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Zanatto RM, Santos G, Oliveira JC, Pracucho EM, Nunes AJF, Lopes-Filho GJ, Saad SS. IMPACT OF KRAS MUTATIONS IN CLINICAL FEATURES IN COLORECTAL CANCER. ACTA ACUST UNITED AC 2020; 33:e1524. [PMID: 33331426 PMCID: PMC7743328 DOI: 10.1590/0102-672020200003e1524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/29/2020] [Indexed: 01/04/2023]
Abstract
Background:
KRAS mutations are important events in colorectal carcinogenesis, as well as
negative predictors of response to EGFR inhibitors treatment.
Aim:
To investigate the association of clinical-pathological features with KRAS
mutations in colorectal cancer patients treated.
Methods:
Data from 69 patients with colorectal cancer either metastatic at diagnosis
or later, were retrospectively analyzed. The direct sequencing and
pyrosequencing techniques were related to KRAS exon 2. The mutation
diagnosis and its type were determined.
Results:
KRAS mutation was identified in 43.4% of patients. The most common was
c.35G>T (p.G12V), c.35G>A (p.G12D) and c.38G>A (p.G13D). No
correlation was found between KRAS mutation and age (p=0.646) or gender
(p=0.815). However, mutated group had higher CEA levels at admission
(p=0.048) and codon 13 mutation was associated with involvement of more than
one metastatic site in disease progression (p=0.029). Although there was no
association between primary tumor site and mutation diagnosis (p=0.568),
primary colon was associated with worse overall survival (p=0.009).
Conclusion:
The KRAS mutation was identified in almost half of patients. Mutated KRAS
group had higher levels of CEA at admission and the mutation at codon 13 was
associated with involvement of more than one metastatic site in the course
of the disease. Colon disease was associated with the worst overall
survival.
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Affiliation(s)
- Renato Morato Zanatto
- Department of Abdominal and Pelvic Surgery, Hospital Amaral Carvalho, Jaú, SP, Brazil
| | - Gianni Santos
- Department of Biostatistics, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Júnea Caris Oliveira
- Department of Abdominal and Pelvic Surgery, Hospital Amaral Carvalho, Jaú, SP, Brazil
| | | | | | - Gaspar Jesus Lopes-Filho
- Department of Digestive Surgery, Federal University of São Paulo, São Paulo, SP, Brazil.,Postgraduate Program in Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Sarhan Sydney Saad
- Department of Digestive Surgery, Federal University of São Paulo, São Paulo, SP, Brazil.,Postgraduate Program in Surgery, Federal University of São Paulo, São Paulo, SP, Brazil
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Stremitzer S, Stift J, Gruenberger B, Tamandl D, Aschacher T, Wolf B, Wrba F, Gruenberger T. KRAS status and outcome of liver resection after neoadjuvant chemotherapy including bevacizumab. Br J Surg 2012; 99:1575-82. [DOI: 10.1002/bjs.8909] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
Background
The prognostic value of KRAS mutation in patients with colorectal cancer liver metastases (CLM) receiving neoadjuvant chemotherapy including bevacizumab before liver resection is unclear.
Methods
The KRAS and BRAF status of resected CLM was assessed in prospectively studied patients. Mutations were correlated with recurrence-free and overall survival. Only patients with remaining vital tumour cells in the resected specimen and those without disease progression were analysed; those with progressive disease did not undergo resection.
Results
A total of 60 patients were enrolled. Fifteen (25 per cent) had a KRAS mutation, but none of the 60 patients had a BRAF mutation. The radiological response to neoadjuvant chemotherapy including bevacizumab, assessed according to the Response Evaluation Criteria In Solid Tumours, was partial in 52 patients (87 per cent) and the remaining eight had stable disease. The partial response rate was similar in patients with a KRAS mutation and those with the wild-type gene (12 of 15 versus 40 of 45 patients; P = 0·400). KRAS mutation had a negative prognostic effect on recurrence-free survival (hazard ratio (HR) 2·48, 95 per cent confidence interval 1·26 to 4·89; P = 0·009) and overall survival (HR 3·51, 1·30 to 9·45; P = 0·013).
Conclusion
This study provided further evidence for the prognostic importance of KRAS status in terms of recurrence-free and overall survival. Neoadjuvant chemotherapy including bevacizumab elicited a response, irrespective of KRAS status, in this selected group of patients with CLM.
