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Zengin M, Işıkçı ÖT. Tumour Budding Is a Useful Predictor to Identify High-Risk Stage II Colon Cancer Patients After Curative Surgery. Int J Surg Pathol 2024:10668969241265017. [PMID: 39094576 DOI: 10.1177/10668969241265017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Aim. Although it is now accepted in the literature that tumour budding (TB) is a useful survival indicator in colon cancer (CC), there are still uncertainties about daily use. Here we methodologically examined the role of TB on survival in CC. Methods. In our study, we examined colon cancer patients who had surgery up to 15 years before presentation. TB was calculated separately using different comprehensive methodological methods. Results. We first investigated an optimal evaluation method. Relationship with prognostic factors was better (Venous invasion [p = .001], advanced pT [p = .003], perineural invasion [p = .040], MSS [p = .016], advanced size [p = .001], tumour obstruction [p = .005], margin involvement [p = .043], and nodal involvement [p = .028]) in Method-1. Similarly, with the same method, the success of the cut-off value, the correlation of TB data (r = .724), and the repeatability of the method (Κappa = .53-.75) were quite good (ROC = .816 [.707-.925]). Then, survival analysis was performed using the best three methods, including this method. In univariate analysis using Method-1, survival analyses were worse in high TB patients (RFS: 81%, p < .001; OS: 84%, p < .001). Multivariate analyses using the same method confirmed that high TB for RFS and OS was an independent poor prognostic parameter for survival (p = .002, Hazard ratio [HR]: 1.42 [1.13-1.80]) and OS (p = .014, HR: 1.38 [1.07-1.79]). Conclusions. With our study, we showed that tumour budding calculated by the standard method is a very valuable prognostic parameter in stage II CC and can contribute to the detection of patients with poor prognosis in stage II CC.
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Affiliation(s)
- Mehmet Zengin
- Department of Pathology, Kırıkkale University, Kırıkkale, Turkey
| | - Özlem Tanas Işıkçı
- Department of Pathology, Ankara Training and Research Hospital, Ankara, Turkey
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2
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Wang J, Song Z. Analysis of risk factors for postoperative recurrence of stage I colorectal cancer: a retrospective analysis of a large population. Front Surg 2024; 11:1388250. [PMID: 38712335 PMCID: PMC11072714 DOI: 10.3389/fsurg.2024.1388250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide. Patients diagnosed with stage I CRC typically do not require postoperative adjuvant treatment. However, postoperative recurrence is present in at least 40% of patients with CRC and often occurs in those with stage I disease. This study aimed to elucidate the current status of recurrence and clinicopathological characteristics in patients with stage I CRC. Methods Data of indicated patients were obtained from 18 registries in Surveillance, Epidemiology, and End Results (SEER). The multivariable Fine-Gray regression model was used to identify the mortality risk of patients. Disparities in survival were analyzed using Kaplan-Meier curves. Logistic regression was employed to identify factors associated with recurrent risk overestimation. Results Our study indicated a recurrence rate of 15.04% (1,874/12,452) in stage I CRC cases. Notably, we identified race, age, T stage, and carcinoembryonic antigen (CEA) levels as independent risk factors for tumor recurrence, substantially impacting prognosis. Furthermore, gender, race (Black), age (>65 years), elevated CEA levels, and refusal or unknown status regarding radiotherapy significantly correlated with an adverse prognosis in patients with stage I CRC. Conclusions We identified certain key clinicopathological features of patients with stage I CRC and demonstrated the survival benefits of radiotherapy, offering a new perspective on stage I CRC follow-up and treatment recommendations.
