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Risk of Bowel Obstruction in Patients Undergoing Neoadjuvant Chemotherapy for High-risk Colon Cancer: A Nested Case-control-matched Analysis of an International, Multicenter, Randomized Controlled Trial (FOxTROT). Ann Surg 2024; 280:283-293. [PMID: 37947140 PMCID: PMC11224564 DOI: 10.1097/sla.0000000000006145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE This study aimed to identify risk criteria available before the point of treatment initiation that can be used to stratify the risk of obstruction in patients undergoing neoadjuvant chemotherapy (NAC) for high-risk colon cancer. BACKGROUND Global implementation of NAC for colon cancer, informed by the FOxTROT trial, may increase the risk of bowel obstruction. METHODS A case-control study, nested within an international randomized controlled trial (FOxTROT; ClinicalTrials.gov: NCT00647530). Patients with high-risk operable colon cancer (radiologically staged T3-4 N0-2 M0) that were randomized to NAC and developed large bowel obstruction were identified. First, clinical outcomes were compared between patients receiving NAC in FOxTROT who did and did not develop obstruction. Second, obstructed patients (cases) were age-matched and sex-matched with patients who did not develop obstruction (controls) in a 1:3 ratio using random sampling. Bayesian conditional mixed-effects logistic regression modeling was used to explore clinical, radiologic, and pathologic features associated with obstruction. The absolute risk of obstruction based on the presence or absence of risk criteria was estimated for all patients receiving NAC. RESULTS Of 1053 patients randomized in FOxTROT, 699 received NAC, of whom 30 (4.3%) developed obstruction. Patients underwent care in European hospitals including 88 UK, 7 Danish, and 3 Swedish centers. There was more open surgery (65.4% vs 38.0%, P =0.01) and a higher pR1 rate in obstructed patients (12.0% vs 3.8%, P =0.004), but otherwise comparable postoperative outcomes. In the case-control-matched Bayesian model, 2 independent risk criteria were identified: (1) obstructing disease on endoscopy and/or being unable to pass through the tumor [adjusted odds ratio: 9.09, 95% credible interval: 2.34-39.66] and stricturing disease on radiology or endoscopy (odds ratio: 7.18, 95% CI: 1.84-32.34). Three risk groups were defined according to the presence or absence of these criteria: 63.4% (443/698) of patients were at very low risk (<1%), 30.7% (214/698) at low risk (<10%), and 5.9% (41/698) at high risk (>10%). CONCLUSIONS Safe selection for NAC for colon cancer can be informed by using 2 features that are available before treatment initiation and identifying a small number of patients with a high risk of preoperative obstruction.
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van der Linden RLA, Rijstenberg LL, van der Linden JC, Vogelaar FJ, Nagtegaal ID, Pruijt JFM, van de Velde CJH, van den Brule A, Bosscha K. Node negative colorectal cancer patients: assesment of high-risk features on recurrence. Pathol Res Pract 2020; 216:153034. [PMID: 32825973 DOI: 10.1016/j.prp.2020.153034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The introduction of population-based screening programs for colorectal cancer (CRC) results in less patients with advanced disease. There is an increase in the amount of node negative CRC, which makes adequate risk stratification for this particular group of patients necessary. The addition of more risk factors to the conventional histological high-risk factors is investigated in this retrospective study. PATIENTS AND METHODS A cohort of 227 node negative (stage I and II) CRC patients who were not treated with adjuvant chemotherapy were selected from two previously conducted cohort studies. Detailed histopathological examination was performed by two independent observers and molecular background (BRAF/RAS mutations, microsatellite status (MSI)) was studied. Univariate analyses were used to analyse differences in histological and mutational characteristics between patients with and without recurrence. P-values below 0.05 were considered statistically significant. RESULTS Poorly differentiated histology (p:0.002), BRAF mutation (p:0.002) and MSI status (p:0.006) were found significant relevant risk factors that were related to recurrent disease. Poorly differentiated histology was associated with intermediate/high tumor budding (TB) (p:0.001), a BRAF mutation (p:0.001) and MSI status (p:0.001). A combination of all three features (poorly differentiated histology, BRAF and MSI) was more often present in the recurrence group. CONCLUSIONS Recurrence in node negative CRC patients could be better predicted when molecular features such as, BRAF mutation and MSI status are incorporated into a model with poorly differentiated CRC. Therefore, these features might help in the selection of patients who possibly will benefit from adjuvant treatment.
