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He W, Yang Y, Liu Q, Luo D, Li Q, Li X. Conditional survival and the prognostic value of serum carcinoembryonic antigen level in oldest old with colorectal cancer. BMC Gastroenterol 2024; 24:220. [PMID: 38987680 PMCID: PMC11234783 DOI: 10.1186/s12876-024-03318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/04/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND To evaluate the clinical value of serum CEA levels and their implications on the diagnostic value of the conventional TNM staging system in the oldest-old patients with colorectal cancer (CRC). METHODS The recruited subjects were colorectal cancer patients aged 85 and older. The cutoff value for normal CEA level is 5 ng/mL. Patients with elevated CEA levels were categorized as stage C1, and those with normal CEA levels as stage C0. A number of Cox proportional hazard regression models were established to evaluate the prognosis of different prognostic factors with hazard ratios (HRs) and 95% confidence intervals (CIs). The Kaplan-Meier method was utilized to display the disparate prognostic impact of multiple clinicopathological factors with the log-rank test. RESULTS A total of 17,359 oldest-old patients diagnosed with CRC were recruited from the SEER database. The conditional survival of oldest-old patients with CRC was dismal with a 1-year conditional survival of only 11%, 18%, and 30% for patients surviving 1, 3, and 5 years, respectively. Patients with stage C1 exhibited a 48.5% increased risk of CRC-specific mortality compared with stage C0 (HR = 1.485, 95%CI = 1.393-1.583, using stage C0 patients as the reference, P < 0.001). All the stage C0 patients indicated lower HRs relative to the corresponding stage C1 patients. CONCLUSIONS Dismal conditional survival of oldest-old patients with CRC should be given additional consideration. C stage influences the prognosis of oldest-old patients with CRC.
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Affiliation(s)
- Weijing He
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Xuhui District, #270 Dongan' Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yufei Yang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Xuhui District, #270 Dongan' Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Xuhui District, #270 Dongan' Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dakui Luo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Xuhui District, #270 Dongan' Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Xuhui District, #270 Dongan' Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Xuhui District, #270 Dongan' Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Jing PF, Chen J, Yu ED, Miao CY. Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer. World J Gastrointest Oncol 2024; 16:2429-2438. [PMID: 38994158 PMCID: PMC11236233 DOI: 10.4251/wjgo.v16.i6.2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/03/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND In recent years, the incidence of colorectal cancer (CRC) has been increasing. With the popularization of endoscopic technology, a number of early CRC has been diagnosed. However, despite current treatment methods, some patients with early CRC still experience postoperative recurrence and metastasis. AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations. METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study. Results of blood routine test, liver and kidney function tests and tumor markers were collected before surgery. Patients were followed up through disease-specific database and telephone interviews. Tumor recurrence, metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis. RESULTS We comprehensively compared the predictive value of preoperative blood routine, blood biochemistry and tumor markers for disease-free survival (DFS) and overall survival (OS) of CRC. Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS [hazard ratio (HR) = 0.995, 95% confidence interval (CI): 0.991-0.999, P = 0.015], while serum carcinoembryonic antigen (CEA) level (HR = 1.008, 95%CI: 1.001-1.016, P = 0.027) and serum total cholesterol level (HR = 1.538, 95%CI: 1.026-2.305, P = 0.037) were independent risk factors for OS. The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL. Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level, the difference between the two groups was not statistically significant (P = 0.075). CONCLUSION For patients with T2N0M0 or T3N0M0 CRC, preoperative platelet count was a protective factor for DFS, while serum CEA level was an independent risk factor for OS. Given that these measures are easier to detect and more acceptable to patients, they may have broader applications.
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Affiliation(s)
- Peng-Fei Jing
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai 200433, China
| | - Jin Chen
- Department of Endocrinology and Metabolism, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai 200433, China
| | - En-Da Yu
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai 200433, China
| | - Chao-Yu Miao
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai 200433, China
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Jing PF, Chen J, Yu ED, Miao CY. Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer. World J Gastrointest Oncol 2024; 16:2417-2426. [DOI: 10.4251/wjgo.v16.i6.2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/03/2024] [Accepted: 04/09/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND In recent years, the incidence of colorectal cancer (CRC) has been increasing. With the popularization of endoscopic technology, a number of early CRC has been diagnosed. However, despite current treatment methods, some patients with early CRC still experience postoperative recurrence and metastasis.
AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.
METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study. Results of blood routine test, liver and kidney function tests and tumor markers were collected before surgery. Patients were followed up through disease-specific database and telephone interviews. Tumor recurrence, metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.
RESULTS We comprehensively compared the predictive value of preoperative blood routine, blood biochemistry and tumor markers for disease-free survival (DFS) and overall survival (OS) of CRC. Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS [hazard ratio (HR) = 0.995, 95% confidence interval (CI): 0.991-0.999, P = 0.015], while serum carcinoembryonic antigen (CEA) level (HR = 1.008, 95%CI: 1.001-1.016, P = 0.027) and serum total cholesterol level (HR = 1.538, 95%CI: 1.026-2.305, P = 0.037) were independent risk factors for OS. The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL. Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level, the difference between the two groups was not statistically significant (P = 0.075).
CONCLUSION For patients with T2N0M0 or T3N0M0 CRC, preoperative platelet count was a protective factor for DFS, while serum CEA level was an independent risk factor for OS. Given that these measures are easier to detect and more acceptable to patients, they may have broader applications.
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Affiliation(s)
- Peng-Fei Jing
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai 200433, China
| | - Jin Chen
- Department of Endocrinology and Metabolism, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai 200433, China
| | - En-Da Yu
- Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai 200433, China
| | - Chao-Yu Miao
- Department of Pharmacology, Second Military Medical University/Naval Medical University, Shanghai 200433, China
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Xie H, Wei L, Wang Q, Tang S, Gan J. Elevated serum homocysteine levels associated with poor recurrence-free and overall survival in patients with colorectal cancer. Sci Rep 2024; 14:10057. [PMID: 38698172 PMCID: PMC11066114 DOI: 10.1038/s41598-024-60855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/29/2024] [Indexed: 05/05/2024] Open
Abstract
This study aimed to evaluate the significance of homocysteine (HCY) levels in predicting recurrence-free survival (RFS) and overall survival (OS) in colorectal cancer (CRC) patients. This retrospective study involved 1272 CRC patients. The risk of mortality increased with increasing HCY levels in CRC patients. The optimal HCY cutoff value in CRC patients was 15.2 μmol/L. The RFS (45.8% vs. 60.5%, p < 0.001) and OS (48.2% vs. 63.2%, p < 0.001) of patients with high HCY levels were significantly lower than those of patients with low HCY levels. Patients with high HCY levels were older, male, had large tumours, high carcinoembryonic antigen (CEA) levels, and long hospital stays, and incurred high hospitalisation costs. Multivariate analysis showed that when HCY levels exceeded 15.2 μmol/L, the risk of adverse RFS and OS increased by 55.7% and 61.4%, respectively. Subgroup analysis showed that HCY levels could supplement CEA levels and pathological staging. We constructed HCY-based prognostic nomograms, which demonstrated feasible discrimination and calibration values better than the traditional tumour, node, metastasis staging system for predicting RFS and OS. Elevated serum HCY levels were strongly associated with poor RFS and OS in CRC patients. HCY-based prognostic models are effective tools for a comprehensive evaluation of prognosis.
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Affiliation(s)
- Hailun Xie
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital, Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, 530021, Guangxi, People's Republic of China
| | - Lishuang Wei
- Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Qiwen Wang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, 530021, Guangxi, People's Republic of China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, Guangxi, People's Republic of China.
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, 530021, Guangxi, People's Republic of China.
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Zhao H, Su Y, Wang Y, Lyu Z, Xu P, Gu W, Tian L, Fu P. Using tumor habitat-derived radiomic analysis during pretreatment 18F-FDG PET for predicting KRAS/NRAS/BRAF mutations in colorectal cancer. Cancer Imaging 2024; 24:26. [PMID: 38342905 PMCID: PMC10860234 DOI: 10.1186/s40644-024-00670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/29/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND To investigate the association between Kirsten rat sarcoma viral oncogene homolog (KRAS) / neuroblastoma rat sarcoma viral oncogene homolog (NRAS) /v-raf murine sarcoma viral oncogene homolog B (BRAF) mutations and the tumor habitat-derived radiomic features obtained during pretreatment 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in patients with colorectal cancer (CRC). METHODS We retrospectively enrolled 62 patients with CRC who had undergone 18F-FDG PET/computed tomography from January 2017 to July 2022 before the initiation of therapy. The patients were randomly split into training and validation cohorts with a ratio of 6:4. The whole tumor region radiomic features, habitat-derived radiomic features, and metabolic parameters were extracted from 18F-FDG PET images. After reducing the feature dimension and selecting meaningful features, we constructed a hierarchical model of KRAS/NRAS/BRAF mutations by using the support vector machine. The convergence of the model was evaluated by using learning curve, and its performance was assessed based on the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis. The SHapley Additive exPlanation was used to interpret the contributions of various features to predictions of the model. RESULTS The model constructed by using habitat-derived radiomic features had adequate predictive power with respect to KRAS/NRAS/BRAF mutations, with an AUC of 0.759 (95% CI: 0.585-0.909) on the training cohort and that of 0.701 (95% CI: 0.468-0.916) on the validation cohort. The model exhibited good convergence, suitable calibration, and clinical application value. The results of the SHapley Additive explanation showed that the peritumoral habitat and a high_metabolism habitat had the greatest impact on predictions of the model. No meaningful whole tumor region radiomic features or metabolic parameters were retained during feature selection. CONCLUSION The habitat-derived radiomic features were found to be helpful in stratifying the status of KRAS/NRAS/BRAF in CRC patients. The approach proposed here has significant implications for adjuvant treatment decisions in patients with CRC, and needs to be further validated on a larger prospective cohort.
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Affiliation(s)
- Hongyue Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yexin Su
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yan Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhehao Lyu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Peng Xu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wenchao Gu
- Department of Diagnostic and Interventional Radiology, University of Tsukuba, Ibaraki, Japan
| | - Lin Tian
- Department of Pathology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Peng Fu
- Department of Nuclear Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
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Lai YH, Chang YT, Chang YJ, Tsai JT, Li MH, Lin JC. Predictive Value of the Interaction between CEA and Hemoglobin in Neoadjuvant CCRT Outcomes in Rectal Cancer Patients. J Clin Med 2023; 12:7690. [PMID: 38137759 PMCID: PMC10744245 DOI: 10.3390/jcm12247690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The adoption of neoadjuvant concurrent chemoradiotherapy (CCRT) has reshaped the therapeutic landscape, but response prediction remains challenging. This study investigates the interaction between pre-CCRT carcinoembryonic antigen (CEA) and post-CCRT hemoglobin (Hb) levels in predicting the response of locally advanced rectal cancer (LARC) to CCRT. Retrospective data from 93 rectal cancer patients receiving neoadjuvant CCRT were analyzed. Univariate analyses assessed clinical factors associated with tumor regression grade (TRG) and T-stage outcomes. Machine learning identified predictive biomarkers. Interaction effects between CEA and Hb were explored through subgroup analyses. Post-CCRT Hb varied between pre-CCRT CEA groups. The interaction between pre-CCRT CEA and post-CCRT Hb influenced TRG. Males with normal pre-CCRT CEA and anemia showed better treatment responses. Females with elevated pre-CCRT CEA and post-CCRT anemia exhibited poorer responses. The interaction effect between them was significant, indicating that their relationship with TRG was not additive. Inflammatory biomarkers, WBC, neutrophil count, and post-CCRT platelet level correlated with CCRT response. Contrasting with previous findings, anemia was a predictor of better treatment response in males with normal pre-CCRT CEA. The interaction between pre-CCRT CEA and post-CCRT Hb levels predicts the response of LARC to CCRT. CEA, Hb, and sex should be considered when assessing treatment response. Inflammatory biomarkers contribute to response prediction. Understanding these complex relationships can enhance personalized treatment approaches in rectal cancer patients.