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Affiliation(s)
- Jiawei Wang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Biological Treatment of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine Research on Anorectal Diseases of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhangfa Song
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Biological Treatment of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine Research on Anorectal Diseases of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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3
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Wang R, Wang Q, Li P. Significance of carcinoembryonic antigen detection in the early diagnosis of colorectal cancer: A systematic review and meta-analysis. World J Gastrointest Surg 2023; 15:2907-2918. [PMID: 38222002 PMCID: PMC10784816 DOI: 10.4240/wjgs.v15.i12.2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a prevalent malignant tumor involving adenomas that develop into malignant lesions. Carcinoembryonic antigen (CEA) is a non-specific serum biomarker upregulated in CRC. The concentration of CEA is modulated by tumor stage and grade, tumor site in the colon, ploidy status, and patient smoking status. This study aimed to evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults. AIM To evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults. METHODS A systematic search was performed using four databases: MEDLINE, Cochrane Trials, EMBASE, and the Web of Science. The inclusion criteria were as follows: Adult patients aged ≥ 18 years who had completed CRC curative treatment and were followed up postoperatively; reporting the number of CRC recurrences as an outcome; and randomized, clinical, cohort, and case-control study designs. Studies that were not published in English and animal studies were excluded. The following data were extracted by three independent reviewers: Study design, index tests, follow-up, patient characteristics, and primary outcomes. All statistical analyses were performed using the RevMan 5.4.1. RESULTS A total of 3232 studies were identified, with 73 remaining following the elimination of duplicates. After screening on predetermined criteria, 12 studies were included in the final analysis. At a reference standard of 5 mg/L, CEA detected only approximately half of recurrent CRCs, with a pooled sensitivity of 59% (range, 33%-83%) and sensitivity of 89% (range, 58%-97%). CONCLUSION CEA is a significant marker for CRC diagnosis. However, it has insufficient sensitivity and specificity to be used as a single biomarker of early CRC recurrence, with an essential proportion of false negatives.
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Affiliation(s)
- Rui Wang
- Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Qin Wang
- Delivery Room, Chengdu Women’s and Children’s Central Hospital, Chengdu 610000, Sichuan Province, China
| | - Pan Li
- Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
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Paik JH, Ryu CG, Hwang DY. Risk factors of recurrence in TNM stage I colorectal cancer. Ann Surg Treat Res 2023; 104:281-287. [PMID: 37179701 PMCID: PMC10172029 DOI: 10.4174/astr.2023.104.5.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Purpose TNM stage I colorectal cancer (CRC) can recur, although the recurrence rate is low. Few studies have evaluated the risk factors for TNM stage I CRC recurrence. This study aimed to evaluate the TNM stage I CRC recurrence rate, as well as risk factors for recurrence. Methods In this retrospective study, we reviewed the database of patients who had undergone surgery for TNM stage I CRC between November 2008 and December 2014 without receiving neoadjuvant therapy or transanal excision for rectal cancer. Our analysis included 173 patients. Primary lesions were found in the colon of 133 patients and in the rectum of 40 patients. Results The CRC recurrence rate was 2.9% (5 out of 173 patients). For colon cancer patients, tumor size was not associated with higher recurrence risk (P = 0.098). However, for rectal cancer patients, both tumor size (≥3 cm) and T stage were associated with higher recurrence risk (P = 0.046 and P = 0.046, respectively). Of the 5 recurrent cases, 1 patient exhibited disease progression despite treatment, 1 patient maintained stable disease status after recurrence treatment, and 3 patients had no evidence of a tumor after recurrence treatment. Conclusion Our findings suggest that tumor size and T stage are predictors of stage I rectal cancer recurrence, and careful monitoring and follow-up of patients with larger tumors may be warranted.