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Affiliation(s)
- S Stremitzer
- Department of General Surgery, Medical University Vienna, Austria
| | - J Stift
- Clinical Institute of Pathology, Medical University Vienna, Austria
| | - B Gruenberger
- Department of Internal Medicine, St John of God's Hospital, Vienna, Austria
| | - D Tamandl
- Department of General Surgery, Medical University Vienna, Austria
| | - T Aschacher
- Department of General Surgery, Medical University Vienna, Austria
| | - B Wolf
- Department of General Surgery, Medical University Vienna, Austria
| | - F Wrba
- Clinical Institute of Pathology, Medical University Vienna, Austria
| | - T Gruenberger
- Department of General Surgery, Medical University Vienna, Austria
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3
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Is K-ras gene mutation a prognostic factor for colorectal cancer: a systematic review and meta-analysis. Dis Colon Rectum 2012; 55:913-23. [PMID: 22810479 DOI: 10.1097/dcr.0b013e318251d8d9] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND : The K-ras gene is one of the commonly mutated oncogenes associated with colorectal cancer. However, its prognostic significance for patients with colorectal cancer remains inconclusive. OBJECTIVE : To derive a more precise estimation of the prognostic significance of K-ras gene mutations, a systematic review and meta-analysis were performed. DATA SOURCES : We searched PubMed, Embase, and the Cochrane databases from January 1992 to November 2011. STUDY SELECTION : The prognostic value of K-ras gene mutations was examined in patients with colorectal cancer who did not receive preoperative chemotherapy or radiation. MAIN OUTCOME MEASURES : The effect of K-ras gene mutations on the overall survival was measured by the HR and 95% CIs. RESULTS : The pooled HR for the association between K-ras gene mutations and overall survival in patients with colorectal cancer was 1.04 (95% CI: 0.99-1.10, p = 0.11). Subgroup analysis showed significant reductions in the overall survival associated with mutations at K-ras codon 12, the articles that reported HR directly, and the studies published before and after 2005, although publication bias was present. All the associations disappeared after adjustment with the trim-and-fill method. The pooled HR of 3 studies examining mutations at K-ras codon 13 was 1.47 (95% CI: 1.09-1.97, p = 0.02), and no publication bias was observed. No significant association was observed in different study regions. LIMITATIONS : The heterogeneity in the study populations is a potential problem, the use of different staging systems or small groups of different stages may contribute to heterogeneity, and residual confounding may have influenced the results in those studies that did not completely adjust for other factors. CONCLUSIONS : Overall K-ras gene mutations seem not to correlate with the prognosis of patients with colorectal cancer. The association remains to be confirmed with a more precise analysis of a large sample.
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Baas JM, Krens LL, Guchelaar HJ, Morreau H, Gelderblom H. Concordance of predictive markers for EGFR inhibitors in primary tumors and metastases in colorectal cancer: a review. Oncologist 2011; 16:1239-49. [PMID: 21742964 DOI: 10.1634/theoncologist.2011-0024] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Currently, only Kirsten rat sarcoma 2 viral oncogene homolog (KRAS) mutational status is used as a decisional marker for epidermal growth factor receptor (EGFR) inhibitor therapy in colorectal cancer (CRC) patients. Concordance of KRAS status between primary tumors and metastases has always been considered to be close to perfect; however, cases of discordance have been reported. The actual rate of concordance of KRAS status remains unclear, as is the same for v-raf murine sarcoma viral oncogene homolog B1 (BRAF), phosphatidylinositol 3-kinase CA subunit (PIK3CA), and loss of phosphatase and tensin homologue deleted on chromosome ten (PTEN). Therefore, it is unknown whether it is necessary to perform mutational analysis on metastases instead of on (or in addition to) primary tumors. DESIGN A systematic literature search was conducted to collect all studies testing concordance of KRAS in CRC, and also of BRAF, PIK3CA, and loss of PTEN. RESULTS Twenty-one studies have reported concordance of KRAS, with an overall concordance rate of 93% (range, 76%-100%). Overall concordance rates of studies testing concordance of BRAF status and loss of PTEN were 98% and 68%, respectively. Three studies reported concordance of PIK3CA status (range, 89%-94%). CONCLUSION Though discordance of KRAS status does occur, it is uncommon. When considering the downsides of testing metastatic tissue in all patients along with the low incidence of discordance, we conclude that that testing the primary tumor (or whatever tissue available) is sufficient for clinical decision making on EGFR inhibitor therapy.
