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Shahabi F, Mehri A, Abdollahi A, Hoshyar SHH, Ghahramani A, Noei MG, Orafaie A, Ansari M. Post recurrence survival in early versus late period and its prognostic factors in rectal cancer patients. Sci Rep 2024; 14:17661. [PMID: 39085286 PMCID: PMC11291732 DOI: 10.1038/s41598-024-67852-7] [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] [Received: 10/14/2023] [Accepted: 07/16/2024] [Indexed: 08/02/2024] Open
Abstract
To identify factors associated with post-recurrence survival (PRS), we examined our institutional recurrence patterns following definitive resection for rectal cancer. We reviewed all patients with rectal cancer diagnosed at three hospitals in the east of Iran from 2011 to 2020. The optimal cut-off value was determined by receiver operating characteristic (ROC) analysis to determine early recurrence. The effect of recurrence time was evaluated on PRS. 326 eligible patients with a mean ± SD age of 56 ± 12.8 years were included in this study. In a median (IQR: Inter-quartile range) follow-up time of 76 (62.2) months, 106 (32.5%) patients experienced at least any recurrence (locoregional or distant metastasis) following primary resection. The median (IQR) time from initial surgery to recurrence was 29.5 (31.2) months. Based on ROC analysis, early recurrence was specified at ≤ 29 months. However, for the patients who experienced only locoregional recurrence, 33 months was the cut-off to define early recurrence. Recurrence time and recurrence management were both significant variables on PRS. Moreover, TNM staging was significantly associated with early recurrence (P = 0.003). In this research, recurrence time, recurrence management and TNM staging were found to be correlated with PRS.
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Affiliation(s)
- Fatemeh Shahabi
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran
| | - Ali Mehri
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran
| | - Abbas Abdollahi
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran
| | - Seyed Hossein Hosseini Hoshyar
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran
| | - Abolfazl Ghahramani
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran
| | - Mahdie Ghiyasi Noei
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran
| | - Ala Orafaie
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran.
| | - Majid Ansari
- Endoscopic and Minimally Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Ahmadabad Blvd, Mashhad, Iran.
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Boute TC, Swartjes H, Greuter MJ, Elferink MA, van Eekelen R, Vink GR, de Wilt JH, Coupé VM. Cumulative Incidence, Risk Factors, and Overall Survival of Disease Recurrence after Curative Resection of Stage II-III Colorectal Cancer: A Population-based Study. CANCER RESEARCH COMMUNICATIONS 2024; 4:607-616. [PMID: 38363145 PMCID: PMC10903299 DOI: 10.1158/2767-9764.crc-23-0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Real-world data are necessitated to counsel patients about the risk for recurrent disease after curative treatment of colorectal cancer. This study provided a population-based overview of the epidemiology of recurrent disease in patients with surgically resected stage II/III colorectal cancer.Patients diagnosed with stage II/III primary colorectal cancer between July and December 2015 were selected from the Netherlands Cancer Registry (N = 3,762). Cumulative incidence of recurrent disease was estimated, and multivariable competing risk regression was used to identify risk factors for recurrent disease in patients with primary colon and rectal cancer. Moreover, overall survival (OS) after diagnosis of recurrent colorectal cancer was estimated.Median clinical follow-up was 58 months (Q1-Q3: 22-62). Five-year cumulative incidence of recurrent disease was 21.6% [95% confidence interval (CI): 20.0-23.2] and 30.0% (95% CI: 28.3-33.5) for patients with primary colon and rectal cancer, respectively. Stage III disease and incomplete resection margin in patients with primary colon cancer and extramural vascular invasion in patients with primary rectal cancer were strongly (HR ≥ 2) associated with recurrent disease. Median OS of patients with distant, locoregional, or the synchronous combination of distant and locoregional recurrent disease was 29, 27, and 13 months, respectively (P < 0.001). Patients with distant recurrences limited to liver or lung showed a median OS of 46 and 48 months, respectively. The incidence of recurrent disease was higher in patients with rectal cancer than in patients with colon cancer, predominantly due to higher rates of distant recurrences. OS after recurrent disease was impaired, but subgroups of patients diagnosed with recurrent disease limited to one site showed statistically significantly longer OS. SIGNIFICANCE Population-based data on recurrent colorectal cancer are rare, but crucial for counseling patients and their physicians. This large nationwide, population-based study provides an up-to-date overview of the epidemiology of recurrent disease in patients with stage II and III primary colon and rectal cancer treated with surgical resection.
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Affiliation(s)
- Tara C. Boute
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Hidde Swartjes
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marjolein J.E. Greuter
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Marloes A.G. Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Rik van Eekelen
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Geraldine R. Vink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Veerle M.H. Coupé
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
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Sueda T, Tei M, Yasuyama A, Nomura M, Yoshikawa Y, Miyagaki H, Tsujie M, Akamaru Y. Impact of regional lymph node metastasis on pulmonary metastasis as the first recurrence site. Updates Surg 2023; 75:1843-1855. [PMID: 37615847 DOI: 10.1007/s13304-023-01633-1] [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] [Received: 09/26/2022] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
Little is known about the impact of regional lymph node metastasis (LNM) on the first recurrence sites following curative colorectal cancer (CRC) surgery. The present study aimed to clarify the relationship between regional LNM stratified by N status and the first recurrence pattern in patients with stage I-III CRC. We performed a retrospective analysis of 1181 consecutive patients with stage I-III CRC who underwent curative surgery between 2010 and 2018. The total sample size included 1181 patients who underwent elective stage I-III CRC surgery. Median follow-up time was 60 months, and median time to recurrence was 12 months. Overall, the numbers of liver recurrence and pulmonary recurrence were 94 (7.9%) and 70 (5.9%), respectively. Higher N status was significantly associated with increased risk of pulmonary recurrence (N0 vs. N1a, p = 0.02; N0 vs. N1b, p < 0.01; N0 vs. N2a, p < 0.01; N0 vs. N2b, p < 0.01) and worse pulmonary recurrence-free survival, but not other recurrences. In Non-LNM patients, on the other hand, advanced T status was associated with increased risk of pulmonary recurrence. The regional LNM was strongly associated with pulmonary metastasis as the first recurrence site following stage I-III CRC resection.
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Affiliation(s)
- Toshinori Sueda
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
| | - Akinobu Yasuyama
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
| | - Masatoshi Nomura
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
| | - Yukihiro Yoshikawa
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
| | - Hiromichi Miyagaki
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
| | - Masanori Tsujie
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
| | - Yusuke Akamaru
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-Kitaku, Sakai, Osaka, 591-8025, Japan
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Inflammation-Related Signature Profile Expression as a Poor Prognosis Marker after Oxaliplatin Treatment in Colorectal Cancer. Int J Mol Sci 2023; 24:ijms24043821. [PMID: 36835258 PMCID: PMC9965239 DOI: 10.3390/ijms24043821] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Oxaliplatin is successfully used to eradicate micro-metastasis and improve survival, whereas the benefit of adjuvant chemotherapy in the early stages of colorectal cancer remains controversial. Inflammation plays a crucial role in colorectal cancer tumorigenesis. Inflammatory mechanisms are mediated by different immune cells through different cytokines, chemokines, and other proinflammatory molecules that trigger cell progression, an increase of cancer stem cell population, hyperplasia, and metastasis. This study focuses on the analysis of the oxaliplatin effect on tumourspheres formation efficiency, cell viability, cancer stem cells and stemness marker mRNA expression, as well as inflammation-related signature profile expression and its prognosis in primary- and metastatic-derived colorectal tumourspheres derived from colorectal cell lines isolated from the same patient 1 year apart. The results indicate that primary-derived colorectal tumourspheres respond to oxaliplatin, adapting to the adverse conditions through the modulation of CSCs and the stemness properties of tumourspheres. However, metastatic-derived colorectal tumourspheres response led to the release of cytokines and chemokines, promoting an inflammatory process. In addition, the expression of inflammatory markers showing greater difference between primary and metastatic tumours after oxaliplatin treatment correlates with poor prognosis in KM survival studies and is associated with a metastatic phenotype. Our data demonstrated that oxaliplatin triggers an inflammation-related signature profile expression in primary-derived colorectal tumourspheres, related with poor prognosis and a metastatic phenotype, which allow the tumour cells to adapt to the adverse condition. These data highlight the need for of drug testing and personalized medicine in the early stages of colorectal cancer.
