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Liu Y, Sun BJT, Zhang C, Li B, Yu XX, Du Y. Preoperative prediction of perineural invasion of rectal cancer based on a magnetic resonance imaging radiomics model: A dual-center study. World J Gastroenterol 2024; 30:2233-2248. [PMID: 38690027 PMCID: PMC11056922 DOI: 10.3748/wjg.v30.i16.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Perineural invasion (PNI) has been used as an important pathological indicator and independent prognostic factor for patients with rectal cancer (RC). Preoperative prediction of PNI status is helpful for individualized treatment of RC. Recently, several radiomics studies have been used to predict the PNI status in RC, demonstrating a good predictive effect, but the results lacked generalizability. The preoperative prediction of PNI status is still challenging and needs further study. AIM To establish and validate an optimal radiomics model for predicting PNI status preoperatively in RC patients. METHODS This retrospective study enrolled 244 postoperative patients with pathologically confirmed RC from two independent centers. The patients underwent pre-operative high-resolution magnetic resonance imaging (MRI) between May 2019 and August 2022. Quantitative radiomics features were extracted and selected from oblique axial T2-weighted imaging (T2WI) and contrast-enhanced T1WI (T1CE) sequences. The radiomics signatures were constructed using logistic regression analysis and the predictive potential of various sequences was compared (T2WI, T1CE and T2WI + T1CE fusion sequences). A clinical-radiomics (CR) model was established by combining the radiomics features and clinical risk factors. The internal and external validation groups were used to validate the proposed models. The area under the receiver operating characteristic curve (AUC), DeLong test, net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration curve, and decision curve analysis (DCA) were used to evaluate the model performance. RESULTS Among the radiomics models, the T2WI + T1CE fusion sequences model showed the best predictive performance, in the training and internal validation groups, the AUCs of the fusion sequence model were 0.839 [95% confidence interval (CI): 0.757-0.921] and 0.787 (95%CI: 0.650-0.923), which were higher than those of the T2WI and T1CE sequence models. The CR model constructed by combining clinical risk factors had the best predictive performance. In the training and internal and external validation groups, the AUCs of the CR model were 0.889 (95%CI: 0.824-0.954), 0.889 (95%CI: 0.803-0.976) and 0.894 (95%CI: 0.814-0.974). Delong test, NRI, and IDI showed that the CR model had significant differences from other models (P < 0.05). Calibration curves demonstrated good agreement, and DCA revealed significant benefits of the CR model. CONCLUSION The CR model based on preoperative MRI radiomics features and clinical risk factors can preoperatively predict the PNI status of RC noninvasively, which facilitates individualized treatment of RC patients.
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Affiliation(s)
- Yan Liu
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bai-Jin-Tao Sun
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Chuan Zhang
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bing Li
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Xiao-Xuan Yu
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Yong Du
- Department of Radiology, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China.
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Liu NJ, Liu MS, Tian W, Zhai YN, Lv WL, Wang T, Guo SL. The value of machine learning based on CT radiomics in the preoperative identification of peripheral nerve invasion in colorectal cancer: a two-center study. Insights Imaging 2024; 15:101. [PMID: 38578423 PMCID: PMC10997560 DOI: 10.1186/s13244-024-01664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND We aimed to explore the application value of various machine learning (ML) algorithms based on multicenter CT radiomics in identifying peripheral nerve invasion (PNI) of colorectal cancer (CRC). METHODS A total of 268 patients with colorectal cancer who underwent CT examination in two hospitals from January 2016 to December 2022 were considered. Imaging and clinicopathological data were collected through the Picture Archiving and Communication System (PACS). The Feature Explorer software (FAE) was used to identify the peripheral nerve invasion of colorectal patients in center 1, and the best feature selection and classification channels were selected. Finally, the best feature selection and classifier pipeline were verified in center 2. RESULTS The six-feature models using RFE feature selection and GP classifier had the highest AUC values, which were 0.610, 0.699, and 0.640, respectively. FAE generated a more concise model based on one feature (wavelet-HLL-glszm-LargeAreaHighGrayLevelEmphasis) and achieved AUC values of 0.614 and 0.663 on the validation and test sets, respectively, using the "one standard error" rule. Using ANOVA feature selection, the GP classifier had the best AUC value in a one-feature model, with AUC values of 0.611, 0.663, and 0.643 on the validation, internal test, and external test sets, respectively. Similarly, when using the "one standard error" rule, the model based on one feature (wave-let-HLL-glszm-LargeAreaHighGrayLevelEmphasis) achieved AUC values of 0.614 and 0.663 on the validation and test sets, respectively. CONCLUSIONS Combining artificial intelligence and radiomics features is a promising approach for identifying peripheral nerve invasion in colorectal cancer. This innovative technique holds significant potential for clinical medicine, offering broader application prospects in the field. CRITICAL RELEVANCE STATEMENT The multi-channel ML method based on CT radiomics has a simple operation process and can be used to assist in the clinical screening of patients with CRC accompanied by PNI. KEY POINTS • Multi-channel ML in the identification of peripheral nerve invasion in CRC. • Multi-channel ML method based on CT-radiomics can detect the PNI of CRC. • Early preoperative identification of PNI in CRC is helpful to improve the formulation of treatment strategies and the prognosis of patients.
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Affiliation(s)
- Nian-Jun Liu
- The First School of Clinical Medical, Lanzhou University, LanzhouGansu, 73000, China
- Department of Radiology, the First Hospital of Lanzhou University, LanzhouGansu, 73000, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, LanzhouGansu, 73000, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, LanzhouGansu, 73000, China
- Gansu Province clinical research center for radiology imaging, LanzhouGansu, 73000, China
| | - Mao-Sen Liu
- Lichuan People's Hospital, Lichuan, 445400, Hubei, China
| | - Wei Tian
- The First School of Clinical Medical, Lanzhou University, LanzhouGansu, 73000, China
- Department of Radiology, the First Hospital of Lanzhou University, LanzhouGansu, 73000, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, LanzhouGansu, 73000, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, LanzhouGansu, 73000, China
- Gansu Province clinical research center for radiology imaging, LanzhouGansu, 73000, China
| | - Ya-Nan Zhai
- The First School of Clinical Medical, Lanzhou University, LanzhouGansu, 73000, China
- Department of Radiology, the First Hospital of Lanzhou University, LanzhouGansu, 73000, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, LanzhouGansu, 73000, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, LanzhouGansu, 73000, China
- Gansu Province clinical research center for radiology imaging, LanzhouGansu, 73000, China
| | - Wei-Long Lv
- The First School of Clinical Medical, Lanzhou University, LanzhouGansu, 73000, China
- Department of Radiology, the First Hospital of Lanzhou University, LanzhouGansu, 73000, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, LanzhouGansu, 73000, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, LanzhouGansu, 73000, China
- Gansu Province clinical research center for radiology imaging, LanzhouGansu, 73000, China
| | - Tong Wang
- The First School of Clinical Medical, Lanzhou University, LanzhouGansu, 73000, China
- Department of Radiology, the First Hospital of Lanzhou University, LanzhouGansu, 73000, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, LanzhouGansu, 73000, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, LanzhouGansu, 73000, China
- Gansu Province clinical research center for radiology imaging, LanzhouGansu, 73000, China
| | - Shun-Lin Guo
- The First School of Clinical Medical, Lanzhou University, LanzhouGansu, 73000, China.
