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Dai X, Dai Z, Fu J, Liang Z, Du P, Wu T. Prognostic significance of negative lymph node count in microsatellite instability-high colorectal cancer. World J Surg Oncol 2024; 22:186. [PMID: 39030562 PMCID: PMC11264611 DOI: 10.1186/s12957-024-03469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Microsatellite instability-high (MSI-H) tumors, with elevated tumor mutational burden and expression of neoantigens, represent a distinct immune-activated subpopulation in colorectal cancer (CRC), characterized by strong lymph node reaction, locally advanced tumor and higher total lymph nodes harvested (TLN), but less metastatic lymph nodes and fewer incidence of III-IV stage. Host immune response to tumor and lymph nodes may be an important prognostic factor. However, N stage and LNR (Lymph-Node Ratio) have limitations in predicting the prognosis of MSI-H patients. Negative lymph node count (NLC) provided a more precise representation of immune activation status and extent of tumor metastasis. The study aims to detect prognostic significance of NLC in MSI-H CRC patients, and compare it with N stage, TLN and LNR. METHODS Retrospective data of 190 consecutive MSI-H CRC patients who received curative resection were collected. Survival analyses were performed using the Kaplan-Meier method. Clinicopathological variables including NLC, N stage, TLN and LNR were studied in univariate and multivariate COX regression analyses. ROC (receiver operating characteristic curve) and concordance index were employed to compare the differences in predictive efficacy between NLC, N stage, TLN and LNR. RESULTS Patients with increased NLC experienced a significantly improved 5-years DFS and OS in Kaplan-Meier analysis, univariate analysis, and multivariate analysis, independent of potential confounders examined. Increased NLC corresponded to elevated 5-years DFS rate and 5-years OS rate. AUC (area under curve) and concordance index of NLC in DFS and OS predicting were both significantly higher than N stage, TLN and LNR. CONCLUSIONS Negative lymph node is an important independent prognostic factor for MSI-H patients. Reduced NLC is associated with tumor recurrence and poor survival, which is a stronger prognostic factor than N stage, TLN and LNR.
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Affiliation(s)
- Xuan Dai
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhujiang Dai
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jihong Fu
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhonglin Liang
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Du
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Tingyu Wu
- Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Salem A, Ahmed S, Khalfallah M, Hamadan N, ElShikh W, Alfaki M. A Comprehensive Pan-Cancer Analysis Reveals Cyclin-Dependent Kinase Inhibitor 2A Gene as a Potential Diagnostic and Prognostic Biomarker in Colon Adenocarcinoma. Cureus 2024; 16:e60586. [PMID: 38894777 PMCID: PMC11184547 DOI: 10.7759/cureus.60586] [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] [Accepted: 05/18/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Cyclin-dependent kinase inhibitor 2A (CDKN2A) is a suppressor carcinogenic gene that is upregulated across various types of cancer including breast, liver, thyroid, and bile duct cancer due to its crucial role in cell cycle regulation and cell division. Nevertheless, it is mostly investigated at the genetic level, but it is still poorly studied on pan-cancer analysis as a biomarker and this study shows its significant potential diagnostic and prognostic characteristics. However, this study aims to investigate the role of CDKN2A as a diagnostic and prognostic biomarker across various types of cancer focusing primarily on colon adenocarcinoma (COAD). Methods We investigated CDKN2A gene expression in a pan-cancer analysis across different types of cancer to show its diagnostic potential characteristics by using various bioinformatic tools, including Tumor Immune Estimation Resource (TIMER) 2.0, Gene Expression Profiling Interactive Analysis (GEPIA), and University of Alabama at Birmingham Cancer Data Analysis Portal (UALCAN) database. TIMER was used to profile gene expression across 32 types of cancer composed of 10,000 RNA-seq samples obtained from the Cancer Genome Atlas (TCGA) and to analyze the tumor-infiltrating immune cells. In addition, GEPIA and UALCAN were further used to analyze gene expression, in terms of gene regulation, pathological stages, and clinical parameters, including gender, age, and race. Therefore, we used GEPIA, UALCAN, and Kaplan-Meier plotter particularly across adenocarcinoma to investigate CDKN2A prognosis by studying its high expression association with the patient's overall survival rate to show the tumor progression. Then, we looked into the genetic alteration of CDKN2A by using the cBio Cancer Genomics Portal (cBioPortal), including 10 pan-cancer studies. We concluded the analysis with gene validation by using a public cohort in Gene Expression Omnibus (GEO). Results CDKN2A showed a trend of upregulation in most cancers and it was significantly upregulated in five cancers, which were commonly identifiable in three databases, including breast invasive carcinoma (p < 0.001), kidney chromophobe (p < 0.001), kidney renal clear cell carcinoma (p < 0.001), kidney renal papillary cell carcinoma (p < 0.001), and COAD (p < 0.001). The upregulation was significantly different in association with pathogenic stages II and III (pr(>F) = 0.00234) which was identifiable significantly in COAD more than in other cancers. The gene showed a high upregulation in association with poor prognosis of patient survival in three cancers, including COAD (log-rank p = 0.011), mesothelioma (log-rank p = 5.9e-07), and liver hepatocellular carcinoma (log-rank p = 0.0045). Therefore, COAD was the only comprehensively analyzed tumor to show a diagnostic and prognostic potential characteristic during high upregulation of CDKN2A. Furthermore, CDKN2A displayed a rare mutation in the form of deep deletion (9%) and revealed an upregulation associated with CD4+ T cells (p = 0.0108), macrophage (p = 0.0073), and neutrophils (p = 0.0272) as immune cells infiltrating COAD. Conclusion Our study demonstrates the pan-cancer relevance of CDKN2A and revealed a novelty in showing CDKN2A underscores its potential as a diagnostic prognostic biomarker in COAD since CDKN2A is mostly studied at a genetic level across COAD.
