancer (E-LARC Study). Clin Colorectal Cancer 2017; 16:410-415.e1. [PMID: 28410832 DOI: 10.1016/j.clcc.2017.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/16/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND During the past 20 years, considerable improvement has occurred in the treatment of patients with locally advanced rectal cancer (LARC). With the introduction of multimodal treatment, refinements in preclinical staging and improvements in surgical skills, local relapse is no longer the major problem for patients with LARC. However, many patients die of metastatic disease. The present phase Ib study aimed to establish the maximum tolerated dose of everolimus combined with 5-fluorouracil and radiotherapy in patients with LARC. PATIENTS AND METHODS Patients were sequentially assigned to 4 cohorts with an increasing dose of everolimus, starting from 14 days before 5-fluorouracil and radiotherapy and continuing throughout concomitant treatment. The secondary endpoints were the Dworak tumor regression grade, pathologic complete response rate, neoadjuvant rectal score, biomarker assessment (phosphorylated mTOR [mammalian target of rapamycin] protein and phosphorylated-p70S6K protein). RESULTS At the time of this report, 12 patients had been treated, and no dose-limiting toxicity was recorded. The most frequently reported acute toxicities were rectal tenesmus, skin rash, diarrhea, and dysuria. All 12 patients underwent curative R0 resection. Two patients had Dworak tumor regression grade 4 (pathologic complete response). No everolimus-related postoperative complications were observed. No relationship was found between biomarker expression and the clinicopathologic outcomes. CONCLUSION Although the addition of everolimus did not appear to worsen the toxicity of chemoradiation in patients with LARC, evaluation of its activity deserves further investigation in larger clinical trials.
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Affiliation(s)
- Fabio Gelsomino
- Division of Oncology, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy.
| | - Federica Bertolini
- Division of Oncology, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Gabriele Luppi
- Division of Oncology, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Elisa Pettorelli
- Division of Oncology, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Luca Reggiani Bonetti
- Pathology Unit, Department of Diagnostic Medicine and Public Health, University Hospital of Modena, Modena, Italy
| | - Bruno Meduri
- Division of Radiotherapy, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Gianrocco Manco
- Department of Surgical, Medical, Dental, and Morphological Sciences With Interest in Transplant, Oncological and Regenerative Medicine, University Hospital of Modena, Modena, Italy
| | - Pierfranco Conte
- Division of Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua, Italy
| | - Stefano Cascinu
- Division of Oncology, Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
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Cao Y, Nishihara R, Wu K, Wang M, Ogino S, Willett WC, Spiegelman D, Fuchs CS, Giovannucci EL, Chan AT. Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer. JAMA Oncol 2017; 2:762-9. [PMID: 26940135 DOI: 10.1001/jamaoncol.2015.6396] [Citation(s) in RCA: 218] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE The US Preventive Services Task Force recently recommended the use of aspirin to prevent colorectal cancer and cardiovascular disease among many US adults. However, the association of aspirin use with the risk for other cancer types and the potential population-wide effect of aspirin use on cancer, particularly within the context of screening, remain uncertain. OBJECTIVES To examine the potential benefits of aspirin use for overall and subtype-specific cancer prevention at a range of doses and durations of use and to estimate the absolute benefit of aspirin in the context of screening. DESIGN, SETTING, AND PARTICIPANTS Two large US prospective cohort studies, the Nurses' Health Study (1980-2010) and Health Professionals Follow-up Study (1986-2012), followed up 135 965 health care professionals (88 084 women and 47 881 men, respectively) who reported on aspirin use biennially. The women were aged 30 to 55 years at enrollment in 1976; the men, aged 40 to 75 years in 1986. Final follow-up was completed on June 30, 2012, for the Nurses' Health Study cohort and January 31, 2010, for the Health Professionals Follow-up Study cohort, and data were accessed from September 15, 2014, to December 17, 2015. MAIN OUTCOMES AND MEASURES Relative risks (RRs) for incident cancers and population-attributable risk (PAR). RESULTS Among the 88 084 women and 47 881 men who underwent follow-up for as long as 32 years, 20 414 cancers among women and 7571 cancers among men were documented. Compared with nonregular use, regular aspirin use was associated with a lower risk for overall cancer (RR, 0.97; 95% CI, 0.94-0.99), which was primarily owing to a lower incidence of gastrointestinal tract cancers (RR, 0.85; 95% CI, 0.80-0.91), especially colorectal cancers (RR, 0.81; 95% CI, 0.75-0.88). The benefit of aspirin on gastrointestinal tract cancers appeared evident with the use of at least 0.5 to 1.5 standard aspirin tablets per week; the minimum duration of regular use associated with a lower risk was 6 years. Among individuals older than 50 years, regular aspirin use could prevent 33 colorectal cancers per 100 000 person-years (PAR, 17.0%) among those who had not undergone a lower endoscopy and 18 colorectal cancers per 100 000 person-years (PAR, 8.5%) among those who had. Regular aspirin use was not associated with the risk for breast, advanced prostate, or lung cancer. CONCLUSIONS AND RELEVANCE Long-term aspirin use was associated with a modest but significantly reduced risk for overall cancer, especially gastrointestinal tract tumors. Regular aspirin use may prevent a substantial proportion of colorectal cancers and complement the benefits of screening.
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Affiliation(s)
- Yin Cao
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston3Division of Gastroenterology, Massachusetts General
| | - Reiko Nishihara
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 5Department of Biostatistics, Harvard T. H. Chan School of Public Heal
| | - Kana Wu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Molin Wang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 5Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Shuji Ogino
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 6Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts7Department of Pathology, Brigham and Women's Hosp
| | - Walter C Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 8Channing Division of Network Medicine, Brigham and Women's Hospital a
| | - Donna Spiegelman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Charles S Fuchs
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts8Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts 8Channing Division of Network Medicine, Brigham and Women's Hospital a
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston3Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston8Channing Division of Network Medicine, Brigham
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168
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Hamada T, Keum N, Nishihara R, Ogino S. Molecular pathological epidemiology: new developing frontiers of big data science to study etiologies and pathogenesis. J Gastroenterol 2017; 52:265-275. [PMID: 27738762 PMCID: PMC5325774 DOI: 10.1007/s00535-016-1272-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023]
Abstract
Molecular pathological epidemiology (MPE) is an integrative field that utilizes molecular pathology to incorporate interpersonal heterogeneity of a disease process into epidemiology. In each individual, the development and progression of a disease are determined by a unique combination of exogenous and endogenous factors, resulting in different molecular and pathological subtypes of the disease. Based on "the unique disease principle," the primary aim of MPE is to uncover an interactive relationship between a specific environmental exposure and disease subtypes in determining disease incidence and mortality. This MPE approach can provide etiologic and pathogenic insights, potentially contributing to precision medicine for personalized prevention and treatment. Although breast, prostate, lung, and colorectal cancers have been among the most commonly studied diseases, the MPE approach can be used to study any disease. In addition to molecular features, host immune status and microbiome profile likely affect a disease process, and thus serve as informative biomarkers. As such, further integration of several disciplines into MPE has been achieved (e.g., pharmaco-MPE, immuno-MPE, and microbial MPE), to provide novel insights into underlying etiologic mechanisms. With the advent of high-throughput sequencing technologies, available genomic and epigenomic data have expanded dramatically. The MPE approach can also provide a specific risk estimate for each disease subgroup, thereby enhancing the impact of genome-wide association studies on public health. In this article, we present recent progress of MPE, and discuss the importance of accounting for the disease heterogeneity in the era of big-data health science and precision medicine.
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Affiliation(s)
- Tsuyoshi Hamada
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Room SM1036, Boston, MA, 02215, USA
| | - NaNa Keum
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Reiko Nishihara
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Room SM1036, Boston, MA, 02215, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Shuji Ogino
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, 450 Brookline Ave., Room SM1036, Boston, MA, 02215, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 450 Brookline Ave., Room SM1036, Boston, MA, 02215, USA.
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
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169
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Giampieri R, Restivo A, Pusceddu V, Del Prete M, Maccaroni E, Bittoni A, Faloppi L, Andrikou K, Bianconi M, Cabras F, Berardi R, Zorcolo L, Scintu F, Cascinu S, Scartozzi M. The Role of Aspirin as Antitumoral Agent for Heavily Pretreated Patients With Metastatic Colorectal Cancer Receiving Capecitabine Monotherapy. Clin Colorectal Cancer 2017; 16:38-43. [DOI: 10.1016/j.clcc.2016.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 07/13/2016] [Accepted: 07/28/2016] [Indexed: 12/27/2022]
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170
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Frouws MA, van Herk-Sukel MPP, Maas HA, Van de Velde CJH, Portielje JEA, Liefers GJ, Bastiaannet E. The mortality reducing effect of aspirin in colorectal cancer patients: Interpreting the evidence. Cancer Treat Rev 2017; 55:120-127. [PMID: 28359968 DOI: 10.1016/j.ctrv.2016.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022]
Abstract
In 1971 the first study appeared that suggested a relationship between aspirin and cancer. Currently publications on the subject of aspirin and cancer are numerous, with both a beneficial effect of aspirin on cancer incidence and a beneficial effect on cancer survival. This review focusses on the relation between the use of aspirin and improved survival in colorectal cancer patients. Various study designs have been used, with the main part being observational studies and post hoc meta-analyses of cancer outcomes in cardiovascular prevention trials. The results of these studies are unambiguously pointing towards an effect of aspirin on colorectal cancer survival, and several randomised controlled trials are currently ongoing. Some clinicians feel that the current evidence is conclusive and that the time has come for aspirin to be prescribed as adjuvant therapy. However, until this review, not much attention has been paid to the specific types of bias associated with these studies. One of these biases is confounding by indication, because aspirin is indicated for patients as secondary prevention for cardiovascular disease. This review aims to provide perspective on these biases and provide tools for the interpretation of the current evidence. Albeit promising, the current evidence is not sufficient to already prescribe aspirin as adjuvant therapy for colorectal cancer.
