Assessing the effectiveness of a guideline recommendation for pre-operative radiochemotherapy in rectal cancer

EMX2 gene expression predicts liver metastasis and survival in colorectal cancer

BACKGROUND

The Empty Spiracles Homeobox (EMX-) 2 gene has been associated with regulation of growth and differentiation in neuronal development. While recent studies provide evidence that EMX2 regulates tumorigenesis of various solid tumors, its role in colorectal cancer remains unknown. We aimed to assess the prognostic significance of EMX2 expression in stage III colorectal adenocarcinoma.

METHODS

Expression levels of EMX2 in human colorectal cancer and adjacent mucosa were assessed by qRT-PCR technology, and results were correlated with clinical and survival data. siRNA-mediated knockdown and adenoviral delivery-mediated overexpression of EMX2 were performed in order to investigate its effects on the migration of colorectal cancer cells in vitro.

RESULTS

Compared to corresponding healthy mucosa, colorectal tumor samples had decreased EMX2 expression levels. Furthermore, EMX2 down-regulation in colorectal cancer tissue was associated with distant metastasis (M1) and impaired overall patient survival. In vitro knockdown of EMX2 resulted in increased tumor cell migration. Conversely, overexpression of EMX2 led to an inhibition of tumor cell migration.

CONCLUSIONS

EMX2 is frequently down-regulated in human colorectal cancer, and down-regulation of EMX2 is a prognostic marker for disease-free and overall survival. EMX2 might thus represent a promising therapeutic target in colorectal cancer.

Pathological Assessment of Rectal Cancer after Neoadjuvant Chemoradiotherapy: Distribution of Residual Cancer Cells and Accuracy of Biopsy

We investigated the distribution of residual cancer cells (RCCs) within different layers of the bowel wall in surgical specimens and the value of biopsies of primary rectal lesion after preoperative volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients with rectal cancer. Between April 2011 and April 2013, 178 patients with rectal cancer who received preoperative VMAT, concurrent chemotherapy, and surgery were evaluated; 79 of the patients received a biopsy of the primary lesion after chemoradiotherapy and prior to surgery. The distribution of RCCs in the surgical specimens and the sensitivity and specificity of the biopsy of primary rectal lesions for pathological response were evaluated. Fifty-two patients had a complete pathological response in the bowel wall. Of the 120 patients with ypT2-4, the rate of detection of RCCs in the mucosa, submucosa, and muscularis propria was 20%, 36.7%, 69.2%, respectively. The sensitivity and specificity of biopsies of primary rectal lesions was 12.9% and 94.1%, respectively. After chemoradiotherapy, the RCCs were primarily located in the deeper layers of the bowel wall, and the biopsy results for primary rectal lesions were unreliable due to poor sensitivity.

Colorectal cancer survival by stage of cases diagnosed in Mallorca, Spain, between 2006 and 2011 and factors associated with survival

OBJECTIVES

To establish cause-specific survival by stage of colorectal cancer up to 8 years from diagnosis, and to identify factors which explain and predict the likelihood of survival.

METHODOLOGY

Retrospective follow-up study of people diagnosed with invasive colorectal cancer during 2006-2011, identified through the Mallorca Cancer Registry. DCO and lymphomas were excluded. Sex, age, diagnostic method, site, histology, T, N, M, and stage, date of diagnosis, date of follow-up or death, and cause of death were collected. End point of follow-up was 31st December 2013. Multiple imputation (MI) method was performed to obtain stage when unknown. Actuarial and Kaplan-Meier methods were used for survival analysis. Extended Cox models were built to identify factors that explain and predict survival.

RESULTS

2889 cases were identified, 41.7% in women and 58.3% in men, with a mean age of 70.5 years. Unknown stage represented 15.3% of cases. After MI, 15% were in stage I, 26.7% were in II, 32.7% in III, and 25.6% in IV. Survival was 56% at the end of the 5th year. Survival by stage changed significantly after MI and was estimated to 83% at stage I, 73% at II, 62% at III, and 16% at IV. Extended Cox model showed that survival worsened with age, mucinous histology, and stage. Risk of dying was 17.0 times higher in stage IV compared to stage I, 3.7 times in stage III, and 1.6 times in stage II.

CONCLUSIONS

More than half of colorectal cancer patients will survive 5 years after diagnosis, but only if diagnosed in stages I-III.

Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage II-III rectal cancer: A population-based study

AIMS

Neoadjuvant concurrent chemoradiotherapy (NCCRT) is currently the preferred treatment for rectal cancer of clinical stage II-III based on its efficacy in clinical trials. The population-based effectiveness of NCCRT is rarely reported on in the literature. The purpose of our study is to investigate the nationwide population-based effectiveness of NCCRT as compared with up-front proctectomy.

METHODS

In this retrospective cohort study, we identified the study population by linking datasets including the cancer registry, death registry and other related files in Taiwan. We identified all patients with rectal adenocarcinoma of American Joint Committee on Cancer clinical stage II or III who were diagnosed in 2007 or 2008 and received either NCCRT or up-front proctectomy. We included patients' age, gender, residence, socioeconomic status and clinical stage as covariables. We used overall survival as the measure of effectiveness. The Cox proportional-hazards regression model was used for statistical analyses. We further conducted sensitivity analyses, one in only those who received optimal postoperative chemotherapy and one in two subgroups matched for propensity score.

RESULTS

We included 1933 patients (NCCRT: 424; up-front proctectomy: 1509) in the study population. NCCRT was associated with improved survival as compared with up-front proctectomy (adjusted hazard ratio of death 0.656; 95% confidence interval 0.495-0.871). Our results were robust in the sensitivity analyses.

CONCLUSION

We demonstrated that the use of neoadjuvant concurrent systemic therapy and radiotherapy is associated with better effectiveness in rectal adenocarcinoma of clinical stage II-III as compared with up-front proctectomy. Further studies are needed to elucidate the subgroups most likely to benefit and to clarify NCCRT's cost-effectiveness.

Cancer incidence and mortality projections up to 2020 in Catalonia by means of Bayesian models

PURPOSE

To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010-2020.

METHODS/PATIENTS

Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models.

RESULTS

There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010-2020 a mortality decline is expected in both sexes.

CONCLUSION

The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia.