1
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Eisenberg M, Deboever N, Antonoff MB. Pulmonary Metastasectomy. Thorac Surg Clin 2023; 33:149-158. [PMID: 37045484 DOI: 10.1016/j.thorsurg.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The lung represents the most common site for metastatic spread of extrathoracic primary malignancies. Pulmonary metastatic disease occurs in a wide breadth of cancers with a multitude of histologies, and, historically, has been managed predominantly with systemic therapy. However, in appropriately selected patients, pulmonary metastasectomy can provide extended disease-free intervals, relief from systemic therapy, and prolonged survival. Thus, pulmonary metastasectomy serves a vital role in the armamentarium against a multitude of primary malignancies. Moreover, as systemic agents improve and more patients live longer with stage IV cancer, pulmonary metastasectomy will likely have increasing relevance in the future.
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2
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Powell K, Marquart J, Olivier T, Prasad V. The role of surgery in metastatic cancer: the case for a pragmatic tumor-agnostic randomized trial. Future Oncol 2022; 18:3955-3959. [PMID: 36621818 DOI: 10.2217/fon-2022-0840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Kerrington Powell
- School of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA
| | - John Marquart
- Department of Surgery, Medical College of Wisconsin, 999 North 92nd Street, Suite CCC 320, Milwaukee, WI 53226, USA
| | - Timothée Olivier
- Department of Oncology, Geneva University Hospital, 4 Gabrielle-Perret-Gentil Street, 1205, Geneva, Switzerland.,Department of Epidemiology & Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, USA
| | - Vinay Prasad
- Department of Epidemiology & Biostatistics, University of California San Francisco, 550 16th St, 2nd Fl, San Francisco, CA 94158, USA
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3
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Javid H, Hashemian P, Yazdani S, Sharbaf Mashhad A, Karimi-Shahri M. The role of heat shock proteins in metastatic colorectal cancer: A review. J Cell Biochem 2022; 123:1704-1735. [PMID: 36063530 DOI: 10.1002/jcb.30326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 01/18/2023]
Abstract
Heat shock proteins (HSPs) are a large molecular chaperone family classified by their molecular weights, including HSP27, HSP40, HSP60, HSP70, HSP90, and HSP110. HSPs are likely to have antiapoptotic properties and participate actively in various processes such as tumor cell proliferation, invasion, metastases, and death. In this review, we discuss comprehensively the functions of HSPs associated with the progression of colorectal cancer (CRC) and metastasis and resistance to cancer therapy. Taken together, HSPs have numerous clinical applications as biomarkers for cancer diagnosis and prognosis and potential therapeutic targets for CRC and its related metastases.
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Affiliation(s)
- Hossein Javid
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Laboratory Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Pedram Hashemian
- Jahad Daneshgahi Research Committee, Jahad Daneshgahi Institute, Mashhad, Iran
| | - Shaghayegh Yazdani
- Department of Medical Laboratory Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Laboratory Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Alireza Sharbaf Mashhad
- Department of Medical Laboratory Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Karimi-Shahri
- Department of Pathology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pathology, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
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4
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Antonoff MB, Sofocleous CT, Callstrom MR, Nguyen QN. The roles of surgery, stereotactic radiation, and ablation for treatment of pulmonary metastases. J Thorac Cardiovasc Surg 2021; 163:495-502. [PMID: 33838914 DOI: 10.1016/j.jtcvs.2021.01.143] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Accepted: 01/02/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
| | | | | | - Quynh-Nhu Nguyen
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
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5