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Affiliation(s)
- Martine A Frouws
- Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, The Netherlands.
| | - Myrthe P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30/40, 3528 AE Utrecht, The Netherlands
| | - Huub A Maas
- Department of Geriatric Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Cornelis J H Van de Velde
- Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, The Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Haga Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, The Netherlands
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171
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Løberg M, Holme Ø, Kalager M. Aspirin, Colorectal Cancer, and Cause of Death: A Complex Landscape. J Clin Oncol 2017; 35:568-569. [DOI: 10.1200/jco.2016.70.3751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Magnus Løberg
- Magnus Løberg, University of Oslo, Oslo, Norway; Øyvind Holme, Sørlandet Hospital, Kristiansand, Norway; and Mette Kalager, University of Oslo, Oslo, Norway
| | - Øyvind Holme
- Magnus Løberg, University of Oslo, Oslo, Norway; Øyvind Holme, Sørlandet Hospital, Kristiansand, Norway; and Mette Kalager, University of Oslo, Oslo, Norway
| | - Mette Kalager
- Magnus Løberg, University of Oslo, Oslo, Norway; Øyvind Holme, Sørlandet Hospital, Kristiansand, Norway; and Mette Kalager, University of Oslo, Oslo, Norway
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172
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Bains SJ, Mahic M, Myklebust TÅ, Småstuen MC, Yaqub S, Dørum LM, Bjørnbeth BA, Møller B, Brudvik KW, Taskén K. Reply to M. Løberg et al. J Clin Oncol 2017; 35:569-571. [DOI: 10.1200/jco.2016.70.8263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Simer Jit Bains
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Milada Mahic
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Tor Åge Myklebust
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Sheraz Yaqub
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Liv Marit Dørum
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Bjørn Møller
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Kristoffer Watten Brudvik
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
| | - Kjetil Taskén
- Simer Jit Bains, University of Oslo and Akershus University Hospital, Oslo, Norway; Milada Mahic, Norwegian Institute of Public Health, Oslo, Norway; Tor Åge Myklebust, Cancer Registry of Norway, Oslo, Norway; Milada Cvancarova Småstuen, University of Oslo, Oslo, Norway; Sheraz Yaqub, Oslo University Hospital, Oslo, Norway; Liv Marit Dørum, Cancer Registry of Norway, Oslo, Norway; Bjørn Atle Bjørnbeth, Oslo University Hospital, Oslo, Norway; Bjørn Møller, Cancer Registry of Norway, Oslo, Norway
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Zumwalt TJ, Wodarz D, Komarova NL, Toden S, Turner J, Cardenas J, Burn J, Chan AT, Boland CR, Goel A. Aspirin-Induced Chemoprevention and Response Kinetics Are Enhanced by PIK3CA Mutations in Colorectal Cancer Cells. Cancer Prev Res (Phila) 2017; 10:208-218. [PMID: 28154202 DOI: 10.1158/1940-6207.capr-16-0175] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/19/2017] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
Abstract
This study was designed to determine how aspirin influences the growth kinetics and characteristics of cultured colorectal cancer cells that harbor a variety of different mutational backgrounds, including PIK3CA- and KRAS-activating mutations, and the presence or absence of microsatellite instability. Colorectal cancer cell lines (HCT116, HCT116 + Chr3/5, RKO, SW480, HCT15, CACO2, HT29, and SW48) were treated with pharmacologically relevant doses of aspirin (0.5-10 mmol/L) and evaluated for proliferation and cell-cycle distribution. These parameters were fitted to a mathematical model to quantify the effects and understand the mechanism(s) by which aspirin modifies growth in colorectal cancer cells. We also evaluated the effects of aspirin on key G0-G1 cell-cycle genes that are regulated by the PI3K-Akt pathway. Aspirin decelerated growth rates and disrupted cell-cycle dynamics more profoundly in faster growing colorectal cancer cell lines, which tended to be PIK3CA mutants. Additionally, microarray analysis of 151 colorectal cancer cell lines identified important cell-cycle regulatory genes that are downstream targets of PIK3 and were also dysregulated by aspirin treatment (PCNA and RB1). Our study demonstrated what clinical trials have only speculated, that PIK3CA-mutant colorectal cancers are more sensitive to aspirin. Aspirin inhibited cell growth in all colorectal cancer cell lines regardless of mutational background, but the effects were exacerbated in cells with PIK3CA mutations. Mathematical modeling combined with bench science revealed that cells with PIK3CA-mutations experience significant G0-G1 arrest and explains why patients with PIK3CA mutant colorectal cancers may benefit from aspirin use after diagnosis. Cancer Prev Res; 10(3); 208-18. ©2017 AACR.
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Affiliation(s)
- Timothy J Zumwalt
- Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas
| | - Dominik Wodarz
- Department of Mathematics and Department of Ecology and Evolutionary Biology, University of California, Irvine, California
| | - Natalia L Komarova
- Department of Mathematics and Department of Ecology and Evolutionary Biology, University of California, Irvine, California
| | - Shusuke Toden
- Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas
| | - Jacob Turner
- Baylor Institute for Immunology Research, Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, Texas
| | - Jacob Cardenas
- Baylor Institute for Immunology Research, Baylor Scott and White Research Institute, Baylor University Medical Center, Dallas, Texas
| | - John Burn
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - C Richard Boland
- Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas
| | - Ajay Goel
- Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Sammons Cancer Center, Baylor University Medical Center, Dallas, Texas.
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174
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Campbell PT, Rebbeck TR, Nishihara R, Beck AH, Begg CB, Bogdanov AA, Cao Y, Coleman HG, Freeman GJ, Heng YJ, Huttenhower C, Irizarry RA, Kip NS, Michor F, Nevo D, Peters U, Phipps AI, Poole EM, Qian ZR, Quackenbush J, Robins H, Rogan PK, Slattery ML, Smith-Warner SA, Song M, VanderWeele TJ, Xia D, Zabor EC, Zhang X, Wang M, Ogino S. Proceedings of the third international molecular pathological epidemiology (MPE) meeting. Cancer Causes Control 2017; 28:167-176. [PMID: 28097472 PMCID: PMC5303153 DOI: 10.1007/s10552-016-0845-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023]
Abstract
Molecular pathological epidemiology (MPE) is a transdisciplinary and relatively new scientific discipline that integrates theory, methods, and resources from epidemiology, pathology, biostatistics, bioinformatics, and computational biology. The underlying objective of MPE research is to better understand the etiology and progression of complex and heterogeneous human diseases with the goal of informing prevention and treatment efforts in population health and clinical medicine. Although MPE research has been commonly applied to investigating breast, lung, and colorectal cancers, its methodology can be used to study most diseases. Recent successes in MPE studies include: (1) the development of new statistical methods to address etiologic heterogeneity; (2) the enhancement of causal inference; (3) the identification of previously unknown exposure-subtype disease associations; and (4) better understanding of the role of lifestyle/behavioral factors on modifying prognosis according to disease subtype. Central challenges to MPE include the relative lack of transdisciplinary experts, educational programs, and forums to discuss issues related to the advancement of the field. To address these challenges, highlight recent successes in the field, and identify new opportunities, a series of MPE meetings have been held at the Dana-Farber Cancer Institute in Boston, MA. Herein, we share the proceedings of the Third International MPE Meeting, held in May 2016 and attended by 150 scientists from 17 countries. Special topics included integration of MPE with immunology and health disparity research. This meeting series will continue to provide an impetus to foster further transdisciplinary integration of divergent scientific fields.
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Affiliation(s)
- Peter T Campbell
- Epidemiology Research Program, American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, USA.
| | - Timothy R Rebbeck
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Reiko Nishihara
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrew H Beck
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexei A Bogdanov
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Yin Cao
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Helen G Coleman
- Epidemiology and Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - Gordon J Freeman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Yujing J Heng
- Cancer Research Institute, Beth Israel Deaconess Cancer Center, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Microbial Systems and Communities, Genome Sequencing and Analysis Program, The Broad Institute, Cambridge, MA, USA
| | - Rafael A Irizarry
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - N Sertac Kip
- Laboratory Medicine and Pathology, Geisinger Health System, Danville, PA, USA
| | - Franziska Michor
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Daniel Nevo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ulrike Peters
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Amanda I Phipps
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth M Poole
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Zhi Rong Qian
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - John Quackenbush
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Harlan Robins
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Peter K Rogan
- Department of Biochemistry, University of Western Ontario, London, Canada
| | | | - Stephanie A Smith-Warner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel Xia
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily C Zabor
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Division of MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 450 Brookline Ave, Room SM1036, Boston, MA, 02215, USA.
