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Prognostic Significance of Preoperative Serum Carcinoembryonic Antigen Varies with Lymph Node Metastasis Status in Colorectal Cancer. JOURNAL OF ONCOLOGY 2022; 2021:4487988. [PMID: 34987578 PMCID: PMC8723854 DOI: 10.1155/2021/4487988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022]
Abstract
Background Preoperative serum level of carcinoembryonic antigen (pCEA) is generally recognized as a prognostic factor for colorectal cancer (CRC), but the stage-specific role of pCEA in colorectal cancer remains unclear. Objective We investigated the prognostic significance of pCEA levels in different tumor stages of nonmetastatic CRC patients. Methods Six hundred and fifteen CRC patients at stage I–III were retrospectively analyzed. All of them received curative tumor resection. The X-tile program was used to generate stage-specific cutoff values of pCEA for all patients and two subpopulations (lymph node-positive or -negative). The prognostic significance of pCEA was assessed using Kaplan–Meier analysis and Cox proportional hazards regression analysis. A nomogram model that combined pCEA score and clinical feature indexes was established and evaluated. Results Two cutoff values were identified in the study population. At a cutoff value of 4.9 ng/mL, a significantly higher 5-year overall survival (OS) rate (82.16%) was observed in the pCEA-low group (<4.9 ng/mL) compared with 65.52% in the pCEA-high group (≥4.9 ng/mL). Furthermore, at the second cutoff value of 27.2 ng/mL, 5-year OS was found to be only 40.9%. Stratification analysis revealed that preoperative serum level of pCEA was an independent prognostic factor (OR = 1.991, P < 0.01) in the subpopulation of lymph node metastasis (stage III) patients, and the relative survival rates in the pCEA-low (≤4.9 ng/mL), pCEA-medium (4.9–27.2 ng/mL), and pCEA-high (≥27.2 ng/mL) groups were 73.4%, 60.5%, and 24.8%, respectively (P < 0.05). However, no such effect was observed in the lymph node nonmetastasis (stage I and II) subgroup. The established nomogram showed acceptable predictive power of the 5-year OS rate (C-index: 0.612) in lymph node-positive CRC patients, with an area under the curve value of 0.772, as assessed by ROC curve analysis. Conclusions Pretreatment serum CEA levels had different prognostic significance based on the lymph node metastasis status. Among stage III CRC patients, pCEA was an independent prognostic factor. Five-year OS rates could be predicted according to the individual pCEA level at the different cutoff values.
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Yang YS, Feng F, Qiu YJ, Zheng GH, Ge YQ, Wang YT. High-resolution MRI-based radiomics analysis to predict lymph node metastasis and tumor deposits respectively in rectal cancer. Abdom Radiol (NY) 2021; 46:873-884. [PMID: 32940755 DOI: 10.1007/s00261-020-02733-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To establish and validate two predictive radiomics models for preoperative prediction of lymph node metastases (LNMs) and tumor deposits (TDs) respectively in rectal cancer (RC) patients. METHODS A total of 139 RC patients (98 in the training cohort and 41 in the validation cohort) were enrolled in the present study. High-resolution magnetic resonance images (HRMRI) were retrieved for tumor segmentation and feature extraction. HRMRI findings of RC were assessed by three experienced radiologists. Two radiomics nomograms were established by integrating the clinical risk factors, HRMRI findings and radiomics signature. RESULTS The predictive nomogram of LNMs showed good predictive performance (area under the curve [AUC], 0.90; 95% confidence interval [CI] 0.83-0.96) which was better than clinico-radiological (AUC, 0.83; 95% CI 0.74-0.93; Delong test, p = 0.017) or radiomics signature-only model (AUC, 0.77; 95% CI 0.67-0.86; Delong test, p = 0.003) in training cohort. Application of the nomogram in the validation cohort still exhibited good performance (AUC, 0.87; 95% CI 0.76-0.98). The accuracy, sensitivity and specificity of the combined model in predicting LNMs was 0.86,0.79 and 0.91 in training cohort and 0.83,0.85 and 0.82 in validation cohort. As for TDs, the predictive efficacy of the nomogram (AUC, 0.82; 95% CI 0.71-0.93) was not significantly higher than radiomics signature-only model (AUC, 0.80; 95% CI 0.69-0.92; Delong test, p = 0.71). Radiomics signature-only model was adopted to predict TDs with accuracy=0.76, sensitivity=0.72 and specificity=0.94 in training cohort and 0.68, 0.62 and 0.97 in validation cohort. CONCLUSION HRMRI-based radiomics models could be helpful for the prediction of LNMs and TDs preoperatively in RC patients.