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Affiliation(s)
- Jara M Baas
- Department of Clinical Oncology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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5
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Deschoolmeester V, Baay M, Specenier P, Lardon F, Vermorken JB. A review of the most promising biomarkers in colorectal cancer: one step closer to targeted therapy. Oncologist 2010; 15:699-731. [PMID: 20584808 PMCID: PMC3228001 DOI: 10.1634/theoncologist.2010-0025] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 05/01/2010] [Indexed: 02/06/2023] Open
Abstract
Rapidly growing insights into the molecular biology of colorectal cancer (CRC) and recent developments in gene sequencing and molecular diagnostics have led to high expectations for the identification of molecular markers to be used in optimized and tailored treatment regimens. However, many of the published data on molecular biomarkers are contradictory in their findings and the current reality is that no molecular marker, other than the KRAS gene in the case of epidermal growth factor receptor (EGFR)- targeted therapy for metastatic disease, has made it into clinical practice. Many markers investigated suffer from technical shortcomings, resulting from lack of quantitative techniques to capture the impact of the molecular alteration. This understanding has recently led to the more comprehensive approaches of global gene expression profiling or genome-wide analysis to determine prognostic and predictive signatures in tumors. In this review, an update of the most recent data on promising biological prognostic and/or predictive markers, including microsatellite instability, epidermal growth factor receptor, KRAS, BRAF, CpG island methylator phenotype, cytotoxic T lymphocytes, forkhead box P3-positive T cells, receptor for hyaluronic acid-mediated motility, phosphatase and tensin homolog, and T-cell originated protein kinase, in patients with CRC is provided.
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Affiliation(s)
- Vanessa Deschoolmeester
- Laboratory of Cancer Research and Clinical Oncology, Department of Medical Oncology, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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6
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Murphy B J, Dorudi S, Bustin SA. Molecular staging of colorectal cancer: new paradigm or waste of time? ACTA ACUST UNITED AC 2007; 1:31-45. [DOI: 10.1517/17530059.1.1.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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7
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Bustin SA. Nucleic acid quantification and disease outcome prediction in colorectal cancer. Per Med 2006; 3:207-216. [DOI: 10.2217/17410541.3.2.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Histopathological stage at diagnosis remains the most important prognostic determinant for colorectal cancer. However, conventional staging is unable to predict disease outcome accurately for each individual patient. This results in considerable prognostic heterogeneity within a given tumor stage and is of particular relevance for a subgroup of patients with stage II disease that would benefit from adjuvant therapy. The recent advances in functional genomics are beginning to have a significant impact on clinical oncology, and there is widespread interest in using molecular techniques for clinical applications. These have focused on two approaches: the use of polymerase chain reaction (PCR)-based methods for the detection of occult disease in lymph nodes, bone marrow and blood and the use of microarrays for the expression profiling of primary tumors. The aim is to develop molecular classifiers that will allow the prediction of disease outcome, thus matching patients with individualized treatment. Despite the obvious attractions of these approaches, there have been significant technical, biological and analytical problems in their translation into clinically relevant practice. This is particularly true for colorectal cancer, the second most common cancer in the western world. Nevertheless, progress is being made and the improved awareness and appreciation of those difficulties is beginning to generate results that should prove useful for clinical oncology.