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Affiliation(s)
- Ahmed Salem
- Biological and Biochemical Sciences, Faculty of Chemical Technology, University of Pardubice, Pardubice, CZE
| | - Sanaa Ahmed
- Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, SDN
| | - Maha Khalfallah
- Zoology, Faculty of Science, University of Khartoum, Khartoum, SDN
| | - Nema Hamadan
- Histopathology and Cytology, Ibn Sina University, Khartoum, SDN
| | - Walaa ElShikh
- Clinical Pharmacy, Faculty of Pharmacy, University of Gezira, Wad Medani, SDN
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Mroczkowski P, Kim S, Otto R, Lippert H, Zajdel R, Zajdel K, Merecz-Sadowska A. Prognostic Value of Metastatic Lymph Node Ratio and Identification of Factors Influencing the Lymph Node Yield in Patients Undergoing Curative Colon Cancer Resection. Cancers (Basel) 2024; 16:218. [PMID: 38201643 PMCID: PMC10778473 DOI: 10.3390/cancers16010218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/10/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Due to the impact of nodal metastasis on colon cancer prognosis, adequate regional lymph node resection and accurate pathological evaluation are required. The ratio of metastatic to examined nodes may bring an additional prognostic value to the actual staging system. This study analyzes the identification of factors influencing a high lymph node yield and its impact on survival. The lymph node ratio was determined in patients with fewer than 12 or at least 12 evaluated nodes. The study included patients after radical colon cancer resection in UICC stages II and III. For the lymph node ratio (LNR) analysis, node-positive patients were divided into four categories: i.e., LNR 1 (<0.05), LNR 2 (≥0.05; <0.2), LNR 3 (≥0.2; <0.4), and LNR 4 (≥0.4), and classified into two groups: i.e., those with <12 and ≥12 evaluated nodes. The study was conducted on 7012 patients who met the set criteria and were included in the data analysis. The mean number of examined lymph nodes was 22.08 (SD 10.64, median 20). Among the study subjects, 94.5% had 12 or more nodes evaluated. These patients were more likely to be younger, women, with a lower ASA classification, pT3 and pN2 categories. Also, they had no risk factors and frequently had a right-sided tumor. In the multivariate analysis, a younger age, ASA classification of II and III, high pT and pN categories, absence of risk factors, and right-sided location remained independent predictors for a lymph node yield ≥12. The univariate survival analysis of the entire cohort demonstrated a better five-year overall survival (OS) in patients with at least 12 lymph nodes examined (68% vs. 63%, p = 0.027). The LNR groups showed a significant association with OS, reaching from 75.5% for LNR 1 to 33.1% for LNR 4 (p < 0.001) in the ≥12 cohort, and from 74.8% for LNR2 to 49.3% for LNR4 (p = 0.007) in the <12 cohort. This influence remained significant and independent in multivariate analyses. The hazard ratios ranged from 1.016 to 2.698 for patients with less than 12 nodes, and from 1.248 to 3.615 for those with at least 12 nodes. The LNR allowed for a more precise estimation of the OS compared with the pN classification system. The metastatic lymph node ratio is an independent predictor for survival and should be included in current staging and therapeutic decision-making processes.
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Affiliation(s)
- Paweł Mroczkowski
- Department for General and Colorectal Surgery, Medical University of Lodz, Pl. Hallera 1, 90-647 Lodz, Poland;
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.K.); (R.O.); (H.L.)
- Department for Surgery, University Hospital Knappschaftskrankenhaus, Ruhr-University, In der Schornau 23-25, 44892 Bochum, Germany
| | - Samuel Kim
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.K.); (R.O.); (H.L.)
- Sanitätsversorgungszentrum Torgelow, Bundeswehr Neumühler Str. 10b, 17358 Torgelow, Germany
| | - Ronny Otto
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.K.); (R.O.); (H.L.)
| | - Hans Lippert
- Institute for Quality Assurance in Operative Medicine Ltd., Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.K.); (R.O.); (H.L.)