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Affiliation(s)
- R L A van der Linden
- Department of Surgery, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands; Department of Pathology, Radboudumc, Nijmegen, The Netherlands.
| | - L L Rijstenberg
- Department of Pathology, Radboudumc, Nijmegen, The Netherlands
| | - J C van der Linden
- Department of Pathology, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
| | - F J Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - I D Nagtegaal
- Department of Pathology, Radboudumc, Nijmegen, The Netherlands
| | - J F M Pruijt
- Department of Oncology, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - A van den Brule
- Department of Pathology, Lab for Molecular Diagnostics, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital,' s-Hertogenbosch, The Netherlands
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Sloothaak D, van der Linden R, van de Velde C, Bemelman W, Lips D, van der Linden J, Doornewaard H, Tanis P, Bosscha K, van der Zaag E, Buskens C. Prognostic implications of occult nodal tumour cells in stage I and II colon cancer. Eur J Surg Oncol 2017; 43:1456-1462. [DOI: 10.1016/j.ejso.2017.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/16/2017] [Accepted: 04/26/2017] [Indexed: 12/20/2022] Open
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Use of a combination of CEA and tumor budding to identify high-risk patients with stage II colon cancer. Int J Biol Markers 2017; 32:e267-e273. [PMID: 28478638 DOI: 10.5301/jbm.5000255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND High-risk patients with stage II colon cancer may benefit from adjuvant chemotherapy, but identifying this patient population can be difficult. We assessed the prognosis value for predicting tumor progression in patients with stage II colon cancer, of a panel of 2 biomarkers for colon cancer: tumor budding and preoperative carcinoembryonic antigen (CEA). METHODS Consecutive patients (N = 134) with stage II colon cancer who underwent curative surgery from 2000 to 2007 were included. Multivariate analysis was used to evaluate the association of CEA and tumor budding grade with 5-year disease-free survival (DFS). The prognostic accuracy of CEA, tumor budding grade and the combination of both (CEA-budding panel) was determined. RESULTS The study found that both CEA and tumor budding grade were associated with 5-year DFS. The prognostic accuracy for disease progression was higher for the CEA-budding panel (82.1%) than either CEA (70.9%) or tumor budding grade (72.4%) alone. CONCLUSIONS The findings indicate that the combination of CEA levels and tumor budding grade has greater prognostic value for identifying patients with stage II colon cancer who are at high-risk for disease progression, than either marker alone.
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Clinical impact of elastic laminal invasion in colon cancer: elastic laminal invasion-positive stage II colon cancer is a high-risk equivalent to stage III. Dis Colon Rectum 2014; 57:830-8. [PMID: 24901683 DOI: 10.1097/dcr.0000000000000124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Elastic laminal invasion is defined as tumor invasion beyond the peritoneal elastic lamina. It is one of the factors affecting the prognosis of patients with colon cancer. OBJECTIVE This study aimed to investigate the clinical impact of elastic laminal invasion in colon cancer and the magnitude of the worse prognosis of elastic laminal invasion-positive, node-negative patients. DESIGN This was a retrospective cohort study. SETTINGS This study reviewed data from a tertiary care cancer center in Japan. PATIENTS The records of 436 patients with pT3 or pT4a colon cancer who underwent curative resection between January 1996 and December 2006 were reviewed. MAIN OUTCOME MEASURES The primary outcome measure was recurrence-free survival. Cox regression analyses established the factors associated with recurrence-free survival. Six groups formed by combining the factors were compared. RESULTS Of the patients with pT3 disease, those who were positive for elastic laminal invasion had a 5-year recurrence-free survival rate of 73.8% compared with a rate of 85.0% in those who were negative for elastic laminal invasion and 53.5% in patients with pT4 disease. Three unfavorable prognostic factors were identified, including lymph node metastasis, positive elastic laminal invasion, and a lack of adjuvant chemotherapy. Log-rank analysis revealed statistically significant differences in recurrence-free survival between group 1 (node negative, elastic laminal invasion negative, and no adjuvant chemotherapy) and group 3 (node negative, elastic laminal invasion positive, and no adjuvant chemotherapy). The HR for group 1 compared with group 3 was 0.49 (95% CI, 0.27-0.90). Furthermore, the HRs for group 2 (node positive, elastic laminal invasion negative, and received adjuvant chemotherapy) and group 4 (node positive, elastic laminal invasion positive, and received adjuvant chemotherapy) vs group 3 were 0.77 (95% CI, 0.35-1.69) and 1.36 (95% CI, 0.62-2.98). LIMITATIONS Our study has limited prediction accuracy of our prognostic stratification, and an analysis of small subgroups may not have been capable of detecting significant differences. In addition, a wide range of hematoxylin and eosin- and elastica-stained slides were examined per case. CONCLUSIONS Elastic laminal invasion adversely influences prognosis in pT3 and pT4a colon cancer. Although elastic laminal invasion positivity does not affect prognosis in node-positive patients receiving adjuvant chemotherapy, node-negative patients with elastic laminal invasion have a similar risk of recurrence as node-positive patients.