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Affiliation(s)
- Stephen A Bustin
- University of London, Institute of Cell and Molecular Science, Barts and the London, Queen Mary’s School of Medicine and Dentistry, London, UK
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8
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Bustin SA, Mueller R. Real-time reverse transcription PCR and the detection of occult disease in colorectal cancer. Mol Aspects Med 2006; 27:192-223. [PMID: 16445974 DOI: 10.1016/j.mam.2005.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Molecular diagnostics offers the promise of accurately matching patient with treatment, and a resultant significant effect on improved disease outcome. More specifically, the real-time reverse transcription polymerase chain reaction (qRT-PCR), with its combination of conceptual simplicity and technical utility, has the potential to become a valuable analytical tool for the detection of mRNA targets from tissue biopsies and body fluids. Its potential is particularly promising in cancer patients, both as a prognostic assay and for monitoring response to therapy. Colorectal cancer provides an instructive paradigm for this potential as well as the problems associated with its use as a clinical assay. Currently, histopathological staging, which provides a static description of the anatomical extent of tumour spread within a surgical specimen, defines patient prognosis. The detection of lymph node (LN) metastasis constitutes the most important prognostic factor in colorectal cancer and as the primary indicator of systemic disease spread, LN status determines the choice of postoperative adjuvant chemotherapy. However, its limitations are emphasised by the considerable prognostic heterogeneity of patients within a given tumour stage: not all patients with LN-negative cancers are cured and not all patients with LN-positive tumours die from their disease. This has resulted in a search for more accurate staging protocols and has seen the introduction of the concept of "molecular staging", the incorporation of molecular parameters into clinical tumour staging. Quantification of disease-associated mRNA is one such parameter that utilises the qRT-PCR assay's potential for generating quantitative results. These are not only more informative than qualitative data, but contribute to assay standardisation and quality management. This review provides an assessment of the practical value to the clinician of RT-PCR-based molecular diagnostics. It points out reasons for the many contradictory results encountered in the literature and concludes that there is an urgent need for standardisation at every level, starting with pre-assay sample acquisition and template preparation, assay protocols and post-assay analysis.
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Affiliation(s)
- Stephen A Bustin
- Institute of Cell and Molecular Science, Barts and the London, Queen Mary's School of Medicine and Dentistry, University of London, UK.
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9
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Doekhie FS, Kuppen PJK, Peeters KCMJ, Mesker WE, van Soest RA, Morreau H, van de Velde CJH, Tanke HJ, Tollenaar RAEM. Prognostic relevance of occult tumour cells in lymph nodes in colorectal cancer. Eur J Surg Oncol 2006; 32:253-8. [PMID: 16412600 DOI: 10.1016/j.ejso.2005.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 10/07/2005] [Accepted: 10/20/2005] [Indexed: 01/14/2023] Open
Abstract
AIMS Presently, in Europe the treatment of node-negative colorectal cancer (CRC) patients consists of surgical resection of the primary tumour without adjuvant systemic therapy. However, up to 30% of these patients will develop disease recurrence. These high-risk patients are possibly identified by occult tumour cell (OTC) assessment in lymph nodes. In this paper, studies on the clinical relevance of OTC in lymph nodes are reviewed. METHODS A literature search was conducted in the National Library of Medicine by using the keywords colonic, rectal, colorectal, neoplasm, adenocarcinoma, cancer, lymph node, polymerase chain reaction, mRNA, immunohistochemistry, micrometastases and isolated tumour cells. Additional articles were identified by cross-referencing from papers retrieved in the initial search. RESULTS The upstaging percentages through OTC assessment and the prognostic relevance of OTC in lymph nodes vary among studies, which is related to differences in techniques used to detect OTC. CONCLUSIONS We conclude that OTC examination techniques should be standardized to illuminate whether OTC in lymph nodes can reliably identify high-risk node-negative patients.
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Affiliation(s)
- F S Doekhie
- Department of Surgery K6-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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10
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Castagnola P, Giaretti W. Mutant KRAS, chromosomal instability and prognosis in colorectal cancer. Biochim Biophys Acta Rev Cancer 2005; 1756:115-25. [PMID: 16112461 DOI: 10.1016/j.bbcan.2005.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 06/14/2005] [Accepted: 06/29/2005] [Indexed: 12/23/2022]
Abstract
The RAS gene family provides a global effect on gene expression by encoding small GTP-binding proteins which act as molecular switches connecting extracellular signals with nuclear transcription factors. While wild type RAS proteins are switched off shortly after activation, mutant RAS proteins remain constitutively activated leading to complex interactions among their downstream effectors. For some human tumor types, these interactions were shown to contribute to cancer genesis and progression by inducing changes in cell survival, apoptosis, angiogenesis, invasion and metastasis. This review addresses the controversial link of KRAS mutations in colorectal cancer with chromosomal instability and patient prognosis.