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Vitale MG, Crispo A, Arundine D, Ronga R, Barbato C, Luongo A, Habetswallner F, De Martino BM, Maione A, Eisenwagen S, Vitale G, Riccardi F. Survival analyses of the ZeOxaNMulti trial: Follow-up randomized, double-blinded, placebo-controlled trial of oral PMA-zeolite to prevent chemotherapy-induced side effects, especially peripheral neuropathy. Front Pharmacol 2022; 13:874028. [DOI: 10.3389/fphar.2022.874028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
Following the previously published results of the clinical randomized ZeOxaNMulti trial, we evaluated the potential of the tested product PMA-ZEO (Multizeo Med) in the prevention of chemotherapy-induced side effects (especially peripheral neuropathy) within a 30-month follow-up analysis. The aim was to determine the disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS) in a study-population suffering from colorectal cancer that was previously enrolled in the ZeOxaNMulti trial from April 2015 to October 2018. The participants of the study were randomized to receive either PMA-ZEO or placebo while undergoing oxaliplatin-based chemotherapy. A total of 104 patients (pts) (51% of participants randomized to the PMA-ZEO group and 49% to the placebo group), out of a total of 120 pts included in the ZeOxaNMulti trial in 2015, were followed up until March 2021 and were included in the follow-up analysis. According to the chemotherapy line, 44.2% of patients received chemotherapy in an adjuvant setting, and 55.8% of patients received chemotherapy as first-line treatment. The statistical analysis for DFS, PFS, and OS was performed by comparison of the end results with data from the PMA-ZEO/placebo-intervention start point. The analysis of OS did not show statistically significant differences in the first-line chemotherapy patients randomized to PMA-ZEO than among the placebo group (p = 0.1) over the whole period of follow-up (30 months). However, focusing on the PMA-ZEO supplementation time point (7 months), a positive and statistically significant trend (p = 0.004) was documented in the OS analysis for the first-line chemotherapy patients with increasing months of PMA-ZEO treatment compared to the placebo group. Furthermore, borderline statistical significance was reached for PFS at the PMA-ZEO supplementation time point (7 months) in the first-line chemotherapy patients (p = 0.05) for cancer progression events. After stratification of the first-line chemotherapy patients, statistically relevant trends for OS for age, comorbidities, and oxaliplatin dosage (cycles) were also determined. The overall results for DFS (adjuvant patients), PFS (first-line chemotherapy patients), and OS (adjuvant and first-line chemotherapy patients) were generally slightly better in the PMA-ZEO group than in the placebo group, even though no statistically significant results were obtained between the groups within the follow-up period until 2021 (30 months). Based on this follow-up analysis, protective effects of PMA-zeolite supplementation can be deduced. A positive trend and more importantly, significant results in PFS and OS for specific patient groups during and/or after PMA-ZEO treatment were determined, which supports the use of PMA-ZEO as an oncological supportive therapy.
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Su JQ, Lai PY, Hu PH, Hu JM, Chang PK, Chen CY, Wu JJ, Lin YJ, Sun CA, Yang T, Hsu CH, Lin HC, Chou YC. Differential DNA methylation analysis of SUMF2, ADAMTS5, and PXDN provides novel insights into colorectal cancer prognosis prediction in Taiwan. World J Gastroenterol 2022; 28:825-839. [PMID: 35317099 PMCID: PMC8900576 DOI: 10.3748/wjg.v28.i8.825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/24/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with colorectal cancer (CRC) undergo surgery, as well as perioperative chemoradiation or adjuvant chemotherapy primarily based on the tumor–node– metastasis (TNM) cancer staging system. However, treatment responses and prognostic outcomes of patients within the same stage vary markedly. The potential use of novel biomarkers can improve prognostication and shared decision making before implementation into certain therapies.
AIM To investigate whether SUMF2, ADAMTS5, and PXDN methylation status could be associated with CRC prognosis.
METHODS We conducted a Taiwan region cohort study involving 208 patients with CRC recruited from Tri-Service General Hospital and applied the candidate gene approach to identify three genes involved in oncogenesis pathways. A methylation-specific polymerase chain reaction (MS-PCR) and EpiTYPER DNA methylation analysis were employed to detect methylation status and to quantify the methylation level of candidate genes in tumor tissue and adjacent normal tissue from participants. We evaluated SUMF2, ADAMTS5, and PXDN methylation as predictors of prognosis, including recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS), using a Cox regression model and Kaplan–Meier analysis.
RESULTS We revealed various outcomes related to methylation and prognosis. Significantly shorter PFS and OS were associated with the CpG_3+CpG_7 hypermethylation of SUMF2 from tumor tissue compared with CpG_3+CpG_7 hypomethylation [hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 1.03-4.85 for PFS, HR = 2.56 and 95%CI = 1.08-6.04 for OS]. By contrast, a significantly longer RFS was associated with CpG_2 and CpG_13 hypermethylation of ADAMTS5 from normal tissue compared with CpG_2 and CpG_13 hypomethylation [HR (95%CI) = 0.15 (0.03-0.71) for CpG_2 and 0.20 (0.04-0.97) for CpG_13]. The relationship between the methylation status of PXDN and the prognosis of CRC did not reach statistical significance.
CONCLUSION Our study found that CpG_3+CpG_7 hypermethylation of SUMF2 from tumor tissue was associated with significantly shorter PFS and OS compared with CpG_3+CpG_7 hypomethylation. CpG_2 and CpG_13 hypermethylation of ADAMTS5 from normal tissue was associated with a significantly longer RFS compared with CpG_2 and CpG_13 hypomethylation. These methylation-related biomarkers which have implications for CRC prognosis prediction may aid physicians in clinical decision-making.
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Affiliation(s)
- Jing-Quan Su
- School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Pin-Yu Lai
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Pei-Hsuan Hu
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Je-Ming Hu
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
| | - Pi-Kai Chang
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Jia-Jheng Wu
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Yu-Jyun Lin
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
| | - Tsan Yang
- Department of Health Business Administration, Meiho University, Pingtung County 912, Taiwan
| | - Chih-Hsiung Hsu
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Hua-Ching Lin
- Division of Colorectal Surgery, Department of Surgery, Cheng-Hsin General Hospital, Taipei 112, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
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Ghatak S, Mehrabi SF, Mehdawi LM, Satapathy SR, Sjölander A. Identification of a Novel Five-Gene Signature as a Prognostic and Diagnostic Biomarker in Colorectal Cancers. Int J Mol Sci 2022; 23:ijms23020793. [PMID: 35054980 PMCID: PMC8776147 DOI: 10.3390/ijms23020793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. The current TNM (Tumor, Node, and Metastasis) classification approach is suboptimal in determining the prognosis of CRC patients. The prognosis for CRC is affected by a variety of features that are present at the initial diagnosis. Herein, we performed a systematic exploration and established a novel five-panel gene signature as a prognostic and early diagnosis biomarker after performing differential gene expression analyses in five independent in silico CRCs cohort and independently validating it in one clinical cohort, using immunohistochemistry. Four genes (BDNF, PTGS2, GSK3B, and CTNNB1) were significantly upregulated and one gene (HPGD) was significantly downregulated in primary tumor tissues compared with adjacent normal tissues throughout all the five in silico datasets. The univariate CoxPH analysis yielded a five-gene signature that accurately predicted overall survival (OS) and recurrence-free survival (RFS) in the in silico training (AUC = 0.73 and 0.69, respectively) and one independent in silico validation cohort (AUC = 0.69 and 0.74, respectively). This five-gene signature demonstrated significant associations with poor OS in independent clinical validation cohorts of colon cancer (CC) patients (AUC = 0.82). Intriguingly, a risk stratification model comprising of the five-gene signature together with TNM stage and gender status achieved an even superior AUC of 0.89 in the clinical cohorts. On the other hand, the circulating mRNA expression of the upregulated four-gene signature achieved a robust AUC = 0.83 with high sensitivity and specificity as a diagnosis marker in plasma from CRC patients. We have identified a novel, five-gene signature as an independent predictor of OS, which in combination with TNM stage and gender offers an easy-to-translate and facile assay for the personalized risk-assessment in CRC patients.