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Schweiger T, Liebmann-Reindl S, Glueck O, Starlinger P, Laengle J, Birner P, Klepetko W, Pils D, Streubel B, Hoetzenecker K. Mutational profile of colorectal cancer lung metastases and paired primary tumors by targeted next generation sequencing: implications on clinical outcome after surgery. J Thorac Dis 2018; 10:6147-6157. [PMID: 30622786 DOI: 10.21037/jtd.2018.10.72] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Pulmonary metastasectomy is one of the cornerstones in the treatment of oligometastatic colorectal cancer (CRC). However, the selection of patients who benefit from a surgical resection is difficult. Mutational profiling has become an essential part of diagnosis and treatment of malignant disease. Despite this, comprehensive data on the mutational profile of CRC and its clinical impact in the context of pulmonary metastasectomy is sparse. We therefore aimed to provide a complete mutational status of CRC pulmonary metastases (PM) and corresponding primary tumors by targeted next-generation sequencing (tNGS), and correlate sequencing data with clinical outcome variables. Methods Case-matched, formalin-fixed paraffin embedded surgical specimens of lung metastases (n=47) and matched primary CRC (n=24) were sequenced using the TruSeq Amplicon Cancer Panel (Illumina platform). Penalized Cox regression models were applied to identify mutations with prognostic impact. Results Mutations were found most frequently in APC, TP53 and KRAS, in both PM and matched primary tumors. Concordance between primary tumors and PM was 83.5%. Adaptive elastic-net regularized Cox regression models identified mutations being prognostic for time to pulmonary recurrence (EGFR, GNAQ, KIT, MET, and PTPN11) and for overall survival (OS) (PDGFRA, SMARCB1, and TP53). Conclusions Our findings suggest that CRC PM harbor a variety of conserved and de novo mutations. We could identify a mutational profile predicting clinical outcome after pulmonary metastasectomy. Moreover, our data provide a rationale for future targeted therapies of patients with CRC lung metastases.
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Affiliation(s)
- Thomas Schweiger
- Division of Thoracic Surgery, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Sandra Liebmann-Reindl
- Core Facility Genomics, Comprehensive Cancer Center, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Department of Pathology, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Olaf Glueck
- Division of Thoracic Surgery, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Patrick Starlinger
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Johannes Laengle
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Peter Birner
- Department of Pathology, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Dietmar Pils
- Division of General Surgery, Department of Surgery, Comprehensive Cancer Center Vienna, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Institute of Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Berthold Streubel
- Core Facility Genomics, Comprehensive Cancer Center, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Department of Pathology, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
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6
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Kollmann D, Schweiger T, Schwarz S, Ignatova D, Chang YT, Lewik G, Schoppmann SF, Hoetzenecker W, Klepetko W, Guenova E, Hoetzenecker K. PD1-positive tumor-infiltrating lymphocytes are associated with poor clinical outcome after pulmonary metastasectomy for colorectal cancer. Oncoimmunology 2017; 6:e1331194. [PMID: 28932634 DOI: 10.1080/2162402x.2017.1331194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 01/07/2023] Open
Abstract
Pulmonary metastasectomy (PM) is routinely performed in colorectal cancer (CRC) patients with oligometastatic spreading to the lungs. Patients with an aggressive tumor phenotype should be excluded from PM, since its benefit is outweighed by early tumor recurrence and impaired prognosis. Expression of PD-1 and its ligands are prognostic factors in a variety of primary tumors. However, their impact on patients' outcome in the setting of PM for CRC has not been evaluated before. 53 CRC patients with pulmonary metastases receiving PM with curative intent were included in this study. Tissue samples of resected pulmonary metastases and available corresponding primary tumors were collected and assessed for PD-1, PD-L1 and PD-L2 expression by tumor-infiltrating lymphocytes (TILs) and tumor cells. Expression patterns were correlated with clinical outcome parameters. PD-1 and PD-L1 expression was commonly found in TILs and tumor cells. Expression levels significantly differed between metastases and primary tumors. High PD-1 expression by TILs was associated with impaired overall survival (low vs high expression (mean, 95% CI): 78 mo (60-96) vs 35 mo (25-44); p = 0.011). Additionally, the subgroup of patients, who experienced an upgrading in their TILs/PD1 status between primary and metastasis had a worse survival outcome compared with patients with the same grade or a downgrading (34 mo (26-42) vs 96 mo (72-120); p = 0.004). Thus, PD-1 expression by TILs is a strong prognostic marker in CRC patients with pulmonary spreading treated by PM. Moreover, this study provides a rationale for a therapeutic PD-1 pathway blockade in the treatment of CRC lung metastases. Future, large-scale studies are warranted to validate the findings of this single-center, retrospective analysis.
