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Cao Y, Peng T, Li H, Yang M, Wu L, Zhou Z, Zhang X, Han S, Bao H, Cai K, Zhao N. Development and validation of MMR prediction model based on simplified clinicopathological features and serum tumour markers. EBioMedicine 2020; 61:103060. [PMID: 33096478 PMCID: PMC7578682 DOI: 10.1016/j.ebiom.2020.103060] [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: 06/01/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although simplified clinicopathological features and serum tumour markers (STMs) were reported to be associated with the status of mismatch repair (MMR) in colorectal cancer (CRC) patients, their predictive value alone or in combination for MMR status remains unknown. METHODS A retrospective analysis of 3274 participants with MMR testing and STMs measurements from two institutions was conducted. The prediction model was developed in the primary cohort that consisted of 1964 participants. Best subset regression was applied to select the most useful predictors from the primary dataset. The performance of the nomogram was evaluated with respect to its calibration, discrimination, and clinical usefulness. External validation was performed in an independent validation cohort of 1310 consecutive CRC patients. FINDINGS Among the ten simplified clinicopathological features, seven variables were selected as the best subset of risk factors to develop pathology-based model, including age, tumour diameters, histology, tumour location, perineural invasion, the number of sampled lymph nodes (LNs) and positive LNs. The model showed good calibration and discrimination, with an AUC of 0.756 (95% CI, 0.722 to 0.789) in the primary cohort and 0.754 (95% CI, 0.715 to 0.793) in the validation cohort. After the addition of CEA and CA 72-4, the performance of pathology-based model was significantly improved in in both the primary cohort (AUC: 0.805 (0.774-0.835) vs. 0.756 (0.722-0.789), P < 0.001) and validation cohort (AUC: 0.796 (0.758-0.835) vs. 0.754 (0.715-0.793), P < 0.001). The results of decision curve analysis revealed that using our models to predict the status of MMR would add more benefit than either the detect-all-patients scheme or the detect-none scheme. INTERPRETATION The models based on simplified clinicopathological features alone or in combination with STMs can be conveniently used to facilitate the postoperative individualized prediction of MMR status in CRC patients.
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Affiliation(s)
- Yinghao Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China
| | - Tao Peng
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Han Li
- Department of Gastrointestinal Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130000, China
| | - Ming Yang
- Department of Pathology, Union Hospital, Tongji Medical, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Liang Wu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China
| | - Zili Zhou
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China
| | - Xudan Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China
| | - Shengbo Han
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China
| | - Haijun Bao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China.
| | - Ning Zhao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road No. 1277, Wuhan, Hubei 430022, China.
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Spoto CP, Gullo I, Carneiro F, Montgomery EA, Brosens LA. Hereditary gastrointestinal carcinomas and their precursors: An algorithm for genetic testing. Semin Diagn Pathol 2018; 35:170-183. [DOI: 10.1053/j.semdp.2018.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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The molecular pathogenesis of colorectal cancer and its potential application to colorectal cancer screening. Dig Dis Sci 2015; 60:762-72. [PMID: 25492499 PMCID: PMC4779895 DOI: 10.1007/s10620-014-3444-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/15/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Advances in our understanding of the molecular genetics and epigenetics of colorectal cancer have led to novel insights into the pathogenesis of this common cancer. These advances have revealed that there are molecular subtypes of colon polyps and colon cancer and that these molecular subclasses have unique and discrete clinical and pathological features. Although the molecular characterization of these subgroups of colorectal polyps and cancer is only partially understood at this time, it does appear likely that classifying colon polyps and cancers based on their genomic instability and/or epigenomic instability status will eventually be useful for informing approaches for the prevention and early detection of colon polyps and colorectal cancer. CONCLUSIONS In this review, we will discuss our current understanding of the molecular pathogenesis of the polyp to cancer sequence and the potential to use this information to direct screening and prevention programs.
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Samadder NJ, Curtin K, Wong J, Tuohy TMF, Mineau GP, Smith KR, Pimentel R, Pappas L, Boucher K, Garrido-Laguna I, Provenzale D, Burt RW. Epidemiology and familial risk of synchronous and metachronous colorectal cancer: a population-based study in Utah. Clin Gastroenterol Hepatol 2014; 12:2078-84.e1-2. [PMID: 24768809 DOI: 10.1016/j.cgh.2014.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/11/2014] [Accepted: 04/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients diagnosed with colorectal cancer (CRC) are at risk for synchronous and metachronous lesions at the time of diagnosis or during follow-up evaluation. We performed a population-based study to evaluate the rate, predictors, and familial risk for synchronous and metachronous CRC in Utah. METHODS All newly diagnosed cases of CRC between 1980 and 2010 were obtained from the Utah Cancer Registry and linked to pedigrees from the Utah Population Database. RESULTS Of the 18,782 patients diagnosed with CRC, 134 were diagnosed with synchronous CRC (0.71%) and 300 were diagnosed with metachronous CRC (1.60%). The risk for synchronous CRC was significantly higher in men (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.02-2.06) and in patients aged 65 years or older (OR, 1.50; 95% CI, 1.02-2.21). Synchronous CRCs were located more often in the proximal colon (OR, 1.70; 95% CI, 1.20-2.41). First-degree relatives of cases with synchronous (OR, 1.86; 95% CI, 1.37-2.53), metachronous (OR, 2.34; 95% CI, 1.62-3.36), or solitary CRC (OR, 1.75; 95% CI, 1.63-1.88) were at increased risk for developing CRC, compared with relatives of CRC-free individuals. Four percent of first-degree relatives of patients with synchronous or metachronous cancer developed CRC at younger ages than the age recommended for initiating CRC screening (based on familial risk), and therefore would not have been screened. CONCLUSIONS Of patients diagnosed with CRC, 2.3% are found to have synchronous lesions or develop metachronous CRC during follow-up evaluation. Relatives of these patients have a greater risk of CRC than those without a family history of CRC. These results highlight the importance of obtaining a thorough family history and adhering strictly to surveillance guidelines during management of high-risk patients.