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8
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Nikolic N, Radosavljevic D, Gavrilovic D, Nikolic V, Stanic N, Spasic J, Cacev T, Castellvi-Bel S, Cavic M, Jankovic G. Prognostic Factors for Post-Recurrence Survival in Stage II and III Colorectal Carcinoma Patients. ACTA ACUST UNITED AC 2021; 57:medicina57101108. [PMID: 34684145 PMCID: PMC8538010 DOI: 10.3390/medicina57101108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022]
Abstract
Background and objectives: This study aimed to evaluate prognostic factors for post-recurrence survival in local and locally advanced colorectal cancer patients. Materials and Methods: A total of 273 patients with stage III and high-risk stage II colorectal cancer were prospectively enrolled. All patients underwent operative treatment of the primary tumor and adjuvant fluorouracil-based chemotherapy. Results: Over the three-year period (2008–2010), a cohort of 273 patients with stage III and high-risk stage II colorectal cancer had been screened. During follow up, 105 (38.5%) patients had disease recurrence. Survival rates 1-, 3- and 5-year after recurrence were 53.9, 18.2 and 6.5%, respectively, and the median post-recurrence survival time was 13 months. Survival analysis showed that age at diagnosis (p < 0.01), gender (p < 0.05), elevated postoperative Ca19-9 (p < 0.01), tumor histology (adenocarcinoma vs. mucinous vs. signet ring tumors, p < 0.01) and tumor stage (II vs. III, p < 0.05) had a significant influence on post-recurrence survival. Recurrence interval and metastatic site were not related to survival following recurrence. Multivariate analysis showed that older age (HR 2.43), mucinous tumors (HR 1.51) and tumors expressing Ca19-9 at baseline (HR 3.51) were independently associated with survival following recurrence. Conclusions: Baseline patient and tumor characteristics largely predicted patient outcomes after disease recurrence. Recurrence intervals in local and locally advanced colorectal cancer were not found to be prognostic factors for post-recurrence survival. Older age, male gender, stage III and mucinous histology were poor prognostic factors after the disease had recurred. Stage II patients had remarkable post-recurrence survival compared to stage III patients.
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Affiliation(s)
- Neda Nikolic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
- Correspondence:
| | - Davorin Radosavljevic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Dusica Gavrilovic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Vladimir Nikolic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Nemanja Stanic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Jelena Spasic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Tamara Cacev
- Division of Molecular Medicine, Rudjer Boskovic Institute, 10000 Zagreb, Croatia;
| | - Sergi Castellvi-Bel
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, 08007 Barcelona, Spain;
| | - Milena Cavic
- Institute for Oncology and Radiology of Serbia, 11000 Belgrade, Serbia; (D.R.); (D.G.); (V.N.); (N.S.); (J.S.); (M.C.)
| | - Goran Jankovic
- Clinic for Gastroenterology and Hepatology, Clinical Centre of Serbia, 11000 Belgrade, Serbia;
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Luo D, Yang Y, Shan Z, Liu Q, Cai S, Li Q, Li X. Clinicopathological Features of Stage I-III Colorectal Cancer Recurrence Over 5 Years After Radical Surgery Without Receiving Neoadjuvant Therapy: Evidence From a Large Sample Study. Front Surg 2021; 8:666400. [PMID: 34434955 PMCID: PMC8381332 DOI: 10.3389/fsurg.2021.666400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
Late recurrence (5 or more years) after radical resection of colorectal cancer (CRC) is rare. This study aims to investigate the features of late recurrence in stage I–III CRC. A total of 9,754 stage I–III patients with CRC who underwent radical surgery without receiving neoadjuvant therapy, at the Fudan University Shanghai Cancer Center (FUSCC), were enrolled in this study. These patients were divided into three groups: early recurrence (3 months−2 years), intermediate recurrence (2–5 years), and late recurrence (over 5 years). The median duration of follow-up was 53.5 ± 30.1 months. A total of 2,341 (24.0%) patients developed recurrence. The late recurrence rate was 11.7%. Patients with a higher risk of late recurrence were more likely to be older, to be at the T4 stage, to have a higher degree of colon cancer, to have a lower frequency of signet ring cell carcinoma, to have fewer poorly differentiated tumors, to be at the early stage of CRC, along with less perineural and vascular invasions. Multivariate logistic regression analysis identified age, differentiation, T stage, N stage, perineural, and vascular invasions as independent factors for late recurrence. Late recurrent CRC has some distinctive characteristics. Although recurrence over 5 years after surgery is infrequent, an enhanced follow-up is still needed for the selected patients after 5 years.
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Affiliation(s)
- Dakui Luo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yufei Yang
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zezhi Shan
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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10
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Qin S, Xu RH, Shen L, Xu J, Bai Y, Yang L, Deng Y, Chen ZD, Zhong H, Pan H, Guo W, Shu Y, Yuan Y, Zhou J, Xu N, Liu T, Ma D, Wu C, Cheng Y, Chen D, Li W, Sun S, Yu Z, Cao P, Chen H, Wang J, Wang S, Wang H, Wang N, Zhang B, Zhang Q, Su W, Guo X, Li J. Subgroup Analysis by Liver Metastasis in the FRESCO Trial Comparing Fruquintinib versus Placebo Plus Best Supportive Care in Chinese Patients with Metastatic Colorectal Cancer. Onco Targets Ther 2021; 14:4439-4450. [PMID: 34408440 PMCID: PMC8364970 DOI: 10.2147/ott.s307273] [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: 02/18/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022] Open
Abstract
Objective The aim of the present subgroup analysis of the FRESCO trial is to determine the efficacy and hepatotoxicity of fruquintinib in Chinese patients with metastatic CRC with liver metastasis (CRLM) who were receiving third-line or posterior-line therapy. Methods Overall survival (OS) and progression-free survival (PFS) were evaluated by Kaplan–Meier method. Hazard ratio (HR) was estimated through Cox proportional hazards model. Hepatotoxicity was coded using the standardized MedDRA queries of hepatic failure, fibrosis, cirrhosis, and other liver injury-related conditions and graded using the Common Terminology Criteria Adverse Events grades. The efficacy of fruquintinib in patients with CRLM was evaluated in various subgroups. Results A total of 287 (69.0%) patients with metastatic CRC had liver metastasis (LM, fruquintinib: 185 and placebo: 102). Median OS in patients with CRLM was significantly prolonged with fruquintinib compared with placebo (8.61 months vs 5.98 months; HR=0.59, 95% CI, 0.45–0.77, P<0.001). In patients with CRLM, the incremental median PFS for patients in the fruquintinib-treated group was significantly higher than in the placebo group (median PFS: 3.71 vs.1.84 months; HR=0.22, 95% CI: 0.17–0.30; P<0.001). Compared with placebo, significant improvements in OS were observed with fruquintinib in LM patients regardless of lung metastasis, prior target therapy, and K-RAS status. In patients with CRLM, treatment-emergent hepatotoxicities of any grade occurred in 7 (3.8%) patients in the fruquintinib group vs 2 (2.0%) in the placebo group. Conclusion Fruquintinib demonstrated a statistically significant increase in OS and PFS as compared with placebo in Chinese patients with CRLM. The hepatotoxicity of fruquintinib was less reported, and comparable with placebo in patients with CRLM. ClinicalTrials.gov Identifier NCT02314819.