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Affiliation(s)
- Jin-Hee Paik
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Seoul, Korea
| | - Chun-Geun Ryu
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Seoul, Korea
| | - Dae-Yong Hwang
- Department of Surgery, Colorectal Cancer Center, Konkuk University Medical Center, Seoul, Korea
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
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5
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Fan S, Cui X, Zheng L, Ma W, Zheng S, Wang J, Qi L, Ye Z. Prognostic value of desmoplastic stromal reaction, tumor budding and tumor-stroma ratio in stage II colorectal cancer. J Gastrointest Oncol 2022; 13:2903-2921. [PMID: 36636094 PMCID: PMC9830322 DOI: 10.21037/jgo-22-758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/29/2022] Open
Abstract
Background Existing high-risk factors are insufficient to accurately predict the postoperative recurrence risk of stage II colorectal cancer (CRC). The discovery of additional prognostic markers may be the key to improving the current status of stage II CRC treatment. The present study aimed to evaluate the relationship among desmoplastic reaction (DR), tumor budding (TBd), the tumor-stroma ratio (TSR) and their prognostic value for relapse-free survival (RFS). Methods In this study, 207 patients with histologically confirmed stage II CRC from January 2012 to August 2018 were retrospectively reviewed from a single center; the cohort was divided into subgroups based on low or high TSR, and low, intermediate or high DR and TBd. Kaplan-Meier curve analysis and log-rank test were applied to examine RFS among subgroups. Univariate and multivariate Cox proportional hazards analyses were used to identify independent factors associated with RFS, and a nomogram was subsequently developed. Results Abnormal CA242, CEA, T4 stage, presence of hypertension, internal obstruction or perforation (IOP), lymphovascular or/and perineural invasion (PNI), number of nodes examined less than 12, low-frequency microsatellite instability (MSI-L), higher Ki-67 and immature DR were associated with a lower RFS. In multivariable analysis, DR (HR =2.111; 95% CI: 1.184-3.766; P=0.011), LVI (HR =1.919; 95% CI: 1.004-3.669; P=0.049) and PNI (HR =2.724; 95% CI: 1.362-5.448; P=0.005) were prognostic factors for RFS. On this basis, a nomogram that integrated DR and clinicopathologic predictors for predicting RFS passed the calibration and had an area under the curve of 0.826. Conclusions The prognostic significance of DR outperformed TBd and TSR, therefore, we recommend adding DR as a biomarker in routine pathological reports. The novel nomogram combining these factors may be used as a reliable and effective tool for the prediction of RFS in stage II CRC, thus helping optimize therapeutic regimens under cooperation of oncologists and surgeons. Further multicentric studies are required for validation of this novel, simple and cost-effective prognostic model.
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Affiliation(s)
- Shuxuan Fan
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaonan Cui
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lei Zheng
- Department of Colorectal Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Sunyi Zheng
- Westlake University, School of Engineering, Artificial Intelligence and Biomedical Image Analysis Lab, Hangzhou, China;,Westlake Institute for Advanced Study, Institute of Advanced Technology, Hangzhou, China
| | - Jing Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lisha Qi
- Department of Pathology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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6
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Jankowski M, Wysocki WM, Las-Jankowska M, Tkaczyński K, Wiśniewski D, Bała D, Zegarski W. Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study. World J Surg Oncol 2021; 19:308. [PMID: 34670554 PMCID: PMC8529797 DOI: 10.1186/s12957-021-02413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023] Open
Abstract
Background Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis. Methods We performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR. Results During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy. Conclusions The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02413-0.
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Affiliation(s)
- Michal Jankowski
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland. .,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland.
| | - Wojciech M Wysocki
- Department of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1 Street, 30-705, Kraków, Poland.,Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, Wrocławska 1-3 Street, 30-901, Kraków, Poland.,National Institute of Oncology, Maria Skłodowska-Curie Memorial, Scientific Editorial Office, W.K. Roentgena 5 Street, 02-781, Warszawa, Poland
| | - Manuela Las-Jankowska
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Clinical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Karol Tkaczyński
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Dorian Wiśniewski
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Dariusz Bała
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
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7
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Liemburg GB, Brandenbarg D, Berger MY, Duijts SF, Holtman GA, de Bock GH, Korevaar JC, Berendsen AJ. Diagnostic accuracy of follow-up tests for detecting colorectal cancer recurrences in primary care: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2021; 30:e13432. [PMID: 33704843 PMCID: PMC8518902 DOI: 10.1111/ecc.13432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/11/2021] [Accepted: 02/25/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Traditionally, follow-up of colorectal cancer (CRC) is performed in secondary care. In new models of care, the screening part care could be replaced to primary care. We aimed to synthesise evidence on the diagnostic accuracy of commonly used screeners in CRC follow-up applicable in primary care: carcinoembryonic antigen (CEA), ultrasound and physical examination. METHODS Medline, EMBASE, Cochrane Trial Register and Web of Science databases were systematically searched. Studies were included if they provided sufficient data for a 2 × 2 contingency tables. QUADAS-2 was used to assess methodological quality. We performed bivariate random effects meta-analysis, generated a hypothetical cohort, and reported sensitivity and specificity. RESULTS We included 12 studies (n = 3223, median recurrence rate 19.6%). Pooled estimates showed a sensitivity for CEA (≤ 5 μg/l) of 59% [47%-70%] and a specificity of 89% [80%-95%]. Only few studies reported sensitivities and specificities for ultrasound (36-70% and 97-100%, respectively) and clinical examination (23% and 27%, respectively). CONCLUSION In practice, GPs could perform CEA screening. Radiological examination in a hospital setting should remain part of the surveillance strategy. Personalised algorithms accounting for recurrence risk and changes of CEA-values over time might add to the diagnostic value of CEA in primary care.