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Affiliation(s)
- Dagmar Kollmann
- Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Desislava Ignatova
- Department of Dermatology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Yun-Tsan Chang
- Department of Dermatology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Gerrit Lewik
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Sebastian F Schoppmann
- Department of Surgery, Upper-GI-Service, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Wolfram Hoetzenecker
- Department of Dermatology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Emmanuella Guenova
- Department of Dermatology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, Kantonspital St. Gallen, University of Zurich, Zurich, Switzerland
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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7
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Lang C, Hrdliczka E, Schweiger T, Glueck O, Lewik G, Schwarz S, Benazzo A, Lang G, Klepetko W, Hoetzenecker K. Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy. J Thorac Dis 2017; 9:621-635. [PMID: 28449470 DOI: 10.21037/jtd.2017.02.83] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulmonary metastasectomy (PM) is a standard procedure in the treatment of stage IV colorectal cancer (CRC). In most centers the indication for PM is solely based on clinical factors without taking the tumor biology into account. This results in diverse outcomes ranging from long-term remission to early recurrence. Inflammation is considered a hallmark of cancer development and progression. On the other hand the accessibility of CRC cells to the immune system reflects the grade of tumor aggressiveness. We sought to investigate the impact of cyclooxygenase-2 (COX-2) and prostaglandin-E2 (PGE2) expression in pulmonary metastases on different outcome parameters following PM. METHODS From 04/2009 to 11/2013 53 patients with complete PM for CRC were included in this single-center study. Tissue samples of resected pulmonary metastases and available corresponding primaries were collected and assessed by immunohistochemistry for COX-2 and PGE2 expression of the tumor tissue and the peritumoral stroma. Results were correlated with clinical outcome parameters. RESULTS COX-2 and PGE2 were detected in nearly every pulmonary CRC metastasis. Staining intensities of pulmonary metastases correlated only weakly with intensities found in primary tumors. When dividing metastases in high expressing and low expressing tumors, a trend towards longer recurrence free survival and improved survival was found in tumors with strong COX-2 and PGE2 staining. CONCLUSIONS In conclusion, this pilot study shows that COX-2 and PGE2 are uniformly overexpressed in pulmonary metastases from CRC. High expression of COX-2 and PGE2 seems to reflect a beneficial tumor biology with late tumor recurrence and prolonged overall survival after PM.
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Affiliation(s)
- Christian Lang
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Emilie Hrdliczka
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Olaf Glueck
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Gerrit Lewik
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Stefan Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Alberto Benazzo
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - György Lang
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Austria
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8
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Paku S, Laszlo V, Dezso K, Nagy P, Hoda MA, Klepetko W, Renyi-Vamos F, Timar J, Reynolds AR, Dome B. The evidence for and against different modes of tumour cell extravasation in the lung: diapedesis, capillary destruction, necroptosis, and endothelialization. J Pathol 2017; 241:441-447. [PMID: 28026875 DOI: 10.1002/path.4855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 12/17/2022]
Abstract