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Affiliation(s)
- Yi-Hsuan Lai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
| | - Yu-Tien Chang
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan;
| | - Yu-Jia Chang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Ming-Hsien Li
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
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Xie Z, Zhang Q, Wang X, Chen Y, Deng Y, Lin H, Wu J, Huang X, Xu Z, Chi P. Development and validation of a novel radiomics nomogram for prediction of early recurrence in colorectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107118. [PMID: 37844471 DOI: 10.1016/j.ejso.2023.107118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Early recurrence (ER) is a significant concern following curative resection of advanced colorectal cancer (CRC) and is linked to poor long-term survival. Reliable prediction of ER is challenging, necessitating the development of a novel radiomics-based nomogram for CRC patients. METHODS We enrolled 405 patients, with 298 in the training set and 107 in the external test set. Radiomic features were extracted from preoperative venous-phase computed tomography (CT) images. A radiomics signature was created using univariate logistic regression analyses and the least absolute shrinkage and selection operator algorithm. Clinical factors were integrated into the analyses to develop a comprehensive predictive tool in a multivariate logistic regression model, resulting in a radiomics nomogram. Subsequently, the calibration, discrimination, and clinical usefulness of the nomogram were evaluated. RESULTS The radiomics signature, consisting of four selected CT features, was significantly associated with ER in both the training and test datasets (P < 0.05). Independent predictors of ER included TNM stage, carcinoembryonic antigen level and differentiation grade were identified. The radiomics nomogram, incorporating all these predictors, exhibited good predictive ability in both the training set with an area under the curve (AUC) of 0.82 (95 % confidence interval (CI), 0.74-0.90) and the test set with an AUC of 0.85 (95 % CI, 0.72-0.99), surpassing the performance of any single candidate factor alone. Furthermore, additional analysis demonstrated that the nomogram was clinically useful. CONCLUSIONS We have developed a radiomics-based nomogram that effectively predicts early recurrence in CRC patients, enhancing the potential for timely intervention and improved outcomes.
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Affiliation(s)
- Zhongdong Xie
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Qingwei Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Digestive Diseases, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Deng
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Hanbin Lin
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Jiashu Wu
- Department of Science and Technology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinming Huang
- Department of Radiology, Union Hospital, Fujian Medical University, Fuzhou, China.
| | - Zongbin Xu
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
| | - Pan Chi
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.
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Huang W, Lin R, Ke X, Ni S, Zhang Z, Tang L. Utility of Machine Learning Algorithms in Predicting Preoperative Lymph Node Metastasis in Patients With Rectal Cancer Based on Three-Dimensional Endorectal Ultrasound and Clinical and Laboratory Data. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2615-2627. [PMID: 37401518 DOI: 10.1002/jum.16297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND We aimed to investigate the value of a machine learning (ML) algorithm in the preoperative prediction of lymph node metastasis in patients with rectal cancer. METHODS Based on the histopathological results, 126 rectal cancer patients were divided into two groups: lymph node metastasis-positive and metastasis-negative groups. We collected clinical and laboratory data, three-dimensional endorectal ultrasound (3D-ERUS) findings, and parameters of the tumor for between-group comparisons. We constructed a clinical prediction model based on the ML algorithm, which demonstrated the best diagnostic performance. Finally, we analyzed the diagnostic results and processes of the ML model. RESULTS Between the two groups, there were significant differences in serum carcinoembryonic antigen (CEA) levels, tumor length, tumor breadth, circumferential extent of the tumor, resistance index (RI), and ultrasound T-stage (P < 0.05). The extreme gradient boosting (XGBoost) model had the best comprehensive diagnostic performance for predicting lymph node metastasis in patients with rectal cancer. Compared with experienced radiologists, the XGBoost model showed significantly higher diagnostic value in predicting lymph node metastasis; the area under curve (AUC) value of the receiver operating characteristic (ROC) curve of the XGBoost model and experienced radiologists was 0.82 and 0.60, respectively. CONCLUSIONS Preoperative predictive utility in lymph node metastasis was demonstrated by the XGBoost model based on the 3D-ERUS finding and related clinical information. This could be useful in guiding clinical decisions on the selection of different treatment strategies.
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Affiliation(s)
- Weiqin Huang
- Department of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Ruoxuan Lin
- Department of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Xiaohui Ke
- Department of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Shixiong Ni
- Department of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Zhen Zhang
- Department of Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Lina Tang
- Department of Ultrasonography, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
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Xie H, Wei L, Liu M, Liang Y, Wang Q, Tang S, Gan J. The value of carcinoembryonic antigen stage in staging, prognosis, and management of colorectal cancer: results from two cohort studies. Front Oncol 2023; 13:1268783. [PMID: 37869103 PMCID: PMC10586050 DOI: 10.3389/fonc.2023.1268783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Background Combining the carcinoembryonic antigen (CEA) level (C stage) with TNM staging can provide a more comprehensive prognostic assessment of colorectal cancer (CRC). However, the clinical value of incorporating CEA status into the TNM staging system needs to be evaluated. Methods We used the SEER database (N = 49,350) and a retrospective cohort from China (N = 1,440). A normal CEA level was staged as C0 and an elevated CEA level was staged as C1. Restricted cubic spline analysis was used to examine the dose-response relationship between the CEA level and survival. The Kaplan-Meier method with the log-rank test was used to plot survival curves. Multivariable Cox proportional hazards regression models with forward stepwise variable selection were used to estimate the hazard ratios and 95% confidence intervals. Results Patients with C1 were more likely to have advanced disease than those with C0. CEA on a continuous scale was positively associated with mortality risk. Compared with patients with C0 stage, those with C1 stage had significantly lower survival rates. In the SEER dataset, C1 was independently associated with poor prognosis in patients with CRC, with an approximately 70% increased risk of mortality. Patients with C1 stage had significantly lower survival than those with C0 stage at all clinical stages. Incorporating the C stage into the TNM staging refined the prediction of prognosis of patients with CRC, with a gradual decline in prognosis from stage I C0 to stage IV C1. A similar pattern was observed in the present retrospective cohort study. At each lymph node stage, patients with C1 had significantly lower 5-year survival rates than patients with C0. Compared with lymph node positivity, CEA positivity may have a stronger correlation with a worse prognosis. Conclusion Our findings not only validated the independent prognostic significance of CEA in CRC but also demonstrated its enhanced prognostic value when combined with TNM staging. Our study provides evidence supporting the inclusion of C stage in the TNM staging system.
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Affiliation(s)
- Hailun Xie
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, China
| | - Lishuang Wei
- Department of Geriatric Respiratory Disease Ward, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Mingxiang Liu
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, China
| | - Yanren Liang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, China
| | - Qiwen Wang
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, China
| | - Shuangyi Tang
- Department of Pharmacy, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Jialiang Gan
- Department of Colorectal and Anal Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, Guangxi, China
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Başpınar A, Özkan D, Tokgöz S, Özkardeş AB, Kaya İO. Diagnostic value of serum autotaxin level in colorectal cancer. Biomark Med 2023; 17:787-798. [PMID: 38095984 DOI: 10.2217/bmm-2023-0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Background: Autotaxin (ATX) is a nucleotide enzyme linked to cell growth, differentiation and migration. This study investigated serum levels of ATX in colorectal cancer (CRC). Methods: The study involved stage I-III CRC diagnosed between December 2020 and 2021, excluding those with neoadjuvant or adjuvant therapy, or metastasis. Healthy volunteers were controls. Serum ATX levels were measured by ELISA and compared. Results: This study included 129 patients (91 in the patient group and 38 in the control group). The optimal cutoff value of ATX for CRC was 169.98 ng/ml, and sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 91.2% (95% CI: 89.4-96.2), 78.9% (95% CI: 62.7-90.4), 4.33 and 0.11, respectively. Conclusion: The serum ATX level is a useful biomarker for CRC.
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Affiliation(s)
- Abdurrahman Başpınar
- Department of General Surgery, Ankara Training and Research Hospital, University of Health Science, Ankara, 06230, Turkey
| | - Didem Özkan
- Department of Microbiology, Etlik City Hospital, University of Health Science, Ankara, 06170, Turkey
| | - Serhat Tokgöz
- Department of General Surgery, Etlik City Hospital, University of Health Science, Ankara, 06170, Turkey
| | - Alper Bilal Özkardeş
- Department of General Surgery, Ankara Hospital, Lokman Hekim University, Ankara, 06510, Turkey
| | - İsmail Oskay Kaya
- Department of General Surgery, Etlik City Hospital, University of Health Science, Ankara, 06170, Turkey
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11
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Lee TH, Kim JS, Baek SJ, Kwak JM, Kim J. Diagnostic Accuracy of Carcinoembryonic Antigen (CEA) in Detecting Colorectal Cancer Recurrence Depending on Its Preoperative Level. J Gastrointest Surg 2023; 27:1694-1701. [PMID: 37407895 DOI: 10.1007/s11605-023-05761-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/11/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Serum carcinoembryonic antigen (CEA) increase in patients with colorectal cancer (CRC) recurrence was observed to vary depending on their initial values. This study aimed to evaluate the diagnostic accuracy of CEA for detecting CRC recurrence in patients with normal and elevated initial CEA levels. METHODS A total of 261 CRC recurrence patients who underwent curative resection were included and divided into two groups, normal and elevated initial CEA. Analysis was performed comparing patient, tumor, and recurrence characteristics retrospectively. RESULTS There were 192 patients with normal and 69 with high initial CEA levels. Patient and tumor characteristics were similar. Eighty-six patients had elevated CEA at the time of recurrence, and the overall sensitivity of CEA for recurrence was 33.0%. In the high initial CEA group, 59.4% exhibited increased CEA level at recurrence, whereas in patients with normal initial CEA levels, only 23.4% showed elevated levels (p < 0.001). Patients with both high CEA preoperatively and at recurrence had more local recurrence, but there was no statistical significance (p = 0.053), and the rate of lung metastasis was higher in patients whose CEA remained normal at recurrence (38.3% vs. 24.4%, p = 0.026). The overall survival of patients with elevated CEA at recurrence was worse than those with normal CEA levels (56.9% vs. 42.4%, p = 0.003). CONCLUSION The diagnostic accuracy of CEA for detecting recurrence depends on initial CEA level. Regardless of the initial CEA level, elevation at recurrence was significantly associated with overall survival in patients with recurrent CRC.
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Affiliation(s)
- Tae-Hoon Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ji-Seon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Se-Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
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12
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Muñoz-Montaño WR, López-Basave HN, Castillo-Morales A, Castillo-Morales C, Sánchez-Trejo K, Catalán R, Díaz-Romero C, Lino-Silva LS, Maliachi-Díaz A, Ruiz-García E, Herrera-Martínez M, Calderillo-Ruíz G. Persistent high levels of carcinoembryonic antigen after tumor resection are associated with poorer survival outcomes in patients with resected colon cancer. BMC Cancer 2023; 23:678. [PMID: 37468881 DOI: 10.1186/s12885-023-11126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/28/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Interindividual survival and recurrence rates in cases of locoregional colon cancer following surgical resection are highly variable. The aim of the present study was to determine whether elevated pre-operative and post-operative CEA values are useful prognostic biomarkers for patients with stage I-III colon cancer who underwent surgery with curative intent. METHODS We conducted a retrospective study in patients with histologically confirmed stage I-III primary colonic adenocarcinoma who underwent radical surgical resection at Mexico's National Cancer Institute, between January 2008 and January 2020. We determined pre-operative and post-operative CEA and analyzed the association of scores with poorer survival outcomes in patients with resected colon cancer, considering overall survival (OS) and disease-free survival (DFS). RESULTS We included 640 patients with stage I-III colon cancer. Pre-operative CEA levels were in the normal range in 460 patients (group A) and above the reference value in the other 180. Of the latter, 134 presented normalized CEA levels after surgery, but 46 (group C) continued to show CEA levels above the reference values after surgery. Therefore, propensity score matching (PSM) was carried out to reduce the bias. Patients were adjusted at a 1:1:1 ratio with 46 in each group, to match the number in the smallest group. Median follow- up was 46.4 months (range, 4.9-147.4 months). Median DFS was significantly shorter in Group C: 55.5 months (95% CI 39.6-71.3) than in the other two groups [Group A: 77.1 months (95% CI 72.6-81.6). Group B: 75.7 months (95% CI 66.8-84.5) (p-value < 0.001)]. Overall survival was also significantly worse in group C [57.1 (95% CI 37.8-76.3) months] than in group A [82.8 (95% CI 78.6-86.9 months] and group B [87.1 (95% CI 79.6-94.5 months] (p-value = 0.002). To identify whether change in CEA levels operative and post-surgery was an independent prognostic factor for survival outcomes, a Cox proportional hazard model was applied. In multivariate analysis, change in CEA level was a statistically significant, independent prognostic factor for overall survival (p-value = 0.031). CONCLUSIONS When assessed collectively, pre-operative and post-operative CEA values are useful biomarkers for predicting survival outcomes in patients with resected colon cancer. Prognoses are worse for patients with elevated pre-operative and post-surgical CEA values, but similar in patients with normal post-surgical values, regardless of their pre-surgery values.