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Affiliation(s)
- Patrizio Castagnola
- National Institute for Cancer Research, Largo R. Benzi, 10, 16132-Genoa, Italy
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11
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Wolfrum F, Vogel I, Fändrich F, Kalthoff H. Detection and clinical implications of minimal residual disease in gastro-intestinal cancer. Langenbecks Arch Surg 2005; 390:430-41. [PMID: 15991048 DOI: 10.1007/s00423-005-0558-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 03/23/2005] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Metastatic dissemination is an important factor for the prognosis of patients with gastro-intestinal cancer. Exact staging is crucial to determine appropriate multimodal therapeutic strategies. At present, the sensitivity of routinely performed diagnostic techniques is suboptimal for the detection of minimal residual disease (MRD) and occult metastases since the number of disseminated tumour cells (DTCs) is mostly marginal. To amend the verification of DTCs, immunohistochemical and molecular methods were applied to retrieve epithelial cell-specific proteins in non-epithelial tissue of different body compartments or fluids. Many groups have eagerly focussed on the identification of new markers and novel tests, yet specificity and sensitivity of these methods as well as robustness in the clinical setting are frequently missing. MATERIALS AND METHODS This review critically evaluates the prognostic impact of MRD in patients with pancreatic, colorectal and gastric cancer by outlining those studies showing diagnostic results of DTC detection in lymph nodes, bone marrow, venous blood and peritoneal lavage, some of which present novel strategies. CONCLUSION The analysed data concerning MRD in gastro-intestinal cancers reveal that results are undesirably heterogeneous. From a critical point of view, many clinical studies missed their chance because of small cohort size; moreover, methodological standardisation is generally lacking. On the other hand, the very encouraging results achieved so far, together with the comprehensive analyses of a few research groups, foster the prediction that DTC/MRD issues will soon expand the standard TNM classification.
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Affiliation(s)
- Fabian Wolfrum
- Department of General and Thoracic Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 7, 24105, Kiel, Germany
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12
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Conzelmann M, Linnemann U, Berger MR. Molecular detection of clinical colorectal cancer metastasis: how should multiple markers be put to use? Int J Colorectal Dis 2005; 20:137-46. [PMID: 15459772 DOI: 10.1007/s00384-004-0640-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Up to 45% of colorectal cancer (CRC) patients will develop local recurrence or metastasis following curative resection. The latter is due to cells shed from the primary carcinoma prior to or during surgery. The aim of this study was to contribute toward a "rational"-approach for detecting these disseminated tumor cells (DTC) using a combination of independent markers and detection methods. PATIENTS/METHODS Liver, lymph node, and bone marrow samples from 246 CRC patients were screened for DTC using three markers: mutated K-ras was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and cytokeratin 20 (CK20) and guanylylcyclase C (GCC), indicating circulating epithelial cells, were tracked by nested reverse-transcription (RT) PCR. RESULTS The rate of positive findings of the individual markers (CK20: 88%; GCC: 88%; K-ras: 67%) and their combinations (88-50%) was significantly higher in biopsies from liver metastases than in liver samples from patients without evident distant metastasis (M0; p<0.03). The detection rate of individual markers (except GCC) was also significantly elevated in inconspicuous liver tissue adjacent to metastasis compared with specimens from M0 patients. When using the concomitant detection of all three markers as criterion for DTC in the liver of M0 patients, however, no patient was DTC-positive. Therefore, the concomitant presence of the two CEC markers (CK20 plus GCC) and/or the presence of mutated K-ras were preferred for a combined evaluation, which resulted in a 24% detection rate for biopsies from both liver lobes. This translates into 39% of M0 patients with at least one positive liver biopsy. CONCLUSION Our results suggest that the concomitant detection of CK20 plus GCC and/or the presence of mutated K-ras are a rational approach for tracking CEC/DTC in CRC patients.