The development of lung metastasis is a significant negative prognostic factor for cancer patients. The extravasation phase of lung metastasis involves interactions of tumour cells with the pulmonary endothelium. These interactions may have broad biological and medical significance, with potential clinical implications ranging from the discovery of lung metastasis biomarkers to the identification of targets for intervention in preventing lung metastases. Because of the potential significance, the mechanisms of tumour cell extravasation require cautious, systematic studies. Here, we discuss the literature pertaining to the proposed mechanisms of extravasation and critically compare a recently proposed mechanism (tumour cell-induced endothelial necroptosis) with the already described extravasation mechanisms in the lung. We also provide novel data that may help to explain the underlying physiological basis for endothelialization as a mechanism of tumour cell extravasation in the lung. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Sándor Paku
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.,Tumour Progression Research Group, Hungarian Academy of Sciences-Semmelweis University, Budapest, Hungary
| | - Viktoria Laszlo
- Department of Thoracic Surgery, Medical University of Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Katalin Dezso
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Peter Nagy
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Mir Alireza Hoda
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Austria
| | - Ferenc Renyi-Vamos
- Department of Thoracic Surgery, Medical University of Vienna, Austria.,Department of Thoracic Surgery, Semmelweis University-National Institute of Oncology, Budapest, Hungary
| | - Jozsef Timar
- Tumour Progression Research Group, Hungarian Academy of Sciences-Semmelweis University, Budapest, Hungary.,2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Andrew R Reynolds
- Tumour Biology Team, The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Balazs Dome
- Department of Thoracic Surgery, Medical University of Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.,Department of Thoracic Surgery, Semmelweis University-National Institute of Oncology, Budapest, Hungary.,National Koranyi Institute of Pulmonology, Budapest, Hungary
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9
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Tumor-infiltrating lymphocyte subsets and tertiary lymphoid structures in pulmonary metastases from colorectal cancer. Clin Exp Metastasis 2016; 33:727-39. [PMID: 27449756 PMCID: PMC5035322 DOI: 10.1007/s10585-016-9813-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/18/2016] [Indexed: 12/19/2022]
Abstract
The presence of tumor-infiltrating lymphocytes (TILs) and tertiary lymphoid structures (TLSs) reflects an active inflammatory tumor microenvironment. High density of TILs as well as presence of TLS is associated with improved survival in various solid cancer types. We aimed to describe the density and distribution of TILs and TLS in pulmonary metastases (PMs) from primary colorectal cancer (CRC) and its correlation with clinicopathological variables. Fifty-seven CRC pulmonary metastasectomy specimen (PM) and 31 matched primary CRC specimen were included. Cluster of differentiation (CD)3+, CD8+, CD45RO+ and FoxP3+ TILs were evaluated by immunohistochemistry and density was scored semiquantitatively. TLS were evaluated based on morphological criteria. Survival time was defined from pulmonary metastasectomy to death or last follow up. A marked infiltration with CD3+, CD8+, CD45RO+ and FoxP3+ TILs was evident in CRC PM and matched primary CRC. Further assessment of the immune infiltrate in PM showed that a high density of FOXP3+ TILs at the invasive margin [HR 2.40 (1.11-6.96); P = 0.031] and low density of CD8+ cells in TLS [HR 0.30 (0.14-0.79); P = 0.016] were associated with a worse prognosis in univariate analysis. Moreover, a low CD8/FoxP3-ratio of TILs at the invasive margin (P = 0.042) and in TLS (P = 0.027) conferred an impaired prognosis after pulmonary metastasectomy. Our findings suggest that CRC PM harbor an immune active microenvironment. The balance of CD8+ and FoxP3+ T-cells at the tumor border and in TLS provides prognostic information in patients with CRC PM.