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Affiliation(s)
- Yan-Song Yang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China
- Department of Radiology, Affiliated Cancer Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Feng Feng
- Department of Radiology, Affiliated Cancer Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Yong-Juan Qiu
- Department of Radiology, Affiliated Cancer Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Gui-Hua Zheng
- Department of Pathology, Affiliated Cancer Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | | | - Yue-Tao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No.185, Juqian Street, Changzhou, 213003, Jiangsu, China.
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Pont L, Kuzyk V, Benavente F, Sanz-Nebot V, Mayboroda OA, Wuhrer M, Lageveen-Kammeijer GSM. Site-Specific N-Linked Glycosylation Analysis of Human Carcinoembryonic Antigen by Sheathless Capillary Electrophoresis-Tandem Mass Spectrometry. J Proteome Res 2021; 20:1666-1675. [PMID: 33560857 PMCID: PMC8023805 DOI: 10.1021/acs.jproteome.0c00875] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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With 28 potential N-glycosylation sites, human
carcinoembryonic antigen (CEA) bears an extreme amount of N-linked glycosylation, and approximately 60% of its molecular
mass can be attributed to its carbohydrates. CEA is often overexpressed
and released by many solid tumors, including colorectal carcinomas.
CEA displays an impressive heterogeneity and variability in sugar
content; however, site-specific distribution of carbohydrate structures
has not been reported so far. The present study investigated CEA samples
purified from human colon carcinoma and human liver metastases and
enabled the characterization of 21 out of 28 potential N-glycosylation sites with respect to their occupancy. The coverage
was achieved by a multienzymatic digestion approach with specific
enzymes, such as trypsin, endoproteinase Glu-C, and the nonspecific enzyme, Pronase, followed by analysis using
sheathless CE-MS/MS. In total, 893 different N-glycopeptides
and 128 unique N-glycan compositions were identified.
Overall, a great heterogeneity was found both within (micro) and in
between (macro) individual N-glycosylation sites.
Moreover, notable differences were found on certain N-glycosylation sites between primary adenocarcinoma and metastatic
tumor in regard to branching, bisection, sialylation, and fucosylation.
Those features, if further investigated in a targeted manner, may
pave the way toward improved diagnostics and monitoring of colorectal
cancer progression and recurrence. Raw mass spectrometric data and
Skyline processed data files that support the findings of this study
are available in the MassIVE repository with the identifier MSV000086774
[DOI: 10.25345/C5Z50X].