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA, USA.
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175
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Drew DA, Chin SM, Gilpin KK, Parziale M, Pond E, Schuck MM, Stewart K, Flagg M, Rawlings CA, Backman V, Carolan PJ, Chung DC, Colizzo FP, Freedman M, Gala M, Garber JJ, Huttenhower C, Kedrin D, Khalili H, Kwon DS, Markowitz SD, Milne GL, Nishioka NS, Richter JM, Roy HK, Staller K, Wang M, Chan AT. ASPirin Intervention for the REDuction of colorectal cancer risk (ASPIRED): a study protocol for a randomized controlled trial. Trials 2017; 18:50. [PMID: 28143522 PMCID: PMC5286828 DOI: 10.1186/s13063-016-1744-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/06/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although aspirin is recommended for the prevention of colorectal cancer, the specific individuals for whom the benefits outweigh the risks are not clearly defined. Moreover, the precise mechanisms by which aspirin reduces the risk of cancer are unclear. We recently launched the ASPirin Intervention for the REDuction of colorectal cancer risk (ASPIRED) trial to address these uncertainties. METHODS/DESIGN ASPIRED is a prospective, double-blind, multidose, placebo-controlled, biomarker clinical trial of aspirin use in individuals previously diagnosed with colorectal adenoma. Individuals (n = 180) will be randomized in a 1:1:1 ratio to low-dose (81 mg/day) or standard-dose (325 mg/day) aspirin or placebo. At two study visits, participants will provide lifestyle, dietary and biometric data in addition to urine, saliva and blood specimens. Stool, grossly normal colorectal mucosal biopsies and cytology brushings will be collected during a flexible sigmoidoscopy without bowel preparation. The study will examine the effect of aspirin on urinary prostaglandin metabolites (PGE-M; primary endpoint), plasma inflammatory markers (macrophage inhibitory cytokine-1 (MIC-1)), colonic expression of transcription factor binding (transcription factor 7-like 2 (TCF7L2)), colonocyte gene expression, including hydroxyprostaglandin dehydrogenase 15-(NAD) (HPGD) and those that encode Wnt signaling proteins, colonic cellular nanocytology and oral and gut microbial composition and function. DISCUSSION Aspirin may prevent colorectal cancer through multiple, interrelated mechanisms. The ASPIRED trial will scrutinize these pathways and investigate putative mechanistically based risk-stratification biomarkers. TRIAL REGISTRATION This protocol is registered with the U.S. National Institutes of Health trial registry, ClinicalTrials.gov, under the identifier NCT02394769 . Registered on 16 March 2015.
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Affiliation(s)
- David A. Drew
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Samantha M. Chin
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Katherine K. Gilpin
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Melanie Parziale
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Emily Pond
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Madeline M. Schuck
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Kathleen Stewart
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Meaghan Flagg
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, MA USA
| | | | - Vadim Backman
- McCormick School of Engineering, Northwestern University, Evanston, IL USA
| | - Peter J. Carolan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Daniel C. Chung
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Francis P. Colizzo
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | | | - Manish Gala
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - John J. Garber
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Dmitriy Kedrin
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Hamed Khalili
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Douglas S. Kwon
- The Ragon Institute of MGH, MIT and Harvard, Cambridge, MA USA
| | - Sanford D. Markowitz
- Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, OH USA
| | - Ginger L. Milne
- Eicosanoid Core Laboratory, Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN USA
| | - Norman S. Nishioka
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - James M. Richter
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Hemant K. Roy
- Section of Gastroenterology, Boston Medical Center, Boston, MA USA
| | - Kyle Staller
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
- Broad Institute, Cambridge, MA USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- Division of Gastroenterology and Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, GRJ-825C, Boston, MA 02114 USA
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Berretta M, Alessandrini L, De Divitiis C, Nasti G, Lleshi A, Di Francia R, Facchini G, Cavaliere C, Buonerba C, Canzonieri V. Serum and tissue markers in colorectal cancer: State of art. Crit Rev Oncol Hematol 2017; 111:103-116. [PMID: 28259285 DOI: 10.1016/j.critrevonc.2017.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 12/15/2016] [Accepted: 01/10/2017] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) represents one of the most commonly diagnosed cancers worldwide. It is the second leading cause of cancer death in Western Countries. In the last decade, the survival of patients with metastatic CRC has improved dramatically. Due to the advent of new drugs (irinotecan and oxaliplatin) and target therapies (i.e. bevacizumab, cetuximab, panitumab, aflibercept and regorafenib), the median overall survival has risen from about 12 mo in the mid nineties to 30 mo recently. Molecular studies have recently widened the opportunity for testing new possible markers, but actually, only few markers can be recommended for practical use in clinic. In the next future, the hope is to have a complete panel of clinical biomarkers to use in every setting of CRC disease, and at the same time: 1) to receive information about prognostic significance by their expression and 2) to be oriented in the choice of the adequate treatment. Moreover, molecular analyses have shown that the natural history of all CRCs is not the same. Individual patients with same stage tumors may have different long-term prognosis and response to therapy. In addition, some prognostic variables are likely to be more important than others. Here we review the role of serum and tissue markers according to the recently published English literature. This paper is an extension of the article "Biological and clinical markers in colorectal cancer: state of art" by Cappellani A published in Jan 2010.
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Affiliation(s)
- Massimiliano Berretta
- Department of Medical Oncology, National Cancer Institute, Centro di Riferimento Oncologico of Aviano, IRCCS, 33081 Aviano, PN, Italy.
| | - Lara Alessandrini
- Division of Pathology, National Cancer Institute, Centro di Riferimento Oncologico of Aviano, IRCCS, 33081 Aviano, PN, Italy
| | - Chiara De Divitiis
- Department of Medical Oncology, National Cancer Institute IRCCS Pascale, Naples, Italy
| | - Guglielmo Nasti
- Department of Medical Oncology, National Cancer Institute IRCCS Pascale, Naples, Italy
| | - Arben Lleshi
- Department of Medical Oncology, National Cancer Institute, Centro di Riferimento Oncologico of Aviano, IRCCS, 33081 Aviano, PN, Italy
| | - Raffaele Di Francia
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute IRCCS Pascale, Naples, Italy
| | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Carla Cavaliere
- Department of Onco-Ematology Medical Oncology, S.G. Moscati Hospital of Taranto, Taranto, Italy
| | - Carlo Buonerba
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Vincenzo Canzonieri
- Division of Pathology, National Cancer Institute, Centro di Riferimento Oncologico of Aviano, IRCCS, 33081 Aviano, PN, Italy
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177
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The Influence of BRAF and KRAS Mutation Status on the Association between Aspirin Use and Survival after Colon Cancer Diagnosis. PLoS One 2017; 12:e0170775. [PMID: 28125730 PMCID: PMC5268402 DOI: 10.1371/journal.pone.0170775] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022] Open
Abstract
Background Use of aspirin after diagnosis of colon cancer has been associated with improved survival. Identification of cancer subtypes that respond to aspirin treatment may help develop personalized treatment regimens. The aim of this study was to investigate the influence of BRAF and KRAS mutation status on the association between aspirin use and overall survival after colon cancer diagnosis. Methods A random selection of 599 patients with colon cancer were analyzed, selected from the Eindhoven Cancer Registry, and BRAF and KRAS mutation status was determined. Data on aspirin use (80 mg) were obtained from the PHARMO Database Network. Parametric survival models with exponential (Poisson) distribution were used. Results Aspirin use after colon cancer diagnosis was associated with improved overall survival in wild-type BRAF tumors, adjusted rate ratio (RR) of 0.60 (95% CI 0.44–0.83). In contrast, aspirin use in BRAF mutated tumors was not associated with an improved survival (RR 1.11, 95% CI 0.57–2.16). P-value for interaction was non-significant. KRAS mutational status did not differentiate in the association between aspirin use and survival. Conclusion Low-dose aspirin use after colon cancer diagnosis was associated with improved survival in BRAF wild-type tumors only. However, the large confidence interval of the rate ratio for the use of aspirin in patients with BRAF mutation does not rule out a possible benefit. These results preclude BRAF and KRAS mutation status to be used as a marker for individualized treatment with aspirin, if aspirin becomes regular adjuvant treatment for colon cancer patients in the future.
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178
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Cervantes-Madrid DL, Nagi S, Asting Gustafsson A. FosB transcription factor regulates COX-2 expression in colorectal cancer cells without affecting PGE2 expression. Oncol Lett 2017; 13:1411-1416. [PMID: 28454270 DOI: 10.3892/ol.2017.5571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/15/2016] [Indexed: 02/06/2023] Open
Abstract
The expression levels of cyclooxygenase (COX)-2 and the prostaglandin E2 (PGE2) content have been associated with poor prognosis in patients with colorectal cancer (CRC). There is a strong correlation between COX-2 expression and PGE2 production in tissues from CRC patients, suggesting an important role for COX-2 on the regulation of PGE2 production. Previous studies by the present authors, where CRC patients were divided into high- or low-COX-2 expressing tumors, displayed important differences in the expression levels of several transcription factors involved in carcinogenesis. Among them, FBJ murine osteosarcoma viral oncogene homolog B (FosB), which is a member of the activator protein-1 complex, was the highest upregulated transcription factor in patients with high expression levels of COX-2. The present study aimed to investigate the role of FosB on the COX-2/PGE2 axis in CRC cells with high COX-2 expression levels. Interference RNA technology was used to knockdown FosB expression in HCA-7 cells, and 72 h later the messenger (m)RNA expression levels of COX-1 and COX-2, as well as the PGE2 content, were measured. The results indicated that FosB knockdown decreased the expression levels of COX-2 but did not affect the PGE2 content or the mRNA expression levels of COX-1. The present findings suggest an important role for FosB on the regulation of COX-2 expression, but no effect on the regulation of the PGE2 levels. In addition, the present results imply independent regulatory mechanisms for COX-2 expression and PGE2 content.
