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Takasu C, Nishi M, Yoshikawa K, Tokunaga T, Nakao T, Kashihara H, Wada Y, Yoshimoto T, Okikawa S, Yamashita S, Shimada M. Role of IDO expression in patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy. BMC Cancer 2022; 22:1263. [PMID: 36471264 PMCID: PMC9720962 DOI: 10.1186/s12885-022-10357-1] [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: 01/02/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of the immune system in locally advanced rectal cancer (LARC) following preoperative chemoradiotherapy (CRT) has been widely investigated in recent years. This study examined the prognostic significance of indoleamine-pyrrole 2,3-dioxygenase (IDO) expression in patients with LARC who received preoperative CRT. METHODS Ninety patients with LARC who underwent preoperative CRT and curative resection were enrolled. IDO and programmed death-ligand 1 (PD-L1) expression was evaluated by immunohistochemistry. RESULTS Clinicopathological factors did not significantly differ between patients with positive or negative IDO expression, excluding the correlation of positive IDO expression with better tumor differentiation (p = 0.02). IDO expression was not associated with pathological response (p = 0.44), but it was associated with PD-L1 expression. The 5-year overall survival (OS) rate was significantly worse in the IDO-positive group than in the IDO-negative group (64.8% vs. 85.4%, p = 0.02). Univariate analysis identified IDO and PD-L1 expression (p = 0.02), surgical procedure (p = 0.01), final pathological stage (p = 0.003), lymph node metastasis (p < 0.001), and lymphatic invasion (p = 0.002) as significant prognostic factors for OS. Multivariate analysis revealed that IDO expression (HR: 7.10, p = 0.0006), surgical procedure (HR: 5.03, p = 0.01), lymph node metastasis (HR: 2.37, p = 0.04) and lymphatic invasion (HR: 4.97, p = 0.01) were independent prognostic indicators. Disease-free survival was not correlated with IDO or PD-L1 expression. CONCLUSIONS IDO expression in patients with LARC who received preoperative CRT could be a potential prognostic indicator. IDO expression could be a useful marker for specifying individual treatment strategies in LARC.
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Affiliation(s)
- Chie Takasu
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Masaaki Nishi
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Kozo Yoshikawa
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Takuya Tokunaga
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Toshihiro Nakao
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Hideya Kashihara
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Yuma Wada
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Toshiaki Yoshimoto
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Shohei Okikawa
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Shoko Yamashita
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Mitsuo Shimada
- grid.267335.60000 0001 1092 3579Department of Surgery, University of Tokushima, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
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Okikawa S, Higashijima J, Nishi M, Yoshimoto T, Eto S, Takasu C, Kashihara H, Tokunaga T, Yoshikawa K, Shimada M. SDF-1 expression after preoperative chemoradiotherapy is associated with prognosis in patients with advanced lower rectal cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:309-314. [PMID: 34759150 DOI: 10.2152/jmi.68.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Stromal cell-derived factor-1 (SDF-1) expression is associated with cancer progression, as a biomarker of prognosis. We clarified the significance of SDF-1 expression on chemoradiotherapy (CRT) resistance and prognosis in advanced lower rectal cancer patients. We evaluated 98 patients with advanced lower rectal cancer who underwent preoperative CRT. All patients received 40 Gy of radiation therapy, with concurrent chemotherapy containing fluorinated pyrimidines, followed by surgical resection. SDF-1 expression in surgical specimens was examined by immunohistochemistry. We divided the patients into SDF-1-positive- (n = 52) and SDF-1-negative groups (n = 46) and compared the clinicopathological factors and survival rates. The SDF-1-positive group was more resistant to CRT than the SDF-1-negative group (non-responder rate, 63.5% vs. 47.8%, respectively ; p = 0.12). Overall survival (OS) in the SDF-1 positive group was significantly poorer vs. the SDF-1-negative group (5-year OS, 73.4% vs. 88.0%, respectively ; p = 0.02), and disease-free survival (DFS) was worse (5-year DFS, 61.0% vs. 74.1%, respectively ; p = 0.07). Multivariate analysis confirmed that SDF-1 expression was a significant independent prognostic predictor of OS (p = 0.04). SDF-1 expression after preoperative CRT is significantly associated with a poor prognosis in advanced lower rectal cancer patients and is a promising biomarker. J. Med. Invest. 68 : 309-314, August, 2021.
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Affiliation(s)
- Shohei Okikawa
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Jun Higashijima
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Masaaki Nishi
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Toshiaki Yoshimoto
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Shohei Eto
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Chie Takasu
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Hideya Kashihara
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Takuya Tokunaga
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Kozo Yoshikawa
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Mitsuo Shimada
- Department of Digestive and Pediatric Surgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
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Fischer J, Eglinton TW, Richards SJ, Frizelle FA. Predicting pathological response to chemoradiotherapy for rectal cancer: a systematic review. Expert Rev Anticancer Ther 2021; 21:489-500. [PMID: 33356679 DOI: 10.1080/14737140.2021.1868992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Pathological complete response (pCR) rates of approximately 20% following neoadjuvant long-course chemoradiotherapy for rectal cancer have given rise to non-operative or watch-and-wait (W&W) management. To improve outcomes there has been significant research into predictors of response. The goal is to optimize selection for W&W, avoid chemoradiotherapy in those who won't benefit and improve treatment to maximize the clinical complete response (cCR) rate and the number of patients who can be considered for W&W.Areas covered: A systematic review of articles published 2008-2018 and indexed in PubMed, Embase or Medline was performed to identify predictors of pathological response (including pCR and recognized tumor regression grades) to fluoropyrimidine-based chemoradiotherapy in patients who underwent total mesorectal excision for rectal cancer. Evidence for clinical, biomarker and radiological predictors is discussed as well as potential future directions.Expert opinion: Our current ability to predict the response to chemoradiotherapy for rectal cancer is very limited. cCR of 40% has been achieved with total neoadjuvant therapy. If neoadjuvant treatment for rectal cancer continues to improve it is possible that the treatment for rectal cancer may eventually parallel that of anal squamous cell carcinoma, with surgery reserved for the minority of patients who don't respond to chemoradiotherapy.