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10
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Schweiger T, Nikolowsky C, Graeter T, Seebacher G, Laufer J, Glueck O, Glogner C, Birner P, Lang G, Klepetko W, Ankersmit HJ, Hoetzenecker K. Increased lymphangiogenesis in lung metastases from colorectal cancer is associated with early lymph node recurrence and decreased overall survival. Clin Exp Metastasis 2015; 33:133-41. [PMID: 26498830 DOI: 10.1007/s10585-015-9763-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/15/2015] [Indexed: 01/15/2023]
Abstract
Pulmonary metastasectomy (PM) is an accepted treatment modality in colorectal cancer (CRC) patients with pulmonary tumor spread. Positive intrathoracic lymph nodes at the time of PM are associated with a poor prognosis and 5-year survival rates of <20 %. Increased lymphangiogenesis in pulmonary metastases might represent an initial step for a subsequent lymphangiogenic spreading. We aimed to evaluate the presence of lymphangiogenesis in clinically lymph node negative patients undergoing PM and its impact on outcome parameters. 71 patients who underwent PM for CRC metastases were included in this dual-center study. Tissue specimens of pulmonary metastases and available corresponding primary tumors were assessed by immunohistochemistry for lymphatic microvessel density (LMVD) and lymphovascular invasion (LVI). Results were correlated with clinical outcome parameters. LMVD was 13.9 ± 8.1 and 13.3 ± 8.5 microvessels/field (mean ± SD) in metastases and corresponding primary CRC; LVI was evident in 46.5 and 58.6 % of metastases and corresponding primary CRC, respectively. Samples with high LMVD had a higher likelihood of LVI. LVI was associated with early tumor recurrence in intrathoracic lymph nodes and a decreased overall survival (p < 0.001 and p = 0.029). Herein, we present first evidence in a well-defined patient collective that increased lymphangiogenesis is already present in a subtype of pulmonary metastases of patients staged as N0 at the time of PM. This lymphangiogenic phenotype has a strong impact on patients' prognosis. Our findings may have impact on the post-surgical therapeutic management of CRC patients with pulmonary spreading.
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Affiliation(s)
- Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria
| | - Christoph Nikolowsky
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria
| | - Thomas Graeter
- Department of Thoracic and Vascular Surgery, Klinik Loewenstein, Loewenstein, Germany
| | - Gernot Seebacher
- Department of Thoracic and Vascular Surgery, Klinik Loewenstein, Loewenstein, Germany
| | - Jürgen Laufer
- Institute for Pathology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - Olaf Glueck
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria
| | - Christoph Glogner
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria
| | - Peter Birner
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - György Lang
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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11
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Marron MC, Lora D, Gamez P, Rivas JJ, Embun R, Molins L, de la Cruz J. Agreement Between Computed Tomography and Pathologic Nodule Counts in Colorectal Lung Metastases. Ann Thorac Surg 2015; 101:259-65. [PMID: 26319489 DOI: 10.1016/j.athoracsur.2015.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Computed tomography is the most common technique used to estimate the number of pulmonary metastases and their resectability. A lack of agreement between radiologic and surgical pathologic findings could potentially lead to incomplete resection or to rejection of patients for potentially curative treatments. The objective of this study was to estimate the disagreement between the number of radiologic lesions and the number of histologically confirmed malignant lesions excised from patients with pulmonary metastases from colorectal cancer. METHODS This was a multicenter longitudinal study using a national registry. All patients underwent open surgery for pulmonary metastasectomy. RESULTS Radiologic unilateral involvement was documented in 345 of 404 patients (85%); 253 (73%) presented with single nodules. The radiologic and malignant pathologic findings were concordant in 316 (78%) patients. The two independent predictors of discordance between computed tomography and the number of pathologic metastases were the bilateral involvement and the number of radiologic nodules. This model explained 28% of the variability in the disagreement frequency and discriminated between agreement and disagreement in 85% of the patients. Discrepancies increased with the nodule count with an odds ratio of 6.17 (95% confidence interval, 4.08 to 9.33) per additional nodule. For similar nodule counts, a lower disagreement frequency was observed among bilateral cases (odds ratio, 0.2; 95% confidence interval, 0.07 to 0.55). CONCLUSIONS Differences between the radiologic and pathologic findings were documented in 1 of every 5 patients. The correlation was very accurate in patients with single radiologic nodules. However, half of the patients with more nodules showed discrepancies.