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Affiliation(s)
- Michael Conzelmann
- Unit of Toxicology and Chemotherapy, German Cancer Research Center, Im Neuenheimer Feld 230, 69120 Heidelberg, Germany
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13
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Ho SB, Hyslop A, Albrecht R, Jacobson A, Spencer M, Rothenberger DA, Niehans GA, D'Cunha J, Kratzke RA. Quantification of colorectal cancer micrometastases in lymph nodes by nested and real-time reverse transcriptase-PCR analysis for carcinoembryonic antigen. Clin Cancer Res 2005; 10:5777-84. [PMID: 15355906 DOI: 10.1158/1078-0432.ccr-03-0507] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Reverse-transcriptase PCR (RT-PCR) assays for carcinoembryonic antigen (CEA) have been described to identify lymph node micrometastases. These assays are not quantitative and can be confounded by false-positive results. The purpose of this study was to determine whether quantification of CEA in lymph nodes could more readily identify clinically relevant groups. EXPERIMENTAL DESIGN Specimens included 400 lymph nodes from 64 patients undergoing colon resections. Specimens were tested by immunohistochemistry and by RT-PCR using nested primers for CEA. Specimens from 59 patients that were positive by nested RT-PCR were further quantified by detection of CEA mRNA fluorescence increase at a threshold PCR cycle. RESULTS CEA was detected by nested RT-PCR analysis in 4 of 34 (12%) nodes of nonneoplastic disease, 2 of 13 (15%) nodes from T(1)N(0) patients, 32 of 81 (40%) nodes of T(2)N(0) patients, 49 of 109 (45%) nodes from T(3)N0 patients, and 92 of 163 (56%) nodes from T(1-4)N(1-2) patients. The overall presence of any RT-PCR-detectable CEA in nodes did not differentiate patient groups. Immunohistochemistry was positive in nodes from 7% of T(3)N(0) patients and 100% of T(1-3)N(1-2) patients. CEA quantification revealed that 0 of 7 patients with nonneoplastic disease and 2 of 17 (12%) patients with stage I T(1-2)N(0) cancers had one or more lymph nodes with >/=1.0 x 10(2) CEA transcripts per sample. In contrast, 4 of 13 (31%) patients with stage II T(3)N(0) cancer and 10 of 22 (45%) stage III patients with known metastases had lymph nodes with >/=1.0 x 10(2) CEA transcripts. CONCLUSIONS These data suggest that quantification of CEA levels in lymph nodes may more accurately identify patients at risk for cancer recurrence than does routine nested RT-PCR or immunohistochemistry.
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Affiliation(s)
- Samuel B Ho
- Departments of Medicine, Surgery, and Laboratory Medicine, Veterans Affairs Medical Center, Minneapolis, MN., USA.
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14
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Anwar S, Frayling IM, Scott NA, Carlson GL. Systematic review of genetic influences on the prognosis of colorectal cancer. Br J Surg 2004; 91:1275-91. [PMID: 15382104 DOI: 10.1002/bjs.4737] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Background
In terms of genetics, colorectal cancer is one of the best understood of all malignant diseases. Genetic influences on prognosis may have far-reaching implications, especially for the design of surgical and chemoradiotherapeutic regimens. However, their significance in determining prognosis remains unclear. This study aimed to review the literature on the specific role of key genes in determining the survival of patients with colorectal cancer.
Methods
A Medline search was carried out to identify all original scientific papers relating colorectal cancer genetics to patient survival, up to December 2002. Cochrane and Embase databases were also searched. Identified articles were retrieved and searched carefully for additional information. This review includes K-ras, p53, DCC, NM23 and DNA mismatch repair genes.
Results and conclusion
Conflicting evidence exists as to the prognostic significance of genes commonly implicated in the pathogenesis of colorectal carcinoma. Possible causes for such discrepancy include differences in study methods and laboratory techniques, variable duration of follow-up, statistical differences in study power, and heterogeneity in study populations. Future studies should adopt standardized protocols to define clinically relevant genetic observations.
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Affiliation(s)
- S Anwar
- Department of Colorectal Surgery, Hope Hospital, Salford, UK
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15
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Mulsow J, Winter DC, O'Keane JC, O'Connell PR. Sentinel lymph node mapping in colorectal cancer. Br J Surg 2003; 90:659-67. [PMID: 12808612 DOI: 10.1002/bjs.4217] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ultrastaging, by serial sectioning combined with immunohistochemical techniques, improves detection of lymph node micrometastases. Sentinel lymph node mapping and retrieval provides a representative node(s) to facilitate ultrastaging. The impact on staging of carcinoma of the colon and rectum in all series emphasizes the importance of this technique in cancer management. Now the challenge is to determine the biological relevance and prognostic implications. METHODS The electronic literature (1966 to present) on sentinel node mapping in carcinoma of the colon and rectum was reviewed. Further references were obtained by cross-referencing from key articles. RESULTS Lymphatic mapping appears to be readily applicable to colorectal cancer and identifies those lymph nodes most likely to harbour metastases. Sentinel node mapping carries a false-negative rate of approximately 10 per cent in larger studies, but will also potentially upstage a proportion of patients from node negative to node positive following the detection of micrometastases. The prognostic implication of these micrometastases requires further evaluation. CONCLUSION Further follow-up to assess the prognostic significance of micrometastases in colorectal cancer is required before the staging benefits of sentinel node mapping can have therapeutic implications.