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Affiliation(s)
- Geertje B. Liemburg
- Department of General Practice & Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Daan Brandenbarg
- Department of General Practice & Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Marjolein Y. Berger
- Department of General Practice & Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Saskia F.A. Duijts
- Department of General Practice & Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Gea A. Holtman
- Department of General Practice & Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Geertruida H. de Bock
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Joke C. Korevaar
- NIVEL Netherlands Institute for Health Services ResearchUtrechtThe Netherlands
| | - Annette J. Berendsen
- Department of General Practice & Elderly Care MedicineUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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8
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Orive M, Anton A, Gonzalez N, Aguirre U, Anula R, Lázaro S, Redondo M, Bare M, Briones E, Escobar A, Sarasqueta C, Ferreiro J, Quintana JM. Factors associated with colon cancer early, intermediate and late recurrence after surgery for stage I-III: A 5-year prospective study. Eur J Cancer Care (Engl) 2020; 29:e13317. [PMID: 32945024 DOI: 10.1111/ecc.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 04/16/2020] [Accepted: 08/07/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify factors associated with early, intermediate or late recurrence colon cancer recurrence. METHODS A total of 1,732 consecutive patients with colon cancer were recruited and followed for a period of 5 years. Recurrence at 1 year (early), from 1 to 2 (early), from 2 to 3 (intermediate) and from 3 to 5 years (late) was the main outcome measures. RESULTS Predictors of early recurrence (AUC (95% CI):0.74 (0.70-0.78) were as follows: TNM stage II and III, more than one type of invasion, haemoglobin <10 g/dl, residual tumour (R1), ASA IV, log odds of positive lymph nodes ratio ≥-0.53, perforation, neoadjuvant chemotherapy, infectious complications within 1 year and CEA pre- and post-intervention. These factors remained significant for predicting intermediate (AUC [95% CI]: 0.72 [0.67-0.77]) and late (AUC [95% CI]: 0.68 [0.63-0.74]) recurrence, except for ASA class, log lymph node ratio, perforation and neoadjuvant chemotherapy. Additionally, laterality (left) and medical complications up to 2 years were significant. CONCLUSIONS These risk factors show good predictive ability of early, intermediate and late recurrence, confirming factors established by guidelines and adding some others. They could serve to provide more appropriate and accurate treatment and follow-up tailored to patient characteristics.