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Affiliation(s)
- Shukui Qin
- Cancer Center, Jinling Hospital, Nanjing, People's Republic of China
| | - Rui-Hua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
| | - Lin Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jianming Xu
- Department of Medical Oncology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yuxian Bai
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Lei Yang
- Department of Medical Oncology, Nantong Cancer Hospital, Nantong, People's Republic of China
| | - Yanhong Deng
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhen-Dong Chen
- Department of Medical Oncology, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Haijun Zhong
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Hongming Pan
- Department of Medical Oncology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Weijian Guo
- Department of Medical Oncology, Shanghai Medical College, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Yongqian Shu
- Department of Medical Oncology, Jiangsu Provincial Hospital, Nanjing, People's Republic of China
| | - Ying Yuan
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jianfeng Zhou
- Department of Medical Oncology, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Nong Xu
- Department of Medical Oncology, The First Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, People's Republic of China
| | - Tianshu Liu
- Department of Medical Oncology, Fudan University Zhongshan Hospital, Shanghai Medical College, Shanghai, People's Republic of China
| | - Dong Ma
- Department of Medical Oncology, Guangdong Provincial People's Hospital, Guangzhou, People's Republic of China
| | - Changping Wu
- Department of Medical Oncology, The First People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Ying Cheng
- Department of Medical Oncology, Jilin Province Cancer Hospital, Changchun, People's Republic of China
| | - Donghui Chen
- Department of Medical Oncology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, People's Republic of China
| | - Wei Li
- Department of Medical Oncology, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Sanyuan Sun
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Zhuang Yu
- Department of Medical Oncology, The Affiliated Hospital of Medical College Qingdao University, Qingdao, People's Republic of China
| | - Peiguo Cao
- Department of Medical Oncology, The Third Xiangya Hospital of Central South University, Changsha, People's Republic of China
| | - Haihui Chen
- Department of Medical Oncology, Liuzhou Worker's Hospital, Liuzhou, People's Republic of China
| | - Jiejun Wang
- Department of Medical Oncology, Shanghai Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China
| | - Shubin Wang
- Department of Medical Oncology, Peking University Shenzhen Hospital, Beijing University, Shenzhen, People's Republic of China
| | - Hongbing Wang
- Department of Medical Oncology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou Medical College, Xuzhou, People's Republic of China
| | - Ning Wang
- Eli Lilly and Company, Shanghai, People's Republic of China
| | - Bin Zhang
- Eli Lilly and Company, Shanghai, People's Republic of China
| | - Qiang Zhang
- Eli Lilly and Company, Shanghai, People's Republic of China
| | - Weiguo Su
- Hutchison MediPharma Limited, Shanghai, People's Republic of China
| | - Xiaojun Guo
- Hutchison MediPharma Limited, Shanghai, People's Republic of China
| | - Jin Li
- Department of Medical Oncology, Tongji University Shanghai East Hospital, Shanghai, People's Republic of China
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11
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Kato Y, Shigeta K, Okabayashi K, Tsuruta M, Seishima R, Matsui S, Sasaki T, Koseki Y, Kitagawa Y. Lymph node metastasis is strongly associated with lung metastasis as the first recurrence site in colorectal cancer. Surgery 2021; 170:696-702. [PMID: 33902923 DOI: 10.1016/j.surg.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/14/2021] [Accepted: 03/09/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND The lymphatic system is known to be the primary pathway of metastasis for colorectal cancer. However, beyond regional lymph node metastases, little is known about the pathway of lymphatic metastases and the differences in the recurrence site risk. The aim of this study was to clarify the relationship between lymph node metastasis and the first recurrence site in colorectal cancer. METHODS Patients with colorectal cancer who underwent curative resection in our institution between January 2003 and December 2016 were included in this analysis. The relationship between the first recurrence site and clinicopathological factors was analyzed by the Cox regression model and competing risk regression model. RESULTS In total, 1,249 patients with colorectal cancer were included in this analysis. We found that the stages of lymph node metastases (N0 vs N1: P = .008, N0 vs N2a: P < .001, N0 vs N2b: P < .001) were significantly associated with lung metastasis in the multivariate analysis. Furthermore, in the competing risk analysis, the stages of lymph node metastases were significantly correlated with lung metastasis (N0 vs N1: P = .002, N0 vs N2a: P < .001, N0 vs N2b: P < .001) but were not correlated with other recurrence sites. CONCLUSION The severity of lymph node involvement had a strong correlation with lung metastases in patients with colorectal cancer.
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Affiliation(s)
- Yujin Kato
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Kohei Shigeta
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
| | - Koji Okabayashi
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Masashi Tsuruta
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Ryo Seishima
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Shimpei Matsui
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Taketo Sasaki
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Yuka Koseki
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan
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12
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Hsu CH, Hsiao CW, Sun CA, Wu WC, Yang T, Hu JM, Huang CH, Liao YC, Chen CY, Lin FH, Chou YC. Novel methylation gene panel in adjacent normal tissues predicts poor prognosis of colorectal cancer in Taiwan. World J Gastroenterol 2020; 26:154-167. [PMID: 31988582 PMCID: PMC6962436 DOI: 10.3748/wjg.v26.i2.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/14/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It is evident that current clinical criteria are suboptimal to accurately estimate patient prognosis. Studies have identified epigenetic aberrant changes as novel prognostic factors for colorectal cancer (CRC).
AIM To estimate whether a methylation gene panel in different clinical stages can reflect a different prognosis.
METHODS We enrolled 120 CRC patients from Tri-Service General Hospital in Taiwan and used the candidate gene approach to select six genes involved in carcinogenesis pathways. Patients were divided into two groups based on the methylation status of the six evaluated genes, namely, the < 3 aberrancy group and ≥ 3 aberrancy group. Various tumor stages were divided into two subgroups (local and advanced stages) on the basis of the pathological type of the following tissues: Tumor and adjacent normal tissues (matched normal). We assessed DNA methylation in tumors and adjacent normal tissues from CRC patients and analyzed the association between DNA methylation with different cancer stages and the prognostic outcome including time to progression (TTP) and overall survival.
RESULTS We observed a significantly increasing trend of hazard ratio as the number of hypermethylated genes increased both in normal tissue and tumor tissue. The 5-year TTP survival curves showed a significant difference between the ≥ 3 aberrancy group and the < 3 aberrancy group. Compared with the < 3 aberrancy group, a significantly shorter TTP was observed in the ≥ 3 aberrancy group. We further analyzed the interaction between CRC prognosis and different cancer stages (local and advanced) according to the methylation status of the selected genes in both types of tissues. There was a significantly shorter 5-year TTP for tumors at advanced stages with the promoter methylation status of selected genes than for those with local stages. We found an interaction between cancer stages and the promoter methylation status of selected genes in both types of tissues.