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Affiliation(s)
- Diana Lizeth Cervantes-Madrid
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.,Department of Basic Research, Institute of Biomedical Sciences, National Autonomous University of Mexico, Mexico City 14080, Mexico
| | - Sabah Nagi
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Annika Asting Gustafsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
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179
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Lin BM, Curhan SG, Wang M, Eavey R, Stankovic KM, Curhan GC. Duration of Analgesic Use and Risk of Hearing Loss in Women. Am J Epidemiol 2017; 185:40-47. [PMID: 27974293 DOI: 10.1093/aje/kww154] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/05/2016] [Indexed: 12/14/2022] Open
Abstract
Aspirin, nonsteroidal antiinflammatory drugs (NSAID), and acetaminophen are commonly used. Frequent use of analgesics has been associated with a higher risk of hearing loss. However, the association between duration of analgesic use and the risk of hearing loss is unclear. We investigated the relationship between duration of analgesic use and self-reported hearing loss among 55,850 women in the Nurses' Health Study. Cox proportional hazards regression was used to adjust for potential confounders. During 873,376 person-years of follow-up (1990-2012), longer durations of NSAID use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.10, 95% confidence interval: 1.06, 1.15; P for trend < 0.001) and acetaminophen use (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.09, 95% confidence interval: 1.04, 1.14; P for trend < 0.001) were associated with higher risks of hearing loss. Duration of aspirin use was not associated with hearing loss (for >6 years of use compared with <1 year, multivariable-adjusted relative risk = 1.01, 95% confidence interval: 0.97, 1.05; P for trend = 0.35). In this cohort of women, longer durations of NSAID and acetaminophen use were associated with slightly higher risks of hearing loss, but duration of aspirin use was not. Considering the high prevalence of analgesic use, this may be an important modifiable contributor to hearing loss.
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180
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Frouws MA, Bastiaannet E, Langley RE, Chia WK, van Herk-Sukel MPP, Lemmens VEPP, Putter H, Hartgrink HH, Bonsing BA, Van de Velde CJH, Portielje JEA, Liefers GJ. Effect of low-dose aspirin use on survival of patients with gastrointestinal malignancies; an observational study. Br J Cancer 2017; 116:405-413. [PMID: 28072768 PMCID: PMC5294482 DOI: 10.1038/bjc.2016.425] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/23/2016] [Accepted: 11/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Previous studies suggested a relationship between aspirin use and mortality reduction. The mechanism for the effect of aspirin on cancer outcomes remains unclear. The aim of this study was to evaluate aspirin use and survival in patients with gastrointestinal tract cancer. METHODS Patients with gastrointestinal tract cancer diagnosed between 1998 and 2011 were included. The population-based Eindhoven Cancer Registry was linked to drug-dispensing data from the PHARMO Database Network. The association between aspirin use after diagnosis and overall survival was analysed using Cox regression models. RESULTS In total, 13 715 patients were diagnosed with gastrointestinal cancer. A total of 1008 patients were identified as aspirin users, and 8278 patients were identified as nonusers. The adjusted hazard ratio for aspirin users vs nonusers was 0.52 (95% CI 0.44-0.63). A significant association between aspirin use and survival was observed for patients with oesophageal, hepatobiliary and colorectal cancer. CONCLUSIONS Post-diagnosis use of aspirin in patients with gastrointestinal tract malignancies is associated with increased survival in cancers with different sites of origin and biology. This adds weight to the hypothesis that the anti-cancer effects of aspirin are not tumour-site specific and may be modulated through the tumour micro-environment.
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Affiliation(s)
- M A Frouws
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - E Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - R E Langley
- MRC Clinical Trials Unit, University College London, Institute of Clinical Trials and Methodology, Aviation House 125 Kingsway, London WC2B 6NH, UK
| | - W K Chia
- Department of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore 169610, Singapore
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30/40, Utrecht 3528 AE, The Netherlands
| | - V E P P Lemmens
- Comprehensive Cancer Organisation The Netherlands, Eindhoven 5600 AE, The Netherlands
- Department of Public Health, Erasmus MC Medical Centre, PO Box 2040, Rotterdam 3000 CA, The Netherlands
| | - H Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - H H Hartgrink
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - B A Bonsing
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - C J H Van de Velde
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
| | - J E A Portielje
- Department of Medical Oncology, Haga Hospital, Leyweg 275, The Hague 2545 CH, The Netherlands
| | - G J Liefers
- Department of Surgical Oncology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands
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181
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Hammerling U, Bergman Laurila J, Grafström R, Ilbäck NG. Consumption of Red/Processed Meat and Colorectal Carcinoma: Possible Mechanisms Underlying the Significant Association. Crit Rev Food Sci Nutr 2016; 56:614-34. [PMID: 25849747 DOI: 10.1080/10408398.2014.972498] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epidemiology and experimental studies provide an overwhelming support of the notion that diets high in red or processed meat accompany an elevated risk of developing pre-neoplastic colorectal adenoma and frank colorectal carcinoma (CRC). The underlying mechanisms are disputed; thus several hypotheses have been proposed. A large body of reports converges, however, on haem and nitrosyl haem as major contributors to the CRC development, presumably acting through various mechanisms. Apart from a potentially higher intestinal mutagenic load among consumers on a diet rich in red/processed meat, other mechanisms involving subtle interference with colorectal stem/progenitor cell survival or maturation are likewise at play. From an overarching perspective, suggested candidate mechanisms for red/processed meat-induced CRC appear as three partly overlapping tenets: (i) increased N-nitrosation/oxidative load leading to DNA adducts and lipid peroxidation in the intestinal epithelium, (ii) proliferative stimulation of the epithelium through haem or food-derived metabolites that either act directly or subsequent to conversion, and (iii) higher inflammatory response, which may trigger a wide cascade of pro-malignant processes. In this review, we summarize and discuss major findings of the area in the context of potentially pertinent mechanisms underlying the above-mentioned association between consumption of red/processed meat and increased risk of developing CRC.
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Affiliation(s)
- Ulf Hammerling
- a Cancer Pharmacology & Computational Medicine, Department of Medical Sciences, Uppsala University and Uppsala Academic Hospital , Uppsala , Sweden
| | - Jonas Bergman Laurila
- b Sahlgrenska Biobank, Gothia Forum, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Roland Grafström
- c Institute of Environmental Medicine, The Karolinska Institute , Stockholm , Sweden.,d Knowledge Intensive Products and Services, VTT Technical Research Centre of Finland , Turku , Finland
| | - Nils-Gunnar Ilbäck
- e Clinical Microbiology & Infectious Medicine, Department of Medical Sciences, Uppsala University and Uppsala Academic Hospital , Uppsala , Sweden
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182
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Lichtenberger LM, Fang D, Bick RJ, Poindexter BJ, Phan T, Bergeron AL, Pradhan S, Dial EJ, Vijayan KV. Unlocking Aspirin's Chemopreventive Activity: Role of Irreversibly Inhibiting Platelet Cyclooxygenase-1. Cancer Prev Res (Phila) 2016; 10:142-152. [PMID: 27998883 DOI: 10.1158/1940-6207.capr-16-0241] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 12/21/2022]
Abstract
The mechanism by which aspirin consumption is linked to significant reductions in the incidence of multiple forms of cancer and metastatic spread to distant tissues, resulting in increased cancer patient survival is not well understood. In this study, using colon cancer as an example, we provide both in vitro (cell culture) and in vivo (chemically induced mouse model of colon cancer) evidence that this profound antineoplastic action may be associated with aspirin's ability to irreversibly inhibit COX-1-mediated platelet activation, thereby blocking platelet-cancer cell interactions, which promote cancer cell number and invasive potential. This process may be driven by platelet-induced epithelial-mesenchymal transition (EMT), as assessed using confocal microscopy, based upon changes in cell morphology, growth characteristics and fibronectin expression, and biochemical/molecular analysis by measuring changes in the expression of the EMT markers; vimentin, β-catenin, and SNAIL. We also provide evidence that a novel, gastrointestinal-safe phosphatidylcholine (PC)-associated aspirin, PL2200 Aspirin, possesses the same or more pronounced actions versus unmodified aspirin with regard to antiplatelet effects (in vitro: reducing platelet activation as determined by measuring the release of thromboxane and VEGF in culture medium; in vivo: inhibiting platelet number/activation and extravasation into tumor tissue) and chemoprevention (in vitro: inhibiting colonic cell growth and invasive activity; in vivo: inhibiting colonic dysplasia, inflammation, and tumor mass). These results suggest that aspirin's chemopreventive effects may be due, in part, to the drug blocking the proneoplastic action of platelets, and the potential use of Aspirin-PC/PL2200 as an effective and safer chemopreventive agent for colorectal cancer and possibly other cancers. Cancer Prev Res; 10(2); 142-52. ©2016 AACR.