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Affiliation(s)
- M Carmen Marron
- Department of Thoracic Surgery, "12 Octubre" University Hospital, Madrid, Spain.
| | - David Lora
- Clinical Research Unit-CIBERESP, "12 Octubre" University Hospital, Madrid, Spain
| | - Pablo Gamez
- Department of Thoracic Surgery, "12 Octubre" University Hospital, Madrid, Spain
| | - Juan J Rivas
- Department of Thoracic Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Raul Embun
- Department of Thoracic Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laureano Molins
- Department of Thoracic Surgery, Sagrat Cor University Hospital, Barcelona, Spain
| | - Javier de la Cruz
- Clinical Research Unit-CIBERESP, "12 Octubre" University Hospital, Madrid, Spain
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12
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Ghanim B, Schweiger T, Jedamzik J, Glueck O, Glogner C, Lang G, Klepetko W, Hoetzenecker K. Elevated inflammatory parameters and inflammation scores are associated with poor prognosis in patients undergoing pulmonary metastasectomy for colorectal cancer. Interact Cardiovasc Thorac Surg 2015; 21:616-23. [PMID: 26242317 DOI: 10.1093/icvts/ivv206] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/23/2015] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Pulmonary metastasectomy (PM) has evolved to become a standard treatment for colorectal cancer lung metastases. However, biomarkers to estimate the prognosis after PM are currently missing. We therefore investigated the prognostic impact of inflammatory-related biomarkers and scores in patients undergoing curative PM for colorectal cancer. METHODS We analysed prospectively collected datasets of 52 patients treated in our institution between April 2009 and June 2014. Fibrinogen (cut-off 325 mg/dl), C-reactive protein (CRP, cut-off 0.5 mg/dl), the modified Glasgow prognostic score (mGPS) and the neutrophil-to-lymphocyte ratio (NLR) at the time of PM were tested for their prognostic power, and correlated to time to recurrence (TTR), time to lung-specific recurrence (TTLR) and overall survival (OS). RESULTS Median OS after PM of all patients (n = 52, 21 females, 31 males, mean age ± standard deviation: 62.65 ± 11.41 years) was 36 months [95% confidence interval (CI) 24.7-47.3 months, number of events: n = 20/38.5%]. In univariable survival analyses, high fibrinogen [hazard ratio (HR) 5.51, 95% CI 1.21-25.17], elevated CRP (HR 2.81, 95% CI 1.08-7.28), mGPS >0 (HR 2.81, 95% CI 1.08-7.28) and an NLR of 4 or higher (HR 3.05, 95% CI 1.02-9.13) was associated with poor OS. Median TTR was 15 months for all patients (number of events: n = 35/67.3%). Fibrinogen (HR 3.79, 95% CI 1.32-10.94) and NLR (HR 2.99, 95% CI 1.20-7.46) but not CRP (P = 0.102) and mGPS (P = 0.102) were found to indicate TTR. With regard to TTLR (number of events: n = 26/50%), only NLR predicted early lung recurrence (HR 3.02, 95% CI 1.06-8.564). After multivariable analyses, fibrinogen was the only significant OS predictor. However, all investigated inflammatory biomarkers and scores were prognostic for TTR in multivariable analyses. Finally, we divided the study population into an inflammatory phenotype (one or more inflammatory marker/score-elevated) and a non-inflammatory phenotype group. The inflammatory phenotype was prognostic in uni- and multivariable analyses for all three outcome parameters (OS, TTR and TTLR). CONCLUSIONS Inflammatory markers provided promising prognostic information in this cohort of curative PM patients after colorectal cancer. Further validation is needed to verify the prognostic role of these markers and establish them in clinical routine.