- Department for General, Visceral and Vascular Surgery, Otto-von-Guericke-University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Radosław Zajdel
- Department of Economic and Medical Informatics, University of Lodz, 90-214 Lodz, Poland;
- Department of Medical Informatics and Statistics, Medical University of Lodz, 90-645 Lodz, Poland;
| | - Karolina Zajdel
- Department of Medical Informatics and Statistics, Medical University of Lodz, 90-645 Lodz, Poland;
| | - Anna Merecz-Sadowska
- Department of Economic and Medical Informatics, University of Lodz, 90-214 Lodz, Poland;
- Department of Allergology and Respiratory Rehabilitation, Medical University of Lodz, 90-725 Lodz, Poland
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Gülşen T, Ergenç M, Şenol Z, Emirzeoğlu L, Güleç B. Clinicopathological outcomes of microsatellite instability in colorectal cancer. J Cancer Res Ther 2024; 20:103-111. [PMID: 38554306 DOI: 10.4103/jcrt.jcrt_1560_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/04/2022] [Indexed: 04/01/2024]
Abstract
AIMS This study aims to evaluate the histopathological features and prognostic parameters of tumors with microsatellite instability (MSI) compared with those without MSI in patients who underwent surgery for colorectal cancer (CRC). SETTING AND DESIGN Follow-up for CRC at Istanbul Sultan 2. Abdulhamid Han Training and Research Hospital was retrospectively evaluated between March 2017 and March 2021. METHODS AND MATERIAL The patients were divided into two groups: those with and without MSI. Groups were compared in survival parameters. As a secondary result, groups were compared in pathological parameters such as stage, tumor diameter, degree of differentiation, and lymphovascular, and perineural invasion. STATISTICAL ANALYSIS USED Survival calculations were performed using the Kaplan-Meier analysis method. The effects of various prognostic factors related to tumor and patient characteristics on disease-free and overall survival (OS) were investigated by log-rank test. RESULTS Two hundred fourteen patients were analyzed. The median age of the patients was 66 (30-89), and 59.3% (n = 127) were male. There were 25 patients in the MSI group and 189 patients in the non-MSI group. We found that MSI tumors had a significantly higher differentiation degree than non-MSI tumors and larger tumor diameters. MSI tumors frequently settled in the proximal colon, and more lymph nodes were removed in the resection material. MSI tumors had longer disease-free survival, cancer-specific survival, and overall survival. CONCLUSIONS By diagnosing microsatellite instability, CRCs can be divided into two groups. The histopathological features of the tumor and the prognosis of the disease differ between these groups. MSI can be a predictive marker in the patient's follow-up and treatment.
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Affiliation(s)
- Taygun Gülşen
- Department of General Surgery, Istanbul Sultanbeyli State Hospital, Istanbul, Turkey
| | - Muhammer Ergenç
- Department of General Surgery, Istanbul Sultanbeyli State Hospital, Istanbul, Turkey
| | - Zafer Şenol
- Department of General Surgery, Istanbul Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Levent Emirzeoğlu
- Department of Oncology, Istanbul Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Bülent Güleç
- Department of General Surgery, Istanbul Sultan 2, Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Liu Q, Huang M, Yang J, Jiang M, Zhao Z, Zhao H, He T, Bai Y, Zhang R, Zhang M. Association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer: a systematic review and meta-analysis. BMJ Open 2023; 13:e072244. [PMID: 38135324 DOI: 10.1136/bmjopen-2023-072244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Clinical practice guidelines recommend retrieving at least 12 lymph nodes for correct staging in colorectal cancer. However, it is difficult to retrieve adequate lymph nodes because of various factors. We aimed to evaluate the association between the number of retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer. DESIGN Systematic review and meta-analysis of primary studies. DATA SOURCES PubMed, Embase, Cochrane and Web of Science were searched from January 2016 to June 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that evaluated the association between retrieved lymph nodes and demographic/tumour-related characteristics in colorectal cancer were included. DATA EXTRACTION AND SYNTHESIS OR with 95% conference intervals was extracted and pooled. RESULTS A total of 54 studies containing 2 05 821 patients were included in this meta-analysis. The results showed that fewer nodes were retrieved from elderly patients (OR=0.70, 95% CI (0.54 to 0.90), p=0.005), and from tumours located in the left colon than in the right colon (OR=0.43, 95% CI (0.33 to 0.56), p<0.001). More lymph nodes were obtained from females than males (OR=1.15, 95% CI (1.04 to 1.28), p=0.006), from the advanced T stage (T3+T4) than T1+T2 stage (OR=1.57, 95% CI (1.25 to 1.97), p<0.001) and from the N2 stage than N0 stage (OR=1.32, 95% CI (1.15 to 1.51), p<0.001). Body mass index, ethnicity, N1 stage, M stage, tumour differentiation and lymph-vascular invasion were not significantly associated with the lymph node yield. CONCLUSIONS The study results suggest that clinicians have an increased opportunity to retrieve sufficient lymph nodes for accurate pathological staging to guide treatment decisions in patients with colorectal cancer who are young, female, with tumours located in the right colon, advanced T stage and N2 stage.