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Affiliation(s)
- Lenard M Lichtenberger
- Department of Integrative Biology & Pharmacology, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas.
| | - Dexing Fang
- Department of Integrative Biology & Pharmacology, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas
| | - Roger J Bick
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas
| | - Brian J Poindexter
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas
| | - Tri Phan
- Department of Integrative Biology & Pharmacology, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas
| | - Angela L Bergeron
- Department of Medicine, Baylor College of Medicine and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Subhashree Pradhan
- Department of Medicine, Baylor College of Medicine and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Elizabeth J Dial
- Department of Integrative Biology & Pharmacology, The University of Texas Health Science Center at Houston-McGovern Medical School, Houston, Texas
| | - K Vinod Vijayan
- Department of Medicine, Baylor College of Medicine and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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183
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Do cancer survivors develop healthier lifestyle behaviors than the cancer-free population in the PLCO study? J Cancer Surviv 2016; 11:233-245. [PMID: 27837443 DOI: 10.1007/s11764-016-0581-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 10/24/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Current studies report mixed results in health status and health behaviors after a diagnosis of cancer. The aim of our study is to investigate potential differences in lifestyle factors among cancer survivors and cancer-free individuals in a prospective cohort study conducted in the United States. METHODS Using data from the Prostate, Lung, Colorectal and Ovarian (PLCO) Trial, 10,133 cancer survivors were identified and compared to 81,992 participants without cancer to evaluate differences in body mass index (BMI), smoking, NSAID use, and physical activity. RESULTS Cancer survivors, compared to the cancer-free, were significantly less likely to engage in physical activity (odds ratio (OR) = 0.82, 95% CI = 0.77-0.88). Compared to those who were obese at baseline, cancer survivors were more likely to be at normal BMI at follow-up compared to the cancer-free (OR = 1.90, 95% CI = 1.42-2.54). Cancer survivors were less likely to report regular aspirin use as compared to the cancer-free population (OR = 0.86, 95 % CI = 0.82-0.92). Of the current smokers, cancer survivors were more likely to be former smokers at follow-up compared to the cancer-free (OR = 1.50, 95% CI = 1.30-1.74). CONCLUSION Upon stratification by baseline health markers, cancer survivors practice healthier lifestyle habits such as smoking cessation and maintenance of a healthy weight. However, cancer survivors are less likely to be physically active as compared to cancer-free individuals, regardless of baseline practices. IMPLICATIONS FOR CANCER SURVIVORS For cancer survivors who reported poor health status and behaviors at baseline, a cancer diagnosis may encourage the practice of healthier lifestyle behaviors.
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Li XH, Chang H, Xu BQ, Tao YL, Gao J, Chen C, Qu C, Zhou S, Liu SR, Wang XH, Zhang WW, Yang X, Zhou SL, Xia YF. An inflammatory biomarker-based nomogram to predict prognosis of patients with nasopharyngeal carcinoma: an analysis of a prospective study. Cancer Med 2016; 6:310-319. [PMID: 27860387 PMCID: PMC5269708 DOI: 10.1002/cam4.947] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 12/27/2022] Open
Abstract
Chronic inflammation plays an important role in tumor progression. The aim of this analysis was to evaluate whether inflammatory biomarkers such as the Glasgow prognostic score (GPS), the neutrophil‐lymphocyte ratio (NLR), the platelet‐lymphocyte ratio (PLR), and the lymphocyte‐monocyte ratio (LMR) could predict the prognosis of nasopharyngeal carcinoma (NPC). In this analysis, pretreatment GPS, NLR, PLR, LMR of 388 patients who were diagnosed as nonmetastatic NPC and recruited prospectively in the 863 Program No. 2006AA02Z4B4 were assessed. Of those, the 249 cases enrolled between December 27th 2006 and July 31st 2011 were defined as the development set. The rest 139 cases enrolled between August 1st 2011 and July 31st 2013 were defined as the validation set. The variables above were analyzed in the development set, together with age, gender, Karnofsky performance score, T stage, and N stage, with respect to their impact on the disease‐specific survival (DSS) through a univariate analysis. The candidate prognostic factors then underwent a multivariate analysis. A nomogram was established to predict the DSS, by involving the independent prognostic factors. Its predction capacity was evaluated through calculating Harrell's concordance index (C‐index) in the validation set. After multivariate analysis for the development set, age (≤50 vs. >50 years old), T stage (T1–2 vs. T3–4), N stage (N0–1 vs. N2–3) and pretreatment GPS (0 vs. 1–2), NLR (≤2.5 vs. >2.5), LMR (≤2.35 vs. >2.35) were independent prognostic factors of DSS (P values were 0.002, 0.008, <0.001, 0.004, 0.018, and 0.004, respectively). A nomogram was established by involving all the factors above. Its C‐index for predicting the DSS of the validation set was 0.734 (standard error 0.056). Pretreatment GPS, NLR, and LMR were independent prognostic factors of NPC. The nomogram based on them could be used to predict the DSS of NPC patients.
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Affiliation(s)
- Xiao-Hui Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China.,Department of Oncology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, Guangdong, China
| | - Hui Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Bing-Qing Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Ya-Lan Tao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Jin Gao
- Department of Radiation Oncology, Anhui Province Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Chen Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Chen Qu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Shu Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Song-Ran Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Xiao-Hui Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Xin Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
| | - Si-Lang Zhou
- Department of Oncology, The 421 Hospital of Chinese People's Liberation Army, Guangzhou, Guangdong, China
| | - Yun-Fei Xia
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China
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Araujo JL, Altorki NK, Sonett JR, Rodriguez A, Sungur-Stasik K, Spinelli CF, Neugut AI, Abrams JA. Prediagnosis aspirin use and outcomes in a prospective cohort of esophageal cancer patients. Therap Adv Gastroenterol 2016; 9:806-814. [PMID: 27803735 PMCID: PMC5076766 DOI: 10.1177/1756283x16657985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Esophageal cancer remains associated with poor outcomes, yet little is known regarding factors that influence survival. Aspirin use prior to cancer diagnosis may influence outcomes. We aimed to assess the effects of prediagnosis aspirin use in patients with esophageal cancer. METHODS We conducted a prospective cohort study of newly-diagnosed esophageal cancer patients at two tertiary care centers. We assessed history of prediagnosis aspirin use, and prospectively followed patients and assessed mortality, cause of death, and development of metastases. RESULTS We enrolled 130 patients, the majority of whom were male (81.5%) and had adenocarcinoma (80.8%). Overall, 57 patients (43.9%) were regular aspirin users. In unadjusted analyses, we found no difference in all-cause mortality between aspirin users and nonusers. In multivariate analyses, prediagnosis aspirin use was not associated with all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.48-1.57] or esophageal cancer-specific mortality (HR 1.07, 95% CI 0.52-2.21). Prediagnosis aspirin use was associated with a significantly increased risk of interval metastasis (HR 3.59, 95% CI 1.08-11.96). CONCLUSIONS In our cohort of esophageal cancer patients, prediagnosis aspirin use was not associated with all-cause or cancer-specific mortality. However, risk of interval metastatic disease was increased among those who took aspirin regularly prediagnosis. Future studies are warranted to assess whether aspirin influences the molecular characteristics of esophageal tumors, with potential prognostic and therapeutic implications.
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Affiliation(s)
- James L. Araujo
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Nasser K. Altorki
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA
| | - Joshua R. Sonett
- Department of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Adriana Rodriguez
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | - Cathy F. Spinelli
- Department of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA
| | - Alfred I. Neugut
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Coyle C, Cafferty FH, Rowley S, MacKenzie M, Berkman L, Gupta S, Pramesh CS, Gilbert D, Kynaston H, Cameron D, Wilson RH, Ring A, Langley RE. ADD-ASPIRIN: A phase III, double-blind, placebo controlled, randomised trial assessing the effects of aspirin on disease recurrence and survival after primary therapy in common non-metastatic solid tumours. Contemp Clin Trials 2016; 51:56-64. [PMID: 27777129 PMCID: PMC5127874 DOI: 10.1016/j.cct.2016.10.004] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a considerable body of pre-clinical, epidemiological and randomised data to support the hypothesis that aspirin has the potential to be an effective adjuvant cancer therapy. METHODS Add-Aspirin is a phase III, multi-centre, double-blind, placebo-controlled randomised trial with four parallel cohorts. Patients who have undergone potentially curative treatment for breast (n=3100), colorectal (n=2600), gastro-oesophageal (n=2100) or prostate cancer (n=2120) are registered into four tumour specific cohorts. All cohorts recruit in the United Kingdom, with the breast and gastro-oesophageal cohort also recruiting in India. Eligible participants first undertake an active run-in period where 100mg aspirin is taken daily for approximately eight weeks. Participants who are able to adhere and tolerate aspirin then undergo a double-blind randomisation and are allocated in a 1:1:1 ratio to either 100mg aspirin, 300mg aspirin or a matched placebo to be taken daily for at least five years. Those participants ≥75years old are only randomised to 100mg aspirin or placebo due to increased toxicity risk. RESULTS The primary outcome measures are invasive disease-free survival for the breast cohort, disease-free survival for the colorectal cohort, overall survival for the gastro-oesophageal cohort, and biochemical recurrence-free survival for the prostate cohort, with a co-primary outcome of overall survival across all cohorts. Secondary outcomes include adherence, toxicity including serious haemorrhage, cardiovascular events and some cohort specific measures. CONCLUSIONS The Add-Aspirin trial investigates whether regular aspirin use after standard therapy prevents recurrence and prolongs survival in participants with four non-metastatic common solid tumours.