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Affiliation(s)
- N Jewel Samadder
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah.
| | - Karen Curtin
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Genetic Epidemiology), University of Utah, Salt Lake City, Utah
| | - Jathine Wong
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Geraldine P Mineau
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah, Salt Lake City, Utah
| | - Ken Robert Smith
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Richard Pimentel
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ken Boucher
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ignacio Garrido-Laguna
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Medical Oncology), University of Utah, Salt Lake City, Utah
| | - Dawn Provenzale
- Veterans Affairs Cooperative Studies Epidemiology Center-Durham, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine (Gastroenterology), Duke University, Durham, North Carolina
| | - Randall W Burt
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Medicine (Gastroenterology), University of Utah, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah, Salt Lake City, Utah
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Quirke P, Palmer T, Hutchins GGA, West NP. Histopathological work-up of resection specimens, local excisions and biopsies in colorectal cancer. Dig Dis 2012. [PMID: 23207926 DOI: 10.1159/000341875] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The pathological examination of material removed from patients with colorectal neoplasia is important. It provides a wide range of information on, for example, the quality and completeness of excision, the stage and biological aggressiveness, the need for further therapy, and response to therapy. Molecular testing adds valuable information on genetic risk and is required before treatment with anti-EGF-r antibodies. This article highlights the value derived from macroscopic inspection of surgical specimens, careful microscopy and excellent reporting according to national guidelines. Increasing use of a number of preoperative therapies and combinations in rectal cancer change the pathological features found and a standardised approach to the diagnosis of complete response is required. It touches upon the issues with frequent changes in TNM staging and the difficulties these changes are causing. The widespread introduction of bowel cancer screening is changing the stage of presentation of colorectal cancer leading to increasing numbers of local excisions and polyp cancers.
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Affiliation(s)
- Philip Quirke
- Department of Histopathology, Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
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Søreide K. Endoscopic surveillance after curative surgery for sporadic colorectal cancer: patient-tailored, tumor-targeted or biology-driven? Scand J Gastroenterol 2010; 45:1255-61. [PMID: 20553114 DOI: 10.3109/00365521.2010.496492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Endoscopy has been endorsed and introduced in most surveillance programs following curative surgery for colorectal cancer (CRC), yet little data are available to support its use in terms of patient selection, efficacy and frequency of surveillance. MATERIAL AND METHODS A literature search in the English language using the PubMed/Medline database for the MeSH terms "colorectal cancer", "surveillance", and "endoscopy", with focus on sporadic CRC, excluding CRC developed on a hereditary or inflammatory bowel disease background. Focus on results from the past 5 years was applied. RESULTS Recent systematic reviews, meta-analyses, randomized trials and prospective studies made the backbone of the article, supported by population-based findings and recent reports on tumor biology. Hard evidence to support a survival benefit from endoscopy alone is lacking. Definitions of "synchronous", "interval", and "metachronous" cancers are not uniform and hampers comparison of studies. The number of metachronous cancers (usually 2-4%) that develop after curative CRC surgery is small, and better patient-tailored surveillance could improve the diagnostic yield. Compliance with endoscopy is low compared to other modalities. Age and socio-demographic factors influence on the surveillance coverage and need to be addressed in any given program. The majority of local recurrences occur within the first 3 years after surgery independent of stage, and microsatellite instable (MSI) tumors appear to be at higher risk. CONCLUSIONS Endoscopy in surveillance after curative surgery for CRC is a resource demanding procedure. A tailored approach according to factors associated with an increased risk for metachronous cancer/local recurrence would increase efficiency.
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Affiliation(s)
- Kjetil Søreide
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
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Köklü S, Akbal E, Demirel AH, Gönültaş MA. Multiple Cancer Foci in the Colon of a Man with Operated Rectum Carcinoma. Am Surg 2010. [DOI: 10.1177/000313481007600942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Erdem Akbal
- Ankara Training and Research Hospital Ankara, Turkey
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Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Sakaguchi K, Shiratori Y. Sensitivity of immunochemical fecal occult blood test to small colorectal adenomas. Am J Gastroenterol 2007; 102:2259-64. [PMID: 17617203 DOI: 10.1111/j.1572-0241.2007.01404.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the immunochemical fecal occult blood test (FOBT) is reportedly more sensitive to large adenomas or colorectal cancer (CRC) than the guaiac-based FOBT, the sensitivity of the immunochemical FOBT to small adenomas has scarcely been reported. Previous reports have indicated that the guaiac-based FOBT can detect small adenomas only by serendipity. OBJECTIVES To investigate the sensitivity of immunochemical FOBT to small adenomas using a large-scale cohort. METHODS We analyzed 21,805 consecutively enrolled asymptomatic persons who underwent colonoscopy and immunochemical FOBT. RESULTS The sensitivity to adenomas </=9 mm was significantly higher than the false-positive rate as revealed by analysis of all eligible subjects (7.0%vs 4.5%, P < 0.001). In men, the sensitivity was superior to the false-positive rate and increased with age (<50 yr 6.1% and >60 yr 11.3%). On the other hand, the sensitivity in women was not significantly different from the false-positive rate in any generation (5.1%vs 4.7% for all eligible women, P= 0.72). CONCLUSIONS Immunochemical FOBT detected a small percentage of small adenomas in men at a rate that is significantly higher than the false-positive rate. Studies comparing the guaiac and immunochemical FOBTs using the end point of CRC-related death are expected.
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Affiliation(s)
- Tamiya Morikawa
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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