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Affiliation(s)
- Laura Pont
- Department of Chemical Engineering and Analytical Chemistry, University of Barcelona, 08007 Barcelona, Spain
| | - Valeriia Kuzyk
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.,Division of Bioanalytical Chemistry, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Fernando Benavente
- Department of Chemical Engineering and Analytical Chemistry, University of Barcelona, 08007 Barcelona, Spain
| | - Victoria Sanz-Nebot
- Department of Chemical Engineering and Analytical Chemistry, University of Barcelona, 08007 Barcelona, Spain
| | - Oleg A Mayboroda
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Fan J, Liu Y, Cai X, Wang J, Guo R, Ji Y, Li C, Xu Y, Li X, Zhang C, Zhang R, Zhu J, Cai S. A Novel Prognostic Model Incorporating Carcinoembryonic Antigen in 3-Week or Longer Postoperative Period for Stage III Colon Cancer: A Multicenter Retrospective Study. Front Oncol 2020; 10:566784. [PMID: 33335852 PMCID: PMC7736239 DOI: 10.3389/fonc.2020.566784] [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: 05/28/2020] [Accepted: 11/02/2020] [Indexed: 01/21/2023] Open
Abstract
Background The prognostic stratification of colon cancer using only the tumor-node-metastasis (TNM) stage has some limitations. We sought to increase the accuracy of stratifying patients with stage III colon cancer by constructing a prognostic model combining carcinoembryonic antigen (CEA) with TNM. Methods We retrospectively analyzed the data generated from stage III colon cancer patients who had early postoperative CEA measurement from 21 to 100 days after surgery from 2006 to 2017. CEA value was processed using restricted cubic splines (RCS) method. The prognostic model was developed using cox proportional hazards regression. Results The time later than 20 days after surgery was optimal for measuring CEA, which was determined by comparing the prognostic value for preoperative and postoperative CEA (N = 2,049), and by evaluating the relationship between the hazard ratio (HR) and postoperative CEA measuring time. Postoperative CEA, T stage and N stage were selected into the final model, and the mean integrated-AUC (iAUC) was 0.78 with 1,000 × bootstrap resampling, which was higher than the model using only T and N stages (TN model; mean iAUC, 0.66). The net reclassification improvement (NRI) was 15% when compared with TN model. Patients could be divided into high and low risk groups by the model, and 3-year disease-free survival (DFS) were 53.7% and 87.0%, respectively (HR, 4.30; 95% CI, 2.65 to 6.96; P < 0.001). Similar results were found in the validation set. Conclusions Stage III colon cancer could be stratified more accurately using the new prognostic model combining postoperative CEA with T and N stage.
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Affiliation(s)
- Jin Fan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xin Cai
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Jingwen Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Rui Guo
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yuan Ji
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
| | - Chao Li
- Department of Radiation Oncology, Huashan Hospital Fudan University, Shanghai, China
| | - Ye Xu
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xinxiang Li
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chundong Zhang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.,Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rui Zhang
- Department of Colorectal Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Ji Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Lin YH, Wu CH, Fu HC, Chen YJ, Chen YY, Ou YC, Lin H. Prognostic significance of elevated pretreatment serum levels of CEA and CA-125 in epithelial ovarian cancer. Cancer Biomark 2020; 28:285-292. [PMID: 32390605 DOI: 10.3233/cbm-201455] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Epithelial ovarian cancer is a highly lethal gynecological malignancy. Accurate and cost-effective predictive tools to estimate the prognosis of patients with epithelial ovarian cancer before treatment are currently lacking. OBJECTIVE The purpose of this study was to evaluate the prognostic significance of pretreatment serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen-125 (CA-125) in primary epithelial ovarian cancer. METHODS Between 2008 and 2016, 326 patients with a diagnosis of primary epithelial ovarian cancer were retrospectively reviewed. We attempted to identify an optimal cut-off value of CEA to predict survival using ROC curve analysis. Cox regression univariate and multivariate analyses were used to evaluate prognostic factors. RESULTS The optimal cut-off value of CEA was 2.6 ng/mL. In univariate and multivariate analyses, FIGO stage and pretreatment CA-125 and CEA levels significantly predicted progression-free and overall survival. The 5-year progression-free survival rate for patients with both a CEA level < 2.6 ng/mL and CA-125 level < 35 U/mL was 84%, compared to only 33% for the patients with higher levels of both markers (p< 0.001). The 5-year cancer specific survival rate was 94% in those with a CEA level < 2.6 ng/mL and CA-125 level < 35 U/mL, and only 39% for those with higher levels of both markers (p< 0.001). CONCLUSIONS In addition to traditional prognostic factors, a pretreatment serum CEA level ⩾ 2.6 ng/mL and CA-125 level ⩾ 35 U/mL were also independent prognostic factors for epithelial ovarian cancer. Patients with an elevated CEA and/or CA-125 level before treatment should be considered to be at high-risk of recurrence and death.