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Affiliation(s)
- Qianqian Liu
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Min Huang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jing Yang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Mengyuan Jiang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ziru Zhao
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Haitong Zhao
- Evidence-Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Tingting He
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Yuping Bai
- The Department of Pathology, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Rui Zhang
- The First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Min Zhang
- Department of Scientific Research office, Gansu Provincial Hospital, Lanzhou, Gansu, China
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Qiao Y, Zhu J, Han T, Jiang X, Wang K, Chen R, Du Y, Li J, Sun L. Finding the minimum number of retrieved lymph nodes in node-negative colorectal cancer using Real-world Data and the SEER database. Int J Surg 2023; 109:4173-4184. [PMID: 37755374 PMCID: PMC10720778 DOI: 10.1097/js9.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Current clinical guidelines recommend the removal of at least 12 lymph nodes (LNs) in resectable colorectal cancer (CRC). With advancements in lymphadenectomy technologies, the number of retrieved lymph nodes (rLNs) has markedly increased. This study aimed to investigate the lowest number of rLNs in node-negative patients. MATERIALS AND METHODS A total of 1103 N0 and 208 N1a stage patients were enrolled in our cohort, while 8503 N0 and 1276 N1a patients from the Surveillance, Epidemiology, and End Results CRC database were included. Propensity score matching and multivariate Cox regression analyses were performed to mitigate the influence of selection bias and control for potential confounding variables. RESULTS The median number of rLNs in N0 patients increased from 13.5 (interquartile range [IQR]: 9-18) in 2013 to 17 (IQR: 15-20) in 2019. The restrictive cubic spline illustrated a nonlinear relationship between rLNs and prognosis (nonlinearity, P =0.009), with a threshold ( N =16) influencing clinical outcomes. Patients at either N0 or N1a stage with sufficient rLNs (≥16) demonstrated superior prognoses to those with a limited rLNs (<16). After adjusting for clinical confounders, similar prognoses were observed in N0 limited and N1a adequate populations. Furthermore, Kaplan-Meier curves revealed that N0 limited patients who received chemotherapy exhibited better outcomes than those who did not. CONCLUSIONS Among patients with node-negative CRC, it is crucial to remove 16 or more LNs effectively. Fewer than 16 rLNs should be regarded as an independent risk factor, implying the need for adjuvant chemotherapy.
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Affiliation(s)
- Yihuan Qiao
- Department of Digestive Surgery, Honghui Hospital, Xi’an Jiaotong University
| | - Jun Zhu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of General Surgery, The Southern Theater Air Force Hospital, Guangzhou, People’s Republic of China
| | - Tenghui Han
- Department of Neurology, Airborne Army Hospital, Wuhan
| | - Xunliang Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Ke Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Rujie Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Yongtao Du
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
- Department of Biochemistry and Molecular Biology, State Key Laboratory of Cancer Biology, Air Force Medical University, Shaanxi
| | - Jipeng Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University
| | - Li Sun
- Department of Digestive Surgery, Honghui Hospital, Xi’an Jiaotong University
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Lee SH, Pankaj A, Neyaz A, Ono Y, Rickelt S, Ferrone C, Ting D, Patil DT, Yilmaz O, Berger D, Deshpande V, Yılmaz O. Immune microenvironment and lymph node yield in colorectal cancer. Br J Cancer 2023; 129:917-924. [PMID: 37507544 PMCID: PMC10491581 DOI: 10.1038/s41416-023-02372-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Lymph node (LN) harvesting is associated with outcomes in colonic cancer. We sought to interrogate whether a distinctive immune milieu of the primary tumour is associated with LN yield. METHODS A total of 926 treatment-naive patients with colorectal adenocarcinoma with more than 12 LNs (LN-high) were compared with patients with 12 or fewer LNs (LN-low). We performed immunohistochemistry and quantification on tissue microarrays for HLA class I/II proteins, beta-2-microglobulin (B2MG), CD8, CD163, LAG3, PD-L1, FoxP3, and BRAF V600E. RESULTS The LN-high group was comprised of younger patients, longer resections, larger tumours, right-sided location, and tumours with deficient mismatch repair (dMMR). The tumour microenvironment showed higher CD8+ cells infiltration and B2MG expression on tumour cells in the LN-high group compared to the LN-low group. The estimated mean disease-specific survival was higher in the LN-high group than LN-low group. On multivariate analysis for prognosis, LN yield, CD8+ cells, extramural venous invasion, perineural invasion, and AJCC stage were independent prognostic factors. CONCLUSION Our findings corroborate that higher LN yield is associated with a survival benefit. LN yield is associated with an immune high microenvironment, suggesting that tumour immune milieu influences the LN yield.
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Affiliation(s)
- Soo Hyun Lee
- Department of Pathology, Boston Medical Center, Boston, MA, USA
| | - Amaya Pankaj
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Azfar Neyaz
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Yuho Ono
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Steffen Rickelt
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Cristina Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David Ting
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Deepa T Patil
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Omer Yilmaz
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David Berger
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Vikram Deshpande
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Osman Yılmaz
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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8
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Zannier F, Angerilli V, Spolverato G, Brignola S, Sandonà D, Balistreri M, Sabbadin M, Lonardi S, Bergamo F, Mescoli C, Scarpa M, Bao QR, Dei Tos AP, Pucciarelli S, Urso ELD, Fassan M. Impact of DNA mismatch repair proteins deficiency on number and ratio of lymph nodal metastases in colorectal adenocarcinoma. Pathol Res Pract 2023; 243:154366. [PMID: 36774759 DOI: 10.1016/j.prp.2023.154366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Approximately 15 % of colorectal adenocarcinomas (CRCs) are characterized by an altered expression of DNA mismatch repair (MMR) proteins (i.e. MMR deficiency [MMRd]). Lymph node ratio (LNR) represents one of the most important prognostic markers in non-advanced CRCs. No significant data are available regarding LNR distribution depending on MMR status. PURPOSE OF THE STUDY The aim of the present work was to compare pathological and clinical characteristics of MMRd tumors versus MMR proficient (MMRp) cases. Particular attention was paid to how these molecular sub-groups relate to the LNR. MATERIALS AND METHODS A mono-Institutional series of 1037 consecutive surgically treated stage I-IV CRCs were retrospectively selected and data were obtained from pathological reports. Cases were characterized for MMR/MSI status by means of immunohistochemistry or for microsatellite instability (MSI) analysis. RESULTS MMRd/MSI tumors (n = 194; 18.7 %) showed significant differences in comparison to MMRp lesions for sex (female prevalence 50.5 % vs 40.7 %; p = 0.013), age (74.2 vs 69.2; p < 0.001), location (right side; p < 0.001), diameter (larger than MMRp; p < 0.001), growth pattern (expansive pattern of growth; p < 0.001), peri- (p = 0.0002) and intra-neoplastic (p = 0.0018) inflammatory infiltrate, presence of perineural invasion (p < 0.001), stage (lower stage at presentation; p < 0.001), grade (higher prevalence of high-grade tumors; p < 0.001), and LNR (lower; p < 0.001). CONCLUSIONS MMRd/MSI tumors are a distinct molecular CRC subtype characterized by a significantly lower LNR in comparison to MMRp lesions. These data further support the prognostic impact of MMRd/MSI status in early-stage CRCs.