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Affiliation(s)
- Miren Orive
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Ane Anton
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Nerea Gonzalez
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Urko Aguirre
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
| | - Rocío Anula
- Colorectal Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Santiago Lázaro
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,General Surgery Service, Hospital Universitario Basurto, Bilbao, Spain
| | - Maximino Redondo
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,Research Unit, Hospital Costa del Sol, Málaga, Spain
| | - Marisa Bare
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,Clinical Epidemiology Unit, Corporacio Parc Tauli, Barcelona, Spain
| | | | - Antonio Escobar
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,Research Unit, Hospital Universitario Basurto, Bilbao, Spain
| | - Cristina Sarasqueta
- Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain.,Research Unit, Hospital Universitario Donostia, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Josefa Ferreiro
- Oncology Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - José M Quintana
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Barakaldo, Spain
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Zengin M, Çifci A. Tumour budding in preoperative biopsy specimens is a useful prognostic index for identifying high-risk patients in early-stage (pN0) colon cancer. Turk J Med Sci 2020; 50:375-385. [PMID: 32011836 PMCID: PMC7164766 DOI: 10.3906/sag-1903-142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 02/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background/aim Tumour budding (BD) is considered a valuable prognostic factor in colon cancer (CC), but its use in daily practice is uncertain. We investigated the prognostic effect of BD using preoperative biopsy specimens in a fairly homogeneous population. Materials and methods Eighty-two (pN0) CC patients who underwent surgery after preoperative biopsy between 1997 and 2013 were included in the study. Model A (using the ‘deeply invasive blocks & hot-spot area & invasive margin) and method 1 (using the ‘20× objective & immunohistochemistry staining & quantitive counting’) were used as standard methods. Results High BD was significantly associated with poor prognostic factors (lymphatic invasion [P = 0.008], perineural invasion [P = 0.041], advanced pT [P = 0.015], invasive margin [P = 0.008], and margin involvement [P = 0.019]). Moreover, correlations between different BD estimates (r = 0.613–0.696), reproducibility of study (Κappa = 0.68–0.73), and usefulness of cut-off value (area of under ROC = 0.746 [0.663–0.829]) were well. In univariate analysis, 5-year survival was poor in patients with high BD (relaps-free survival [RFS]: 71 %, P < 0.001; overall survival [OS]: 73 %, P = 0.004, local recurrence [LR]: 18 %, P = 0.032). Multivariate analyses confirmed that high BD is an independent worse survival parameter for RFS (Hazard ratio [HR]: 1.53 [1.14–2.80], P = 0.015), OS (HR: 1.44 [1.17–2.75], P = 0.032, and LR (HR: 1.59 [1.05–2.76], P = 0.045). Conclusion Our data show that BD provides valuable prognostic information for early-stage (pN0) CC in preoperative biopsy specimens and that adding BD to current risk classification may contribute to better patient selection.
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Affiliation(s)
- Mehmet Zengin
- Department of Pathology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Aydin Çifci
- Department of Internal Medical Sciences, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Rose J, Homa L, Kong CY, Cooper GS, Kattan MW, Ermlich BO, Meyers JP, Primrose JN, Pugh SA, Shinkins B, Kim U, Meropol NJ. Development and validation of a model to predict outcomes of colon cancer surveillance. Cancer Causes Control 2019; 30:767-778. [DOI: 10.1007/s10552-019-01187-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 05/17/2019] [Indexed: 11/28/2022]
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11
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Ha GW, Kim JH, Lee MR. Oncologic Effects of Primary Tumor-Sidedness on Patients with Stages 1–3 Colon Cancer: A Meta-Analysis. Ann Surg Oncol 2019; 26:1366-1375. [DOI: 10.1245/s10434-019-07164-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Indexed: 02/06/2023]
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Zhu Y, Liu H, Xie N, Liu X, Huang H, Wang C, Hou J. Impact of tumor budding in head and neck squamous cell carcinoma: A meta‐analysis. Head Neck 2018; 41:542-550. [PMID: 30549142 DOI: 10.1002/hed.25462] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 06/11/2018] [Accepted: 08/22/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yue Zhu
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
| | - Haichao Liu
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
| | - Nan Xie
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
- Department of Oral PatholgoyGuanghua School of Stomatology, Hospital of Stomatology Guangzhou China
| | - Xiqiang Liu
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
| | - Hongzhang Huang
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
| | - Cheng Wang
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
| | - Jinsong Hou
- Department of Oral and Maxillofacial SurgeryGuanghua School of Stomatology, Hospital of Stomatology, Sun Yat‐sen University Guangzhou China
- Guangdong Provincial Key Laboratory of StomatologySun Yat‐sen University Guangzhou China
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Guo XD, Liu L, Xiao HY. High-throughput metabolomics for discovering metabolic biomarkers from intestinal tumorigenesis in APC min/+ mice based on liquid chromatography/mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1100-1101:131-139. [PMID: 30316137 DOI: 10.1016/j.jchromb.2018.09.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/10/2018] [Accepted: 09/28/2018] [Indexed: 01/20/2023]
Abstract
As a major public health concern, colon cancer is one of the most common cancer types, which is also the second cause of cancer death in developed countries and the third most common cancer in other parts of the world. It was reported that patients diagnosed at early stage have a chance to obtain 5-year survival rates at least compared to patients with late stage. Facing the multistep process in intestinal tumorigenesis, there is an urgent need to develop more effective early detection strategies for ameliorating the patient clinical outcome. Metabolomics open up a novel avenue of seeking valuable potential biomarkers for assessing disease severity and prognosticating course by dynamic snapshot of small molecule metabolites. The study aims to provide deeper insights into the discovery, identification and functional pathways analysis of differentially expressed metabolites in intestinal tumorigenesis in APC min/+ mice used by the serum metabolomics, and bring about useful information for further effective prevention and treatment of the disease. 17 marker metabolites and related metabolism pathway were identified using non-targeted metabolomics based on liquid chromatography/mass spectrometry (LC/MS) associated with multivariate statistical analysis. The ingenuity pathway analysis platform involved multiple-pathways was applied to metabolic network analysis for further understanding the relationship between functional metabolic pathways and disease.