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Affiliation(s)
- Jesse Fischer
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, North Shore Hospital, Auckland, New Zealand
| | - Tim W Eglinton
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Simon Jg Richards
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, The Royal Melbourne Hospital, Melbourne, Australia
| | - Frank A Frizelle
- Department of Surgery, University of Otago, Christchurch, New Zealand.,Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
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Ferreiro-Neira I, Torres NE, Liesenfeld LF, Chan CHF, Penson T, Landesman Y, Senapedis W, Shacham S, Hong TS, Cusack JC. XPO1 Inhibition Enhances Radiation Response in Preclinical Models of Rectal Cancer. Clin Cancer Res 2016; 22:1663-73. [PMID: 26603256 DOI: 10.1158/1078-0432.ccr-15-0978] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 11/04/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Combination of radiation with radiosensitizing chemotherapeutic agents improves outcomes for locally advanced rectal cancer. Current treatment includes 5-fluorouracil-based chemoradiation prior to surgical resection; however pathologic complete response varies from 15% to 20%, prompting the need to identify new radiosensitizers. Exportin 1 (XPO1, also known as chromosome region 1, CRM1) mediates the nuclear export of critical proteins required for rectal cancer proliferation and treatment resistance. We hypothesize that inhibition of XPO1 may radiosensitize cancer cells by altering the function of these critical proteins resulting in decreased radiation resistance and enhanced antitumoral effects. EXPERIMENTAL DESIGN To test our hypothesis, we used the selective XPO1 inhibitor, selinexor, to inhibit nuclear export in combination with radiation fractions similar to that given in clinical practice for rectal cancer: hypofractionated short-course radiation dosage of 5 Gy per fraction or the conventional long-course radiation dosage of 1 Gy fractions. Single and combination treatments were tested in colorectal cancer cell lines and xenograft tumor models. RESULTS Combination treatment of radiotherapy and selinexor resulted in an increase of apoptosis and decrease of proliferation compared with single treatment, which correlated with reduced tumor size. We found that the combination promoted nuclear survivin accumulation and subsequent depletion, resulting in increased apoptosis and enhanced radiation antitumoral effects. CONCLUSIONS Our findings suggest a novel therapeutic option for improving radiation sensitivity in the setting of rectal cancer and provide the scientific rationale to evaluate this combination strategy for clinical trials.
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Affiliation(s)
- Isabel Ferreiro-Neira
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.
| | - Nancy E Torres
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | - Lukas F Liesenfeld
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | - Carlos H F Chan
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | - Tristan Penson
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Theodore S Hong
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - James C Cusack
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts.
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Abstract
Survivin, a member of the inhibitor of apoptosis protein family, is one of the most cancer-specific proteins identified to date. Survivin expression is low or undetectable in most adult tissues, but, alternatively, is overexpressed in a large number of tumors. This multifunctional protein is recognized as a key regulator in apoptosis, proliferation and angiogenesis in the tumor environment. Several studies have shown a correlation between survivin upregulation and poor cancer prognosis, and, as expected, its downregulation or inactivation leads to inhibition of tumor growth. Therefore, survivin has attracted increasing attention both as a potential cancer biomarker and as a new target for anticancer therapies. This review summarizes and discusses survivin expression and its potential as a prognostic and diagnostic biomarker in different types of tumors, as well as provides an overview of the current therapeutic challenges of targeting survivin as a treatment strategy.
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Krieg A, Werner TA, Verde PE, Stoecklein NH, Knoefel WT. Prognostic and clinicopathological significance of survivin in colorectal cancer: a meta-analysis. PLoS One 2013; 8:e65338. [PMID: 23755220 PMCID: PMC3670901 DOI: 10.1371/journal.pone.0065338] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/24/2013] [Indexed: 12/17/2022] Open
Abstract
Survivin/BIRC5 is a potentially interesting prognostic marker and therapeutic target in colorectal cancer (CRC). However, the available data on survivin expression in CRC are heterogeneous. Thus, to clarify the prognostic relevance of survivin in patients with CRC and its association with clinicopathological parameters we performed a meta-analysis. We screened PubMed and EMBASE for those studies that investigated the prognostic value of survivin and its association with clinicopathological parameters in CRC. Data from eligible studies were extracted and included into the meta-analyses using a random effects model. Electronical literature search identified 15 studies including 1934 patients with CRC mostly detecting survivin by immunohistochemistry (IHC). Pooled hazard ratios of 11 studies that performed survival analysis revealed a positive correlation between survivin expression and poor prognosis (HR 1.93; 95% CI: 1.55–2.42; P<0.00001; I2 = 23%). Subgroup analyses with respect to the detection method, HR estimation, global quality score and the country of origin in which the study was conducted supported the stability of this observation. In addition, meta-analyses revealed a significant association between expression of survivin and the presence of lymph node metastases (OR: 0.37; 95% CI: 0.19–0.75; I2 = 61%) or blood vessel invasion (OR: 0.50; 95% CI: 0.28–0.90; I2 = 0%). Expression of survivin indicates poor prognosis and a pro-metastatic phenotype and may be useful in identifying a subgroup of patients that could benefit from a targeted therapy against survivin in CRC.
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Affiliation(s)
- Andreas Krieg
- Department of Surgery A, Heinrich-Heine-University and University Hospital Duesseldorf, Duesseldorf, Germany.
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