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Vogelaar FJ, Reimers MS, van der Linden RLA, van der Linden JC, Smit VTHBM, Lips DJ, van de Velde CJH, Bosscha K. The diagnostic value of one-step nucleic acid amplification (OSNA) for sentinel lymph nodes in colon cancer patients. Ann Surg Oncol 2014; 21:3924-30. [PMID: 24912612 DOI: 10.1245/s10434-014-3820-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lymph node status in colon cancer is critical for prognosis estimation and treatment allocation. The purpose of this study was to compare the performance of one-step nucleic acid amplification (OSNA) through detection of cytokeratin 19 mRNA levels with routine pathological examination (RP) and multilevel fine pathological examination (FP) in sentinel lymph nodes (SLN), detected using the ex vivo SLN mapping (SLNM) procedure, in presurgically defined nonmetastatic colon cancer patients. METHODS In this prospective study, 325 SLNs of 128 patients from the Jeroen Bosch Hospital in 's-Hertogenbosch and the Leiden University Medical Center were investigated by RP (H&E), FP (H&E and Keratin Pan immunohistochemical staining), and OSNA. The SLNs were harvested by the SLNM procedure, using Patent blue or Indocyanine green. SLNs were divided and separate parts were used for RP, FP, and the OSNA assay. RESULTS The diagnostic value of OSNA was 82.1 and 100 % for both FP and combined method (OSNA and FP) compared with RP. An upstaging rate of 20.2 % was obtained with the use of OSNA only and 36.4 % with the use of FP only. An upstaging rate of 46.5 % was obtained by combining the two methods together. CONCLUSIONS OSNA and FP appeared to be promising tools for the detection of lymph node micro- and macrometastases in SLNs after SLNM. The performances of OSNA and FP in this study were superior to RP. Because OSNA allows analysis of the whole lymph node, sampling bias can be avoided. OSNA therefore may improve tumor staging.
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Affiliation(s)
- F J Vogelaar
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Huang SM, Chen TS, Chiu CM, Chang LK, Liao KF, Tan HM, Yeh WL, Chang GRL, Wang MY, Lu DY. GDNF increases cell motility in human colon cancer through VEGF-VEGFR1 interaction. Endocr Relat Cancer 2014; 21:73-84. [PMID: 24165321 DOI: 10.1530/erc-13-0351] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Glial cell line-derived neurotrophic factor (GDNF), a potent neurotrophic factor, has been shown to affect cancer cell metastasis and invasion. However, the molecular mechanisms underlying GDNF-induced colon cancer cell migration remain unclear. GDNF is found to be positively correlated with malignancy in human colon cancer patients. The migratory activities of two human colon cancer cell lines, HCT116 and SW480, were found to be enhanced in the presence of human GDNF. The expression of vascular endothelial growth factor (VEGF) was also increased in response to GDNF stimulation, along with VEGF mRNA expression and transcriptional activity. The enhancement of GDNF-induced cancer cell migration was antagonized by a VEGF-neutralizing antibody. Our results also showed that the expression of VEGF receptor 1 (VEGFR1) was increased in response to GDNF stimulation, whereas GDNF-induced cancer cell migration was reduced by a VEGFR inhibitor. The GDNF-induced VEGF expression was regulated by the p38 and PI3K/Akt signaling pathways. Treatment with GDNF increased nuclear hypoxia-inducible factor 1 α (HIF1α) accumulation and its transcriptional activity in a time-dependent manner. Moreover, GDNF increased hypoxia responsive element (HRE)-containing VEGF promoter transcriptional activity but not that of the HRE-deletion VEGF promoter construct. Inhibition of HIF1α by a pharmacological inhibitor or dominant-negative mutant reduced the GDNF-induced migratory activity in human colon cancer cells. These results indicate that GDNF enhances the migration of colon cancer cells by increasing VEGF-VEGFR interaction, which is mainly regulated by the p38, PI3K/Akt, and HIF1α signaling pathways.