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Affiliation(s)
| | | | - Gaya Spolverato
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Stefano Brignola
- Department of Pathology, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy
| | - Daniele Sandonà
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | | | - Marianna Sabbadin
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Francesca Bergamo
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Claudia Mescoli
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Marco Scarpa
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Quoc Riccardo Bao
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | | | - Salvatore Pucciarelli
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Emanuele L D Urso
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Matteo Fassan
- Department of Medicine (DIMED), University of Padua, Padua, Italy; Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy.
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9
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Xiao BY, Zhang X, Cao TY, Li DD, Jiang W, Kong LH, Tang JH, Han K, Zhang CZ, Mei WJ, Xiao J, Pan ZZ, Li YF, Zhang XS, Ding PR. Neoadjuvant Immunotherapy Leads to Major Response and Low Recurrence in Localized Mismatch Repair-Deficient Colorectal Cancer. J Natl Compr Canc Netw 2023; 21:60-66.e5. [PMID: 36630898 DOI: 10.6004/jnccn.2022.7060] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/01/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Our study aimed to evaluate the efficacy and feasibility of neoadjuvant anti-PD-1 treatment for localized mismatch repair-deficient (dMMR) colorectal cancer (CRC). PATIENTS AND METHODS The study cohort included patients with localized dMMR CRC who received PD-1 inhibitors as neoadjuvant therapy from 3 medical centers in Southern China. Main eligibility criteria included age between 18 and 75 years, ECOG performance status of 0 or 1, and receipt of ≥2 doses of PD-1 inhibitors. RESULTS A total of 73 patients were included. Most of the tumors were locally advanced, including 19 (26.0%) T4a and 29 (39.7%) T4b. Most patients (79.5%) received PD-1 inhibitor monotherapy. Objective response per radiologic assessment was achieved in 62 (84.9%) patients, including 17 (23.3%) with complete response (CR) and 45 (61.6%) with partial response, with a median time to response of 9.6 weeks. Patients with T4a/4b disease had a similar response rate as those with T2-3 disease (84.0% vs 85.4%; P=.999). As of writing, a total of 50 patients have undergone surgery. Pathologic CR was achieved in most (57.1%) patients and remained high (59.5%) even among the 38 patients with T4a/4b disease. The 17 patients with CR did not undergo surgery and adopted a watch-and-wait strategy. After a median follow-up of 17.2 months (range, 3.4-45.1 months), the overall median recurrence-free and overall survivals were not reached. Among patients undergoing surgery or achieving CR, the 2-year tumor-specific disease-free and overall survival rates were both 100%. During neoadjuvant treatment, grade 3-4 adverse events occurred in 8 patients; 4 required acute intervention. Severe postoperative complications were recorded in 4 patients, 3 of whom required a second surgery. CONCLUSIONS Neoadjuvant therapy with PD-1 blockade is highly effective for localized dMMR CRC, with an acceptable safety profile and low recurrence rate. This treatment holds promise for becoming the new standard of care for localized dMMR CRCs.
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Affiliation(s)
- Bin-Yi Xiao
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Xuan Zhang
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Guangzhou, China
| | - Tai-Yuan Cao
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dan-Dan Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Wu Jiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Ling-Heng Kong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jing-Hua Tang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Kai Han
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Chen-Zhi Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Wei-Jian Mei
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jian Xiao
- Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Zhong Pan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Yun-Feng Li
- Department of Colorectal Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Guangzhou, China
| | - Xiao-Shi Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Pei-Rong Ding
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
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10
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Wang Q, Yin R, Tang W, Li C, Zheng H, Zhang X, Jin X, Ying M, Fu J. Resection of primary lesion with chemotherapy improves the survival of patients with metastatic colorectal neuroendocrine carcinoma. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:594-602. [PMID: 36581574 PMCID: PMC10264974 DOI: 10.3724/zdxbyxb-2021-0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of resection of primary lesion and chemotherapy on survival of patients with metastatic colorectal neuroendocrine carcinoma (CRNEC). METHODS Clinical data of 393 patients with metastatic CRNECs between January 2010 and December 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, including 171 patients who received resection of primary lesion and 221 patients who did not undergo surgery. With the propensity score matching method 172 non-operated patients were selected as controls. Kaplan-Meier method and Log-rank test were used to evaluate the survival differences, while the prognostic factors were analyzed by Cox proportional-hazards model. Metastatic CRNEC patients from January 2001 to December 2021 in Affiliated Jinhua Hospital, Zhejiang University School of Medicine were selected for validation. RESULTS Compared with non-operated patients, patients who received resection had longer cause-specific survival ( P<0.05). Patients with resected positive lymph nodes>8 had a poorer prognosis compared to those with resected positive lymph nodes≤8 ( P<0.05). Multivariate analysis showed that gender, location of primary lesion and treatments were independent risk factors for cause-specific survival in patients with metastatic CRNEC (all P<0.05). For metastatic CRNEC patients with resection of primary lesion, rectal neuroendocrine carcinoma, positive resected lymph nodes≤8 and resection of primary lesion combined with chemotherapy were associated with better cause-specific survival (all P<0.05). CONCLUSIONS Patients with metastatic CRNEC may benefit from resection of primary lesion, and resection of primary lesion combined with chemotherapy might be the better strategy for metastatic CRNECs. The number of positive lymph nodes resected is correlated with the prognosis of patients.