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Affiliation(s)
- Xiang-Dong Guo
- Gastroenterology department, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, 157000, China
| | - Lei Liu
- Gastroenterology department, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, 157000, China.
| | - Han-Yan Xiao
- Gastroenterology department, The Second Affiliated Hospital of Mudanjiang Medical University, Mudanjiang, 157000, China
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Urushibara F, Shiozawa E, Miyachi H, Misawa M, Cho T, Takehara Y, Arai N, Funaki T, Tazawa S, Homma M, Norose T, Omatsu M, Yamochi T, Kunimura T, Tate G, Honda K, Fumio I, Kudo SE, Takimoto M. Expression of matrix metalloproteinase-7 correlates with the invasion of T1 colorectal carcinoma. Oncol Lett 2018; 15:3614-3620. [PMID: 29456729 PMCID: PMC5795909 DOI: 10.3892/ol.2018.7746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 03/03/2017] [Indexed: 01/21/2023] Open
Abstract
T1 colorectal carcinomas (CRCs) are an initial site of metastatic spread. Various risk factors for lymph node metastasis have been investigated in T1 CRCs. However, the major step in the entire process of metastasis remains unclear. In terms of carcinoma invasion and metastasis, matrix metalloproteinases (MMPs) have recently gained increasing attention. Notably, MMP-7 is frequently overexpressed in CRCs, but its implication has not been determined in T1 CRCs yet. The present study aimed to clarify the associations between the pathological risk factors of T1 CRCs and MMP-7. In the current study, 211 lesions of T1 CRC that were resected endoscopically or surgically at Showa University Northern Yokohama Hospital (Yokohama, Japan) between April 2008 and December 2009 were retrospectively analyzed. MMP-7 was immunostained and evaluated by its frequency of expression. Pathological factors of T1 CRCs were analyzed in association with MMP-7 expression. Furthermore, the ultrastructural alterations of carcinoma invasion were examined using low vacuum-scanning electron microscopy (LV-SEM). MMP-7 expression was associated with venous invasion (P=0.005), and LV-SEM revealed the disappearance of the normal structure of collagen and elastic fibers of veins invaded by tumor cells expressing MMP-7. At the invasive front, MMP-7 has a vital role in carcinoma invasion, correlating with venous invasion of T1 CRCs.