- Department of Radiology, the First Hospital of Lanzhou University, LanzhouGansu, 73000, China.
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, LanzhouGansu, 73000, China.
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, LanzhouGansu, 73000, China.
- Gansu Province clinical research center for radiology imaging, LanzhouGansu, 73000, China.
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Que Y, Wu R, Li H, Lu J. A prediction nomogram for perineural invasion in colorectal cancer patients: a retrospective study. BMC Surg 2024; 24:80. [PMID: 38439014 PMCID: PMC10913563 DOI: 10.1186/s12893-024-02364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Perineural invasion (PNI), as the fifth recognized pathway for the spread and metastasis of colorectal cancer (CRC), has increasingly garnered widespread attention. The preoperative identification of whether colorectal cancer (CRC) patients exhibit PNI can assist clinical practitioners in enhancing preoperative decision-making, including determining the necessity of neoadjuvant therapy and the appropriateness of surgical resection. The primary objective of this study is to construct and validate a preoperative predictive model for assessing the risk of perineural invasion (PNI) in patients diagnosed with colorectal cancer (CRC). MATERIALS AND METHODS A total of 335 patients diagnosed with colorectal cancer (CRC) at a single medical center were subject to random allocation, with 221 individuals assigned to a training dataset and 114 to a validation dataset, maintaining a ratio of 2:1. Comprehensive preoperative clinical and pathological data were meticulously gathered for analysis. Initial exploration involved conducting univariate logistic regression analysis, with subsequent inclusion of variables demonstrating a significance level of p < 0.05 into the multivariate logistic regression analysis, aiming to ascertain independent predictive factors, all while maintaining a p-value threshold of less than 0.05. From the culmination of these factors, a nomogram was meticulously devised. Rigorous evaluation of this nomogram's precision and reliability encompassed Receiver Operating Characteristic (ROC) curve analysis, calibration curve assessment, and Decision Curve Analysis (DCA). The robustness and accuracy were further fortified through application of the bootstrap method, which entailed 1000 independent dataset samplings to perform discrimination and calibration procedures. RESULTS The results of multivariate logistic regression analysis unveiled independent risk factors for perineural invasion (PNI) in patients diagnosed with colorectal cancer (CRC). These factors included tumor histological differentiation (grade) (OR = 0.15, 95% CI = 0.03-0.74, p = 0.02), primary tumor location (OR = 2.49, 95% CI = 1.21-5.12, p = 0.013), gross tumor type (OR = 0.42, 95% CI = 0.22-0.81, p = 0.01), N staging in CT (OR = 3.44, 95% CI = 1.74-6.80, p < 0.001), carcinoembryonic antigen (CEA) level (OR = 3.13, 95% CI = 1.60-6.13, p = 0.001), and platelet-to-lymphocyte ratio (PLR) (OR = 2.07, 95% CI = 1.08-3.96, p = 0.028).These findings formed the basis for constructing a predictive nomogram, which exhibited an impressive area under the receiver operating characteristic (ROC) curve (AUC) of 0.772 (95% CI, 0.712-0.833). The Hosmer-Lemeshow test confirmed the model's excellent fit (p = 0.47), and the calibration curve demonstrated consistent performance. Furthermore, decision curve analysis (DCA) underscored a substantial net benefit across the risk range of 13% to 85%, reaffirming the nomogram's reliability through rigorous internal validation. CONCLUSION We have formulated a highly reliable nomogram that provides valuable assistance to clinical practitioners in preoperatively assessing the likelihood of perineural invasion (PNI) among colorectal cancer (CRC) patients. This tool holds significant potential in offering guidance for treatment strategy formulation.
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Affiliation(s)
- Yao Que
- The University of South China, Hengyang, People's Republic of China
| | - Ruiping Wu
- Department of General Surgery, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China
| | - Hong Li
- Department of General Surgery, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China
| | - Jinli Lu
- Department of General Surgery, The First People's Hospital of Changde City, Changde, 415003, People's Republic of China.
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María GSI, Teresa EJM, Manuel MF, Miguel MPJ. Convined clinical prognostic model in colorectal cancer. Updates Surg 2024:10.1007/s13304-023-01690-6. [PMID: 38236504 DOI: 10.1007/s13304-023-01690-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/25/2023] [Indexed: 01/19/2024]
Abstract
Current staging systems in patients with colorectal cancer (CRC) utilize relatively few patient characteristics in comparison to the breadth of information available. The objective of our study is to analyze the heterogeneous set of variables that may influence mortality and recurrence independently in patients with CCR, and prepare a predictive model of survival and recurrence. Data from 288 patients who had undergone scheduled surgery for stage I-III cancer of the colon and upper rectum were used to construct Cox models for DFS and overall CSS at five years. We have jointly examined clinical variables, serological markers and histological variables with the aim of identifying new prognostic factors. Internal and external validation was carried out on each of the nomograms obtained. Perineural invasion; high platelet-lymphocyte ratio (PLR) and the pN stage were the variables that emerged as an independent risk factor of recurrence. The variables related independently to overall CSS were the presence of blood in stools, high PLR and nodal involvement. We have created a predictive model of recurrence and mortality at 5 years with data that is easily available (clinical, analytical and histological variables) which can help personalize the treatment and follow-up of patients with CRC. We also conducted an adequate internal and external validation.
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Affiliation(s)
- Gallarín Salamanca Isabel María
- Division of Colorectal Surgery, Department of Surgery, Badajoz University Hospital, Carrillo Arenas 20A, Villafranca de los Barros, 06220, Badajoz, Spain.
| | - Espín Jaime María Teresa
- Division of Colorectal Surgery, Department of Surgery, Badajoz University Hospital, Carrillo Arenas 20A, Villafranca de los Barros, 06220, Badajoz, Spain
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Liu J, Sun L, Zhao X, Lu X. Development and validation of a combined nomogram for predicting perineural invasion status in rectal cancer via computed tomography-based radiomics. J Cancer Res Ther 2023; 19:1552-1559. [PMID: 38156921 DOI: 10.4103/jcrt.jcrt_2633_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/05/2023] [Indexed: 01/03/2024]
Abstract
AIM This study aimed to create and validate a clinic-radiomics nomogram based on computed tomography (CT) imaging for predicting preoperative perineural invasion (PNI) of rectal cancer (RC). MATERIAL AND METHODS This study enrolled 303 patients with RC who were divided into training (n = 242) and test datasets (n = 61) in an 8:2 ratio with all their clinical outcomes. A total of 3,296 radiomic features were extracted from CT images. Five machine learning (ML) models (logistic regression (LR)/K-nearest neighbor (KNN)/multilayer perceptron (MLP)/support vector machine (SVM)/light gradient boosting machine (LightGBM)) were developed using radiomic features derived from the arterial and venous phase images, and the model with the best diagnostic performance was selected. By combining the radiomics and clinical signatures, a fused nomogram model was constructed. RESULTS After using the Mann-Whitney U-test and least absolute shrinkage and selection operator (LASSO) to remove redundant features, the MLP model proved to be the most efficient among the five ML models. The fusion nomogram based on MLP prediction probability further improves the ability to predict the PNI status. The area under the curve (AUC) of the training and test sets was 0.883 and 0.889, respectively, which were higher than those of the clinical (training set, AUC = 0.710; test set, AUC = 0.762) and radiomic models (training set, AUC = 0.840; test set, AUC = 0.834). CONCLUSIONS The clinical-radiomics combined nomogram model based on enhanced CT images efficiently predicted the PNI status of patients with RC.