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Affiliation(s)
- Qinghua Wang
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Ruihua Yin
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Wanfen Tang
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Chenghui Li
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Hongjuan Zheng
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Xia Zhang
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Xiayun Jin
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Mingliang Ying
- 2. Department of Medical Imaging, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Jianfei Fu
- 1. Department of Medical Oncology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
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11
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Colon cancer microsatellite instability influences computed tomography assessment of regional lymph node morphology and diagnostic performance. Eur J Radiol 2022; 154:110396. [PMID: 35709643 DOI: 10.1016/j.ejrad.2022.110396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To elucidate whether a high level of microsatellite instability (MSI-high) in colon cancer influences the CT assessment of regional lymph node (rLN) morphology and diagnostic performance on predicting pathological node-negative (pN0) patients. METHOD We retrospectively reviewed 507 patients with cecal/proximal ascending colon cancer (age, 63.0 ± 11.6 years; MSI-stable, n = 398; MSI-high, n = 109) who underwent right hemicolectomy between July 1, 2009, and December 31, 2018. Preoperative CT images were assessed for number of rLNs, long/short diameter of the largest rLN, and CT LN grade (CTN0, low probability of metastasis; CTN1, borderline; CTN2, high probability). Sensitivity, specificity, positive predictive value and negative predictive value for predicting pN0 was calculated. Multivariable logistic regression analysis was performed. Statistical significance was defined as P < 0.05. RESULTS A study population of 507 patients (mean age ± standard deviation, 63.0 ± 11.6; 264 women) were evaluated. In patients with rLN metastasis, the rLN long axis (pN1: P = 0.013, pN2: P = 0.039) and short axis (pN1: P = 0.001, pN2: P = 0.009) were both longer in MSI-high tumors compared with MSI-stable tumors. High specificity for predicting pN0 was only achieved in MSI-high tumors [sensitivityMSI-stable = 58.3% (n = 137/235), specificityMSI-stable = 71.2% (n = 116/163); sensitivityMSI-high = 38.4% (n = 33/86), specificityMSI-high = 91.3% (n = 21/23)]. Multivariable logistic regression indicated MSI-high (P < 0.001, odds ratio = 3.701), smaller LN long axis (P = 0.023, odds ratio = 0.905), and lower CT LN grade (CTN0: P = 0.009, odds ratio = 2.987; CTN1: P = 0.014, odds ratio = 2.195) as significant parameters in predicting pN0. CONCLUSION MSI-high colon cancer is associated with larger rLNs and high specificity for predicting pN0 on CT assessment.
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12
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Hwang J, Lee D, Shin JK, Jang JH, Huh JW, Park YA, Cho YB, Kim HC, Yun SH, Lee WY, Chun HK. Is a cutoff value of 12 still useful in stage II right-sided colon cancer without risk factors? KOREAN JOURNAL OF CLINICAL ONCOLOGY 2022; 18:27-35. [PMID: 36945331 PMCID: PMC9942765 DOI: 10.14216/kjco.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/07/2022]
Abstract
Purpose Various clinical practice guidelines recommend at least 12 regional lymph nodes should be removed for resected colon cancer. According to a recent study, the lymph node yield (LNY) in colon cancer surgery in the last 20 years has tended to increase from 14.91 to 21.30. However, it is unclear whether these guidelines adequately reflect recent findings on the number of harvested lymph nodes in colon cancer surgery. The aim of this study is to assess the impact of an LNY of more than 25 on survival in right-sided colon cancer. Methods We included 285 patients who underwent a right hemicolectomy during the period from January 2010 through December 2015. Patients were divided into two groups (<25 nodes and ≥25 nodes). Primary endpoints included 5-year and 10-year survival including disease-free and overall. Results We found that survival outcomes of patients with a harvest of ≥25 nodes were not significantly different compared with a <25 group. Large tumor size (5 cm) is significantly associated with poor 5-year and 10-year overall survival. Conclusion Survival outcomes of patients with a harvest of ≥25 nodes were not significantly different compared with the <25 group in stage II colon cancer with no risk.