CONCLUSION Our data provide a significant association between the methylation markers in normal tissues with advanced stage and prognosis of CRC. We recommend using these novel markers to assist in clinical decision-making.
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Affiliation(s)
- Chih-Hsiung Hsu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
- Teaching Office, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Cheng-Wen Hsiao
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
- Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 242, Taiwan
| | - Wen-Chih Wu
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
- Department of Surgery, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Yilan County 264, Taiwan
| | - Tsan Yang
- Department of Health Business Administration, Meiho University, Pingtung County 912, Taiwan
| | - Je-Ming Hu
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Adjunct Instructor, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Chi-Hua Huang
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Yu-Chan Liao
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Chao-Yang Chen
- Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Adjunct Instructor, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
| | - Yu-Ching Chou
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
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13
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Yu Y, Carey M, Pollett W, Green J, Dicks E, Parfrey P, Yilmaz YE, Savas S. The long-term survival characteristics of a cohort of colorectal cancer patients and baseline variables associated with survival outcomes with or without time-varying effects. BMC Med 2019; 17:150. [PMID: 31352904 PMCID: PMC6661748 DOI: 10.1186/s12916-019-1379-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Colorectal cancer is the third most common cancer in the world. In this study, we assessed the long-term survival characteristics and prognostic associations and potential time-varying effects of clinico-demographic variables and two molecular markers (microsatellite instability (MSI) and BRAF Val600Glu mutation) in a population-based patient cohort followed up to ~ 19 years. METHODS The patient cohort included 738 incident cases diagnosed between 1999 and 2003. Cox models were used to analyze the association between the variables and a set of survival outcome measures (overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), metastasis-free survival (MFS), recurrence/metastasis-free survival (RMFS), and event-free survival (EFS)). Cox proportional hazard (PH) assumption was tested for all variables, and Cox models with time-varying effects were used if any departure from the PH assumption was detected. RESULTS During the follow-up, ~ 61% patients died from any cause, ~ 26% died from colorectal cancer, and ~ 10% and ~ 20% experienced recurrences and distant metastases, respectively. Stage IV disease and post-diagnostic recurrence or metastasis were strongly linked to risk of death from colorectal cancer. If a patient had survived the first 6 years without any disease-related event (i.e., recurrence, metastasis, or death from colorectal cancer), their risks became very minimal after this time period. Distinct sets of markers were associated with different outcome measures. In some cases, the effects by variables were constant throughout the follow-up. For example, MSI-high tumor phenotype and older age at diagnosis predicted longer MFS times consistently over the follow-up. However, in some other cases, the effects of the variables varied with time. For example, adjuvant radiotherapy treatment was associated with increased risk of metastasis in patients who received this treatment after 5.5 years post-diagnosis, but not before that. CONCLUSIONS This study describes the long-term survival characteristics of a prospective cohort of colorectal cancer patients, relationships between baseline variables and a detailed set of patient outcomes over a long time, and time-varying effects of a group of variables. The results presented advance our understanding of the long-term prognostic characteristics in colorectal cancer and are expected to inspire future studies and clinical care strategies.
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Affiliation(s)
- Yajun Yu
- Discipline of Genetics, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, New Medical Education Building, St. John's, NL, A1B 3V6, Canada
| | - Megan Carey
- Discipline of Genetics, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, New Medical Education Building, St. John's, NL, A1B 3V6, Canada
| | - William Pollett
- Discipline of Surgery, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Jane Green
- Discipline of Genetics, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, New Medical Education Building, St. John's, NL, A1B 3V6, Canada
| | - Elizabeth Dicks
- Discipline of Medicine, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Patrick Parfrey
- Discipline of Medicine, Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - Yildiz E Yilmaz
- Discipline of Genetics, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, New Medical Education Building, St. John's, NL, A1B 3V6, Canada.,Discipline of Medicine, Faculty of Medicine, Memorial University, St. John's, NL, Canada.,Department of Mathematics and Statistics, Faculty of Science, Memorial University, St. John's, NL, Canada
| | - Sevtap Savas
- Discipline of Genetics, Faculty of Medicine, Memorial University, 300 Prince Philip Drive, New Medical Education Building, St. John's, NL, A1B 3V6, Canada. .,Discipline of Oncology, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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14
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The volume-time index (VTI) is prognostic in patients with colorectal cancer peritoneal metastases undergoing cytoreductive surgery and intraperitoneal chemotherapy. Am J Surg 2019; 219:58-64. [PMID: 30982572 DOI: 10.1016/j.amjsurg.2019.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Peritoneal cancer index (PCI) is an important prognostic factor in colorectal cancer peritoneal metastases (CRPM), however it fails to consider the time period over which disease burden develops. The volume-time index (VTI) is the ratio between PCI and time from primary tumour resection. METHODS A retrospective cohort study of 182 patients managed from 1996 to 2017 was performed. RESULTS As stratified by high vs low VTI groups, median overall survival (OS) was 23 months (95% 17-46) vs 44 months (95% 35-72) with a difference in 5-year OS of 20.3% (95%CI 10.2-40.4) vs 40.1% (95%CI 29.7-54.1), p = 0.002. No difference in 5-year recurrence free survival (RFS) exists. On multivariable analysis, an elevated VTI was independently associated with poorer OS (adjusted HR 3.20, 95%CI 1.64-6.23, p < 0.001) and RFS (adjusted HR 1.90, 95%CI 1.10-3.29, p = 0.02). CONCLUSION VTI is an independent prognostic factor for OS and RFs in patients with CRPM undergoing CRS/IPC, behaving as a surrogate of tumour aggressiveness.
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15
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Rectal Cancer Surveillance-Recurrence Patterns and Survival Outcomes from a Cohort Followed up Beyond 10 Years. J Gastrointest Cancer 2019; 49:422-428. [PMID: 28660522 DOI: 10.1007/s12029-017-9984-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The intensity and duration of surveillance for rectal cancer after surgical resection remain contentious. We evaluated the pattern of recurrences in a rectal cancer cohort followed up beyond 10 years. METHODS An analysis was performed on a retrospective database of 326 patients with rectal cancer who underwent curative surgical resection from 1999 to 2007. The above study duration was chosen to ensure at least 10 years of follow-up. Data on patient demographics, peri-operative details, and follow-up outcomes were extracted from the database. The pattern of recurrences and investigative modality that detected recurrences was identified. Patients were followed up until either year 2016 or the day of their demise. RESULTS Two hundred seventeen patients (66.6%) were male and 109 patients (33.3%) female. Median age was 64 years old. Close to a third of the patients received adjuvant therapy (34%). Among the 326 patients studied, 29.8% of (97/326) patients developed recurrence. 7.7% (25/326) had loco-regional recurrence while 22.1% (72/326) had distant metastasis. Median time to recurrence was 16 months (4-83) and 18 months (3-81), respectively. Computed tomography scan was the best modality to detect both loco-regional and distant recurrences (48% in loco-regional and 41.7% in distant metastasis). The most common site of distant metastasis is the lung (34.7%). The salvage rate for loco-regional and distant recurrences was 52 and 12.5%, respectively. CONCLUSION The predominant pattern of recurrence in rectal cancer is distant disease. Surveillance regimes may need to be altered to increase early detection of distant metastases.