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Affiliation(s)
- Jiaxuan Liu
- Department of Radiology, The Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Lingling Sun
- Department of Radiology, The Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Xiang Zhao
- Institute of Innovative Science and Technology, Shenyang University, Liaoning, China
| | - Xi Lu
- Department of Radiology, The Fourth Affiliated Hospital of China Medical University, Liaoning, China
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Zhang B, Lin Y, Wang C, Chen Z, Huang T, Chen H, Wang G, Lan P, He X, He X. Combining perineural invasion with staging improve the prognostic accuracy in colorectal cancer: a retrospective cohort study. BMC Cancer 2023; 23:675. [PMID: 37464346 DOI: 10.1186/s12885-023-11114-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Current guidelines only propose the importance of perineural invasion(PNI) on prognosis in stage II colon cancer. However, the prognostic value of PNI in other stages of colorectal cancer (CRC) is ambiguous. METHODS This single-center retrospective cohort study included 3485 CRC patients who underwent primary colorectal resection between January 2013 and December 2016 at the Sixth Affiliated Hospital of Sun Yat-sen University. Associations of PNI with overall survival (OS) and disease-free survival (DFS) were evaluated using multivariable Cox proportional hazards regression models. In addition, interaction analyses were performed to explore the prognostic effects of PNI in different clinical subgroups. RESULTS After median follow-up of 61.9 months, we found PNI was associated with poorer OS (adjusted hazard ratio [aHR], 1.290; 95% CI, 1.087-1.531) and DFS (aHR, 1.397; 95% CI, 1.207-1.617), irrespective of tumor stage. Interestingly, the weight of PNI was found second only to incomplete resection in the nomogram for risk factors of OS and DFS in stage II CRC patients. Moreover, OS and DFS were insignificantly different between stage II patients with PNI and stage III patients (both P > 0.05). PNI was found to be an independent prognostic factor of DFS in stage III CRC (aHR: 1.514; 95% CI, 1.211-1.892) as well. Finally, the adverse effect of PNI on OS was more significant in female, early-onset, and diabetes-negative patients than in their counterparts (interaction P = 0.0213, 0.0280, and 0.0186, respectively). CONCLUSION PNI was an important prognostic factor in CRC, more than in stage II. The survival of patients with stage II combined with perineural invasion is similar with those with stage III. PNI in stage III CRC also suggests a worse survival.
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Affiliation(s)
- Bin Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Yanyun Lin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Chao Wang
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Zexian Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Tianze Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Hao Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Guannan Wang
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Ping Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China
| | - Xiaowen He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China.
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China.
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China.
| | - Xiaosheng He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China.
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China.
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, Guangdong, China.
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Qin L, Heng Y, Deng S, Gu J, Mao F, Xue Y, Jiang Z, Wang J, Cheng D, Wu K, Cao Y, Cai K. Perineural invasion affects prognosis of patients undergoing colorectal cancer surgery: a propensity score matching analysis. BMC Cancer 2023; 23:452. [PMID: 37202778 DOI: 10.1186/s12885-023-10936-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Tumour perineural invasion (PNI) is a predictor of poor prognosis, but its effect on the prognosis of patients with colorectal cancer (CRC) has not yet been elucidated. METHODS This retrospective study used propensity score matching (PSM). The clinical case data of 1470 patients with surgically treated stage I-IV CRC at Wuhan Union Hospital were collected. PSM was used to analyse and compare the clinicopathological characteristics, perioperative outcomes, and long-term prognostic outcomes of the PNI(+) and PNI(-) groups. The factors influencing prognosis were screened using Cox univariate and multivariate analyses. RESULTS After PSM, 548 patients were included in the study (n = 274 in each group). Multifactorial analysis showed that neurological invasion was an independent prognostic factor affecting patients' OS and DFS (hazard ratio [HR], 1.881; 95% confidence interval [CI], 1.35-2.62; P = 0.0001; HR, 1.809; 95% CI, 1.353-2.419; P < 0.001). Compared to PNI(+) patients without chemotherapy, those who received chemotherapy had a significant improvement in OS (P < 0.01). The AUROC curve of OS in the PNI(+) subgroup (0.802) was higher than that after PSM (0.743), while that of DFS in the PNI(+) subgroup (0.746) was higher than that after PSM (0.706). The independent predictors of PNI(+) could better predict the prognosis and survival of patients with PNI(+). CONCLUSIONS PNI significantly affects the long-term survival and prognosis of patients with CRC undergoing surgery and is an independent risk factor for OS and DFS in patients with CRC undergoing surgery. Postoperative chemotherapy significantly improved the OS of PNI(+) patients.
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Affiliation(s)
- Le Qin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832008, Xinjiang, P.R. China
| | - Yixin Heng
- Department of General Surgery, The First Affiliated Hospital of Shihezi University, Shihezi, 832008, Xinjiang, P.R. China
| | - Shenghe Deng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Junnan Gu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Fuwei Mao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yifan Xue
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Zhenxing Jiang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Jun Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Denglong Cheng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ke Wu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yinghao Cao
- Department of Digestive Surgical Oncology, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Huang T, Lin Y, Chen J, Hu J, Chen H, Zhang Y, Zhang B, He X. CD51 Intracellular Domain Promotes Cancer Cell Neurotropism through Interacting with Transcription Factor NR4A3 in Colorectal Cancer. Cancers (Basel) 2023; 15:cancers15092623. [PMID: 37174090 PMCID: PMC10177513 DOI: 10.3390/cancers15092623] [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: 02/17/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
The abundant nervous system in intestine provides the basis for perineural invasion (PNI) of colorectal cancer (CRC). PNI is defined as the invasion of the nerves by cancer cells. Although PNI is already known to be an independent prognostic factor in CRC, the molecular mechanism underlying PNI remains obscure. In this study, we first demonstrated that CD51 could promote the neurotropism of tumor cells through cleavage with γ-secretase to generate an intracellular domain (ICD). Mechanistically, ICD of CD51 could bind to the transcription factor NR4A3, and act as a coactivator to promote the expression of downstream effectors, such as NTRK1, NTRK3, and SEMA3E. Pharmacological inhibition of γ-secretase impedes PNI mediated by CD51 in CRC both in vitro and in vivo and may become a potential therapeutic target for PNI in CRC.