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Affiliation(s)
- Jinseok Hwang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyuck Jang
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine Changwon, Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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13
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Uil SH, Coupé VMH, Bril H, Meijer GA, Fijneman RJA, Stockmann HBAC. KCNQ1 and lymphovascular invasion are key features in a prognostic classifier for stage II and III colon cancer. BMC Cancer 2022; 22:372. [PMID: 35395779 PMCID: PMC8991490 DOI: 10.1186/s12885-022-09473-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The risk of recurrence after resection of a stage II or III colon cancer, and therefore qualification for adjuvant chemotherapy (ACT), is traditionally based on clinicopathological parameters. However, the parameters used in clinical practice are not able to accurately identify all patients with or without minimal residual disease. Some patients considered ‘low-risk’ do develop recurrence (undertreatment), whilst other patients receiving ACT might not have developed recurrence at all (overtreatment). We previously analysed tumour tissue expression of 28 protein biomarkers that might improve identification of patients at risk of recurrence. In the present study we aimed to build a prognostic classifier based on these 28 biomarkers and clinicopathological parameters. Methods Classification and regression tree (CART) analysis was used to build a prognostic classifier based on a well described cohort of 386 patients with stage II and III colon cancer. Separate classifiers were built for patients who were or were not treated with ACT. Routine clinicopathological parameters and tumour tissue immunohistochemistry data were included, available for 28 proteins previously published. Classification trees were pruned until lowest misclassification error was obtained. Survival of the identified subgroups was analysed, and robustness of the selected CART variables was assessed by random forest analysis (1000 trees). Results In patients not treated with ACT, prognosis was estimated best based on expression of KCNQ1. Poor disease-free survival (DFS) was observed in those with loss of expression of KCNQ1 (HR = 3.38 (95% CI 2.12 – 5.40); p < 0.001). In patients treated with ACT, key prognostic factors were lymphovascular invasion (LVI) and expression of KCNQ1. Patients with LVI showed poorest DFS, whilst patients without LVI and high expression of KCNQ1 showed most favourable survival (HR = 7.50 (95% CI 3.57—15.74); p < 0.001). Patients without LVI and loss of expression of KCNQ1 had intermediate survival (HR = 3.91 (95% CI 1.76 – 8.72); p = 0.001). Conclusion KCNQ1 and LVI were identified as key features in prognostic classifiers for disease-free survival in stage II and III colon cancer patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09473-9.
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Affiliation(s)
- Sjoerd H Uil
- Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, de Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands
| | - Herman Bril
- Department of Pathology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
| | - Gerrit A Meijer
- Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Remond J A Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Hein B A C Stockmann
- Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands
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14
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Primary tumour immune response and lymph node yields in colon cancer. Br J Cancer 2022; 126:1178-1185. [PMID: 35043009 PMCID: PMC9023574 DOI: 10.1038/s41416-022-01700-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/01/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Abstract
Background
The mechanism underlying improved survival in non-metastatic colon cancer with higher lymph node (LN) yield is unknown. This study aimed to identify whether molecular features in the primary tumour were predictive of LN yield.
Methods
Clinical, genomic, transcriptomic, proteomic and methylation data of non-metastatic, colon cancers studied in The Cancer Genome Atlas were interrogated for associations with LN yield. Based on maximal survival effects, patients were segregated into high (>15) and low (≤15) LN yield. Gene set enrichment analysis was performed on transcriptomic changes to identify biological processes associated with LN yield. Correlations were validated in an independent set of Stage II colon cancers.
Results
High LN yield was found predictive of overall and disease-free survival. There was no association of higher LN yield and increasing nodal positivity. High LN yield was strongly linked with gene expression changes associated with the adaptive and dendritic cell immune response. This association was most prominent in node-negative cancers. Analogous findings were reproduced in the validation dataset.
Conclusion
The study shows a strong association of an activated immune response in tumours with a high LN yield. Immunogenic tumours have a better prognosis, likely explaining the survival benefit with higher LN yields.
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15
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T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer. Eur Surg 2021. [DOI: 10.1007/s10353-021-00714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Summary
Objective
To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages.
Methods
In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time.
Results
From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes.
Conclusion
In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.
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16
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Nussbaum DP, Rushing CN, Sun Z, Yerokun BA, Worni M, Saunders RS, McClellan MB, Niedzwiecki D, Greenup RA, Blazer DG. Hospital-level compliance with the commission on cancer's quality of care measures and the association with patient survival. Cancer Med 2021; 10:3533-3544. [PMID: 33943026 PMCID: PMC8178497 DOI: 10.1002/cam4.3875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background Quality measurement has become a priority for national healthcare reform, and valid measures are necessary to discriminate hospital performance and support value‐based healthcare delivery. The Commission on Cancer (CoC) is the largest cancer‐specific accreditor of hospital quality in the United States and has implemented Quality of Care Measures to evaluate cancer care delivery. However, none has been formally tested as a valid metric for assessing hospital performance based on actual patient outcomes. Methods Eligibility and compliance with the Quality of Care Measures are reported within the National Cancer Database, which also captures data for robust patient‐level risk adjustment. Hospital‐level compliance was calculated for the core measures, and the association with patient survival was tested using Cox regression. Results Seven hundred sixty‐eight thousand nine hundred sixty‐nine unique cancer cases were included from 1323 facilities. Increasing hospital‐level compliance was associated with improved survival for only two measures, including a 35% reduced risk of mortality for the gastric cancer measure G15RLN (HR 0.65, 95% CI 0.58–0.72) and a 19% reduced risk of mortality for the colon cancer measure 12RLN (HR 0.81, 95% CI 0.77–0.85). For the lung cancer measure LNoSurg, increasing compliance was paradoxically associated with an increased risk of mortality (HR 1.14, 95% CI 1.08–1.20). For the remaining measures, hospital‐level compliance demonstrated no consistent association with patient survival. Conclusion Hospital‐level compliance with the CoC’s Quality of Care Measures is not uniformly aligned with patient survival. In their current form, these measures do not reliably discriminate hospital performance and are limited as a tool for value‐based healthcare delivery.