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Affiliation(s)
- Christopher Coyle
- MRC Clinical Trials Unit, UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - Fay H Cafferty
- MRC Clinical Trials Unit, UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - Samuel Rowley
- MRC Clinical Trials Unit, UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - Mairead MacKenzie
- Independent Cancer Patient Voices, 17 Woodbridge Street, London EC1R 0LL, UK
| | - Lindy Berkman
- NCRI Consumer Forum, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - Sudeep Gupta
- Room No. 1109, 11th Floor, Homi Bhabha Block, Tata Memorial Centre/Hospital, Parel, Mumbai 400012, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Dr Ernest Borges Marg, Parel, Mumbai 400012, India
| | - Duncan Gilbert
- MRC Clinical Trials Unit, UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK; Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, Sussex BN2 5BE, UK
| | - Howard Kynaston
- Room 2F65, Block A2, Cardiff School of Medicine, Heath Park, Cardiff CF14 4XN, UK
| | - David Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Crewe Road South, EH4 2XR, UK
| | - Richard H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, Northern Ireland, UK
| | - Alistair Ring
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit, UCL, Aviation House, 125 Kingsway, London WC2B 6NH, UK.
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Liu Y, Sun H, Hu M, Zhang Y, Chen S, Tighe S, Zhu Y. The Role of Cyclooxygenase-2 in Colorectal Carcinogenesis. Clin Colorectal Cancer 2016; 16:165-172. [PMID: 27810226 DOI: 10.1016/j.clcc.2016.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/08/2016] [Accepted: 09/22/2016] [Indexed: 12/16/2022]
Abstract
Colorectal cancer is a major worldwide health care problem that accounts for 1 million new cases each year. The risk factors for this disease include hereditary factors, environmental agents, and inflammatory stimuli that affect the gastrointestinal tract. Among these risk factors, cyclooxygenase-2 (COX-2) is one of the major players in the progression of colorectal cancer; however, the detailed mechanism of its role in causing colorectal cancer is still not well understood. In addition, the role of COX-2 signaling through the interaction in the epithelial and stromal compartments on colorectal carcinogenesis has not been fully illustrated. In the present review, we provide published evidence to demonstrate that (1) COX-2 signaling plays a major role in the progression of colorectal cancer, (2) activation of COX-2 in the stromal compartment also contributes to colorectal carcinogenesis, and (3) inhibition of COX-2 signaling by COX-2 inhibitors might be an effective method to control colorectal cancer. We have also summarized recent advances and insights from mechanistic studies of colorectal cancer to help prevent and control this deadly disease and provide our opinion regarding the importance of risk reduction and disease prevention for colorectal cancer.
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Affiliation(s)
| | - Hong Sun
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Hu
- The Second People's Hospital of Yunnan Province, Kunming, China
| | - Yuan Zhang
- Research and Development Department, Tissue Tech, Inc., Miami, FL
| | - Shuangling Chen
- Research and Development Department, Tissue Tech, Inc., Miami, FL
| | - Sean Tighe
- Research and Development Department, Tissue Tech, Inc., Miami, FL
| | - Yingting Zhu
- Research and Development Department, Tissue Tech, Inc., Miami, FL.
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188
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Acetylsalicylic Acid Exhibits Antitumor Effects in Esophageal Adenocarcinoma Cells In Vitro and In Vivo. Dig Dis Sci 2016; 61:2896-2907. [PMID: 27343037 DOI: 10.1007/s10620-016-4225-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 06/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM Recent observational studies have shown therapeutic benefits of acetylsalicylic acid (ASA) in several types of cancer. We examined whether ASA exerts antitumor activity in esophageal adenocarcinoma (EAC). METHODS Human EAC cells (OE33) were treated with ASA (0-5 mM) to evaluate proliferation, apoptosis, and migration. In vivo model: OE33-derived tumors were subcutaneously implanted into athymic mice which were allocated to ASA (5 or 50 mg/kg/day)/vehicle (5-6 animals/group). Tumor growth was assessed every 2-3 days, and after 40 days, mice were euthanized. Plasma drug levels were determined by high-performance liquid chromatography. Histological and immunohistochemical (Ki67, activated caspase-3) analysis of tumors were performed. The effect of ASA on tumor prostaglandin E2 (PGE2) levels was also evaluated. RESULTS In vitro cell proliferation and migration were significantly inhibited while apoptosis increased (p < 0.05) by ASA. Although ASA did not induce tumor remission, tumor progression was significantly lower in ASA-treated mice when compared to non-treated animals (478 % in mice treated with 5 mg/kg/day ASA vs. 2696 % control; 748 % in mice treated with 50 mg/kg/day ASA vs. 2670 % control). Maximum tumor inhibition was 92 and 85 %, respectively. This effect was associated with a significant decrease of proliferation index in tumors. ASA 5 mg/kg/day did not modify tumor PGE2 levels. Whereas tumor PGE2 content in mice treated with ASA 50 mg/kg was lower than in control mice, the difference was not significant. CONCLUSION Although these results need to be confirmed in other EAC cells, our data suggest a role for ASA in the treatment of this tumor.
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189
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Cohen SA, Turner EH, Beightol MB, Jacobson A, Gooley TA, Salipante SJ, Haraldsdottir S, Smith C, Scroggins S, Tait JF, Grady WM, Lin EH, Cohn DE, Goodfellow PJ, Arnold MW, de la Chapelle A, Pearlman R, Hampel H, Pritchard CC. Frequent PIK3CA Mutations in Colorectal and Endometrial Tumors With 2 or More Somatic Mutations in Mismatch Repair Genes. Gastroenterology 2016; 151:440-447.e1. [PMID: 27302833 PMCID: PMC5016834 DOI: 10.1053/j.gastro.2016.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Some colorectal and endometrial tumors with microsatellite instability not attributable to MLH1 hypermethylation or germline mutations contain 2 or more somatic mutations in genes encoding mismatch repair (MMR) proteins. We sought to define the molecular phenotype of this newly recognized tumor subtype. METHODS From 2 prospective studies of the efficacy of screening for Lynch syndrome, we identified patients with colorectal and endometrial tumors who had 2 or more somatic (but not germline) mutations in genes encoding MMR proteins (double somatic). We determined the frequencies of tumor mutations in PIK3CA, BRAF, KRAS, NRAS, and PTEN by targeted next-generation sequencing and used logistic-regression models to compare them with those from patients with Lynch syndrome, MLH1-hypermethylated, or microsatellite-stable tumors. We validated our findings using independent data sets from The Cancer Genome Atlas. RESULTS Among colorectal cancer cases, we found that 14 of 21 (67%) patients with double somatic tumors also had PIK3CA mutations, compared with 4 of 18 (22%) tumors from patients with Lynch syndrome, 2 of 10 (20%) tumors with MLH1 hypermethylation, and 12 of 78 (15%) tumors with microsatellite stability (P < .0001 for patients with double somatic tumors vs other subgroups). Mutations in PIK3CA were detected in all 13 patients with double somatic endometrial cancers (P = .04 compared with other subgroups). We did not detect BRAF mutations in patients with double somatic colorectal tumors or Lynch syndrome. We found highly similar results in a validation cohort from The Cancer Genome Atlas (113 patients with colorectal tumors, 178 endometrial tumors); 100% of double somatic cases had a somatic mutation in PIK3CA (P < .0001 compared with other subgroups). CONCLUSIONS Most patients with colorectal or endometrial tumors with 2 or more somatic (but not germline) mutations in MMR proteins also have mutations in PIK3CA; mutations in PIK3CA are detected at substantially higher frequencies in these double somatic tumors than in other microsatellite-instability subgroups. PIK3CA mutation status might be used to identify a specific group of colorectal tumors, and to select treatment or determine prognosis.
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Affiliation(s)
- Stacey A Cohen
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - Emily H Turner
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Mallory B Beightol
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Angela Jacobson
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ted A Gooley
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - Stephen J Salipante
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Sigurdis Haraldsdottir
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, California
| | - Christina Smith
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Sheena Scroggins
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jonathan F Tait
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - William M Grady
- Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington; Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Edward H Lin
- Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, Washington
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University, Columbus, Ohio
| | - Paul J Goodfellow
- Division of Gynecologic Oncology, The Ohio State University, Columbus, Ohio
| | - Mark W Arnold
- Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
| | - Albert de la Chapelle
- Department of Molecular Virology, Immunology, and Medical Genetics, The Ohio State University, Columbus, Ohio
| | - Rachel Pearlman
- Division of Human Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Heather Hampel
- Division of Human Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Colin C Pritchard
- Department of Laboratory Medicine, University of Washington, Seattle, Washington.