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Affiliation(s)
- Tianze Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Yanyun Lin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Junguo Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Jiancong Hu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Hao Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Yanhong Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Bin Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
| | - Xiaosheng He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510655, China
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Riffet M, Dupont B, Faisant M, Cerasuolo D, Menahem B, Alves A, Dubois F, Levallet G, Bazille C. New Histoprognostic Factors to Consider for the Staging of Colon Cancers: Tumor Deposits, Invasive Tumor Infiltration and High-Grade Budding. Int J Mol Sci 2023; 24:ijms24043573. [PMID: 36834985 PMCID: PMC9959523 DOI: 10.3390/ijms24043573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Colorectal cancer is a major public health issue due to its high incidence and mortality. It is, therefore, essential to identify histological markers for prognostic purposes and to optimize the therapeutic management of patients. The main objective of our study was to analyze the impact of new histoprognostic factors, such as tumor deposits, budding, poorly differentiated clusters, mode of infiltration, the intensity of inflammatory infiltrate and the type of tumor stroma, on the survival of patients with colon cancer. Two hundred and twenty-nine resected colon cancers were fully histologically reviewed, and survival and recurrence data were collected. Survival was analyzed using Kaplan-Meier curves. A univariate and multivariate Cox model was constructed to identify prognostic factors for overall survival and recurrence-free survival. The median overall survival of the patients was 60.2 months and the median recurrence-free survival was 46.9 months. Overall survival and recurrence-free survival were significantly worse in the presence of isolated tumor deposits (log rank = 0.003 and 0.001, respectively) and for an infiltrative type of tumor invasion (log rank = 0.008 and 0.02, respectively). High-grade budding was associated with a poor prognosis, with no significant difference. We did not find a significant prognostic impact of the presence of poorly differentiated clusters, the intensity of the inflammatory infiltrate or the stromal type. In conclusion, the analysis of these recent histoprognostic factors, such as tumor deposits, mode of infiltration, and budding, could be integrated into the results of pathological reports of colon cancers. Thus, the therapeutic management of patients could be adjusted by providing more aggressive treatments in the presence of some of these factors.
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Affiliation(s)
- Marc Riffet
- Department of Pathology, CHU de Caen, 14000 Caen, France
| | - Benoît Dupont
- Department of Gastroenterology, CHU de Caen, 14000 Caen, France
- ANTICIPE, INSERM UMR 1086, UNICAEN, Normandie Université, 14076 Caen, France
| | - Maxime Faisant
- Department of Pathology, CHU de Caen, 14000 Caen, France
| | - Damiano Cerasuolo
- Biostatistics and Clinical Research Unit, CHU de Caen, 14000 Caen, France
| | - Benjamin Menahem
- ANTICIPE, INSERM UMR 1086, UNICAEN, Normandie Université, 14076 Caen, France
- Department of Digestive Surgery, CHU de Caen, 14000 Caen, France
| | - Arnaud Alves
- ANTICIPE, INSERM UMR 1086, UNICAEN, Normandie Université, 14076 Caen, France
- Department of Digestive Surgery, CHU de Caen, 14000 Caen, France
| | - Fatémeh Dubois
- Department of Pathology, CHU de Caen, 14000 Caen, France
- ISTCT, GIP CYCERON, CNRS, UNICAEN, Normandie Université, 14074 Caen, France
- Structure Fédérative D’oncogénétique cyto-Moléculaire, CHU de Caen, 14000 Caen, France
| | - Guénaëlle Levallet
- Department of Pathology, CHU de Caen, 14000 Caen, France
- ISTCT, GIP CYCERON, CNRS, UNICAEN, Normandie Université, 14074 Caen, France
- Structure Fédérative D’oncogénétique cyto-Moléculaire, CHU de Caen, 14000 Caen, France
| | - Céline Bazille
- Department of Pathology, CHU de Caen, 14000 Caen, France
- ISTCT, GIP CYCERON, CNRS, UNICAEN, Normandie Université, 14074 Caen, France
- Correspondence:
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10
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Sung SY, Kim SH, Jang HS, Song JH, Jeong S, Jung JH, Lee JH. Pathologic Implications of Radial Resection Margin and Perineural Invasion to Adjuvant Chemotherapy after Preoperative Chemoradiotherapy and Surgery for Rectal Cancer: A Multi-Institutional and Case-Matched Control Study. Cancers (Basel) 2022; 14:cancers14174112. [PMID: 36077649 PMCID: PMC9454910 DOI: 10.3390/cancers14174112] [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: 07/11/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
We assessed the exact role of adjuvant chemotherapy after neoadjuvant chemoradiotherapy (CRT) and surgery in rectal cancer patients with positive surgical margin or perineural invasion (PNI). This multi-institutional study included 1799 patients with rectal cancer at cT3-4N0-2M0 stages. Patients were divided into two groups. The high-risk group had a positive margin and/or perineural invasion. The low-risk group showed no positive margin or PNI. Propensity-score matching analysis was performed, and a total of 928 patients, with 464 in each arm, were evaluated. The high-risk group showed significant differences in overall survival (OS, 73.4% vs. 53.9%, p < 0.01) and recurrence-free survival (RFS, 52.7% vs. 40.9%, p = 0.01) at five years between the adjuvant chemotherapy arm and observation arm. The low-risk group showed no significant differences in 5-year OS (p = 0.61) and RFS (p = 0.75) between the two arms. Multivariate analyses showed that age, pathologic N stage, and adjuvant chemotherapy were significantly correlated with OS and RFS in the high-risk group (all p < 0.05). Adjuvant chemotherapy improved OS and RFS more significantly in rectal cancer patients with positive surgical margin or PNI than in those with negative surgical margin and PNI.
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Affiliation(s)
- Soo-Yoon Sung
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jin Ho Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Songmi Jeong
- Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 11765, Korea
| | - Ji-Han Jung
- Department of Hospital Pathology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea
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11
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Ma J, Guo D, Miao W, Wang Y, Yan L, Wu F, Zhang C, Zhang R, Zuo P, Yang G, Wang Z. The value of 18F-FDG PET/CT-based radiomics in predicting perineural invasion and outcome in non-metastatic colorectal cancer. Abdom Radiol (NY) 2022; 47:1244-1254. [PMID: 35218381 DOI: 10.1007/s00261-022-03453-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Perineural invasion (PNI) has been recognized as an important prognosis factor in patients with colorectal cancer (CRC). The purpose of this retrospective study was to investigate the value of 18F-FDG PET/CT-based radiomics integrating clinical information, PET/CT features, and metabolic parameters for preoperatively predicting PNI and outcome in non-metastatic CRC and establish an easy-to-use nomogram. METHODS A total of 131 patients with non-metastatic CRC who undergo PET/CT scan were retrospectively enrolled. Univariate analysis was used to compare the differences between PNI-present and PNI-absent groups. Multivariate logistic regression was performed to select the independent predictors for PNI status. Akaike information criterion (AIC) was used to select the best prediction models for PNI status. CT radiomics signatures (RSs) and PET-RSs were selected by maximum relevance minimum redundancy (mRMR) and the least absolute shrinkage and selection operator algorithm (LASSO) regression and radiomics scores (Rad-scores) were calculated for each patient. The prediction models with or without Rad-score were established. According to the nomogram, nomogram scores (Nomo-scores) were calculated for each patient. The performance of different models was assessed with the area under the curve (AUC), specificity, and sensitivity. The clinical usefulness was assessed by decision curve (DCA). Multivariate Cox regression was used to selected independent predictors of progression-free survival (PFS). RESULTS Among all the clinical information, PET/CT features, and metabolic parameters, CEA, lymph node metastatic on PET/CT (N stage), and total lesion glycolysis (TLG) were independent predictors for PNI (p < 0.05). Six CT-RSs and 12 PET-RSs were selected as the most valuable factors to predict PNI. The Rad-score calculated with these RSs was significantly different between PNI-present and PNI-absent groups (p < 0.001). The AUC of the constructed model was 0.90 (95%CI: 0.83-0.97) in the training cohort and 0.80 (95%CI: 0.65-0.95) in the test cohort. The nomogram's predicting sensitivity was 0.84 and the specificity was 0.83 in the training cohort. The clinical model's predicting sensitivity and specificity were 0.66 and 0.85 in the training cohort, respectively. Besides, DCA showed that patients with non-metastatic CRC could get more benefit with our model. The results also indicated that N stage, PNI status, and the Nomo-score were independent predictors of PFS in patients with non-metastatic CRC. CONCLUSION The nomogram, integrating clinical data, PET/CT features, metabolic parameters, and radiomics, performs well in predicting PNI status and is associated with the outcome in patients with non-metastatic CRC.