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Affiliation(s)
- Wendy R Muñoz-Montaño
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Horacio N López-Basave
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Alison Castillo-Morales
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Carolina Castillo-Morales
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Karen Sánchez-Trejo
- Mexican Agency for the Evaluation of Health Technologies, Mexico City, Mexico
| | - Rodrigo Catalán
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Consuelo Díaz-Romero
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Leonardo S Lino-Silva
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Andrea Maliachi-Díaz
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Erika Ruiz-García
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - Marytere Herrera-Martínez
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico
| | - German Calderillo-Ruíz
- Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando 22, Belisario Domínguez Secc. 16, Tlalpan, 14080, Ciudad de México, Mexico.
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13
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Wong KK. Integrated transcriptomics and proteomics data analysis identifies CDH17 as a key cell surface target in colorectal cancer. Comput Biol Chem 2023; 105:107897. [PMID: 37247573 DOI: 10.1016/j.compbiolchem.2023.107897] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/28/2023] [Accepted: 05/20/2023] [Indexed: 05/31/2023]
Abstract
Immunotherapy development against colorectal cancer (CRC) is hindered by the lack of cell surface target highly expressed in cancer cells but with restricted presence in normal tissues to minimize off-tumor toxicities. In this in silico analysis, a longlist of genes (n = 13,488) expressed in CRCs according to the Human Protein Atlas (HPA) database were evaluated to shortlist for potential surface targets based on the following prerequisites: (i) Absent from the brain and lung tissues to minimize the likelihood of neurologic and pulmonary toxicities; (ii) Restricted expression profile in other normal human tissues; (iii) Genes that potentially encode cell surface proteins and; (iv) At least moderately expressed in CRC cases. Fifteen potential targets were shortlisted and subsequently ranked according to the combination of their transcript and protein expression levels in CRCs derived from multiple datasets (i.e. DepMap, TCGA, CPTAC-2, and HPA CRCs). The top-ranked target with the highest and homogenous expression in CRCs was cadherin 17 (CDH17). Downstream analysis of CRC transcriptomics and proteomics datasets showed that CDH17 was significantly correlated with carcinoembryonic antigen expression. Moreover, CDH17 expression was significantly lower in CRC cases with high microsatellite instability, as well as negatively associated with immune response gene sets and the expression of MHC class I and II molecules. CDH17 represents an optimal target for therapeutic development against CRCs, and this study provides a novel framework to identify key cell surface targets for therapeutic development against other malignancies.
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Affiliation(s)
- Kah Keng Wong
- Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kelantan, Malaysia.
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14
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Aldilaijan AF, Kim YI, Kim CW, Yoon YS, Park IJ, Lim SB, Kim J, Ro JS, Kim JC. Clinical implication of tissue carcinoembryonic antigen expression in association with serum carcinoembryonic antigen in colorectal cancer. Sci Rep 2023; 13:7616. [PMID: 37165043 PMCID: PMC10172318 DOI: 10.1038/s41598-023-34855-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/09/2023] [Indexed: 05/12/2023] Open
Abstract
This study aimed to evaluate the prognostic significance of carcinoembryonic antigen (CEA) expression in tumor tissues of patients with colorectal cancer (CRC). The cohort included 7,412 patients with CRC from January 2010 to December 2015. Survival outcomes were assessed based on tissue CEA (t-CEA) patterns and intensities. Three-year (76.7% versus 81.3%) and 5-year (71.7% versus 77.6%, p < 0.001) disease-free survival (DFS) rates were significantly (p < 0.001) poorer in patients with a diffuse-cytoplasmic pattern than an apicoluminal pattern. Three-year (79% versus 86.6%) and 5-year (74.6% versus 84.7%) DFS rates were also significantly (p < 0.001) poorer in patients with high than low t-CEA intensity. Three-year (84.6% versus 88.4%) and 5-year (77.3% versus 82.6%) overall survival (OS) rates were significantly (p < 0.001) poorer in patients with diffuse-cytoplasmic than apicoluminal pattern of CEA expression, and both 3-year (86.7% versus 91.2%) and 5-year (80.1% versus 87.7%) OS rates were significantly (p < 0.001) poorer in patients with high than low t-CEA intensity. Multivariate analyses showed that high-intensity t-CEA was independently associated with DFS (p = 0.02; hazard ratio [HR] = 1.233) and OS (p = 0.032; HR = 1.228). Therefore, high-intensity t-CEA is a significant prognostic factor in CRC, independent of serum CEA (s-CEA), and can complement s-CEA in predicting survival outcomes after CRC resection.
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Affiliation(s)
- Abdulmohsin Fawzi Aldilaijan
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jihun Kim
- Department of Pathology, Institute of Innovative Cancer Research, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Soo Ro
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin Cheon Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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15
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Finotti M, D’Amico FE, Romano M, Brizzolari M, Scopelliti M, Zanus G. Colorectal Liver Metastases: A Literature Review of Viable Surgical Options with a Special Focus on Microwave Liver Thermal Ablation and Mini-Invasive Approach. J Pers Med 2022; 13:33. [PMID: 36675694 PMCID: PMC9866288 DOI: 10.3390/jpm13010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common tumor worldwide and it is characterized in 20-30% of cases by liver involvement, which strongly affects the long-term patient outcome. There are many available therapies for liver colorectal metastases (CRLMs); the current standard of care is represented by liver resection, and when feasible, associated with systemic chemotherapy. Microwave thermal ablation (MWA) is a viable option in unresectable patients or to achieve treatment with a parenchymal spearing approach. A literature review was performed for studies published between January 2000 and July 2022 through a database search using PUBMED/Medline and the Cochrane Collaboration Library with the following MeSH search terms and keywords: microwave, ablation, liver metastases, colorectal neoplasm, and colon liver rectal metastases. The recurrence rate and overall patients' survival were evaluated, showing that laparoscopic MWA is safe and effective to treat CRLMs when resection is not feasible, or a major hepatectomy in fragile patients is necessary. Considering the low morbidity of this procedure, it is a viable option to treat patients with recurrent diseases in the era of effective chemotherapy and multimodal treatments.
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Affiliation(s)
- Michele Finotti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
- Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical, Dallas, TX 75204, USA
| | | | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
| | - Marco Brizzolari
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
| | - Michele Scopelliti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
| | - Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy
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16
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You JF, Hsu YJ, Chern YJ, Cheng CC, Jong BK, Liao CK, Hsieh PS, Hsu HC, Tsai WS. Preoperative Cancer Inflammation Prognostic Index as a Superior Predictor of Short- and Long-Term Outcomes in Patients with Stage I-III Colorectal Cancer after Curative Surgery. Cancers (Basel) 2022; 14:cancers14246232. [PMID: 36551717 PMCID: PMC9777276 DOI: 10.3390/cancers14246232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Inflammatory reactions play a crucial role in cancer progression and may contribute to systemic inflammation. In routine clinical practice, some inflammatory biomarkers can be utilized as valuable predictors for colorectal cancer (CRC). This study aims to determine the usefulness of a novel cancer-inflammation prognostic index (CIPI) marker derived from calculating carcinoembryonic antigen (CEA) multiplied by the neutrophil-to-lymphocyte ratio (NLR) values established for non-metastatic CRCs. Between January 1995 and December 2018, 12,092 patients were diagnosed with stage I to III primary CRC and had radical resection—they were all included in this study for further investigation. There were 5996 (49.6%) patients in the low-CIPI group and 6096 (50.4%) patients in the high-CIPI group according to the cutoff value of 8. For long-term outcomes, the high-CIPI group had a significantly higher incidence of recurrence (30.6% vs. 16.0%, p < 0.001) and worse relapse-free survival (RFS) and overall survival (OS) rates (p < 0.001). High CIPI was an independent prognostic factor for RFS and OS in univariate and multivariate analyses. This research is the first to document the independent significance of CIPI as a prognostic factor for CRC. To ensure that it works, this CIPI needs to be tested on more CRC prediction models.
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Affiliation(s)
- Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Yu-Jen Hsu
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Yih-Jong Chern
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Ching-Chung Cheng
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Bor-Kang Jong
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Chun-Kai Liao
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Hung-Chih Hsu
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Wen-Sy Tsai
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Correspondence:
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17
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Pang X, Xu B, Lian J, Wang R, Wang X, Shao J, Tang S, Lu H. Real-world survival of colon cancer after radical surgery: A single-institutional retrospective analysis. Front Oncol 2022; 12:914076. [PMID: 36185216 PMCID: PMC9525022 DOI: 10.3389/fonc.2022.914076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
The survival rate for colon cancer after radical surgery has been the focus of extensive debate. To assess the postoperative survival and prognostic factors for overall survival (OS), we collected clinicopathological information for 2,655 patients. The survival time and potential risk factors for OS were analyzed by using Kaplan–Meier curves, Cox proportional hazards models, best subset regression (BSR), and least absolute shrinkage and selection operator (LASSO). The 5-year survival rates of stage I–IV colon cancer were 96.6%, 88.7%, 69.9%, and 34.3%, respectively. Adjuvant chemotherapy improved the survival rate (90.4% vs. 82.4%, with versus without adjuvant chemotherapy, respectively) in stage II patients with high-risk factors. Elevated preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were significantly associated with worse OS compared with patients without these elevations. Less than 12 versus more than 12 harvested lymph nodes (LNs) affected prognosis (84.6% vs. 89.7%, respectively). Regarding the lymph node ratio (LNR), the 5-year OS rate was 89.2%, 71.5%, 55.8%, and 34.5% in patients with LNR values of 0, 0.3, 0.3–0.7, and >0.7, respectively. We constructed a nomogram comprising the independent factors associated with survival to better predict prognosis. On the basis of these findings, we propose that stage II colon cancer patients without high-risk factors and with both elevated preoperative CEA and CA199 should receive adjuvant therapy. Furthermore, the LNR could complement TNM staging in patients with <12 harvested LNs. Our nomogram might be useful as a new prognosis prediction system for colon cancer patients.
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18
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Yoshino K, Osumi H, Ito H, Kamiimabeppu D, Ooki A, Wakatsuki T, Shimozaki K, Nakayama I, Ogura M, Takahari D, Chin K, Oba A, Ono Y, Sato T, Inoue Y, Takahashi Y, Yamaguchi K, Shinozaki E. Clinical Usefulness of Postoperative Serum Carcinoembryonic Antigen in Patients with Colorectal Cancer with Liver Metastases. Ann Surg Oncol 2022; 29:8385-8393. [PMID: 35974233 DOI: 10.1245/s10434-022-12301-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer with liver metastasis (CLM) has high postoperative recurrence rates; therefore, optimizing perioperative treatment is imperative. Postoperative carcinoembryonic antigen (CEA) can aid in detecting minimal residual disease in colon cancer following curative resection. This study aimed to identify the potential role of serum CEA following liver resection in patients with CLM. METHODS This retrospective study was conducted at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research from 2004 to 2018 and enrolled patients with CLM who underwent complete resection of primary tumors and CLM. Associations between perioperative CEA levels and characteristics of recurrence were investigated. RESULTS Recurrence was detected during a median follow-up period of 90.1 months in 343 (54.2%) out of 633 analyzed patients. Patients in the postoperative CEA level > 5 ng/ml group had a significantly higher recurrence rate (75.7% versus 50.0%, p < 0.01) and shorter time until recurrence (4.4 versus 36.9 months, p < 0.01) than those in the postoperative CEA level ≤ 5 ng/ml group. Multivariate analysis revealed that postoperative CEA level > 5 ng/ml was an independent predictor, with hazard ratios of 2.77 (p < 0.01) for recurrence-free survival (RFS) and 3.18 (p < 0.01) for overall survival (OS). Additionally, RFS was significantly shorter among patients in the postoperative CEA level > 5 ng/ml group who did not have normalized CEA levels following adjuvant chemotherapy than among those in the normalized CEA group. CONCLUSIONS The postoperative and post-adjuvant chemotherapy CEA levels in the CEA level > 5 ng/ml group may be predictors of RFS and OS.