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190
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Jiang MJ, Dai JJ, Gu DN, Huang Q, Tian L. Aspirin in pancreatic cancer: chemopreventive effects and therapeutic potentials. Biochim Biophys Acta Rev Cancer 2016; 1866:163-176. [PMID: 27567928 DOI: 10.1016/j.bbcan.2016.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/04/2016] [Accepted: 08/23/2016] [Indexed: 12/20/2022]
Abstract
Pancreatic cancer is one of the most aggressive malignancies with dismal prognosis. Recently, aspirin has been found to be an effective chemopreventive agent for many solid tumors. However, the function of aspirin use in pancreatic cancer largely remains unknown. We herein argued that aspirin could also lower the risk of pancreatic cancer. Importantly, aspirin assumes pleiotropic effects by targeting multiple molecules. It could further target the unique tumor biology of pancreatic cancer and modify the cancer microenvironment, thus showing remarkable therapeutic potentials. Besides, aspirin could reverse the chemoradiation resistance by repressing tumor repopulation and exert synergistic potentials with metformin on pancreatic cancer chemoprevention. Moreover, aspirin secondarily benefits pancreatic cancer patients through modestly reducing cancer pain and the risk of venous thromboembolism. Furthermore, new aspirin derivatives and delivery systems might help to improve risk-to-benefit ratio. In brief, aspirin is a promising chemopreventive agent and exerts significant therapeutic potentials in pancreatic cancer.
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Affiliation(s)
- Ming-Jie Jiang
- Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China; Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Juan-Juan Dai
- Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China; Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Dian-Na Gu
- Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China; Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Qian Huang
- Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China; Comprehensive Cancer Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Ling Tian
- Institute of Translational Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China; Shanghai Key Laboratory of Pancreatic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China.
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191
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Kudryavtseva AV, Lipatova AV, Zaretsky AR, Moskalev AA, Fedorova MS, Rasskazova AS, Shibukhova GA, Snezhkina AV, Kaprin AD, Alekseev BY, Dmitriev AA, Krasnov GS. Important molecular genetic markers of colorectal cancer. Oncotarget 2016; 7:53959-53983. [PMID: 27276710 PMCID: PMC5288236 DOI: 10.18632/oncotarget.9796] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 05/21/2016] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) ranks third in the incidences of cancer morbidity and mortality worldwide. CRC is rather heterogeneous with regard to molecular genetic characteristics and pathogenic pathways. A wide spectrum of biomarkers is used for molecular subtype determination, prognosis, and estimation of sensitivity to different drugs in practice. These biomarkers can include germline and somatic mutations, chromosomal aberrations, genomic abnormalities, gene expression alterations at mRNA or protein level and changes in DNA methylation status. In the present review we discuss the most important and well-studied CRC biomarkers, and their potential clinical significance and current approaches to molecular classification of colorectal tumors.
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Affiliation(s)
- Anna V. Kudryavtseva
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
- National Medical Research Radiological Centre, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Anastasia V. Lipatova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Andrew R. Zaretsky
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Alexey A. Moskalev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - Maria S. Fedorova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
- National Medical Research Radiological Centre, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Galina A. Shibukhova
- National Medical Research Radiological Centre, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Andrey D. Kaprin
- National Medical Research Radiological Centre, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Boris Y. Alekseev
- National Medical Research Radiological Centre, Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Alexey A. Dmitriev
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
| | - George S. Krasnov
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia
- Orekhovich Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, Moscow, Russia
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192
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Bao Y, Bertoia ML, Lenart EB, Stampfer MJ, Willett WC, Speizer FE, Chavarro JE. Origin, Methods, and Evolution of the Three Nurses' Health Studies. Am J Public Health 2016; 106:1573-81. [PMID: 27459450 DOI: 10.2105/ajph.2016.303338] [Citation(s) in RCA: 365] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We have summarized the evolution of the Nurses' Health Study (NHS), a prospective cohort study of 121 700 married registered nurses launched in 1976; NHS II, which began in 1989 and enrolled 116 430 nurses; and NHS3, which began in 2010 and has ongoing enrollment. Over 40 years, these studies have generated long-term, multidimensional data, including lifestyle- and health-related information across the life course and an extensive repository of various biological specimens. We have described the questionnaire data collection, disease follow-up methods, biorepository resources, and data management and statistical procedures. Through integrative analyses, these studies have sustained a high level of scientific productivity and substantially influenced public health recommendations. We have highlighted recent interdisciplinary research projects and discussed future directions for collaboration and innovation.
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Affiliation(s)
- Ying Bao
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Monica L Bertoia
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Elizabeth B Lenart
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Meir J Stampfer
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Walter C Willett
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Frank E Speizer
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Jorge E Chavarro
- Ying Bao, Meir J. Stampfer, and Frank E. Speizer are with the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. Monica L. Bertoia, Elizabeth B. Lenart, Walter C. Willett, and Jorge E. Chavarro are with the Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA
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Bains SJ, Mahic M, Myklebust TÅ, Småstuen MC, Yaqub S, Dørum LM, Bjørnbeth BA, Møller B, Brudvik KW, Taskén K. Aspirin As Secondary Prevention in Patients With Colorectal Cancer: An Unselected Population-Based Study. J Clin Oncol 2016; 34:2501-8. [DOI: 10.1200/jco.2015.65.3519] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (CRC). However, aspirin as primary prevention is debated because of the risk of hemorrhagic adverse effects. Aspirin as secondary prevention may be more justified from a risk-benefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CRC-specific survival (CSS) and overall survival (OS). Materials and Methods An observational, population-based, retrospective cohort study was conducted by linking patients diagnosed with CRC from 2004 through 2011 (Cancer Registry of Norway) with data on their aspirin use (The Norwegian Prescription Database). These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS. Results A total of 23,162 patients diagnosed with CRC were included, 6,102 of whom were exposed to aspirin after the diagnosis of CRC (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific. In multivariable analysis, aspirin exposure after the diagnosis of CRC was independently associated with improved CSS (hazard ratio [HR], 0.85; 95% CI, 0.79 to 0.92) and OS (HR, 0.95; 95% CI, 0.90 to 1.01). Conclusion Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS.
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Affiliation(s)
- Simer J. Bains
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Milada Mahic
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Sheraz Yaqub
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Liv Marit Dørum
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Bjørn Atle Bjørnbeth
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Bjørn Møller
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Kristoffer Watten Brudvik
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
| | - Kjetil Taskén
- Simer J. Bains, Kjetil Taskén, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo; Milada Mahic, Norwegian Institute of Public Health; Tor Åge Myklebust, Liv Marit Dørum, Bjørn Møller, Cancer Registry of Norway; and Simer J. Bains, Milada Cvancarova Småstuen, Sheraz Yaqub, Bjørn Atle Bjørnbeth, Kristoffer Watten Brudvik, Kjetil Taskén, Oslo University Hospital, Oslo, Norway
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A Second WNT for Old Drugs: Drug Repositioning against WNT-Dependent Cancers. Cancers (Basel) 2016; 8:cancers8070066. [PMID: 27429001 PMCID: PMC4963808 DOI: 10.3390/cancers8070066] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 06/24/2016] [Accepted: 07/07/2016] [Indexed: 12/21/2022] Open
Abstract
Aberrant WNT signaling underlies cancerous transformation and growth in many tissues, such as the colon, breast, liver, and others. Downregulation of the WNT pathway is a desired mode of development of targeted therapies against these cancers. Despite the urgent need, no WNT signaling-directed drugs currently exist, and only very few candidates have reached early phase clinical trials. Among different strategies to develop WNT-targeting anti-cancer therapies, repositioning of existing drugs previously approved for other diseases is a promising approach. Nonsteroidal anti-inflammatory drugs like aspirin, the anti-leprotic clofazimine, and the anti-trypanosomal suramin are among examples of drugs having recently revealed WNT-targeting activities. In total, 16 human-use drug compounds have been found to be working through the WNT pathway and show promise for their prospective repositioning against various cancers. Advances, hurdles, and prospects of developing these molecules as potential drugs against WNT-dependent cancers, as well as approaches for discovering new ones for repositioning, are the foci of the current review.
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195
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Williams GR, Mackenzie A, Magnuson A, Olin R, Chapman A, Mohile S, Allore H, Somerfield MR, Targia V, Extermann M, Cohen HJ, Hurria A, Holmes H. Comorbidity in older adults with cancer. J Geriatr Oncol 2016; 7:249-57. [PMID: 26725537 PMCID: PMC4917479 DOI: 10.1016/j.jgo.2015.12.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
Abstract
Comorbidity is an issue of growing importance due to changing demographics and the increasing number of adults over the age of 65 with cancer. The best approach to the clinical management and decision-making in older adults with comorbid conditions remains unclear. In May 2015, the Cancer and Aging Research Group, in collaboration with the National Cancer Institute and the National Institute on Aging, met to discuss the design and implementation of intervention studies in older adults with cancer. A presentation and discussion on comorbidity measurement, interventions, and future research was included. In this article, we discuss the relevance of comorbidities in cancer, examine the commonly used tools to measure comorbidity, and discuss the future direction of comorbidity research. Incorporating standardized comorbidity measurement, relaxing clinical trial eligibility criteria, and utilizing novel trial designs are critical to developing a larger and more generalizable evidence base to guide the management of these patients. Creating or adapting comorbidity management strategies for use in older adults with cancer is necessary to define optimal care for this growing population.