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Affiliation(s)
- Jie Ma
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China
| | - Dong Guo
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenjie Miao
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China
| | - Yangyang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China
| | - Lei Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China
| | - Fengyu Wu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China
| | - Chuantao Zhang
- Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Ran Zhang
- Huiying Medical Technology Co.Ltd, Beijing, China
| | - Panli Zuo
- Huiying Medical Technology Co.Ltd, Beijing, China
| | - Guangjie Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China.
| | - Zhenguang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, No. 59 Hair Road, Qingdao, Shandong, China.
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12
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Li J, Mei S, Zhou S, Zhao F, Liu Q. Perineural invasion is a prognostic factor in stage II colorectal cancer but not a treatment indicator for traditional chemotherapy: a retrospective cohort study. J Gastrointest Oncol 2022; 13:710-721. [PMID: 35557585 PMCID: PMC9086063 DOI: 10.21037/jgo-22-277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/13/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Perineural invasion (PNI) is considered a risk factor of survival but does not yet inform treatment decisions, and has not been studied separately in stage II colorectal cancer (CRC) patients whose postoperative traditional chemotherapy is controversial. This cohort study aimed to assess the association of PNI with basic clinicopathological features and patient outcomes after curative resection and the effects of PNI on responses to adjuvant chemotherapy in stage II CRC. METHODS The clinical data of 371 stage II CRC patients who underwent curative-intent surgery at the National Cancer Center/Cancer Hospital in 2014 were retrospectively reviewed. The adjuvant chemotherapy data were acquired from follow-up information. PNI status was examined, and the overall survival (OS) and disease-free survival (DFS) rates were analyzed. RESULTS PNI was detected in 82 of the 371 patients (22.1%) and was closely correlated with preoperative serum carcinoembryonic antigen (CEA) levels (P=0.030), gross tumor type (P=0.010), tumor differentiation (P=0.010), p stage (P<0.001), and extramural vascular invasion (EMVI) (P<0.001). The median follow-up time was 71 months. The 5-year OS was 84.1% and 96.5% (P<0.001), and the 5-year DFS was 75.6% and 91.3% (P<0.001) for PNI-positive (+) and PNI-negative (-) patients, respectively. The multivariate regression analyses identified PNI as an independent negative prognostic factor for DFS [hazard ratio (HR): 2.95; 95% confidence interval (CI), 1.546-5.626; P=0.001] and OS (HR: 3.966; 95% CI, 1.642-9.575; P=0.002). Among PNI (+) patients, DFS and OS were positively correlated with CEA levels (P=0.005 and P=0.004, respectively). Postoperative chemotherapy failed to improve DFS (P=0.480 and P=0.267, respectively) and OS (P=0.940 and P=0.077, respectively) regardless of whether the patients were PNI positive or not. CONCLUSIONS In stage II CRC patients, PNI was a poor independent predictor for DFS and OS. Among PNI (+) patients, CEA levels were positively correlated with DFS and OS. Traditional postoperative adjuvant chemotherapy does not improve outcomes of PNI (+) patients. Therefore, as to the active role of PNI and vacancy for treatment in allusion to PNI, follow-up of PNI (+) patients with elevated CEA level should be strengthened and further research on drug conducted on PNI deserve to be carried on.
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Affiliation(s)
- Juan Li
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sichen Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fuqiang 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, Beijing, China
| | - Qian 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, Beijing, China
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13
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Gysler SM, Drapkin R. Tumor innervation: peripheral nerves take control of the tumor microenvironment. J Clin Invest 2021; 131:e147276. [PMID: 34060481 DOI: 10.1172/jci147276] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In recent decades, cancer research has expanded exponentially beyond the study of abnormally dividing cells to include complex and extensive heterotypic interactions between cancer and noncancer cells that constitute the tumor microenvironment (TME). Modulation of stromal, immune, and endothelial cells by cancer cells promotes proliferation, survival, and metabolic changes that support tumor growth and metastasis. Recent evidence demonstrates that tumors can recruit peripheral nerves to the TME, leading to enhanced tumor growth in a range of cancer models through distinct mechanisms. This process, termed tumor innervation, is associated with an aggressive tumor phenotype and correlates with poor prognosis in clinical studies. Therefore, the peripheral nervous system may play an underrecognized role in cancer development, harboring targetable pathways that warrant investigation. To date, nerves have been implicated in driving proliferation, invasion, metastasis, and immune evasion through locally delivered neurotransmitters. However, emerging evidence suggests that cell-cell communication via exosomes induces tumor innervation, and thus exosomes may also mediate neural regulation of the TME. In this Review, seminal studies establishing tumor innervation are discussed, and known and putative signaling mechanisms between peripheral nerves and components of the TME are explored as a means to identify potential opportunities for therapeutic intervention.
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Affiliation(s)
- Stefan M Gysler
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology.,Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, and
| | - Ronny Drapkin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology.,Penn Ovarian Cancer Research Center, Department of Obstetrics and Gynecology, and.,Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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14
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Yang YS, Qiu YJ, Zheng GH, Gong HP, Ge YQ, Zhang YF, Feng F, Wang YT. High resolution MRI-based radiomic nomogram in predicting perineural invasion in rectal cancer. Cancer Imaging 2021; 21:40. [PMID: 34039436 PMCID: PMC8157664 DOI: 10.1186/s40644-021-00408-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To establish and validate a high-resolution magnetic resonance imaging (HRMRI)-based radiomic nomogram for prediction of preoperative perineural invasion (PNI) of rectal cancer (RC). METHODS Our retrospective study included 140 subjects with RC (99 in the training cohort and 41 in the validation cohort) who underwent a preoperative HRMRI scan between December 2016 and December 2019. All subjects underwent radical surgery, and then PNI status was evaluated by a qualified pathologist. A total of 396 radiomic features were extracted from oblique axial T2 weighted images, and optimal features were selected to construct a radiomic signature. A combined nomogram was established by incorporating the radiomic signature, HRMRI findings, and clinical risk factors selected by using multivariable logistic regression. RESULTS The predictive nomogram of PNI included a radiomic signature, and MRI-reported tumor stage (mT-stage). Clinical risk factors failed to increase the predictive value. Favorable discrimination was achieved between PNI-positive and PNI-negative groups using the radiomic nomogram. The area under the curve (AUC) was 0.81 (95% confidence interval [CI], 0.71-0.91) in the training cohort and 0.75 (95% CI, 0.58-0.92) in the validation cohort. Moreover, our result highlighted that the radiomic nomogram was clinically beneficial, as evidenced by a decision curve analysis. CONCLUSIONS HRMRI-based radiomic nomogram could be helpful in the prediction of preoperative PNI in RC patients.