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Affiliation(s)
- Koichiro Yoshino
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroki Osumi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiromichi Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisaku Kamiimabeppu
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akira Ooki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeru Wakatsuki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keitaro Shimozaki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Izuma Nakayama
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mariko Ogura
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Takahari
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keisho Chin
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Oba
- Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshihiro Ono
- Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takafumi Sato
- Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Inoue
- Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Takahashi
- Division of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Shinozaki
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
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Shin JK, Huh JW, Lee WY, Yun SH, Kim HC, Cho YB, Park YA. Elevated Carcinoembryonic Antigen at the Time of Recurrence as a Poor Prognostic Factor in Colorectal Cancer: A Propensity Score Matching Analysis. Front Oncol 2022; 12:821986. [PMID: 35747835 PMCID: PMC9209715 DOI: 10.3389/fonc.2022.821986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
There are few studies on the prognostic impact of CEA level at the time of recurrence in recurrent colorectal cancer. The objective of this study was to evaluate the prognostic value of serum CEA levels at the time of recurrence in patients with recurrent colorectal cancer. Between 2007 and 2014, 962 consecutive recurrent patients for colorectal cancer were analyzed. These patients were divided into two groups according to CEA level at the time of recurrence (r-CEA): high r-CEA (≥5 ng/ml) (n = 428) and normal r-CEA (<5 ng/ml) (n = 534). The prognostic effects of r-CEA were evaluated by one-to-one propensity score matching (PSM) to adjust factors between groups. After matching, a total of 778 patients, 389 per group, were analyzed. After matching, the 5-year disease-free survival rate for the high r-CEA group was significantly lower than that for the normal r-CEA group. The 5-year overall survival rate was 56.5% in the high r-CEA group and 66.0% in the normal r-CEA group (p = 0.008). The 5-year cancer-specific survival rate was 61.7% in the high group and 67.5% in the normal group (p = 0.035). In a multivariate analysis of prognostic factors, high preoperative CEA level at the time of recurrence, poor histologic grade, and lymphatic invasion were associated with poorer overall survival. The high r-CEA level group showed significantly poorer prognosis than the normal r-CEA group. Therefore, the r-CEA level can be used as a prognostic factor in recurrent colorectal cancer. Aggressive adjuvant treatment needs to be considered for patients with an initially high CEA level and lymph node positivity who are prone to recurrence.
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Vogel JD, Felder SI, Bhama AR, Hawkins AT, Langenfeld SJ, Shaffer VO, Thorsen AJ, Weiser MR, Chang GJ, Lightner AL, Feingold DL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Colon Cancer. Dis Colon Rectum 2022; 65:148-177. [PMID: 34775402 DOI: 10.1097/dcr.0000000000002323] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | | | | | | | | | | | - Amy J Thorsen
- Colon and Rectal Surgery Associates, Minneapolis, Minnesota
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21
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Xu M, Liu Y, Xue T, Ye Q, Xiang J, Liu L, Yan B. Prognostic Implication of Preoperative Serum Albumin to Carcinoembryonic Antigen Ratio in Colorectal Cancer Patients. Technol Cancer Res Treat 2022; 21:15330338221078645. [PMID: 35253553 PMCID: PMC8905062 DOI: 10.1177/15330338221078645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Preoperative serum albumin (ALB) and carcinoembryonic antigen (CEA) were useful prognostic factors in colorectal cancer (CRC); however, the ALB to CEA ratio (ACR) and their individual prognostic efficacies have been less studied. Methods: A retrospective study with 156 CRC patients staged I to IV was performed. The prognostic efficacy of ACR was estimated and subsequently compared with ALB, CEA, and other systemic inflammation markers, including the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR). Differences in progression-free survival (PFS) and overall survival (OS) were determined by Kaplan–Meier (K-M) analysis, and the risk factors for survival were calculated by the Cox proportional hazards model. Results: A total of 31.41% (49 of 156) of patients presented with ACR-low disease, and these patients had tumors with advanced T stages, larger tumor diameters and distant metastases, and a lower LMR. When 5.98 was used as the cut-off point, it had a sensitivity of 58.50% and 61.50% and a specificity of 83.50% and 80.50% for PFS and OS, respectively. ACR displayed a superior prognostic efficacy than individual ALB, CEA and NLR, LMR, and PLR for both PFS and OS (except LMR). Patients in the ACR-low group displayed significantly worse PFS and OS than those in the ACR-high group. Finally, ACR was an independent prognostic factor for both PFS (HR = 0.31, 95% CI: 0.17−0.56, P < .01) and OS (HR = 0.33, 95% CI: 0.16−0.66, P < .01). Conclusions: ACR was a robust prognostic factor in CRC, and patients with a relatively low preoperative ACR would have significantly worse survival.
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Affiliation(s)
- Mingyue Xu
- Department of General Surgery, Hainan Hospital of Chinese PLA General Sanya city of Hainan Province, P.R. China
| | - You Liu
- Department of General Surgery, Hainan Hospital of Chinese PLA General Sanya city of Hainan Province, P.R. China
| | - Tianhui Xue
- Department of General Surgery, Hainan Hospital of Chinese PLA General Sanya city of Hainan Province, P.R. China
| | - Qianwen Ye
- Department of General Surgery, Hainan Hospital of Chinese PLA General Sanya city of Hainan Province, P.R. China
| | - Jia Xiang
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya City of Hainan Province, P.R. China
| | - Long Liu
- Department Traditional Chinese Medicine, Tianyou Hospital of Tongji University, Shanghai, P.R. China
| | - Bing Yan
- Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya City of Hainan Province, P.R. China
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22
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Wu ZX, Wang F, Li L, Yao Y, Long J, Luo QQ, Zhao ZB, Li WL, Cao J, Lian ZX. The Clinical Significance of Mesenteric Lymphocytes in Human Colorectal Cancer. Front Oncol 2021; 11:685577. [PMID: 34604029 PMCID: PMC8481834 DOI: 10.3389/fonc.2021.685577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/27/2021] [Indexed: 01/08/2023] Open
Abstract
Objective The mesentery is a potential site of residual tumor in patients with colorectal cancer (CRC). However, the mesenteric immune microenvironment remains unclear. In this study, we investigated the immune landscape of the mesentery, particularly the role of lymphocytes and its association with the clinicopathological characteristics of CRC. Methods Flow cytometry was used to detect lymphocytes in the paired mesenteric tissue specimens adjacent to the colorectal tumors and normal mesenteric tissue specimens 10 cm away from the colorectal tumor edge and preoperative peripheral blood samples obtained from patients with CRC who underwent surgery. T-distributed stochastic neighbor embedding was utilized to analyze multiparameter flow cytometry data. Multiplex immunohistochemistry was performed to evaluate T cells subsets in the paired mesentery adjacent to the colorectal tumors and normal mesentery. The Fisher’s exact test and non-parametric Wilcoxon’s matched-pairs tests were used for statistical analysis. The non-parametric Mann-Whitney U test was used to determine associations between percentage data and clinical parameters of patients with CRC. Results We found that immune cells in the normal mesentery were mainly of lymphoid lineage. Compared with peripheral blood, the normal mesentery showed decreased NK cells and the CD4/CD8 ratio and increased CD3+ CD56+, memory CD4+ T, memory CD8+ T, CD4+ tissue-resident memory T (TRM), and CD8+ TRM cells. Compared with the normal mesentery, the mesentery adjacent to the colorectal tumor showed increased B and regulatory T cells and decreased NK, CD3+ CD56+, CD4+ TRM, and CD8+ TRM cells. Moreover, memory CD8+ T cells and plasmablasts are negatively correlated with the depth of invasion of CRC. Increased memory CD4+ T cells are associated with distant metastasis of CRC and high preoperative serum carcinoembryonic antigen levels. Conclusion The mesentery shows a specific immune microenvironment, which differs from that observed in peripheral blood. CRC can alter the mesenteric immune response to promote tumor progression.
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Affiliation(s)
- Zi-Xin Wu
- Department of Colorectal Surgery, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Fei Wang
- Department of Colorectal Surgery, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Liang Li
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuan Yao
- Department of Colorectal Surgery, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Jie Long
- Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qing-Qing Luo
- Department of Colorectal Surgery, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhi-Bin Zhao
- Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wang-Lin Li
- Department of Colorectal Surgery, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Jie Cao
- Department of Colorectal Surgery, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Zhe-Xiong Lian
- School of Medicine, South China University of Technology, Guangzhou, China
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23
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Guan A, Sun L, Liu M, Mao Y. Letter to the editor: prediction of survival in colorectal cancer using artificial intelligence. Gut 2021; 70:1804-1805. [PMID: 33148552 DOI: 10.1136/gutjnl-2020-323382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/08/2022]
Affiliation(s)
- Ai Guan
- Department of Liver Surgery, Peking Union Medical College Hospital, Dongcheng-qu, China
| | - Lejia Sun
- Department of Liver Surgery, Peking Union Medical College Hospital, Dongcheng-qu, China
| | - Meixi Liu
- Department of Liver Surgery, Peking Union Medical College Hospital, Dongcheng-qu, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Dongcheng-qu, China
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Mizuno H, Miyake H, Nagai H, Yoshioka Y, Shibata K, Asai S, Takamizawa J, Yuasa N. Optimal cutoff value of preoperative CEA and CA19-9 for prognostic significance in patients with stage II/III colon cancer. Langenbecks Arch Surg 2021; 406:1987-1997. [PMID: 34148158 DOI: 10.1007/s00423-021-02236-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE This unicentric, retrospective cohort study aimed to identify the optimal cutoff values of preoperative serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) for the prognosis in patients with stage II/III colon cancer. METHODS After excluding 43 patients with CA19-9 levels < 0.2 U/mL, 588 were included. Receiver operating characteristic curves were constructed to determine the optimal cutoff values of CEA and CA 19-9 for disease relapse. RESULTS The median CEA and CA19-9 values were 3.6 (interquartile range: 2.1-7.2 ng/mL) and 14.3 (interquartile range: 8.1-30.0) U/mL, respectively. The optimal cutoff values of CEA and CA19-9 were 5.4 ng/mL and 22.4 U/mL, respectively. A multivariate analysis of relapse-free survival (RFS) showed that cancer stage, CEA, and CA19-9 were significant independent factors. The RFS of patients with stages II and III colon cancer was significantly stratified by CEA (< 5.4/ ≥ 5.4 ng/mL) and CA19-9 (< 22.4/ ≥ 22.4 U/mL). Prognostication based on the reference values (< 5.0 ng/mL for CEA and < 37.0 U/mL for CA19-9) was less significant than that based on the optimal cutoff values. Both elevated CEA and CA19-9 had no value dependency on RFS: RFS curves were similar between extremely elevated CEA (≥ 54.0 ng/ml) and intermediate CEA (5.4-54.0 ng/ml) and between extremely elevated CA19-9 (≥ 224.0 U/ml) and intermediate CA19-9 (22.4-224.0 U/ml). CONCLUSION The optimal cutoff values of preoperative CEA and CA19-9 for RFS were 5.4 ng/ml and 22.4 U/mL, respectively, in patients with stages II and III colon cancer. Further relapse risk stratification is possible using these values.
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Affiliation(s)
- Hironori Mizuno
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Koji Shibata
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Soichiro Asai
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Junichi Takamizawa
- Department of Laboratory Medicine, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan. .,Department of Laboratory Medicine, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
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25
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Zhang X, Yi FS, Shi HZ. Predicting Survival for Patients with Malignant Pleural Effusion: Development of the CONCH Prognostic Model. Cancer Manag Res 2021; 13:4699-4707. [PMID: 34163245 PMCID: PMC8214552 DOI: 10.2147/cmar.s305223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malignant pleural effusion (MPE) is a frequent complication of advanced malignancies that leads to a poor quality of life and limits treatment options. OBJECTIVE The objective of this study was to identify biomarkers of survival in patients with MPE, which will greatly facilitate the clinical management of this complication. METHODS This retrospective study recruited patients who had been pathologically diagnosed with MPE, regardless of the type of primary cancer, at Beijing Chao-Yang Hospital over 158 months. Demographic, clinical, hematological, and pleural fluid data were collected and analyzed as potential predictors of survival, and a new predictive model was developed based on Cox and logistic regression analyses. RESULTS In our alternative prognostic model (n = 281), four routinely detected variables, namely, carcinoembryonic antigen (CEA) level, monocyte count, N-terminal pro B-type natriuretic peptide (NT-pro-BNP) level, and pleural effusion chloride level on admission, were identified as predictors (the CONCH prognostic score). Patients were divided into three prognosis subgroups based on risk stratification, with median survival periods of 17, 11, and 5 months, respectively. In comparison with the low-risk group, patients in the medium- and high-risk groups showed significantly poorer survival (medium-risk group: hazard ratio [HR], 1.586; 95% confidence interval [CI], 1.047-2.402; P = 0.029; high-risk group: HR, 4.389; 95% CI, 2.432-7.921; P < 0.001). CONCLUSION Four routinely detected variables were used to develop the CONCH scoring system, which was confirmed to be an accurate prognostic score for patients with MPE. This system can guide the selection of interventions and management for MPE.