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16
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Bozkaya Y, Albayrak I, Tucer D, Kaya Z, Usta U. Late-Onset Lung Metastasis in Rectum Cancer Can Be Confused with Primary Lung Cancer; a Case Report and Literature Review. J Gastrointest Cancer 2019; 50:1029-1033. [PMID: 30613927 DOI: 10.1007/s12029-018-00190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y Bozkaya
- Clinic of Medical Oncology, Edirne State Hospital, 22030, Edirne, Turkey.
| | - I Albayrak
- Clinic of Thoracic Surgery, Edirne State Hospital, Edirne, Turkey
| | - D Tucer
- Clinic of Gastroenterology, Edirne State Hospital, Edirne, Turkey
| | - Z Kaya
- Clinic of Radiology, Edirne State Hospital, Edirne, Turkey
| | - U Usta
- Department of Pathology, Trakya University Faculty of Medicine, Edirne, Turkey
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17
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Suman G, Baheti AD, Ankathi SK, Shetty N, Kulkarni S, Ostwal V, Saklani AP. Role of Ultrasonography in the Surveillance of Disease-Free Patients with Colorectal Cancer: a Retrospective Audit. Indian J Surg Oncol 2018; 9:452-455. [PMID: 30538371 PMCID: PMC6265162 DOI: 10.1007/s13193-018-0815-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/22/2018] [Indexed: 12/18/2022] Open
Abstract
Close surveillance of colorectal cancer (CRC) patients is helpful as early detection of resectable metastasis has a survival benefit. Ultrasonography (USG) is a frequently used modality to detect liver recurrence, although international guidelines do not include it. To evaluate the potential added role of USG in early detection of CRC recurrence. We performed a retrospective analysis of 230 patients of colorectal cancer treated at our institute in 2013-2014 who underwent abdominal USG for surveillance. 77/230 (33%) developed recurrence, with liver being the second most common site (22/230). 5/230 (2%) patients had recurrent disease first detected on USG, four of which also had raised serum CEA (carcinoembryonic antigen) levels. There were three false positive and four false-negative cases on USG. There was no added advantage of USG for early detection of CRC recurrence.
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Affiliation(s)
- Garima Suman
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, India
| | - Akshay D. Baheti
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, India
| | | | - Nitin Shetty
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, India
| | - Suyash Kulkarni
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Center, Mumbai, India
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18
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Walker R, Wood T, LeSouder E, Cleghorn M, Maganti M, MacNeill A, Quereshy FA. Comparison of two novel staging systems with the TNM system in predicting stage III colon cancer survival. J Surg Oncol 2018; 117:1049-1057. [PMID: 29473957 DOI: 10.1002/jso.25009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Adaptations of the TNM staging system that incorporate the Lymph Node Ratio (LNR) have been proposed for stage III colon cancer. This study compared the concordance of two novel staging systems and the TNM system with observed survival outcomes in stage III patients. METHODS A review of patients who underwent surgery for stage III colon cancer between January 2002 and April 2015 at a tertiary care centre was performed. The Kaplan-Meier method was used to estimate the 5-year overall (OS) and disease free survival (DFS) rates, and the concordance probability was calculated to evaluate the discriminatory power of the staging systems. RESULTS Two hundred and sixty-one patients were identified. For TNM stages IIIA, IIIB, and IIIC, 5-year OS was 83.4%, 67.6%, and 38.3%, respectively (P < 0.001). All three staging systems were independently predictive of OS and DFS (P < 0.001). However, the novel staging system by Sugimoto et al18 was the most favourable prognostic tool, with a concordance of 0.646 for DFS and 0.659 for OS. CONCLUSIONS The novel staging system by Sugimoto et al18 was superior to the TNM system. Incorporating LNR into staging models for node positive colon cancers may improve survival information available to patients and potentially aid treatment decisions.
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Affiliation(s)
- Richard Walker
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Trevor Wood
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Emily LeSouder
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Michelle Cleghorn
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - Manjula Maganti
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrea MacNeill
- BC Cancer Agency and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Fayez A Quereshy
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
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19
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Mant D, Gray A, Pugh S, Campbell H, George S, Fuller A, Shinkins B, Corkhill A, Mellor J, Dixon E, Little L, Perera-Salazar R, Primrose J. A randomised controlled trial to assess the cost-effectiveness of intensive versus no scheduled follow-up in patients who have undergone resection for colorectal cancer with curative intent. Health Technol Assess 2017; 21:1-86. [PMID: 28641703 PMCID: PMC5494506 DOI: 10.3310/hta21320] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Intensive follow-up after surgery for colorectal cancer is common practice but lacks a firm evidence base. OBJECTIVE To assess whether or not augmenting symptomatic follow-up in primary care with two intensive methods of follow-up [monitoring of blood carcinoembryonic antigen (CEA) levels and scheduled imaging] is effective and cost-effective in detecting the recurrence of colorectal cancer treatable surgically with curative intent. DESIGN Randomised controlled open-label trial. Participants were randomly assigned to one of four groups: (1) minimum follow-up (n = 301), (2) CEA testing only (n = 300), (3) computerised tomography (CT) only (n = 299) or (4) CEA testing and CT (n = 302). Blood CEA was measured every 3 months for 2 years and then every 6 months for 3 years; CT scans of the chest, abdomen and pelvis were performed every 6 months for 2 years and then annually for 3 years. Those in the minimum and CEA testing-only arms had a single CT scan at 12-18 months. The groups were minimised on adjuvant chemotherapy, gender and age group (three strata). SETTING Thirty-nine NHS hospitals in England with access to high-volume services offering surgical treatment of metastatic recurrence. PARTICIPANTS A total of 1202 participants who had undergone curative treatment for Dukes' stage A to C colorectal cancer with no residual disease. Adjuvant treatment was completed if indicated. There was no evidence of metastatic disease on axial imaging and the post-operative blood CEA level was ≤ 10 µg/l. MAIN OUTCOME MEASURES Primary outcome Surgical treatment of recurrence with curative intent. Secondary outcomes Time to detection of recurrence, survival after treatment of recurrence, overall survival and quality-adjusted life-years (QALYs) gained. RESULTS Detection of recurrence During 5 years of scheduled follow-up, cancer recurrence was detected in 203 (16.9%) participants. The proportion of participants with recurrence surgically treated with curative intent was 6.3% (76/1202), with little difference according to Dukes' staging (stage A, 5.1%; stage B, 7.4%; stage C, 5.6%; p = 0.56). The proportion was two to three times higher in each of the three more intensive arms (7.5% overall) than in the minimum follow-up arm (2.7%) (difference 4.8%; p = 0.003). Surgical treatment of recurrence with curative intent was 2.7% (8/301) in the minimum follow-up group, 6.3% (19/300) in the CEA testing group, 9.4% (28/299) in the CT group and 7.0% (21/302) in the CEA testing and CT group. Surgical treatment of recurrence with curative intent was two to three times higher in each of the three more intensive follow-up groups than in the minimum follow-up group; adjusted odds ratios (ORs) compared with minimum follow-up were as follows: CEA testing group, OR 2.40, 95% confidence interval (CI) 1.02 to 5.65; CT group, OR 3.69, 95% CI 1.63 to 8.38; and CEA testing and CT group, OR 2.78, 95% CI 1.19 to 6.49. Survival A Kaplan-Meier survival analysis confirmed no significant difference between arms (log-rank p = 0.45). The baseline-adjusted Cox proportional hazards ratio comparing the minimum and intensive arms