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Affiliation(s)
- Yu-Han Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chen-Hsuan Wu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Lin-Kou, Taiwan
| | - Hung-Chun Fu
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jen Chen
- Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Yin-Yi Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Meltzer S, Bjørnetrø T, Lyckander LG, Flatmark K, Dueland S, Samiappan R, Johansen C, Kalanxhi E, Ree AH, Redalen KR. Circulating Exosomal miR-141-3p and miR-375 in Metastatic Progression of Rectal Cancer. Transl Oncol 2019; 12:1038-1044. [PMID: 31146167 PMCID: PMC6542769 DOI: 10.1016/j.tranon.2019.04.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/17/2019] [Indexed: 12/21/2022] Open
Abstract
As many as 30% to 40% of locally advanced rectal cancer (LARC) patients experience metastatic progression of the disease. Recognizing the potential of the genetic cargo in tumor-derived exosomes, we hypothesized that plasma exosomal microRNA (miRNA) may reflect biological aggressiveness in LARC and provide new markers for rectal cancer aggressiveness and risk stratification. In a prospective LARC cohort (NCT01816607), plasma samples were collected from 29 patients at the time of diagnosis, before neoadjuvant therapy and surgery. Exosomes, precipitated from plasma using a commercial kit, were verified by cryo-electron microscopy, nanoparticle tracking analysis, and western blotting. Expression of exosomal miRNAs was profiled using a miRCURY LNA miRNA microarray and validation of six miRNAs associated with pathological and clinical end-points was undertaken in plasma collected at the time of diagnosis from 64 patients in an independent prospective LARC cohort (NCT00278694). In both cohorts, exosomal miR-141-3p and miR-375 were higher in patients with synchronous liver metastasis than in those without (P = .010 and P = .017 respectively in the investigative cohort, and P < .001 for both in the validation cohort). Further, high exosomal miR-141-3p was associated with post-operative metastatic liver progression in the investigative cohort (P = .034). Because both miRNAs are associated with tumor angiogenesis and immune modulation, we propose that these miRNAs in circulating exosomes may reflect rectal cancer aggressiveness and accordingly be candidate biomarkers for further investigations.
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Affiliation(s)
- Sebastian Meltzer
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Tonje Bjørnetrø
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | | | - Kjersti Flatmark
- Department of Gastroenterological Surgery, Oslo University Hospital, 0424 Oslo, Norway; Department of Tumor Biology, Oslo University Hospital, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Svein Dueland
- Department of Oncology, Oslo University Hospital, 0424 Oslo, Norway
| | - Rampradeep Samiappan
- Department of Bioscience and Nutrition, Karolinska Institutet, SE-141 83 Huddinge, Sweden
| | - Christin Johansen
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Erta Kalanxhi
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Anne Hansen Ree
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Kathrine Røe Redalen
- Department of Oncology, Akershus University Hospital, 1478 Lørenskog, Norway; Department of Physics, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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Dendy MS, Ludwig JM, Kim HS. Predictors and prognosticators for survival with Yttrium-90 radioembolization therapy for unresectable colorectal cancer liver metastasis. Oncotarget 2017; 8:37912-37922. [PMID: 28415671 PMCID: PMC5514961 DOI: 10.18632/oncotarget.16007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023] Open
Abstract
This critical review aims to explore predictive and prognostic biomarkers of Yttrium-90 (Y90) radioembolization therapy of colorectal liver metastases. A brief overview of established predictive and prognostic molecular and genetic biomarkers in colorectal cancer therapies will be discussed. A review of the literature on imaging modalities, genetic, metabolic and other molecular markers and the subsequent outcomes in post-Y90 treatment will be presented. How these biomarkers and future biomarker research can inform locoregional treatment decisions in the clinical setting of metastatic colorectal cancer lesions of the liver will be explored. There are opportunities for personalized cancer treatment in the setting of Y90 radioembolization. The ability to predict tumor response after Ytrium-90 radioembolization therapy can greatly impact clinical decision making and enhance treatment outcomes, therefore further research into the field is needed.
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Affiliation(s)
- Meaghan S. Dendy
- Drexel University College of Medicine, Philadelphia, PA, USA
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Johannes M. Ludwig
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Hyun S. Kim
- Department of Radiology and Biomedical Imaging, Division of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Center, Yale University, New Haven, CT, USA
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