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Affiliation(s)
- Xin Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Feng-Shuang Yi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China
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26
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Iacuzzo C, Germani P, Troian M, Cipolat Mis T, Giudici F, Osenda E, Bortul M, de Manzini N. Serum carcinoembryonic antigen pre-operative level in colorectal cancer: revisiting risk stratification. ANZ J Surg 2021; 91:E367-E374. [PMID: 33870621 DOI: 10.1111/ans.16861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/28/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Biomarkers may play a role as predictive and prognostic factors in colorectal cancer patients. The aims of the study were to verify the prognostic role of pre-operative serum carcinoembryonic antigen (CEA) level in predicting overall survival and risk of recurrence in a cohort of colorectal cancer patients and to evaluate optimal cut-off values. METHODS A retrospective cohort analysis was performed on colorectal cancer patients undergoing elective curative surgery between 2004 and 2019 at an Italian Academic Hospital. Main outcomes were overall survival, disease-free survival at 3-years and risk of local, loco-regional and distant recurrence during follow-up. A receiver operating characteristic (ROC) curve analysis was plotted using CEA pre-operative values and follow-up data in order to estimate the optimal cut-off values. RESULTS A total of 559 patients were considered. The mean CEA value was 12.1 ± 54.1 ng/mL, and the median 29.3 (0-4995) ng/mL. The ROC curve analysis identified 12.5 ng/mL as the best CEA cut-off value to predict the risk of metastatic development after surgery in stage I-III colorectal cancer patients, and 10 ng/mL as the best CEA cut-off value to predict overall survival and disease-free survival in stage III-IV patients. These data suggest a stratification of colorectal cancer patients in three classes of risk: a low risk class (CEA <10 ng/mL), a moderate risk class (CEA 10-12.5 ng/mL) and a high risk class (CEA >12.5 ng/mL). CONCLUSION In conclusion, pre-operative serum CEA measurements could integrate information to enhance patient risk stratification and tailored therapy.
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Affiliation(s)
- Cristiana Iacuzzo
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Paola Germani
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Marina Troian
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Tommaso Cipolat Mis
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Fabiola Giudici
- Department of Medicine, Surgery and Health Sciences, Biostatistics Unit, University of Trieste, Trieste, Italy.,Epidemiology and Public Health Department, Biostatistics Unit, University of Padua, Padua, Italy
| | - Edoardo Osenda
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Marina Bortul
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Nicolò de Manzini
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
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27
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Zhang B, Hu X, Jia Y, Li J, Zhao Z. Polyaniline@Au organic-inorganic nanohybrids with thermometer readout for photothermal immunoassay of tumor marker. Mikrochim Acta 2021; 188:63. [PMID: 33537897 DOI: 10.1007/s00604-021-04719-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/18/2021] [Indexed: 01/31/2023]
Abstract
A photothermal immunoassay using a thermometer as readout based on polyaniline@Au organic-inorganic nanohybrids was built. Temperature output is acquired due to the photothermal effect of the photothermal nanomaterial. Polyaniline@Au organic-inorganic nanohybrids were synthesized by interfacial reactions with high photothermal conversion efficiency. A sandwich structure of the immunocomplex was prepared on a microplate for determination of carcinoembryonic antigen (CEA) by polyaniline@Au organic-inorganic nanohybrids as nanolabel. The released heat based on light-to-heat conversion from the photothermal nanolabel under NIR irradiation is detectable using the thermometer. The increased temperature is directly proportional to CEA concentration. The linear range of the photothermal immunoassay is 0.20 to 25 ng mL-1 with determination limit of 0.17 ng mL-1. Polyaniline@Au organic-inorganic nanohybrids with high photothermal conversion efficiency was synthesized as labels to construct photothermal immunosensor. The sandwich-type immunoassay was built on 96 hole plate based on specific binding of antigen and antibody. Carcinoembryonic antigen in sample was detected quantitatively by thermometer readout.
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Affiliation(s)
- Bing Zhang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China.
| | - Xing Hu
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Yejing Jia
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Jing Li
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Zhihuan Zhao
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, 030024, China
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Kim HR, Joo JI, Lim SW, Oh BY. Prognostic value of carcinoembryonic antigen levels before and after curative surgery in colon cancer patients. Ann Surg Treat Res 2020; 100:33-39. [PMID: 33457395 PMCID: PMC7791194 DOI: 10.4174/astr.2021.100.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/31/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose CEA is a useful tumor marker for colon cancer. The aim of this study was to investigate the prognostic value of changes in CEA levels before and after surgery in colon cancer patients who underwent radical surgery. Methods A total of 601 colon cancer patients who underwent radical surgery from January 2007 to December 2017 at a single institution were evaluated. Patients were categorized according to preoperative and postoperative CEA levels. We adjusted patient characteristics using propensity score matched analysis between groups and compared survival outcomes according to changes in CEA levels before and after surgery. Results According to the preoperative and postoperative CEA levels, patients were classified into 3 groups: group 1, ≤5 and ≤5 ng/mL, respectively (n = 407); group 2, >5 and ≤5 ng/mL, respectively (n = 127); and group 3 (>5 and >5 ng/mL, respectively (n = 67). Postoperative CEA elevation was associated with adverse clinical features. Before and after matching, the patients in group 3 showed significantly lower disease-free survival and overall survival rates compared to the patients in group 1 and group 2. In multivariate analysis, changes in CEA levels were an independent prognostic factor of overall survival (P = 0.041). Conclusion The changes in CEA levels before and after surgery can be a useful prognostic factor for disease-free survival and overall survival in colon cancer patients.
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Affiliation(s)
- Hyun Ryung Kim
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jeong Il Joo
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sang Woo Lim
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Bo Young Oh
- Department of Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Lu Y, Wu S, Cui C, Yu M, Wang S, Yue Y, Liu M, Sun Z. Gene Expression Along with Genomic Copy Number Variation and Mutational Analysis Were Used to Develop a 9-Gene Signature for Estimating Prognosis of COAD. Onco Targets Ther 2020; 13:10393-10408. [PMID: 33116619 PMCID: PMC7569059 DOI: 10.2147/ott.s255590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aims to systematically analyze multi-omics data to explore new prognosis biomarkers in colon adenocarcinoma (COAD). MATERIALS AND METHODS Multi-omics data of COAD and clinical information were obtained from The Cancer Genome Atlas (TCGA). Univariate Cox analysis was used to select genes which significantly related to the overall survival. GISTIC 2.0 software was used to identify significant amplification or deletion. Mutsig 2.0 software was used to identify significant mutation genes. The 9-gene signature was screened by random forest algorithm and Cox regression analysis. GSE17538 dataset was used as an external dataset to verify the predictive ability of 9-gene signature. qPCR was used to detect the expression of 9 genes in clinical specimens. RESULTS A total of 71 candidate genes are obtained by integrating genomic variation, mutation and prognostic data. Then, 9-gene signature was established, which includes HOXD12, RNF25, CBLN3, DOCK3, DNAJB13, PYGO2, CTNNA1, PTPRK, and NAT1. The 9-gene signature is an independent prognostic risk factor for COAD patients. In addition, the signature shows good predicting performance and clinical practicality in training set, testing set and external verification set. The results of qPCR based on clinical samples showed that the expression of HOXD12, RNF25, CBLN3, DOCK3, DNAJB13, and PYGO2 was increased in colon cancer tissues and the expression of CTNNA1, PTPRK, NAT1 was decreased in colon cancer tissues. CONCLUSION In this study, 9-gene signature is constructed as a new prognostic marker to predict the survival of COAD patients.
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Affiliation(s)
- Yiping Lu
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Si Wu
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Changwan Cui
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Miao Yu
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Shuang Wang
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Yuanyi Yue
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Miao Liu
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
| | - Zhengrong Sun
- BioBank, The Affiliated Shengjing Hospital, China Medical University, Shenyang, Liaoning 110004, People's Republic of China
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Al-Ghafari AB, Al Qahtani AM, Alturki SN, Al Doghaither HA, Elmorsy EM, Tashkandi HM, Abusanad AM, Alkhayyat SS, Omar UM, Zeeneldin AA. Association between MDR1 polymorphisms and XELIRI and XELOX chemoresistance in Saudi patients with colorectal cancer. Oncol Lett 2020; 20:155. [PMID: 32934723 PMCID: PMC7471754 DOI: 10.3892/ol.2020.12016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Multidrug resistance member 1 (MDR1) is located on chromosome 7 and encodes P-glycoprotein, which is universally accepted as a drug resistance biomarker. MDR1 polymorphisms can alter protein expression or function, which has been previously reported to associate with various types of malignancies, such as colorectal cancer (CRC). Therefore, the present study aimed to determine the effects of MDR1 polymorphisms on drug responses of Saudi patients with CRC. DNA samples were obtained from 62 patients with CRC and 100 healthy controls. Genotypes and allele frequencies of MDR1 single nucleotide polymorphisms (SNPs) G2677T and T1236C were determined using the PCR-restriction fragment length polymorphism procedure. The results showed no significant differences in the genotype distribution and allele frequency of T1236C between patients with CRC and controls. However, G2677T was found to serve a highly significant role in protecting against the progression of CRC. In addition, none of the genotypes in SNPs T1236C and G2677T was found to affect chemoresistance to XELIRI and XELOX. In conclusion, although T1236C in the MDR1 gene is not associated with CRC risk, G2677T protects against the development of CRC. Neither of the MDR1 SNPs tested were associated with the risk of chemoresistance. Therefore, these two SNPs cannot be used as molecular markers for predicting drug response in patients with CRC.
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Affiliation(s)
- Ayat B Al-Ghafari
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia.,Unit of Experimental Biochemistry, Faculty of Science, King Fahd Medical Research Center, Jeddah 21589, Kingdom of Saudi Arabia.,Unit of Cancer and Mutagenesis, Faculty of Science, King Fahd Medical Research Center, Jeddah 21589, Kingdom of Saudi Arabia.,Unit of Cancer Metabolism and Epigenetics, Faculty of Science, King Fahd Medical Research Center, Jeddah 21589, Kingdom of Saudi Arabia
| | - Areej M Al Qahtani
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Suzan N Alturki
- University Medical Services Center, Female's Campus, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Huda A Al Doghaither
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Ekramy M Elmorsy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Hanaa M Tashkandi
- Department of General Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Atlal M Abusanad
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Shadi S Alkhayyat
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Ulfat M Omar
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Kingdom of Saudi Arabia
| | - Ahmed A Zeeneldin
- Department of Medical Oncology, King Abdullah Medical City, Makkah 24246, Kingdom of Saudi Arabia.,Department of Medical Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt
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Beom SH, Shin SJ, Kim CG, Kim JH, Hur H, Min BS, Lee KY, Kim NK, Ahn JB. Clinical Significance of Preoperative Serum Carcinoembryonic Antigen Within the Normal Range in Colorectal Cancer Patients Undergoing Curative Resection. Ann Surg Oncol 2020; 27:2774-2783. [PMID: 32180063 DOI: 10.1245/s10434-020-08256-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Serum carcinoembryonic antigen (CEA) is a widely used tumor marker in colorectal cancer (CRC), but within normal range of preoperative CEA levels the clinical significance of CEA is unknown. OBJECTIVE The aim of this study was to evaluate the usefulness of CEA within the normal range as a prognosticator of non-metastatic CRC. METHODS This retrospective cohort study included 2021 CRC patients with normal preoperative CEA who underwent elective curative surgery (discovery group). We determined the optimal cut-off value for disease-free survival (DFS) discrimination using the Contal and O'Quigley method. We also assessed the prognostic significance of the cut-off value in a prospective cohort of 171 stage III colon cancer patients treated with oxaliplatin-based adjuvant chemotherapy (validation group). RESULTS The optimal cut-off CEA value was 2.1 ng/mL in the discovery group. The DFS rates were significantly poorer in patients with high-normal preoperative CEA levels (2.1-5.0 ng/mL) than in those with low-normal CEA levels (< 2.1 ng/mL) in both groups. A high-normal CEA level was an independent risk factor for DFS in both groups, and was associated with inferior DFS in patients with stage II and III disease and in never or former smokers. The correlation between DFS and CEA levels was more distinct in left-sided colon and rectal cancer. CONCLUSIONS A high-normal preoperative CEA level (≥ 2.1 ng/mL), even within the normal range, was an independent prognosticator for poor DFS in CRC. The usefulness of CEA was influenced by smoking status and tumor location in addition to tumor stage.