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Affiliation(s)
- Yan-Song Yang
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China.,Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Yong-Juan Qiu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Gui-Hua Zheng
- Department of Pathology, Affiliated Tumor Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China
| | - Hai-Peng Gong
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | | | - Yi-Fei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China
| | - Feng Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, 226001, Jiangsu Province, China.
| | - Yue-Tao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu Province, China.
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15
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Kim HE, Park SY, Kim H, Kim DJ, Kim SI. Prognostic effect of perineural invasion in surgically treated esophageal squamous cell carcinoma. Thorac Cancer 2021; 12:1605-1612. [PMID: 33811752 PMCID: PMC8107023 DOI: 10.1111/1759-7714.13960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Although perineural invasion is a well known prognostic factor used in several cancers, its prognostic role in esophageal squamous cell carcinoma remains controversial. Here, we investigated the prognostic role of perineural invasion in surgically treated esophageal squamous cell carcinoma. Methods We retrospectively reviewed the medical records of 316 patients who underwent esophagectomy and lymph node dissection for esophageal squamous cell carcinoma between 2007 and 2016. Results Overall, 287 men (mean age: 62.73 ± 7.97 years) were included in the study. The median follow‐up period was 35.97 ± 30.99 months, perineural invasion was confirmed in 25 patients, and three‐year overall and disease‐free survival were significantly lower in the perineural invasion group than in the no‐perineural invasion group (75.9% vs. 40.0%, p < 0.001; 70.3% vs. 21.6%, p < 0.001). Cumulative incidences of locoregional recurrence and distant metastasis over three years were higher in the perineural invasion group (13.8% vs. 9.6%, p = 0.009 and 52.8% vs. 14.6%, p < 0.001). On performing multivariable analysis, perineural invasion, pathological stage, incomplete resection, and neoadjuvant therapy were adverse risk factors for disease‐free survival. The concordance index increased when perineural invasion was included in the model (0.712 vs. 0.723). On subgroup analysis, perineural invasion demonstrated a prognostic value in node‐negative patients (79.4% vs. 35.7%, p = 0.012). Conclusions Perineural invasion was found to be an adverse risk factor for disease‐free survival in surgically treated patients with esophageal squamous cell carcinoma. Close observation and individualized adjuvant therapy may be helpful for patients with perineural invasion.
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Affiliation(s)
- Ha Eun Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Ill Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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Tu J, Yao Z, Wu W, Ju J, Xu Y, Liu Y. Perineural Invasion Is a Strong Prognostic Factor but Not a Predictive Factor of Response to Adjuvant Chemotherapy in Node-Negative Colon Cancer. Front Oncol 2021; 11:663154. [PMID: 33859950 PMCID: PMC8042311 DOI: 10.3389/fonc.2021.663154] [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: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To validate the prognostic value and evaluate the predictive value of response to adjuvant chemotherapy of perineural invasion (PNI) in node-negative colon cancer using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 tumor registry database. Methods Patients diagnosed with colon cancer from the SEER database between January 1, 2010 and December 31, 2015 were identified. Chi-square analysis was performed to evaluate different demographic and clinical features of patients between PNI-negative (PNI (-)) and PNI-positive (PNI (+)) groups. Univariate and multivariate Cox proportional hazard regression models were built to examine the relationship of demographic and clinical features and survival outcomes with the hazard ratios (HRs) and 95% confidence intervals (CIs). Results In total, 57,255 node-negative colon cancer patients were extracted from the SEER database. The receipt of chemotherapy was not an independent prognostic factor for CSS in T3 colon cancer with or without the presence of PNI (P >0.05). The receipt of chemotherapy was independently associated with 34.0% decreased risk of cancer-specific mortality compared with those without the receipt of chemotherapy in T4 colon cancer without the presence of PNI (HR = 0.660, 95%CI = 0.559-0.779, P <0.001); the receipt of chemotherapy was independently associated with 36.0% decreased risk of cancer-specific mortality compared with those without the receipt of chemotherapy in T4 colon cancer with the presence of PNI (HR = 0.640, 95%CI = 0.438-0.935, P = 0.021). Conclusions The present study demonstrated the poor prognosis of PNI (+) in both stage I and II colon cancer. However, the presence of PNI was not a predictive factor of response to adjuvant chemotherapy in node-negative colon cancer.
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Affiliation(s)
- Junhao Tu
- Department of General Surgery, Suzhou Wuzhong People's Hospital, Suzhou, China
| | - Zongxi Yao
- Department of General Surgery, Suzhou Wuzhong People's Hospital, Suzhou, China
| | - Wenqing Wu
- Department of General Surgery, Suzhou Wuzhong People's Hospital, Suzhou, China
| | - Jianxiang Ju
- Department of General Surgery, Suzhou Wuzhong People's Hospital, Suzhou, China
| | - Yinkai Xu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yulin Liu
- Department of General Surgery, Suzhou Wuzhong People's Hospital, Suzhou, China
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Perineural invasion is increased in patients receiving colonic stenting as a bridge to surgery: a systematic review and meta-analysis. Tech Coloproctol 2020; 25:167-176. [PMID: 33200308 DOI: 10.1007/s10151-020-02350-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, there has been growing concern about the potential association of stent placement as a bridge to surgery in malignant colon obstruction and some anatomopathological findings that could lead to worsening long-term cancer outcomes, such as perineural, vascular and lymphatic invasion. The aim of the present review was to assess the pathological changes found in surgical specimens after stent placement for obstructing colon cancer vs. emergency surgery, and the impact of perineural invasion on survival rates METHODS: MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed four meta-analyses to estimate the pooled effect sizes using a random effect model. The outcomes were perineural, vascular and lymphatic invasion rates, and 5-year overall survival rate in patients with obstructive colon cancer, depending on the presence or absence of perineural invasion. RESULTS Ten studies with a total of 1273 patients were included in the meta-analysis. We found that patients in the stent group had a significantly higher risk of perineural (OR 1.98, 95% CI 1.22-3.21; p = 0.006) and lymphatic invasion (OR 1.45, 95% CI 1.10-1.90; p = 0.008). Furthermore, patients with positive perineural invasion had almost twice the risk of dying compared to those with no perineural invasion (HR 1.92, 95% CI 1.22-3.02; p = 0.005). CONCLUSIONS Stent placement as a bridge to surgery in colorectal cancer patients modifies the pathological characteristics such as perineural and lymphatic invasion, and this may worsen the long-term prognosis of patients. The presence of perineural infiltration in obstructed colon cancer decreases the long-term survival of patients.