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Affiliation(s)
- Grant R Williams
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | | | | | - Rebecca Olin
- University of California San Francisco, San Francisco, CA, USA
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Schottinger JE, Kanter MH, Litman KC, Lau H, Schwartz GE, Brasfield FM, Alshak NS, DiFronzo LA. Using Literature Review and Structured Hybrid Electronic/Manual Mortality Review to Identify System-Level Improvement Opportunities to Reduce Colorectal Cancer Mortality. Jt Comm J Qual Patient Saf 2016; 42:303-10. [DOI: 10.1016/s1553-7250(16)42041-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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197
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Mcilhatton MA, Boivin GP, Groden J. Manipulation of DNA Repair Proficiency in Mouse Models of Colorectal Cancer. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1414383. [PMID: 27413734 PMCID: PMC4931062 DOI: 10.1155/2016/1414383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022]
Abstract
Technical and biological innovations have enabled the development of more sophisticated and focused murine models that increasingly recapitulate the complex pathologies of human diseases, in particular cancer. Mouse models provide excellent in vivo systems for deciphering the intricacies of cancer biology within the context of precise experimental settings. They present biologically relevant, adaptable platforms that are amenable to continual improvement and refinement. We discuss how recent advances in our understanding of tumorigenesis and the underlying deficiencies of DNA repair mechanisms that drive it have been informed by using genetically engineered mice to create defined, well-characterized models of human colorectal cancer. In particular, we focus on how mechanisms of DNA repair can be manipulated precisely to create in vivo models whereby the underlying processes of tumorigenesis are accelerated or attenuated, dependent on the composite alleles carried by the mouse model. Such models have evolved to the stage where they now reflect the initiation and progression of sporadic cancers. The review is focused on mouse models of colorectal cancer and how insights from these models have been instrumental in shaping our understanding of the processes and potential therapies for this disease.
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Affiliation(s)
- Michael A. Mcilhatton
- Department of Cancer Biology and Genetics, The Ohio State University, 460 West 12th Avenue, Columbus, OH 43210, USA
| | - Gregory P. Boivin
- Department of Pathology, Boonshoft School of Medicine, Wright State University, Health Sciences Building 053, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA
| | - Joanna Groden
- Department of Cancer Biology and Genetics, The Ohio State University, 460 West 12th Avenue, Columbus, OH 43210, USA
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Huang YC, Huang FI, Mehndiratta S, Lai SC, Liou JP, Yang CR. Anticancer activity of MPT0G157, a derivative of indolylbenzenesulfonamide, inhibits tumor growth and angiogenesis. Oncotarget 2016; 6:18590-601. [PMID: 26087180 PMCID: PMC4621912 DOI: 10.18632/oncotarget.4068] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/15/2015] [Indexed: 11/30/2022] Open
Abstract
Histone deacetylases (HDACs) display multifaceted functions by coordinating the interaction of signal pathways with chromatin structure remodeling and the activation of non-histone proteins; these epigenetic regulations play an important role during malignancy progression. HDAC inhibition shows promise as a new strategy for cancer therapy; three HDAC inhibitors have been approved. We previously reported that N-hydroxy-3-{4-[2-(2-methyl-1H-indol-3-yl)-ethylsulfamoyl]-phenyl}-acrylamide (MPT0G157), a novel indole-3-ethylsulfamoylphenylacrylamide compound, demonstrated potent HDAC inhibition and anti-inflammatory effects. In this study, we evaluated its anti-cancer activity in vitro and in vivo. MPT0G157 treatment significantly inhibited different tumor growth at submicromolar concentration and was particularly potent in human colorectal cancer (HCT116) cells. Apoptosis and inhibited HDACs activity induced by MPT0G157 was more potent than that by the marketed drugs PXD101 (Belinostat) and SAHA (Vorinostat). In an in vivo model, MPT0G157 markedly inhibited HCT116 xenograft tumor volume and reduced matrigel-induced angiogenesis. The anti-angiogenetic effect of MPT0G157 was found to increase the hyperacetylation of heat shock protein 90 (Hsp90) and promote hypoxia-inducible factor-1α (HIF-1α) degradation followed by down-regulation of vascular endothelial growth factor (VEGF) expression. Our results demonstrate that MPT0G157 has potential as a new drug candidate for cancer therapy.
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Affiliation(s)
- Yen-Chia Huang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fang-I Huang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Samir Mehndiratta
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Ssu-Chia Lai
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jing-Ping Liou
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Chia-Ron Yang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
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199
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Rozek LS, Schmit SL, Greenson JK, Tomsho LP, Rennert HS, Rennert G, Gruber SB. Tumor-Infiltrating Lymphocytes, Crohn's-Like Lymphoid Reaction, and Survival From Colorectal Cancer. J Natl Cancer Inst 2016; 108:djw027. [PMID: 27172903 DOI: 10.1093/jnci/djw027] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 02/05/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND While clinical outcomes from colorectal cancer (CRC) are influenced by stage at diagnosis and treatment, mounting evidence suggests that an enhanced lymphocytic reaction to a tumor may also be an informative prognostic indicator. METHODS The roles of intratumoral T lymphocyte infiltration (TIL), peritumoral Crohn's-like lymphoid reaction (CLR), microsatellite instability (MSI), and clinicopathological characteristics in survival from CRC were examined using 2369 incident CRCs from a population-based case-control study in northern Israel. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC-specific and all-cause mortality in multivariable models adjusted for age, sex, ethnicity, grade, stage, and MSI. All statistical tests were two-sided. RESULTS Tumors with TIL/high-powered field (HPF) of 2 or greater were associated with a statistically significant increase in CRC-specific (P < .001) and overall survival (P < .001) compared with tumors with TIL/HPF of less than 2. Similarly, tumors with a prominent CLR experienced better CRC-specific (P < .001) and overall survival (P < .001) as compared with those with no response. High TILs (HR = 0.76, 95% CI = 0.64 to 0.89, P < .001) and a prominent CLR (HR = 0.71, 95% CI = 0.62 to 0.80, P < .001), but not MSI, were associated with a statistically significant reduction in all-cause mortality after adjustment for established prognostic factors. CONCLUSIONS TILs and CLR are both prognostic indicators for CRC after adjusting for traditional prognostic indicators.
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Affiliation(s)
- Laura S Rozek
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
| | - Stephanie L Schmit
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
| | - Joel K Greenson
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
| | - Lynn P Tomsho
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
| | - Hedy S Rennert
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
| | - Gad Rennert
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
| | - Stephen B Gruber
- Affiliations of authors: Department of Environmental Health Sciences, University of Michigan School of Public Health (LSR), and Department of Pathology (JKG) and Department of Internal Medicine (LPT), University of Michigan Medical School, Ann Arbor, MI; USC Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA (SLS, SBG); Clalit National Israeli Cancer Control Center, Haifa, Israel (HSR, GR)
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200
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Bradley MC, Black A, Freedman AN, Barron TI. Prediagnostic aspirin use and mortality in women with stage I to III breast cancer: A cohort study in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Cancer 2016; 122:2067-75. [PMID: 27149646 DOI: 10.1002/cncr.30004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a body of evidence indicating that aspirin may reduce the risk of cancer mortality. However, to the authors' knowledge, the optimal exposure timing and mechanism of action remain unclear. In the current study, the authors investigated associations between prediagnostic aspirin use and breast cancer-specific mortality in a US population. METHODS Postmenopausal women diagnosed with stage I to III breast cancer (1993-2009) were identified (2925 women with a total of 18,073 person-years) from the National Cancer Institute's Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Prediagnostic aspirin use (1274 women) was identified from study questionnaires. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs) for associations between aspirin use and breast cancer-specific mortality. Effect modification by lymph node status was evaluated. RESULTS Prediagnostic aspirin use was not found to be associated with lower breast cancer-specific mortality (HR, 0.95; 95% CI, 0.68-1.31 [P = .74]). In analyses stratified by lymph node status, aspirin use was found to be associated with lower breast cancer-specific mortality among women with lymph node-negative tumors (HR, 0.54; 95% CI, 0.32-0.93 [P = 0.02]), but not those with lymph node-positive tumors (HR, 1.41; 95% CI, 0.92-2.16 [P = 0.11]). Tests for interaction were found to be statistically significant (P for interaction =.006). No association was noted between aspirin use and lymph node status. CONCLUSIONS Prediagnostic aspirin use was not found to be associated with a reduction in breast cancer-specific mortality overall. However, effect modification by lymph node status was observed and mortality was found to be reduced by approximately one-half among aspirin users with lymph node-negative disease. This represents a clinically significant reduction in breast cancer mortality. These findings contribute to the understanding of aspirin's mechanism of action in breast cancer. However, further etiologic research to understand this association is warranted. Cancer 2016;122:2067-75. © 2016 American Cancer Society.
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Affiliation(s)
- Marie C Bradley
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Amanda Black
- Epidemiology and Biostatistics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Andrew N Freedman
- Clinical and Translational Epidemiology Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Thomas I Barron
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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