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Affiliation(s)
- Ssu-Ming Huang
- Graduate Institute of Biotechnology, National Chung Hsing University, Taichung, Taiwan Preventive Medicine Center, Department of Community Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan Division of Colon and Rectal Surgery, Department of Surgery, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan Departments of Pathology Internal Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan Graduate Institute of Integrated Medicine, Department of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Medical Research, Cancer Research Center, Changhua Christian Hospital, Changhua, Taiwan Graduate Institute of Neural and Cognitive Sciences, China Medical University, No.91 Hsueh-Shih Road, Taichung, Taiwan
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Du C, Yao Y, Xue W, Zhu WG, Peng Y, Gu J. The expression of chemokine receptors CXCR3 and CXCR4 in predicting postoperative tumour progression in stages I-II colon cancer: a retrospective study. BMJ Open 2014; 4:e005012. [PMID: 25232565 PMCID: PMC4139647 DOI: 10.1136/bmjopen-2014-005012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES The prognostic significance of chemokine receptors in stage I/II colon cancer is unclear. We assessed the prognostic value of chemokine receptor CXCR3 and CXCR4 in stage I/II colon cancer. METHODS 145 patients with stage I/II colon cancer who underwent curative surgery alone from 2000 to 2007 were investigated. Chemokine receptor expression was assessed by immunohistochemistry. The associations between CXCR3, CXCR4 and clinicopathological variables were analysed using the χ2 test, and the relationships between chemokine receptors and a 5-year disease-free survival were analysed by univariate and multivariate analyses. RESULTS The high-expression rates of CXCR3 and CXCR4 were 17.9% (26/145) and 38.6% (56/145), respectively. There were no significant associations between the expressions of CXCR3, CXCR4 and clinicopathological factors including gender, age, tumour location, histological differentiation, pathological stage, lymphovascular invasion and pretreatment serum carcinoembryonic antigen (CEA). The 5-year disease-free survival was not significantly different between low-expression groups and high-expression groups of CXCR3 and CXCR4. Multivariate analysis revealed that serum CEA and a number of retrieved lymph nodes, rather than chemokine receptors, were independent prognosticators. CONCLUSIONS CXCR3 and CXCR4 are not independent prognosticators for stage I/II colon cancer after curative surgery.
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Affiliation(s)
- Changzheng Du
- Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Yunfeng Yao
- Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Weicheng Xue
- Department of Pathology, Peking University Cancer Hospital, Beijing, China
| | - Wei-Guo Zhu
- Department of Biochemistry and Molecular Biology, Peking University Health Science Center, Beijing, China
| | - Yifan Peng
- Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, China
| | - Jin Gu
- Department of Colorectal Surgery, Peking University Cancer Hospital, Beijing, China
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Biffi R, Botteri E, Bertani E, Zampino MG, Cenciarelli S, Luca F, Pozzi S, Cossu ML, Chiappa A, Rotmensz N, Bazolli B, Magni E, Sonzogni A, Andreoni B. Factors predicting worse prognosis in patients affected by pT3 N0 colon cancer: long-term results of a monocentric series of 137 radically resected patients in a 5-year period. Int J Colorectal Dis 2013; 28:207-15. [PMID: 22903336 DOI: 10.1007/s00384-012-1563-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE For patients with Stage II colon cancer, the use of adjuvant chemotherapy remains controversial. The purpose of this study was to identify clinical and/or pathological findings related to a worse prognosis in this category of patients. PATIENTS AND METHODS We retrospectively analyzed the data of consecutive patients, extracted by an institutional Tumour Registry, admitted to an affiliated University Hospital in Milan (European Institute of Oncology) for adenocarcinoma of the colon (all sites), between 2000 and 2005, and having a final pT3 N0 pathology staging after curative surgery. Adjuvant chemotherapy was decided as a result of a medical decision within a multidisciplinary Tumor Board. RESULTS Data of 137 patients were obtained, with a median follow-up of 77 months (range 6-131). Patients who received chemotherapy were younger than patients who did not. Nine patients out of 137 (6.5 %) died as a consequence of colon cancer recurrence; four of them had received adjuvant chemotherapy. Only histological grade III and mucinous histotype were found to impact on cumulative incidence of colon-related events (p 0.03 and 0.02, respectively); no impact was found on cumulative incidence of colonic neoplasm recurrence-related deaths (p 0.74 and 0.74, respectively). Number of analyzed LNs (lymph nodes) emerged as a factor possibly affecting the cumulative incidence of colon-related events (p 0.09) as well as the cumulative incidence of colonic neoplasm recurrence-related deaths (p 0.10). The risk of events was inversely proportional to the number of dissected LNs, even over 20 up to about 25 LNs. Never-smokers exhibited a lower incidence of colon-related events, although the difference was not statistically significant (p 0.09). All other analyzed variables did not show any impact on survival rate, including age, gender, ASA score, BMI, site of colonic neoplasm, multifocality, perivascular invasion, and use of adjuvant chemotherapy. CONCLUSIONS Histology grading G3 and mucinous histotype were predictors of worse outcome. Efforts to improve LN evaluation should result in clinically significant improvements in outcome, and also the quality of care for patients with radically resected stage II colon cancer.
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Affiliation(s)
- Roberto Biffi
- Division of Abdomino-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Via G. Ripamonti, 435, 20141, Milan, Italy.
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