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S100 Staining Adds to the Prognostic Significance of the Combination of Perineural Invasion and Lymphovascular Invasion in Colorectal Cancer. Appl Immunohistochem Mol Morphol 2020; 28:354-359. [DOI: 10.1097/pai.0000000000000733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Cao Y, Yang M, Yan L, Deng S, Gu J, Mao F, Wu K, Liu L, Cai K. Colon metal stents as a bridge to surgery had no significant effects on the perineural invasion: a retrospective study. World J Surg Oncol 2020; 18:77. [PMID: 32321517 PMCID: PMC7178988 DOI: 10.1186/s12957-020-01845-4] [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: 01/26/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023] Open
Abstract
Purpose The long-term oncological effects of self-expandable metallic stent (SEMS) as a “bridge to surgery” are contradictory, and perineural invasion was supposed to be enhanced by the stenting. In this retrospective study, we compared the perineural invasion and the oncological outcomes between the stent as a bridge to surgery (SBTS)- and emergency surgery (ES)-treated patients to evaluate the results of stenting on the perineural invasion. Methods The clinical data of patients with acute intestinal obstruction caused by colorectal cancer from January 2013 to January 2017 were retrospectively collected. Forty-three patients underwent semi-elective curative resection after endoscopic SEMS insertion, and sixty-three underwent ES. The adverse events and long-term follow-up outcomes were assessed. The clinicopathological characteristics, perineural invasion rates, and survival rates were compared between the two patient groups. Results Stent insertion resulted in significantly lower stoma rate (32.6% vs 46%; P = 0.03), post-operative overall complication rate (11.6% vs 28.6%, P = 0.038), and total hospital stay (17.07 ± 5.544 days vs 20.48 ± 7.372 days, P = 0.042). Compared with the ES group, there was no significant increase in the incidence of peripheral invasion in the SBTS group (39.5% vs 47.6%, P = 0.411). No significant difference was noted in the survival rate and long-term prognosis between the SEMS and ES groups (P = 0.964). The technical success rate was 95.6%, and the clinical success rate was 97.7%. Conclusions Preoperative colon stenting was an effective transitional method for colorectal cancer patients with complete obstruction. Short-term stent implantation had no significant effect on perineural invasion in patients with CRC.
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Affiliation(s)
- Yinghao Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ming Yang
- Department of Pathology, Union Hospital, Tongji Medical, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Lizhao Yan
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Shenghe Deng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Junnan Gu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Fuwei Mao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Ke Wu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Li Liu
- Department of Epidemiology and Biostatistics, The Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Cao Y, Li R, Cheng L, Chen N, Li J, Yu D. p75 Nerve Growth Factor Receptor as a Specific Nerve Marker in the Diagnosis of Perineural Invasion of Squamous Cell Carcinoma. Am J Clin Pathol 2019; 151:574-583. [PMID: 30895287 DOI: 10.1093/ajcp/aqz011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/29/2018] [Accepted: 01/28/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Perineural invasion (PNI) is an important factor in tumor prognosis. We evaluated p75 nerve growth factor receptor (p75NGFR) as a neuromarker for perineural invasion of squamous cell carcinoma. METHODS A comparison of H&E, and S100 and p75NGFR immunohistochemical staining methods, using sequential sections from 29 samples, for identification nerve bundles and PNI diagnosis, was carried out. RESULTS p75NGFR and S100 correctly identified more nerve bundles than H&E. Accuracy of p75NGFR was higher than that of S100, but there was no significant difference from H&E. The accuracy of nerve bundle identification by p75NGFR and S100 showed no significant difference among different histopathologic grades of squamous cell carcinomas. p75NGFR gave mild staining of small vessels, while S100 gave strong staining of smooth muscle and glandular tissue. CONCLUSIONS p75NGFR specifically stains nerve tissue and is better than S100 and H&E in identifying nerve bundles. p75NGFR is expected to become a new neuromarker.
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Affiliation(s)
- Yong Cao
- College of Stomatology, Guangxi Medical University, Nanning, China
| | - Rouxi Li
- College of Stomatology, Guangxi Medical University, Nanning, China
| | - Li Cheng
- College of Stomatology, Guangxi Medical University, Nanning, China
| | - Nian Chen
- College of Stomatology, Guangxi Medical University, Nanning, China
| | - Jing Li
- Department of Stomatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dahai Yu
- Department of Stomatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Song JH, Yu M, Kang KM, Lee JH, Kim SH, Nam TK, Jeong JU, Jang HS, Lee JW, Jung JH. Significance of perineural and lymphovascular invasion in locally advanced rectal cancer treated by preoperative chemoradiotherapy and radical surgery: Can perineural invasion be an indication of adjuvant chemotherapy? Radiother Oncol 2019; 133:125-131. [PMID: 30935568 DOI: 10.1016/j.radonc.2019.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the prognostic significance of lymphovascular space invasion (LVI) and perineural invasion (PNI) in rectal cancer. METHODS AND MATERIALS Clinical data of 1,232 stage II-III rectal cancer patients from six tertiary institutions were analyzed. All patients were treated by long-course preoperative chemoradiotherapy (CRT) followed by total mesorectal excision (TME). Adjuvant systemic chemotherapy was performed for 962 (78.1%) patients according to the multidisciplinary team's decision. Treatment outcomes and prognostic factors were evaluated according to the lymphovascular invasion (LVI) and perineural invasion (PNI) status. RESULTS Five-year overall survival (OS) and recurrence-free survival (RFS) rates of the entire cohort were 84.1% and 71.1%, respectively. There is a significant difference in 5-year OS among both-absent, LVI+ only, PNI+ only, and both-present groups (89.1% vs. 77.9% vs. 67.6% vs. 56.2%; p < 0.001). RFS at five years was significantly different among both-absent, LVI+ only, PNI+ only, and both-present groups (78.7% vs. 58.7% vs. 44.6% vs. 38.6%; p < 0.001). The 5-year distant failure-free survival (DFFS) rate was also significantly different among four groups (84.6% vs. 61.4% vs. 54.2% vs 48.6%; p < 0.001). Although adjuvant chemotherapy did not affect 5-year DFFS in the entire cohort, adjuvant chemotherapy significantly reduced the distant failure rate in patients with PNI+ patients (44.9% vs. 54.6%, p = 0.048), not LVI+ patients (65.0% vs. 56.1%, p = 0.487). CONCLUSION Compared to LVI, PNI is a more significant prognostic factor in stage II-III rectal patients treated by preoperative CRT and TME surgery. The status of PNI rather than LVI could be an indicator for identifying patients who could benefit from adjuvant systemic chemotherapy.