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Affiliation(s)
- Seung-Hoon Beom
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Joon Shin
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Gon Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee Hyung Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang-Young Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joong Bae Ahn
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
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32
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Ji MY, Yuan L, Lu SM, Gao MT, Zeng Z, Zhan N, Ding YJ, Liu ZR, Huang PX, Lu C, Dong WG. Glandular orientation and shape determined by computational pathology could identify aggressive tumor for early colon carcinoma: a triple-center study. J Transl Med 2020; 18:129. [PMID: 32178690 PMCID: PMC7077008 DOI: 10.1186/s12967-020-02297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Identifying the early-stage colon adenocarcinoma (ECA) patients who have lower risk cancer vs. the higher risk cancer could improve disease prognosis. Our study aimed to explore whether the glandular morphological features determined by computational pathology could identify high risk cancer in ECA via H&E images digitally. METHODS 532 ECA patients retrospectively from 2 independent data centers, as well as 113 from The Cancer Genome Atlas (TCGA), were enrolled in this study. Four tissue microarrays (TMAs) were constructed across ECA hematoxylin and eosin (H&E) stained slides. 797 quantitative glandular morphometric features were extracted and 5 most prognostic features were identified using minimum redundancy maximum relevance to construct an image classifier. The image classifier was evaluated on D2/D3 = 223, D4 = 46, D5 = 113. The expression of Ki67 and serum CEA levels were scored on D3, aiming to explore the correlations between image classifier and immunohistochemistry data and serum CEA levels. The roles of clinicopathological data and ECAHBC were evaluated by univariate and multivariate analyses for prognostic value. RESULTS The image classifier could predict ECA recurrence (accuracy of 88.1%). ECA histomorphometric-based image classifier (ECAHBC) was an independent prognostic factor for poorer disease-specific survival [DSS, (HR = 9.65, 95% CI 2.15-43.12, P = 0.003)]. Significant correlations were observed between ECAHBC-positive patients and positivity of Ki67 labeling index (Ki67Li) and serum CEA. CONCLUSION Glandular orientation and shape could predict the high risk cancer in ECA and contribute to precision oncology. Computational pathology is emerging as a viable and objective means of identifying predictive biomarkers for cancer patients.
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Affiliation(s)
- Meng-Yao Ji
- Department of Gastroenterology, Wuhan University Renmin Hospital, Wuhan, Hubei, China.,Key Laboratory of Hubei Province for Digestive System Disease, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Lei Yuan
- Department of Information Center, Wuhan University Renmin Hospital, Wuhan, Hubei, China. .,Key Laboratory of Hubei Province for Digestive System Disease, Wuhan University Renmin Hospital, Wuhan, Hubei, China.
| | - Shi-Min Lu
- Department of Gastroenterology, Wuhan University Renmin Hospital, Wuhan, Hubei, China.,Key Laboratory of Hubei Province for Digestive System Disease, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Meng-Ting Gao
- Department of Information Center, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Zhi Zeng
- Department of Pathology, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Na Zhan
- Department of Pathology, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Yi-Juan Ding
- Department of Gastroenterology, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Zheng-Ru Liu
- Department of Gastroenterology, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Ping-Xiao Huang
- Department of Gastroenterology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Lu
- College of Computer Science, Shaanxi Normal University, Xi'an, Shaanxi, China.
| | - Wei-Guo Dong
- Department of Gastroenterology, Wuhan University Renmin Hospital, Wuhan, Hubei, China.
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Osterman E, Mezheyeuski A, Sjöblom T, Glimelius B. Beyond the NCCN Risk Factors in Colon Cancer: An Evaluation in a Swedish Population-Based Cohort. Ann Surg Oncol 2020; 27:1036-1045. [PMID: 31893351 PMCID: PMC7060230 DOI: 10.1245/s10434-019-08148-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 01/22/2023]
Abstract
Background The purpose of this study was to investigate whether pT3–4 and pN-subclassifications, lymph-node ratio (LNR), tumour deposits, pre- and postoperative carcinoembryonic antigen (CEA), and C-reactive protein (CRP)—all parameters commonly collected in clinical management—add information about recurrence risk against a background of routine clinicopathological parameters as defined by the NCCN. Methods The prospective cohort consisted of all 416 patients diagnosed with colon cancer stage I–III in Uppsala County between 2010 and 2015. Cox proportional hazard models were used to calculate hazard ratios for time to recurrence and overall survival. The results were compared with the entire Swedish population concerning parameters recorded in the national quality registry, SCRCR, during the same time period. Results The Uppsala cohort was representative of the entire Swedish cohort. In unadjusted analyses, pT3-subclassification, pN-subclassification, LNR, tumour deposits, elevated postoperative CEA, and preoperative CRP correlated with recurrence. After adjusting for T-, N-stage, and NCCN risk factors, pN-subclassification, sidedness, and elevated postoperative CEA levels correlated with recurrence. Survival correlated with parameters associated with recurrence, LNR, and elevated postoperative CRP. Conclusions Additional information on recurrence risk is available from several routinely recorded parameters, but most of the risk is predicted by the commonly used clinicopathological parameters. Electronic supplementary material The online version of this article (10.1245/s10434-019-08148-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Erik Osterman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden. .,Department of Surgery, Gävle Hospital, Gävle, Sweden.
| | - Artur Mezheyeuski
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
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34
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Leong E, Ong SK, Madli F, Tan A, Lai D, Basir N, Ramlee N, Chong VH. Survival Rates and Associated Factors of Colorectal Cancer Patients in Brunei Darussalam. Asian Pac J Cancer Prev 2020; 21:259-265. [PMID: 31983194 PMCID: PMC7294032 DOI: 10.31557/apjcp.2020.21.1.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Colorectal cancer (CRC) is the third most common cancer in both men and women. In most Asian countries, both the incidence and mortality rates of CRC are gradually increasing. In Brunei Darussalam, CRC ranks first and second in lifetime risk among men and women respectively. This study aims to report the overall survival rates and associated factors of CRC in Brunei Darussalam. Methods: This is a retrospective study examining CRC data for the period 2007 to 2017 retrieved from a population based cancer registry in Brunei Darussalam. A total of 728 patients were included in the analysis. Kaplan Meier method was used to estimate survival rates. Univariate analysis using log-rank test was used to examine the differences in survival between groups. Multivariate analysis using Cox PH regression was used to estimate hazard of death and obtain significant predictors that influence CRC patients’ survival. Results: The median survival time for colorectal, colon and rectal cancer patients were 57.0, 85.8 and 40.0 months respectively. The overall 1-, 3- and 5- year survival rates for CRC patients were 78.0%, 57.7% and 49.6% respectively. In univariate analysis, age at diagnosis, ethnicity, cancer stage, tumour location and histology were found to have significant difference in CRC patients’ survival. In the Cox PH analysis, older age (≥70 years), cancer stage, ethnicity and other histological type were determined as associated factors of CRC patients’ survival. Conclusion: This study found the overall 5-year survival rate of CRC in Brunei Darussalam is similar to that in some Asian countries such as Singapore and Malaysia. However, more efforts need to be carried out in order to raise awareness of CRC and improve the survival of CRC patients.
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Affiliation(s)
- Elvynna Leong
- Faculty of Science, Universiti Brunei Darussalam, Jln Tungku Link, Brunei Darussalam.,Institute of Applied Data Analytics, Universiti Brunei Darussalam, Jln ungku Link, Brunei Darussalam
| | - Sok King Ong
- NCD Prevention Unit, Ministry of Health, Commonwealth Drive, Brunei Darussalam
| | - Fadhliah Madli
- Faculty of Science, Universiti Brunei Darussalam, Jln Tungku Link, Brunei Darussalam
| | - Abby Tan
- Faculty of Science, Universiti Brunei Darussalam, Jln Tungku Link, Brunei Darussalam
| | - Daphne Lai
- Faculty of Science, Universiti Brunei Darussalam, Jln Tungku Link, Brunei Darussalam.,Institute of Applied Data Analytics, Universiti Brunei Darussalam, Jln ungku Link, Brunei Darussalam
| | - Norwani Basir
- Gastroenterology and Hepatology Unit, Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam
| | - Noraslinah Ramlee
- Early Detection & Cancer Prevention Services, Pantai Jerudong Specialist Centre, Brunei Darussalam
| | - Vui Heng Chong
- Gastroenterology and Hepatology Unit, Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam
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35
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Wang J, Li S, Liu Y, Zhang C, Li H, Lai B. Metastatic patterns and survival outcomes in patients with stage IV colon cancer: A population-based analysis. Cancer Med 2020; 9:361-373. [PMID: 31693304 PMCID: PMC6943094 DOI: 10.1002/cam4.2673] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/12/2019] [Accepted: 10/16/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The goal of this study was to delineate the patterns of distant metastasis from colon adenocarcinoma (CAC) and evaluate the survival differences by metastatic patterns. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, we extracted patients diagnosed with stage IV CAC between 2010 and 2016. Kaplan-Meier survival curves were plotted with log-rank tests to compare overall survival (OS) of patients with different metastatic patterns. Univariate and multivariate Cox proportional hazards regression models were used to evaluate the effects of different metastatic patterns on survival outcomes in terms of OS and disease-specific survival (DSS). RESULTS A total of 26 170 patients were analyzed. The 3- and 5-year OS were 20.7% and 10.5%, respectively, for patients with stage IV CAC. The most common distant metastatic site was the liver, followed by the lung, bone, and brain, but the frequency differed greatly by histology subtypes. The site of metastasis was a significant prognostic factor for OS and DSS in patients with stage IV CAC, independent of the number of metastatic sites and other clinical and demographic prognostic factors. Using liver-only metastasis as reference, lung-only metastasis was associated with better OS (hazard ratio [HR] = 0.82, 95% confidence interval [CI], 0.71-0.94) and DSS (HR = 0.75, 95% CI, 0.64-0.88). Older age, black race, unmarried status, grade III/IV tumors, advanced tumor-node-metastasis (TNM) stage, proximal colon, elevated preoperative carcinoembryonic antigen (CEA), no surgery of the primary site, and no chemotherapy were independent predictors of poor OS. CONCLUSIONS The site of distant metastasis and number of metastasis site were independent prognostic factors for survival of patients with stage IV CAC. This study highlights the need for diverse treatment strategies for patients with different metastatic patterns.
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Affiliation(s)
- Jiwei Wang
- Department of UltrasoundThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Song Li
- Mudanjiang Medical CollegeMudanjiangChina
| | - Yanna Liu
- Department of UltrasoundThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Chunquan Zhang
- Department of UltrasoundThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Honglang Li
- Department of Gastrointestinal SurgeryThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Bin Lai
- Department of Gastrointestinal SurgeryThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
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36
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Hall C, Clarke L, Pal A, Buchwald P, Eglinton T, Wakeman C, Frizelle F. A Review of the Role of Carcinoembryonic Antigen in Clinical Practice. Ann Coloproctol 2019; 35:294-305. [PMID: 31937069 PMCID: PMC6968721 DOI: 10.3393/ac.2019.11.13] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Carcinoembryonic antigen (CEA) is not normally produced in significant quantities after birth but is elevated in colorectal cancer. The aim of this review was to define the current role of CEA and how best to investigate patients with elevated CEA levels. A systematic review of CEA was performed, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were identified from PubMed, Cochrane library, and controlled trials registers. We identified 2,712 papers of which 34 were relevant. Analysis of these papers found higher preoperative CEA levels were associated with advanced or metastatic disease and thus poorer prognosis. Postoperatively, failure of CEA to return to normal was found to be indicative of residual or recurrent disease. However, measurement of CEA levels alone was not sufficient to improve survival rates. Two algorithms are proposed to guide investigation of patients with elevated CEA: one for patients with elevated CEA after CRC resection, and another for patients with de novo elevated CEA. CEA measurement has an important role in the investigation, management and follow-up of patients with colorectal cancer.