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Affiliation(s)
- J Mulsow
- Department of Surgery, University College Dublin and Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
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Abstract
Surgical resection is the primary treatment modality for colorectal cancer, and the pathologic assessment of the resection specimen provides data that is essential for patient management, including the estimation of postoperative outcome and the rationale for adjuvant therapy. The essential elements of the pathological assessment of colorectal cancer resection specimens include the pathologic determination of TNM stage, tumor type, histologic grade, status of resection margins, and vascular invasion. The prognostic and/or predictive value of these elements, as well as guidelines for their derivation and interpretation, are reviewed in detail. Other tissue-based prognostic factors that are strongly suggested by existing data to have stage-independent prognostic value or to predict response to adjuvant therapy but that have not yet been validated for routine patient care are also reviewed. These include perineural invasion, tumor border configuration, host immune response to tumor, and molecular features such as microsatellite instability or loss of heterozygosity of chromosome 18. The need for high-quality, reproducible pathologic data in the care of the colorectal cancer patient, and the dependence of that data on standardization of all aspects of pathological assessment, is emphasized.
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Affiliation(s)
- Carolyn C Compton
- Department of Pathology and University Health Center, McGill University, Montreal, Quebec.
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Jubb AM, Quirke P, Oates AJ. DNA methylation, a biomarker for colorectal cancer: implications for screening and pathological utility. Ann N Y Acad Sci 2003; 983:251-67. [PMID: 12724230 DOI: 10.1111/j.1749-6632.2003.tb05980.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Currently up to one-third of colorectal cancer patients present with locally advanced or metastatic disease that precludes a surgical cure. Performance limitations and low uptake of current screening tools have fueled research to develop minimally invasive approaches that can detect early-stage neoplasms. The observation that altered DNA can be amplified from the stool or circulation has stimulated research on its use as a biomarker of occult neoplasia. De novo methylation of CpG islands 5' to certain tumor suppressor genes has been associated with epigenetic silencing. At certain loci this phenomenon is specific for neoplastic populations, and it is frequently detected at early stages in colorectal tumorigenesis. Accordingly, hypermethylation events have been proposed by researchers as ideal targets for the basis of a screening panel to detect peripheral tumor DNA. This critique reviews research findings on the use of epigenetic biomarkers in screening for occult neoplasia. In addition, the authors consider the pathological utility of epigenetic testing in refining tumor staging and predicting disease recurrence.
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Affiliation(s)
- Adrian M Jubb
- Academic Unit of Pathology, Leeds University, Leeds, UK.
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Bustin SA, Siddiqi S, Ahmed S, Hands R, Dorudi S. Quantification of cytokeratin 20, carcinoembryonic antigen and guanylyl cyclase C mRNA levels in lymph nodes may not predict treatment failure in colorectal cancer patients. Int J Cancer 2003; 108:412-7. [PMID: 14648708 DOI: 10.1002/ijc.11596] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Conventional histopathologic staging of primary colorectal cancers does not allow accurate prognostic stratification within a given tumour stage. Therefore, PCR-based assays are increasingly used to try to predict more accurately the likelihood of disease progression for the individual patient. Real-time reverse transcription PCR (RT-PCR) assays were used to detect and quantitate cytokeratin 20 (ck20), carcinoembryonic antigen (CEA) and guanylyl cyclase C (GCC) mRNA in 149 lymph nodes (LN) from 17 patients with benign disease and 302 LN from 42 patients with colorectal cancer who had curative (R0) resections. None of the markers were specific, with ck20, CEA and GCC mRNA detected in 47%, 89% and 13% of 149 LN, respectively, from patients with benign disease. The sensitivity of all 3 markers was very high, with mRNA detected in 93%, 100% and 97% of 30 histologically involved LN, respectively. There was significant overlap in the mRNA levels of all 3 markers between histologically involved and uninvolved LN. There was no association between mRNA levels and distant recurrence (median follow-up: 3.94 years, range 3.35-5.12). We conclude that the use of molecular techniques to detect occult disease in LN may suffer from the same limitations as conventional methods. Instead, accurate prognostic stratification requires careful assessment of the likely metastatic potential of the primary cancer.
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Affiliation(s)
- Stephen A Bustin
- Centre for Academic Surgery, Barts and the London Queen Mary's School of Medicine and Dentistry, London, United Kingdom.
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