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Affiliation(s)
- Bahil Ghanim
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Olaf Glueck
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Glogner
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - György Lang
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Stromal expression of heat-shock protein 27 is associated with worse clinical outcome in patients with colorectal cancer lung metastases. PLoS One 2015; 10:e0120724. [PMID: 25793600 PMCID: PMC4368667 DOI: 10.1371/journal.pone.0120724] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 01/26/2015] [Indexed: 02/03/2023] Open
Abstract
Background Pulmonary metastases are common in patients with primary colorectal cancer (CRC). Heat-shock protein 27 (Hsp27) is upregulated in activated fibroblasts during wound healing and systemically elevated in various diseases. Cancer-associated fibroblasts (CAFs) are also thought to play a role as prognostic and predictive markers in various malignancies including CRC. Surprisingly, the expression of Hsp27 has never been assessed in CAFs. Therefore we aimed to investigate the expression level of Hsp27 in CAFs and its clinical implications in patients with CRC lung metastases. Methods FFPE tissue samples from 51 pulmonary metastases (PMs) and 33 paired primary tumors were evaluated for alpha-SMA, CD31, Hsp27 and vimentin expression by immunohistochemistry and correlated with clinicopathological variables. 25 liver metastases served as control group. Moreover, serum samples (n=10) before and after pulmonary metastasectomy were assessed for circulating phospho-Hsp27 and total Hsp27 by ELISA. Results Stromal expression of Hsp27 was observed in all PM and showed strong correlation with alpha-SMA (P<0.001) and vimentin (P<0.001). Strong stromal Hsp27 was associated with higher microvessel density in primary CRC and PM. Moreover, high stromal Hsp27 and αSMA expression were associated with decreased recurrence-free survival after pulmonary metastasectomy (P=0.018 and P=0.008, respectively) and overall survival (P=0.031 and P=0.017, respectively). Serum levels of phospho- and total Hsp27 dropped after metastasectomy to levels comparable to healthy controls. Conclusions Herein we describe for the first time that Hsp27 is highly expressed in tumor stroma of CRC. Stromal α-SMA and Hsp27 expressions correlate with the clinical outcome after pulmonary metastasectomy. Moreover, serum Hsp27 might pose a future marker for metastatic disease in CRC.
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Szabo V, Bugyik E, Dezso K, Ecker N, Nagy P, Timar J, Tovari J, Laszlo V, Bridgeman VL, Wan E, Frentzas S, Vermeulen PB, Reynolds AR, Dome B, Paku S. Mechanism of tumour vascularization in experimental lung metastases. J Pathol 2014; 235:384-96. [DOI: 10.1002/path.4464] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/03/2014] [Accepted: 10/13/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Vanessza Szabo
- 1st Department of Pathology and Experimental Cancer Research; Semmelweis University; Budapest Hungary
| | - Edina Bugyik
- 1st Department of Pathology and Experimental Cancer Research; Semmelweis University; Budapest Hungary
| | - Katalin Dezso
- 1st Department of Pathology and Experimental Cancer Research; Semmelweis University; Budapest Hungary
| | - Nora Ecker
- 1st Department of Pathology and Experimental Cancer Research; Semmelweis University; Budapest Hungary
| | - Peter Nagy
- 1st Department of Pathology and Experimental Cancer Research; Semmelweis University; Budapest Hungary
| | - Jozsef Timar
- Tumor Progression Research Group; Hungarian Academy of Sciences-Semmelweis University; Budapest Hungary
- 2nd Department of Pathology; Semmelweis University; Budapest Hungary
| | - Jozsef Tovari
- Department of Experimental Pharmacology; National Institute of Oncology; Budapest Hungary
- Department of Thoracic Surgery; Semmelweis University-National Institute of Oncology; Budapest Hungary
| | - Viktoria Laszlo
- Department of Thoracic Surgery; Medical University of Vienna; Austria
| | - Victoria L Bridgeman
- Tumour Biology Team, Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; London UK
| | - Elaine Wan
- Tumour Biology Team, Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; London UK
| | - Sophia Frentzas
- Tumour Biology Team, Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; London UK
| | - Peter B Vermeulen
- Tumour Biology Team, Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; London UK