was 0.87 (95% CI 0.67 to 1.15). These CIs suggest a maximum survival benefit from intensive follow-up of 3.8%. Cost-effectiveness The incremental cost per patient treated surgically with curative intent compared with minimum follow-up was £40,131 with CEA testing, £43,392 with CT and £85,151 with CEA testing and CT. The lack of differential impact on survival resulted in little difference in QALYs saved between arms. The additional cost per QALY gained of moving from minimum follow-up to CEA testing was £25,951 and for CT was £246,107. When compared with minimum follow-up, combined CEA testing and CT was more costly and generated fewer QALYs, resulting in a negative incremental cost-effectiveness ratio (-£208,347) and a dominated policy. LIMITATIONS Although this is the largest trial undertaken at the time of writing, it has insufficient power to assess whether or not the improvement in detecting treatable recurrence achieved by intensive follow-up leads to a reduction in overall mortality. CONCLUSIONS Rigorous staging to detect residual disease is important before embarking on follow-up. The benefit of intensive follow-up in detecting surgically treatable recurrence is independent of stage. The survival benefit from intensive follow-up is unlikely to exceed 4% in absolute terms and harm cannot be absolutely excluded. A longer time horizon is required to ascertain whether or not intensive follow-up is an efficient use of scarce health-care resources. Translational analyses are under way, utilising tumour tissue collected from Follow-up After Colorectal Surgery trial participants, with the aim of identifying potentially prognostic biomarkers that may guide follow-up in the future. TRIAL REGISTRATION Current Controlled Trials ISRCTN41458548. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 32. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Mant
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Siân Pugh
- University Surgery, University of Southampton, Southampton, UK
| | - Helen Campbell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stephen George
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alice Fuller
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Bethany Shinkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andrea Corkhill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Jane Mellor
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Elizabeth Dixon
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Louisa Little
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Primrose
- University Surgery, University of Southampton, Southampton, UK
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20
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Kandimalla R, Linnekamp JF, van Hooff S, Castells A, Llor X, Andreu M, Jover R, Goel A, Medema JP. Methylation of WNT target genes AXIN2 and DKK1 as robust biomarkers for recurrence prediction in stage II colon cancer. Oncogenesis 2017; 6:e308. [PMID: 28368388 PMCID: PMC5520503 DOI: 10.1038/oncsis.2017.9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 12/18/2022] Open
Abstract
Stage II colon cancer (CC) still remains a clinical challenge with patient stratification for adjuvant therapy (AT) largely relying on clinical parameters. Prognostic biomarkers are urgently needed for better stratification. Previously, we have shown that WNT target genes AXIN2, DKK1, APCDD1, ASCL2 and LGR5 are silenced by DNA methylation and could serve as prognostic markers in stage II CC patients using methylation-specific PCR. Here, we have extended our discovery cohort AMC90-AJCC-II (N=65) and methylation was analyzed by quantitative pyrosequencing. Subsequently, we validated the results in an independent EPICOLON1 CC cohort (N=79). Methylation of WNT target genes is negatively correlated to mRNA expression. A combination of AXIN2 and DKK1 methylation significantly predicted recurrences in univariate (area under the curve (AUC)=0.83, confidence interval (CI): 0.72–0.94, P<0.0001) analysis in stage II microsatellite stable (MSS) CC patients. This two marker combination showed an AUC of 0.80 (CI: 0.68–0.91, P<0.0001) in the EPICOLON1 validation cohort. Multivariate analysis in the Academic Medical Center (AMC) cohort revealed that both WNT target gene methylation and consensus molecular subtype 4 (CMS4) are significantly associated with poor recurrence-free survival (hazard ratio (HR)methylation: 3.84, 95% CI: 1.14–12.43; HRCMS4: 3.73, 95% CI: 1.22–11.48). CMS4 subtype tumors with WNT target methylation showed worse prognosis. Combining WNT target gene methylation and CMS4 subtype lead to an AUC of 0.89 (0.791–0.982, P<0.0001) for recurrence prediction. Notably, we observed that methylation of DKK1 is high in BRAF mutant and CIMP (CpG island methylator phenotype)-positive cancers, whereas AXIN2 methylation appears to be associated with CMS4. Methylation of AXIN2 and DKK1 were found to be robust markers for recurrence prediction in stage II MSS CC patients. Further validation of these findings in a randomized and prospective manner could pave a way to identify poor prognosis patients of stage II CC for AT.
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Affiliation(s)
- R Kandimalla
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Cancer Genomics Center, Amsterdam, The Netherlands.,Center for Gastrointestinal Research and Center for Epigenetics, Cancer Prevention and Cancer Genomics, Baylor Scott and White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
| | - J F Linnekamp
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Cancer Genomics Center, Amsterdam, The Netherlands
| | - S van Hooff
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Cancer Genomics Center, Amsterdam, The Netherlands
| | - A Castells
- Institut de Malaties Digestives i Metabòliques, CIBERehd, Hospital Clínic, Barcelona, Spain
| | - X Llor
- University of Yale, New Haven, CT, USA
| | - M Andreu
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | - R Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - A Goel
- Center for Gastrointestinal Research and Center for Epigenetics, Cancer Prevention and Cancer Genomics, Baylor Scott and White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
| | - J P Medema
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental Molecular Medicine (CEMM), Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Cancer Genomics Center, Amsterdam, The Netherlands
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21
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Garziera M, Bidoli E, Cecchin E, Mini E, Nobili S, Lonardi S, Buonadonna A, Errante D, Pella N, D’Andrea M, De Marchi F, De Paoli A, Zanusso C, De Mattia E, Tassi R, Toffoli G. HLA-G 3'UTR Polymorphisms Impact the Prognosis of Stage II-III CRC Patients in Fluoropyrimidine-Based Treatment. PLoS One 2015; 10:e0144000. [PMID: 26633805 PMCID: PMC4669157 DOI: 10.1371/journal.pone.0144000] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/11/2015] [Indexed: 01/05/2023] Open
Abstract
An important hallmark of CRC is the evasion of immune surveillance. HLA-G is a negative regulator of host's immune response. Overexpression of HLA-G protein in primary tumour CRC tissues has already been associated to worse prognosis; however a definition of the role of immunogenetic host background is still lacking. Germline polymorphisms in the 3'UTR region of HLA-G influence the magnitude of the protein by modulating HLA-G mRNA stability. Soluble HLA-G has been associated to 3'UTR +2960 Ins/Ins and +3035 C/T (lower levels) and +3187 G/G (high levels) genotypes. HLA-G 3'UTR SNPs have never been explored in CRC outcome. The purpose of this study was to investigate if common HLA-G 3'UTR polymorphisms have an impact on DFS and OS of 253 stage II-III CRC patients, after primary surgery and ADJ-CT based on FL. The 3'UTR was sequenced and SNPs were analyzed for their association with survival by Kaplan-Meier and multivariate Cox models; results underwent internal validation using a resampling method (bootstrap analysis). In a multivariate analysis, we estimated an association with improved DFS in Ins allele (Ins/Del +Ins/Ins) carriers (HR 0.60, 95% CI 0.38-0.93, P = 0.023) and in patients with +3035 C/T genotype (HR 0.51, 95% CI 0.26-0.99, P = 0.045). The +3187 G/G mutated carriers (G/G vs A/A+A/G) were associated to a worst prognosis in both DFS (HR 2.46, 95% CI 1.19-5.05, P = 0.015) and OS (HR 2.71, 95% CI 1.16-6.63, P = 0.022). Our study shows a prognostic and independent role of 3 HLA-G 3'UTR SNPs, +2960 14-bp INDEL, +3035 C>T, and +3187 A>G.