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Affiliation(s)
- Fumihiko Urushibara
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Eisuke Shiozawa
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Tokyo 142-8555, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Tokyo 142-8555, Japan
| | - Tomonari Cho
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Yusuke Takehara
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Nana Arai
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Toshitaka Funaki
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Sakiko Tazawa
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Mayumi Homma
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Tomoko Norose
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Mutsuko Omatsu
- Department of Diagnostic Pathology, Showa University Northern Yokohama Hospital, Tokyo 142-8555, Japan
| | - Toshiko Yamochi
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Toshiaki Kunimura
- Department of Diagnostic Pathology, Showa University Northern Yokohama Hospital, Tokyo 142-8555, Japan
| | - Genshu Tate
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, Tokyo 142-8555, Japan
| | - Ishida Fumio
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Tokyo 142-8555, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Tokyo 142-8555, Japan
| | - Masafumi Takimoto
- Department of Pathology, Showa University School of Medicine, Tokyo 142-8555, Japan
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15
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Eriksen AC, Sørensen FB, Lindebjerg J, Hager H, dePont Christensen R, Kjær-Frifeldt S, Hansen TF. The prognostic value of tumour stroma ratio and tumour budding in stage II colon cancer. A nationwide population-based study. Int J Colorectal Dis 2018; 33:1115-1124. [PMID: 29785462 PMCID: PMC6060800 DOI: 10.1007/s00384-018-3076-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE High-risk patients with stage II colon cancer (CC) may benefit from adjuvant chemotherapy, but additional prognostic markers are needed for better stratification. We investigated the prognostic value of tumour stroma ratio (TSR) and tumour budding (TB). METHODS A nationwide population-based cohort of 573 patients with stage II CC was included. TSR was scored on hematoxylin and eosin sections as low TSR (> 50% stroma) and high TSR (≤ 50% stroma). TB was evaluated in hotspots on pan-cytokeratin stained sections in 10 high power fields (HPF) at the invasive front and classified by the mean number of buds per HPF as high grade budding (≥ 10 buds) or low-grade budding (< 10 buds). The prognostic value was investigated in Cox proportional hazard models for recurrence-free survival (RFS) and overall survival (OS). RESULTS Low TSR was associated with worse RFS (HR = 1.342 (95% CI 1.006-1.791), p = 0.045) and OS (HR = 1.376 (95% CI 1.016-1.862), p = 0.039). Furthermore, an association was found between low TSR and microsatellite stabile tumours (p < 0.001). The mean number of buds per HPF was associated to TSR with increasing number of buds related to a lower TSR (p = 0.026). No statistically significant prognostic impact of TB regarding OS or RFS was detected. CONCLUSIONS TSR provided valuable prognostic information, and adding TSR to the current risk stratification may contribute to better patient selection. The estimates of TSR and TB were found to be associated, but no prognostic value of TB was documented.
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Affiliation(s)
- Ann Christina Eriksen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Department of Pathology, Lillebaelt Hospital, Beriderbakken 4, DK-7100 Vejle, Denmark
| | - Flemming B. Sørensen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Department of Clinical Medicine, University Institute of Pathology, Aarhus University Hospital, University of Aarhus, Aarhus, Denmark
| | - Jan Lindebjerg
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Danish Colorectal Cancer Group (DCCG), Hvidovre, Denmark
| | - Henrik Hager
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Torben F. Hansen
- Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark ,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark ,Danish Colorectal Cancer Group (DCCG), Hvidovre, Denmark
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Systematic review and meta-analysis of the impact of tumour budding in colorectal cancer. Br J Cancer 2016; 115:831-40. [PMID: 27599041 PMCID: PMC5046217 DOI: 10.1038/bjc.2016.274] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022] Open
Abstract
Background: Tumour budding is a histological finding in epithelial cancers indicating an unfavourable phenotype. Previous studies have demonstrated that it is a negative prognostic indicator in colorectal cancer (CRC), and has been proposed as an additional factor to incorporate into staging protocols. Methods: A systematic review of papers until March 2016 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases pertaining to tumour budding in CRC was performed. Study end points were the presence of lymph node metastases, recurrence (local and distal) and 5-year cancer-related death. Results: A total of 7821 patients from 34 papers were included, with a mean rate of tumour budding of 36.8±16.5%. Pooled analysis suggested that specimens exhibiting tumour budding were significantly associated with lymph node positivity (OR 4.94, 95% CI 3.96–6.17, P<0.00001), more likely to develop disease recurrence over the time period (OR 5.50, 95% CI 3.64–8.29, P<0.00001) and more likely to lead to cancer-related death at 5 years (OR 4.51, 95% CI 2.55–7.99, P<0.00001). Conclusions: Tumour budding in CRC is strongly predictive of lymph node metastases, recurrence and cancer-related death at 5 years, and its incorporation into the CRC staging algorithm will contribute to more effective risk stratification.
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