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Affiliation(s)
- Claire Hall
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Louise Clarke
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Atanu Pal
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
- Norfolk & Norwich University Hospital, Norwich, UK
| | - Pamela Buchwald
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Tim Eglinton
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Chris Wakeman
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
| | - Frank Frizelle
- Colorectal Unit, Department of Surgery, University of Otago, Christchurch, New Zealand
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37
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Yang S, Liu T, Cheng Y, Bai Y, Liang G. Immune cell infiltration as a biomarker for the diagnosis and prognosis of digestive system cancer. Cancer Sci 2019; 110:3639-3649. [PMID: 31605436 PMCID: PMC6890448 DOI: 10.1111/cas.14216] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 12/24/2022] Open
Abstract
The digestive system cancers are aggressive cancers with the highest mortality worldwide. In this study, we undertook a systematic investigation of the tumor immune microenvironment to identify diagnostic and prognostic biomarkers. The fraction of 22 immune cell types of patients were estimated using CIBERSORT. The least absolute shrinkage and selection operator (LASSO) analysis was carried out to identify important immune predictors. By comparing immune cell compositions in 801 tumor samples and 46 normal samples, we constructed the diagnostic immune score (DIS), showing high specificity and sensitivity in the training (area under the receiver operating characteristic curve [AUC] = 0.929), validation (AUC = 0.935), and different cancer type cohorts (AUC > 0.70 for all). We also established the prognostic immune score (PIS), which was an effective prognostic factor for relapse‐free survival in training, validation, and entire cohorts (P < .05). In addition, PIS provided a higher net benefit than TNM stage. A composite nomogram was built based on PIS and patients' clinical information with well‐fitted calibration curves (c‐index = 0.84). We further used other cohorts from Gene Expression Omnibus databases and obtained similar results, confirming the reliability and validity of the DIS and PIS. In addition, the unsupervised clustering analysis using immune cell proportions revealed 6 immune subtypes, suggesting that the immune types defined as having relatively high levels of M0 or/and M1 macrophages were the high‐risk subtypes of relapse. In conclusion, this study comprehensively analyzed the tumor immune microenvironment and identified DIS and PIS for digestive system cancers.
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Affiliation(s)
- Sheng Yang
- School of Public Health, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, China
| | - Tong Liu
- School of Public Health, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, China
| | - Yanping Cheng
- School of Public Health, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, China
| | - Yunfei Bai
- School of Biological Sciences and Medical Engineering, State Key Laboratory of Bioelectronics, Southeast University, Nanjing, China
| | - Geyu Liang
- School of Public Health, Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Southeast University, Nanjing, China
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38
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Adjuvant chemotherapy does not provide survival benefits to elderly patients with stage II colon cancer. Sci Rep 2019; 9:11846. [PMID: 31413354 PMCID: PMC6694195 DOI: 10.1038/s41598-019-48197-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
To date, the effect of adjuvant chemotherapy after curative resection in patients with stage II colon cancer remains controversial. Still, little is known about the effects of adjuvant chemotherapy in patients with stage II colon cancer who are older than 70 years, as most studies did not focus on this population. This study aimed to investigate the oncologic outcomes of elderly patients with stage II colon cancer who underwent curative resection with or without postoperative adjuvant chemotherapy. We retrospectively reviewed medical records of patients older than 70 years who underwent curative resection of stage II primary colon cancer during 2002–2015. Patients were classified into surgery alone (SA) and adjuvant chemotherapy (AC) groups and propensity score-matched at a 1:1 ratio using a logistic regression. The end points were recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). Of the 623 patients who met the criteria, 145 were assigned to each arm after propensity score matching. The mean ages of the SA and AC groups were 74.3 and 74.0 years, respectively. A log-rank test revealed no significant inter-group differences in RFS (p = 0.202), CSS (p = 0.486) or OS (p = 0.299). In a Cox regression analysis, adjuvant chemotherapy was not found to be an independent factor affecting RFS (p = 0.206), CSS (p = 0.487) or OS (p = 0.301). Adjuvant chemotherapy does not appear to yield survival benefits in elderly patients with stage II colon cancer.
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39
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Guan X, Ma CX, Quan JC, Li S, Zhao ZX, Chen HP, Yang M, Liu Z, Jiang Z, Wang XS. A clinical model to predict the risk of synchronous bone metastasis in newly diagnosed colorectal cancer: a population-based study. BMC Cancer 2019; 19:704. [PMID: 31315606 PMCID: PMC6637577 DOI: 10.1186/s12885-019-5912-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The early detection of synchronous bone metastasis (BM) in newly diagnosed colorectal cancer (CRC) affects its initial management and prognosis. A clinical model to individually predict the risk of developing BM would be attractive in current clinical practice. METHODS A total of 55,869 CRC patients were identified from Surveillance, Epidemiology, and End Results (SEER) database, of whom 317 patients were diagnosed with synchronous BM. Risk factors for BM in CRC patients was identified using multivariable logistic regression. A weighted scoring system was built with beta-coefficients (P < 0.05). A random sample of 75% of the CRC patients was used to establish the risk model, and the remaining 25% was used to validate its accuracy of this model. The performance of risk model was estimated by receiver operating curve (ROC) analysis. RESULTS The risk model consisted of 8 risk factors including rectal cancer, poorly-undifferentiation, signet-ring cell carcinoma, CEA positive, lymph node metastasis, brain metastasis, liver metastasis and lung metastasis. The areas under the receiver operating curve (AUROC) were 0.903 and 0.889 in the development and validation cohort. Patients with scores from 0 to 4 points had about 0.1% risk of developing BM, and the risk increased to about 30% in patients with scores ≥15 points. CONCLUSIONS This clinical risk model is accurate enough to identify the CRC patients with high risk of synchronous BM and to further provide more individualized clinical decision.
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Affiliation(s)
- Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Chen-Xi Ma
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Ji-Chuan Quan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Shuai Li
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Zhi-Xun Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Hai-Peng Chen
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Ming Yang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bejing, China.
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Margalit O, Shacham-Shmueli E, Lawrence YR, Yang YX, Reiss KA, Golan T, Mamtani R, Halpern N, Aderka D, Giantonio B, Boursi B. Lung Metastasis Predicts Better Prognosis in Metastatic Colorectal Cancer With Mutated KRAS. Clin Colorectal Cancer 2019; 18:e300-e307. [PMID: 31324478 DOI: 10.1016/j.clcc.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/04/2019] [Accepted: 06/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies have shown that prognosis in metastatic colorectal cancer (mCRC) might vary according to sites of metastasis. We evaluated prognosis in individuals with mCRC and single-site metastasis, according to several clinical and genetic variables. PATIENTS AND METHODS Using the National Cancer Database we identified 58,044 mCRC patients with a synchronous single site of metastasis. We first examined the effect of metastasis site on prognosis. In a secondary analysis, among individuals who had not undergone surgery or received radiotherapy, we examined the prognostic value of chemotherapy intensity, Kirsten ras (KRAS) status, primary tumor location and carcinoembryonic antigen (CEA) levels. RESULTS Individuals with lung metastasis had the best prognosis (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.77-0.83), followed by those with liver metastasis (HR, 1.11; 95% CI, 1.07-1.15), whereas those with bone or brain metastasis had the worse prognosis. In a subgroup analysis, we assessed prognosis among individuals who received multiagent chemotherapy and had not undergone surgery or received radiotherapy. Individuals with lung metastasis and mutant KRAS had better prognosis compared with those with liver metastasis (HR, 0.69; 95% CI, 0.54-0.88), regardless of primary tumor location or CEA levels. CONCLUSION Single-site metastasis to the lungs is associated with better prognosis in mCRC, specifically among patients with KRAS mutant tumors.
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Affiliation(s)
- Ofer Margalit
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Yaacov R Lawrence
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel; Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kim A Reiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Talia Golan
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | | | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Aderka
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Bruce Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Tel-Aviv, Israel; Division of Gastroenterology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Shen F, Cui J, Hong X, Yu F, Bao X. Preoperative serum carcinoembryonic antigen elevation in stage I colon cancer: improved risk of mortality in stage T1 than in stage T2. Int J Colorectal Dis 2019; 34:1095-1104. [PMID: 31016378 DOI: 10.1007/s00384-019-03298-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to investigate the implications of preoperative serum carcinoembryonic antigen (CEA) elevation in cause-specific survival (CSS) of patients diagnosed with stage I (T1N0M0 and T2N0M0) colon cancer. METHODS Eligible patients diagnosed with stage I colon cancer from the Surveillance, Epidemiology, and End Results (SEER) database from January 2004 to December 2010 were included in this respective and propensity score-matched (PSM) study. Some Cox proportional hazards models were constructed to identify prognostic factors associated with oncologic outcomes of colon cancer. Pearson's chi-squared tests and Kaplan-Meier methods were performed. RESULTS The median follow-up time of the whole cohort was 79 months. A total of 16,659 patients diagnosed with stage I colon cancer were identified from the SEER database. Multivariate Cox analyses showed that stage T1N0M0 in the context of serum CEA elevation (T1, CEA+) presented up to 158.4% increased risk of colon cancer-specific mortality compared with stage T1N0M0 in the context of normal serum CEA [hazard ratio (HR) = 2.584, 95% confidence interval (CI) = 2.167-3.082, P < 0.001]. After PSM, Kaplan-Meier survival curves of stage T1N0M0 colon cancer showed that 5-year CSS rates of normal and elevated CEA were 94.8% and 96.6% (P < 0.001). CONCLUSIONS This large population-based and propensity score-matched study with long follow-up time provides the first evidence that stage T1N0M0 colon cancer with the elevation of preoperative serum CEA would be a surrogate of aggressive tumor biology and predict poor prognosis. In addition, this subgroup of colon cancer might need to be paid more attention of clinicians.
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Affiliation(s)
- Feng Shen
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China
| | - Junhui Cui
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China
| | - Xia Hong
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China
| | - Feng Yu
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China
| | - Xiangdong Bao
- Department of Colorectal Surgery, Tongde Hospital of Zhejiang Province, 234 Gucui Road, Hangzhou, 310012, Zhejiang, China.
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Transposed Data in a Table. JAMA Surg 2019; 154:368. [DOI: 10.1001/jamasurg.2019.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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43
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Baqar AR, Wilkins S, Staples M, Angus Lee CH, Oliva K, McMurrick P. The role of preoperative CEA in the management of colorectal cancer: A cohort study from two cancer centres. Int J Surg 2019; 64:10-15. [DOI: 10.1016/j.ijsu.2019.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/07/2019] [Accepted: 02/19/2019] [Indexed: 01/19/2023]
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Colloca GA, Venturino A, Guarneri D. Carcinoembryonic antigen reduction after medical treatment in patients with metastatic colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:657-666. [PMID: 30671635 DOI: 10.1007/s00384-018-03230-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The introduction of new drugs and multimodal treatments for the management of patients with metastatic colorectal cancer (mCRC) has reduced the importance of time-to-event endpoints and reported the attention on the response-related endpoints. Furthermore, the prognostic role of the surgical scores before the resection of metastases has not been confirmed for multimodal treatments. The purpose of this research is to perform a meta-analysis of the studies that evaluated the relationship between carcinoembryonic antigen (CEA) response and outcome in patients with mCRC receiving systemic chemotherapy. METHODS A systematic review of the literature on two databases and a selection of studies that evaluated the relationship between CEA response and outcome were performed according to predefined criteria. After, three meta-analyses were carried out on the selected studies, each for each outcome variable. RESULTS Nineteen studies have been selected. Fourteen studies (1475 patients) have documented a close association between radiological response and CEA response (odds ratio (OR), 9.03; confidence intervals (CIs), 5.14-15.87; I2 statistic (I2), 72%). Four studies have reported a longer progression-free survival for patients with a CEA response (hazard ratio (HR), 0.73; CIs, 0.64-0.83; I2, 23%). Finally, 10 studies (13 study cohorts) have shown a strong relationship between CEA response and overall survival (OS) (HR, 0. 62; CIs, 0.55-0.70; I2, 35%). CONCLUSIONS CEA response merits further investigation as a surrogate endpoint of clinical trials of first-line medical therapy of patients with mCRC, and should be studied as a prognostic factor for those patients who are candidates for multimodal treatment strategies.