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Affiliation(s)
- Marica Garziera
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
- * E-mail:
| | - Ettore Bidoli
- Epidemiology and Biostatistic Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Erika Cecchin
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Enrico Mini
- Section of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefania Nobili
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Sara Lonardi
- Medical Oncology Unit 1, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Angela Buonadonna
- Division of Medical Oncology B; Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Domenico Errante
- Medical Oncology Unit, Ospedale Civile di Vittorio Veneto, Vittorio Veneto (TV), Italy
| | - Nicoletta Pella
- Medical Oncology Unit, University Hospital, Piazza S. Maria Della Misericordia, Udine, Italy
| | - Mario D’Andrea
- Medical Oncology Unit, “San Filippo Neri Hospital”, Piazza Di S. Maria Della Pietà, Rome, Italy
| | - Francesco De Marchi
- Surgical Oncology Department, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Antonino De Paoli
- Radiotherapy Department, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Chiara Zanusso
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Elena De Mattia
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
| | - Renato Tassi
- Section of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Toffoli
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico (CRO), IRCCS, Aviano National Cancer Institute, via F. Gallini 2, 33081 Aviano, Italy
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22
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Hocking C, Broadbridge VT, Karapetis C, Beeke C, Padbury R, Maddern GJ, Roder DM, Price TJ. Equivalence of outcomes for rural and metropolitan patients with metastatic colorectal cancer in South Australia. Med J Aust 2015; 201:462-6. [PMID: 25332033 DOI: 10.5694/mja14.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the management and outcome of rural and metropolitan patients with metastatic colorectal cancer (mCRC) in South Australia. DESIGN, SETTING AND PATIENTS Retrospective cohort study of patients with mCRC submitted to the South Australian mCRC registry between 2 February 2006 and a cut-off date of 28 May 2012. MAIN OUTCOME MEASURES Differences in oncological and surgical management and overall survival (calculated using the Kaplan-Meier method) between city and rural patients. RESULTS Of 2289 patients, 624 (27.3%) were rural. There was a higher proportion of male patients in the rural cohort, but other patient characteristics did not significantly differ between the cohorts. Equivalent rates of chemotherapy administration between city and rural patients were observed across each line of treatment (first line: 56.0% v 58.3%, P = 0.32; second line: 23.3% v 22.5%, P = 0.78; and third line: 10.1% v 9.3%, P = 0.69). A higher proportion of city patients received combination chemotherapy in the first-line setting (67.4% v 59.9%; P = 0.01). When an oxaliplatin combination was prescribed, oral capecitabine was used more frequently in rural patients (22.9% v 8.4%; P < 0.001). No significant difference was seen in rates of hepatic resection or other non-chemotherapy treatments between cohorts. Median overall survival was equivalent between city and rural patients (14.6 v 14.9 months, P = 0.18). CONCLUSION Patterns of chemotherapy and surgical management of rural patients with mCRC in SA are equivalent to their metropolitan counterparts and lead to comparable overall survival. The centralised model of oncological care in SA may ensure rural patients gain access to optimal care.
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Affiliation(s)
| | | | - Christos Karapetis
- Flinders Cancer Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - Carol Beeke
- Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Robert Padbury
- Division of Surgery, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Guy J Maddern
- Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia
| | - David M Roder
- School of Population Health, University of South Australia, Adelaide, SA, Australia
| | - Timothy J Price
- Medical Oncology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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Oh SY, Sohn SH, Yim H, Lee D, Suh KW, Kim YB. ALDH1 is a prognostic factor for patients treated with neoadjuvant chemoradiotherapy and radical resection for stage III rectal cancer. J Surg Oncol 2014; 111:243-7. [PMID: 25270363 DOI: 10.1002/jso.23792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/25/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The factors relating to changes within a tumor after preoperative chemoradiotherapy associated with rectal cancer prognosis remain to be determined. The aim of this study was to investigate the expression of CD133 and ALDH1 and to analyze the predictive and prognostic roles in patients with rectal cancer after chemoradiotherapy. METHODS We analyzed the expression levels of ALDH1 and CD133 in patients with middle and lower rectal cancers who underwent preoperative chemoradiotherapy between March 2005 and December 2011. RESULTS The expression of CD133 was not associated with survival. The 5-year overall survival rates were lower in patients with high ALDH1 expression compared to low ALDH1 expression in stage III rectal cancer (61.0% vs. 89.7%, P=0.031). Cox multivariate analysis demonstrated that high ALDH1 expression (HR, 5.425; 95% CI, 1.116-26.373; P=0.036), cT (HR, 12.861; 95% CI, 2.188-75.591; P=0.005), and pN2 (HR, 28.481; 95% CI, 4.757-170.518; P<0.001) were independently associated with overall survival in 51 patients with stage III rectal cancer. CONCLUSIONS Expression of ALDH1 indicates a more aggressive feature of stage III rectal cancer and can stratify stage III rectal cancer into different survival groups.
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Affiliation(s)
- Seung Yeop Oh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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24
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Schwitalla S. Tumor cell plasticity: the challenge to catch a moving target. J Gastroenterol 2014; 49:618-27. [PMID: 24566894 DOI: 10.1007/s00535-014-0943-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/04/2014] [Indexed: 02/04/2023]
Abstract
Every cancer cell is "different"--within one and the same tumor, between different lesions originating from the same tumor, among different patients suffering from the same tumor type, and certainly between different tumor types. The complexity of tumor development, with its genetic, phenotypic and functional heterogeneity and plasticity within tumors and between primary tumors and metastases, underlies the unpredictable influences and stimuli of a tumor-associated inflammatory microenvironment, immune response, mechanical and metabolic stress, therapy-induced inflammation or interaction with microbiota. The stochastic and context dependent nature of these factors accounts for the difficulties to investigate the impact of resulting cell plasticity on tumor development, and justifies the challenge to prevent tumor recurrence. The emerging concept of cell plasticity and reciprocity (to change the phenotype by processing signals from the environment) throws more light on the actual complexity of tumor heterogeneity than can be expected solely from a unidirectional, classical cancer stem cell (CSC) model. To date, it remains widely unclear to what extent cell plasticity impacts tumor development, and it is difficult to assess by current methods. As a high tumor plasticity is likely to predict a poor outcome for patients, the future therapeutic challenge will be the development of personalized treatment strategies to predict and finally prevent cell plasticity in patients.
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Affiliation(s)
- Sarah Schwitalla
- Dr. George Daley Laboratory, Division of Hematology/Oncology, Boston Children's Hospital, Harvard Stem Cell Institute, One Blackfan Circle, Boston, MA, 02115, USA,
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25
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Gao Y, Li C, Nie M, Lu Y, Lin S, Yuan P, Sun X. CXCR4 as a novel predictive biomarker for metastasis and poor prognosis in colorectal cancer. Tumour Biol 2014; 35:4171-5. [PMID: 24395653 DOI: 10.1007/s13277-013-1545-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022] Open
Abstract
The clinical significance of CXCR4 expression in colorectal cancer remains unclear. The aim of this study was to investigate the expression and regulatory effects of CXCR4 in colorectal cancer and the association between CXCR4 protein expression and prognosis. The mRNA and protein expression levels of CXCR4 were determined using reverse-transcriptase polymerase chain reaction and immunohistochemistry staining, respectively, and the relationship between the CXCR4 protein level and clinicopathological parameters was analyzed in 720 cases of colorectal cancer. CXCR4 expression was elevated in colorectal cancer tissues compared to pericancerous tissues (P = 0.001). Of the 720 enrolled cases, 208 (28.89%) expressed CXCR4. In univariate analysis, CXCR4 was found to be associated with lymph node metastasis, TNM stage, and liver metastasis (P = 0.001, 0.001, and 0.012, respectively). Further multivariate analysis suggested that histological grade, TNM stage, and CXCR4 expression were related to liver metastasis (P = 0.020, 0.01, and 0.001, respectively). In the Cox regression test, the histological grade, lymph node metastasis, TNM stage, liver metastasis, and CXCR4 expression were found to be independent prognostic factors (P = 0.02, 0.045, 0.01, 0.001, and 0.001, respectively). CXCR4 protein may be a potential biomarker for liver metastasis and an independent marker for survival in colorectal cancer.
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Affiliation(s)
- Ying Gao
- Department of Pathology, Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China
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