- Translational Cancer Research Unit; GZA Hospitals Sint-Augustinus; Antwerp Belgium
| | - Andrew R Reynolds
- Tumour Biology Team, Breakthrough Breast Cancer Research Centre; The Institute of Cancer Research; London UK
| | - Balazs Dome
- Department of Thoracic Surgery; Semmelweis University-National Institute of Oncology; Budapest Hungary
- Department of Thoracic Surgery; Medical University of Vienna; Austria
- National Koranyi Institute of Pulmonology; Budapest Hungary
- Department of Biomedical Imaging and Image-guided Therapy; Medical University of Vienna; Austria
| | - Sandor Paku
- 1st Department of Pathology and Experimental Cancer Research; Semmelweis University; Budapest Hungary
- Tumor Progression Research Group; Hungarian Academy of Sciences-Semmelweis University; Budapest Hungary
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Schur S, Hoetzenecker K, Lamm W, Koestler W, Lang G, Amann G, Funovics P, Nemecek E, Noebauer I, Windhager R, Klepetko W, Brodowicz T. Pulmonary metastasectomy for soft tissue sarcoma – Report from a dual institution experience at the Medical University of Vienna. Eur J Cancer 2014; 50:2289-97. [DOI: 10.1016/j.ejca.2014.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
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Schweiger T, Kollmann D, Nikolowsky C, Traxler D, Guenova E, Lang G, Birner P, Klepetko W, Ankersmit HJ, Hoetzenecker K. Carbonic anhydrase IX is associated with early pulmonary spreading of primary colorectal carcinoma and tobacco smoking. Eur J Cardiothorac Surg 2013; 46:92-9. [DOI: 10.1093/ejcts/ezt542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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17
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Schweiger T, Hegedüs B, Nikolowsky C, Hegedüs Z, Szirtes I, Mair R, Birner P, Döme B, Lang G, Klepetko W, Ankersmit HJ, Hoetzenecker K. EGFR, BRAF and KRAS status in patients undergoing pulmonary metastasectomy from primary colorectal carcinoma: a prospective follow-up study. Ann Surg Oncol 2013; 21:946-54. [PMID: 24281417 DOI: 10.1245/s10434-013-3386-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pulmonary metastasectomy is an integral part of the interdisciplinary treatment of patients with pulmonary metastases (PMs) from colorectal carcinoma (CRC). Although alterations in the epidermal growth factor receptor (EGFR) pathway are common in CRC, there is still insufficient data regarding PM. We hypothesized that EGFR expression and Kirsten rat sarcoma viral oncogene homolog (KRAS)/BRAF mutations (Mts) might be associated with clinicopathological variables and the outcome in patients undergoing pulmonary metastasectomy. METHODS In this single-center study, 44 patients undergoing pulmonary metastasectomy from primary CRC were included and prospectively followed up. Tissue specimens of resected PMs were assessed. Restriction fragment length analysis was used for BRAF V600E and KRAS codons 12 and 13 Mt analyses. EGFR expression was evaluated by immunohistochemistry. Patients were followed up in 3-6-month intervals. RESULTS EGFR expression was evident in 49 % of the PMs, whereas Mts in KRAS and BRAF were detected in 48 and 0 %, respectively. Time to lung-specific recurrence after metastasectomy was significantly decreased in patients with KRAS mutated PMs in univariate (p = 0.013) and multivariate analysis (p = 0.035), whereas EGFR expression had no impact on recurrence free survival. Moreover, KRAS Mts were associated with the number of PMs (p = 0.037) and with the lung as first site of recurrence after metastasectomy (p = 0.047). DISCUSSION This is the first evaluation of EGFR pathway alterations in the setting of pulmonary metastasectomy. Our data suggest that patients with KRAS Mts are at high risk for early pulmonary recurrence and have a more diffuse pattern of metastasis. These findings may have impact on the therapeutic management of CRC patients with pulmonary spreading.
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Affiliation(s)
- Thomas Schweiger
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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Treasure T, Milosevic M, Fiorentino F. Pulmonary metastasectomy and the use of molecular and radiological markers: is this a way to reduce unavailing surgery? Eur J Cardiothorac Surg 2013; 45:417-8. [PMID: 23803509 DOI: 10.1093/ejcts/ezt327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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