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Affiliation(s)
- Giuseppe Antonio Colloca
- Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, I-18038, Sanremo (Imperia), Italy.
| | - Antonella Venturino
- Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, I-18038, Sanremo (Imperia), Italy
| | - Domenico Guarneri
- Department of Oncology, Ospedale Civile di Sanremo, Via G. Borea n. 56, I-18038, Sanremo (Imperia), Italy
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Huang SH, Tsai WS, You JF, Hung HY, Yeh CY, Hsieh PS, Chiang SF, Lai CC, Chiang JM, Tang R, Chen JS. Preoperative Carcinoembryonic Antigen as a Poor Prognostic Factor in Stage I-III Colorectal Cancer After Curative-Intent Resection: A Propensity Score Matching Analysis. Ann Surg Oncol 2019; 26:1685-1694. [PMID: 30915591 DOI: 10.1245/s10434-019-07184-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Preoperative carcinoembryonic antigen (CEA) has yet to be used as a prognostic or adjuvant chemotherapy factor for colorectal cancer (CRC). METHODS This retrospective cohort study included all stage I-III CRC patients with different preoperative serum CEA levels (≤ 5, 5-10, and > 10 ng/ml) at a single center between 1995 and 2010. Propensity score matching was performed in a 1:1 ratio between the two elevated CEA groups (5-10 ng/ml and > 10 ng/ml) and in a 1:2 ratio between the elevated and non-elevated groups (≤ 5 ng/ml), with a caliper of 0.05. RESULTS After exclusion and matching, 3857 patients had preoperative CEA levels ≤ 5 ng/ml, 1121 patients had CEA levels between 5 and 10 ng/ml, and 1121 patients had CEA levels > 10 ng/ml. Elevated preoperative CEA showed an increased risk of overall survival (5-10 ng/ml: hazard ratio [HR] 1.376; > 10 ng/ml: HR 1.523; both p < 0.001), cancer-specific survival (5-10 ng/ml: HR 1.404; > 10 ng/ml: HR 1.712; both p < 0.001), and recurrence free interval (5-10 ng/ml: HR 1.190; > 10 ng/ml: HR 1.468; both p < 0.05). Patients with negative lymph node staging (LNs) and CEA > 10 ng/ml, as well as those with positive LNs and CEA ≤ 5 ng/ml, showed similar overall survival (5-year survival: 72% vs. 69%; p = 0.542) and recurrence free intervals (19.9 vs. 21.72 months; p = 0.662). CONCLUSIONS A preoperative CEA level can be an independent prognostic factor for stage I-III CRC after curative resection. Patients with negative LNs and preoperative CEA level > 10 ng/ml should be considered for intensive follow-up or adjuvant chemotherapy.
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Affiliation(s)
- Shu-Huan Huang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Sy Tsai
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Yuan Hung
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chien-Yuh Yeh
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sum-Fu Chiang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Chou Lai
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jy-Ming Chiang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Reiping Tang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jinn-Shiun Chen
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Wang X, Mao M, He Z, Zhang L, Li H, Lin J, He Y, Dai S, Hu W, Liu W. Development and Validation of a Prognostic Nomogram in AFP-negative hepatocellular carcinoma. Int J Biol Sci 2019; 15:221-228. [PMID: 30662361 PMCID: PMC6329916 DOI: 10.7150/ijbs.28720] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/11/2018] [Indexed: 12/27/2022] Open
Abstract
The aim of this study is to establish and validate an effective prognostic nomogram in patients with AFP-negative hepatocellular carcinoma (HCC). The nomogram was based on a primary cohort that consisted of 419 patients with clinicopathologically diagnosed with HCC, all the data was gathered from 2008 to 2014 in Sun Yat-sen University Cancer Center. All the model factors were determined by univariate and multivariate Cox hazard analysis. The concordance index (C-index) and calibration curve were used to determine the predictive accuracy and discriminative ability of the nomogram, and compared with the TNM staging systems on HCC. Internal validation was assessed. An independent validation cohort contained 150 continuous patients from 2014 to 2015. Independent factors for overall survival (OS) were body mass index (BMI), tumor stage, distant metastases, HBs Ag, lactate dehydrogenase (LDH), gamma-glutamyl transpeptidase (GGT), and albumin (ALB), which were all contained into the nomogram. The calibration curve for probability of OS showed good agreement between prediction by nomogram and actual observation. The C-index of nomogram was 0.807 (95% CI: 0.770-0.844), which was superior to the C-index of AJCC TNM Stage (0.697). The AUC was 0.809(95%CI: 0.762-0.857). In the validation cohort, the nomogram still gave good discrimination (C-index: 0.866, 95% CI: 00.796-0.936; AUC: 0.832, 95%CI: 0.747-0.917) and good calibration. Decision curve analysis demonstrated that the nomogram was clinically useful. Moreover, patients were divided into three distinct risk groups for OS by the nomogram: low risk group, middle risk group and a high risk group, respectively. The proposed nomogram presents more accurate and useful prognostic prediction for patients with AFP-negative HCC.
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Affiliation(s)
- Xueping Wang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Minjie Mao
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhonglian He
- Department of Information section, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin Zhang
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huilan Li
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianhua Lin
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yi He
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wanming Hu
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wanli Liu
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Guo L, Ma L, Liu C, Lei Y, Tang N, Huang Y, Huang G, Li D, Wang Q, Liu G, Tang M, Jing Z, Deng Y. ERp29 counteracts the suppression of malignancy mediated by endoplasmic reticulum stress and promotes the metastasis of colorectal cancer. Oncol Rep 2018; 41:1603-1615. [PMID: 30569094 PMCID: PMC6365697 DOI: 10.3892/or.2018.6943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/29/2018] [Indexed: 01/11/2023] Open
Abstract
Endoplasmic reticulum protein 29 (ERp29), an endoplasmic reticulum (ER) protein, participates in ER stress (ERS), but little is known about the association of ERp29 with ERS in the metastasis and prognosis of cancerous diseases. The present study revealed that ERp29 was important to ERS and interfered with the malignant behaviors of colorectal cancer (CRC). Experiments in in vitro and in animal models revealed that ERS inhibited the cell growth and suppressed the metastatic capacity of CRC cells, but ERp29 counteracted these effects. Furthermore, it was demonstrated that ERp29 recovered the migration and metastatic behaviors of CRC cells suppressed by ERS, mediated only when it combined with cullin5 (CUL5). ERp29 also relied on CUL5 to promote epithelial-mesenchymal transition. From the immunohistochemical examination of CRC tissues, the high expression of ERp29 was revealed to predict the poor prognosis of 457 CRC cases. The retrospective analysis of the clinicopathological data of patients with CRC was consistent with the results of the in vitro and in vivo experiments. Thus, ERp29 protected CRC cells from ERS-mediated reduction of malignancy to promote metastasis and may be a potential target of medical intervention for CRC therapy.
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Affiliation(s)
- Lili Guo
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Lili Ma
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Chao Liu
- Department of Pathology and Laboratory Medicine, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, P.R. China
| | - Yan Lei
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Na Tang
- Department of Pathology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Yingxin Huang
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Guan Huang
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Dazhou Li
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Qi Wang
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Guanglong Liu
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Minshan Tang
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zhiliang Jing
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yongjian Deng
- Department of Pathology, Nanfang Hospital and School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Lin JP, Lin JX, Huang CM, Li P. ASO Author Reflections: Tumor Markers in Gastric Cancer. Ann Surg Oncol 2018; 25:735-736. [PMID: 30306373 DOI: 10.1245/s10434-018-6886-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Jun-Peng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China.,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. .,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian Province, China. .,Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. .,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. .,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Sasaki K, Margonis GA, Andreatos N, Chen Q, Barbon C, Bagante F, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Soubrane O, Martel G, Groot Koerkamp B, Guglielmi A, Endo I, Aucejo FN, Pawlik TM. Serum tumor markers enhance the predictive power of the AJCC and LCSGJ staging systems in resectable intrahepatic cholangiocarcinoma. HPB (Oxford) 2018; 20:956-965. [PMID: 29887261 DOI: 10.1016/j.hpb.2018.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 03/31/2018] [Accepted: 04/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND While several prognostic models have been developed to predict long-term outcomes in resectable intrahepatic cholangiocarcinoma (ICC), their prognostic discrimination remains limited. The addition of tumor markers might improve the prognostic power of the classification schemas proposed by the AJCC 8th edition and the Liver Cancer Study Group of Japan (LCSGJ). METHODS The prognostic discrimination of the AJCC and the LCSGJ were compared before and after the addition of CA 19-9 and CEA, using Harrell's C-index, net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) in an international, multi-institutional cohort. RESULTS Eight hundred and five surgically treated patients with ICC that met the inclusion criteria were identified. On multivariable analysis, CEA5 ng/mL, 100IU/mL CA 19-9< 500IU/mL and CA 19-9500 IU/mL were associated with worse overall survival. The C-index of the AJCC and the LCSGJ improved from 0.540 to 0.626 and 0.553 to 0.626, respectively following incorporation of CA 19-9 and CEA. The NRI and IDI metrics confirmed the superiority of the modified AJCC and LCSGJ, compared to the original versions. CONCLUSION The inclusion of preoperative CA 19-9 and CEA in the AJCC and LCSGJ staging schemas may improve prognostic discrimination among surgically treated patients with ICC.
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Affiliation(s)
| | | | | | - Qinyu Chen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carlotta Barbon
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Fabio Bagante
- Department of Surgery, University of Verona, Verona, Italy
| | - Matthew Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | | | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Todd W Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | - Olivier Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France
| | - Guillaume Martel
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Itaru Endo
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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50
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Liu Q, Lian P, Luo D, Cai S, Li Q, Li X. Combination of carcinoembryonic antigen with the American Joint Committee on Cancer TNM staging system in rectal cancer: a real-world and large population-based study. Onco Targets Ther 2018; 11:5827-5834. [PMID: 30271165 PMCID: PMC6145356 DOI: 10.2147/ott.s171433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIM This study assessed the combination of carcinoembryonic antigen (CEA) with the American Joint Committee on Cancer (AJCC) TNM staging system, aiming to improve the AJCC TNM staging system, in terms of prognostic accuracy and clinical management of rectal cancer. METHODS Eligible patients (N=22,132) were selected from the Surveillance, Epidemiology, and End Results database between January 1, 2004, and December 31, 2010. Patients with elevated CEA levels were designated as "C1 stage" and those with normal CEA amounts as "C0 stage". The outcome of interest was cancer-specific survival (CSS). Cox proportional hazards regression analyses and Kaplan-Meier curves were used to identify independent prognostic factors and analyze the odds of CSS in patients with rectal cancer in different C and TNM stages, respectively. RESULTS C1 stage was associated with a 61.0% risk increase in cancer-specific mortality (HR=1.610, 95% CI=1.219-1.705, P<0.001). In addition, C0-stage patients showed improved CSS compared with C1-stage counterparts. In addition, CSS was improved in stage IIB-C0 patients (HR=2.478, 95% CI=1.660-3.699) compared with stage IIIB-C1 patients (HR=2.431, 95% CI=2.021-2.924) or IIIA-C1 patients (HR=1.060, 95% CI=0.823-1.366, P=0.650) and stage IIC-C0 patients (HR=4.263, 95% CI=3.308-5.493) compared with stage IIIB-C1 or IIIA-C1 counterparts. CONCLUSION C stage is an independent prognostic factor of rectal cancer. The improved prognostic precision of the C-TNM staging system and, thus, more individualized risk-adaptive treatments support the incorporation of C stage into the AJCC TNM staging system in rectal cancer.
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Affiliation(s)
- Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, ;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, ;
| | - Peng Lian
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, ;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, ;
| | - Dakui Luo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, ;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, ;
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, ;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, ;
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, ;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, ;
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China, ;
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, ;
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