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Affiliation(s)
- Jin Ho Song
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Republic of Korea; Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mina Yu
- Department of Radiation Oncology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Taek Keun Nam
- Department of Radiation Oncology, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Jae Uk Jeong
- Department of Radiation Oncology, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Won Lee
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Ji-Han Jung
- Department of Hospital Pathology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Dimitriou N, Felekouras E, Karavokyros I, Alexandrou A, Pikoulis E, Griniatsos J. Neutrophils to lymphocytes ratio as a useful prognosticator for stage II colorectal cancer patients. BMC Cancer 2018; 18:1202. [PMID: 30509242 PMCID: PMC6278137 DOI: 10.1186/s12885-018-5042-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022] Open
Abstract
Background The incidence of colorectal cancer (CRC) is expected to increase by 80% in year 2035. Even though advantages in treatment of CRC have being made over the last decades, the outcome remains poor. Recently, several inflammatory markers including pretreatment neutrophil to lymphocyte ratio (NLR), have being used as prognostic factors, since host inflammatory response to cancer is believed to determine disease progression. The aim of this study is to evaluate the prognostic significance of pretreatment NLR, in terms of overall survival (OS), 5-year survival, disease-free survival (DFS) and recurrence, in CRC patients who underwent curative resection. Methods We retrospectively reviewed 296 patients, who were submitted to elective surgery as first therapeutic option in curative intent, between January 2010 and December 2015. Pretreatment NLR, as well as demographics, clinical, histopathologic, and laboratory data were analyzed. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS, 5-year survival, DFS and recurrence. Results The cutoff point of NLR was calculated with Kaplan-Meier curves and log-rank test to 4.7. Univariate and multivariate analyses disclosed elevated NLR as a significant dismal prognostic factor for DFS (HR 1.88; 95% CI 1.01–3.52; p = 0.048), 5-year survival (HR 2.14; 95% CI 1.12–4.10; p = 0.021) and OS (HR 2.11; 95% CI 1.11–4.03; p = 0.023). In a subgroup analysis, in patients with stage II CRC, NLR > 4.7 was a stronger poor predictor for DFS (HR 2.76; 95% CI 1.07–7.13; p = 0.036), 5-year survival (HR 3.84; 95% CI 1.39–10.63; p = 0.01) and OS (HR 3.62; 95% CI 1.33–4.82; p = 0.012). After adjusting stage for gender, age, location of the primary tumor, differentiation, as well as the presence of perineural, vascular, and lymphovascular invasion, the significance of NLR > 4.7 became more prominent for DFS (HR 2.85; 95% CI 1.21–6.73; p = 0.0176), 5-year survival (HR 4.06; 95% CI 1.66–9.93; p = 0.002) and OS (HR 4.07; 95% CI 1.69–9.91; p = 0.002) in stage II patients. Conclusion Pretreatment NLR > 4.7 is a poor prognostic factor for DFS, 5-year survival and OS in CRC patients undergoing curative resection. The dismal prognostic effect of NRL is magnified in Stage II CRC patients.
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Affiliation(s)
- Nikoletta Dimitriou
- Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Agiou Thoma 17 str, GR 115-27, Athens, Greece.
| | - Evangelos Felekouras
- Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Agiou Thoma 17 str, GR 115-27, Athens, Greece
| | - Ioannis Karavokyros
- Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Agiou Thoma 17 str, GR 115-27, Athens, Greece
| | - Andreas Alexandrou
- Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Agiou Thoma 17 str, GR 115-27, Athens, Greece
| | - Emmanuel Pikoulis
- Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Agiou Thoma 17 str, GR 115-27, Athens, Greece
| | - John Griniatsos
- Department of Surgery, National and Kapodistrian University of Athens, Medical School, Laiko Hospital, Agiou Thoma 17 str, GR 115-27, Athens, Greece
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Kim JC, Ha YJ, Tak KH, Roh SA, Kwon YH, Kim CW, Yoon YS, Lee JL, Park Y, Kim SK, Kim SY, Cho DH, Kim YS. Opposite functions of GSN and OAS2 on colorectal cancer metastasis, mediating perineural and lymphovascular invasion, respectively. PLoS One 2018; 13:e0202856. [PMID: 30148861 PMCID: PMC6110496 DOI: 10.1371/journal.pone.0202856] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/12/2018] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to identify molecules associated with lymphovascular invasion (LVI) and perineural invasion (PNI) and to examine their biological behavior in colorectal cancer (CRC). LVI- and PNI-associated molecules were identified and verified using sequential processes including (1) identification of 117 recurrence-associated genes differentially expressed on RNA-seq analysis using primary cancer tissues from 130 CRC patients with and without systemic recurrence; (2) analysis of molecules associated with LVI and PNI; (3) assessment of biological properties by measuring proliferation, anoikis, invasion/migration, epithelial-mesenchymal transition and autophagy flux; and (4) verification of disease-free survival using public datasets. Gelsolin (GSN) and 2'-5'-oligoadenylate synthetase 2 (OAS2) were associated with PNI and LVI, respectively. Invasion potential was >2-fold greater in GSN-overexpressing LoVo cells than in control cells (p<0.001–0.005), whereas OAS2-overexpressing RKO cells showed reduced invasion (p<0.001–0.005). GSN downregulated E-cadherin, β-catenin, claudin-1 and snail, and upregulated N-cadherin and ZEB1, whereas OAS2 overexpression had the opposite effects. Several autophagy-related proteins including ATG5-12, ATG6/BECN1, ATG7 and ATG101 were downregulated in GSN-overexpressing LoVo cells, whereas the opposite pattern was observed in OAS2-overexpressing RKO cells. Patients with low GSN expression had significantly higher 5-year recurrence-free survival (RFS) rates than those with GSN overexpression (73.6% vs. 64.7%, p = 0.038), whereas RFS was longer in patients with OAS2 overexpression than in those with underexpression (73.4% vs. 63.7%, p = 0.01). In conclusion, GSN and OAS2 were positively and negatively associated with recurrence, respectively, suggesting their potential value as predictors of recurrence or therapeutic targets in CRC patients.
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Affiliation(s)
- Jin Cheon Kim
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
- * E-mail: (JCK); (DHC); (YSK)
| | - Ye Jin Ha
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Ka Hee Tak
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Seon Ae Roh
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Yi Hong Kwon
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Chan Wook Kim
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Yong Sik Yoon
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Jong Lyul Lee
- Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
| | - Yangsoon Park
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
- Department of Pathology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seon-Kyu Kim
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
- Medical Genomics Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon, South Korea
| | - Seon-Young Kim
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
- Medical Genomics Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon, South Korea
| | - Dong-Hyung Cho
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
- School of Life Science, Kyungpook National University, Daegu, Korea
- * E-mail: (JCK); (DHC); (YSK)
| | - Yong Sung Kim
- Institute of Innovative Cancer Research, Asan Medical Center, Seoul, South Korea
- Medical Genomics Research Center, Korea Research Institute of Bioscience & Biotechnology, Daejeon, South Korea
- * E-mail: (JCK); (DHC); (YSK)
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Athanasakis E, Xenaki S, Venianaki M, Chalkiadakis G, Chrysos E. Newly recognized extratumoral features of colorectal cancer challenge the current tumor-node-metastasis staging system. Ann Gastroenterol 2018; 31:525-534. [PMID: 30174388 PMCID: PMC6102465 DOI: 10.20524/aog.2018.0284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/13/2018] [Indexed: 12/12/2022] Open
Abstract
One of the most common malignant tumors in humans, colorectal cancer has been extensively studied during the past few decades. Staging colorectal cancer allows clinicians to obtain precise prognostic information and apply specific treatment procedures. Apart from remote metastases, the depth of tumor infiltration and lymph node involvement have traditionally been recognized as the most important factors predicting outcome. Variations in the molecular signature of colorectal cancer have also revealed differences in phenotypic aggressiveness and therapeutic response rates. This article presents a review of the extratumoral environment in colorectal surgery.
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Affiliation(s)
- Elias Athanasakis
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Sofia Xenaki
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Maria Venianaki
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - George Chalkiadakis
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
| | - Emmanuel Chrysos
- Department of General Surgery, University Hospital of Heraklion Crete, Greece
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