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Affiliation(s)
| | - Christel N Rushing
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Zhifei Sun
- Department of Surgery, Duke University, Durham, NC, USA
| | | | - Mathias Worni
- Department of Visceral Surgery, Clarunis, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland.,Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
| | - Robert S Saunders
- Duke University, Robert J. Margolis Center for Health Policy, Durham, NC, USA
| | - Mark B McClellan
- Duke University, Robert J. Margolis Center for Health Policy, Durham, NC, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery and Population Health Sciences, Duke University, Duke Cancer Institute, Durham, NC, USA
| | - Dan G Blazer
- Department of Surgery, Duke University, Duke Cancer Institute, Durham, NC, USA
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17
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Cai Z, Song H, Fingerhut A, Sun J, Ma J, Zhang L, Li S, Yu C, Zheng M, Zang L. A greater lymph node yield is required during pathological examination in microsatellite instability-high gastric cancer. BMC Cancer 2021; 21:319. [PMID: 33765970 PMCID: PMC7992823 DOI: 10.1186/s12885-021-08044-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
Background The impact of microsatellite status on lymph node (LN) yield during lymphadenectomy and pathological examination has never been assessed in gastric cancer (GC). In this study, we aimed to appraise the association between microsatellite instability-high (MSI-H) and LN yield after curative gastrectomy. Methods We retrospectively analyzed 1757 patients with GC undergoing curative gastrectomy and divided them into two groups: MSI-H (n = 185(10.5%)) and microsatellite stability (MSS) (n = 1572(89.5%)), using a five-Bethesda-marker (NR-24, BAT-25, BAT-26, CAT-25, MONO-27) panel. The median LN count and the percentage of specimens with a minimum of 16 LNs (adequate LN ratio) were compared between the two groups. The log odds (LODDS) of positive LN count (PLNC) to negative LN count (NLNC) and the target LN examined threshold (TLNT(x%)) were calculated in both groups. Results Statistically significant differences were found in the median LN count between MSI-H and MSS groups for the complete cohort (30 vs. 28, p = 0.031), for patients undergoing distal gastrectomy (DG) (30 vs. 27, p = 0.002), for stage II patients undergoing DG (34 vs. 28, p = 0.005), and for LN-negative patients undergoing DG (28 vs. 24, p = 0.002). MSI-H was an independent factor for higher total LN count in patients undergoing DG (p = 0.011), but it was not statistically correlated to the adequate LN ratio. Statistically significant differences in PLNC, NLNC and LODDS were found between MSI-H GC and MSS GC (all p < 0.001). The TLNT(90%) for MSI-H and MSS groups were 31 and 25, respectively. TLNT(X%) of MSI-H GC was always higher than that of MSS GC regardless of the given value of X%. Conclusions MSI-H was associated with higher LN yield in patients undergoing gastrectomy for GC. Although MSI-H did not affect the adequacy of LN harvest, we speculate that a greater lymph node yield is required during pathological examination in MSI-H GC.
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Affiliation(s)
- Zhenghao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Haiqin Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China.,Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Luyang Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Chaoran Yu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China.,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China.
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Er Road, Shanghai, 200025, P. R. China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China.
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Song J, Kataoka K, Yamada T, Shiozawa M, Sonoyama T, Beppu N, Ueda K, Kuriyama S, Kanazawa A, Ikeda M, Ceelen W. The impact of molecular profile on the lymphatic spread pattern in stage III colon cancer. Cancer Sci 2021; 112:1545-1555. [PMID: 33484192 PMCID: PMC8019193 DOI: 10.1111/cas.14819] [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: 12/23/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 12/24/2022] Open
Abstract
The anatomical spread of lymph node (LN) metastasis is of practical importance in the surgical management of colon cancer (CC). We examined the effect of KRAS, BRAF, and microsatellite instability (MSI) on LN count and anatomical spread pattern in stage III CC. We determined KRAS, BRAF, and MSI status from stage III CC patients. Biomarker status was correlated with LN count and anatomical spread pattern, which was classified as sequential or skipped. Relapse-free survival (RFS) was estimated using Kaplan-Meier method, and correlations were assessed using log-rank and Cox regression analyses. We analyzed 369 stage III CC patients. The proportion of KRAS mutant (mt), BRAF mt, and MSI-high (H) were 44.2% (163/344), 6.8% (25/344), and 6.8% (25/344), respectively. The mean number of metastatic LN was higher in microsatellite-stable (MSS) compared with MSI patients (3.5 vs. 2.7, P = .0406), although no differences were observed in accordance with KRAS or BRAF status. Interestingly, patients with BRAF mt and MSI-H were less likely to harbor skipped metastatic LN (9.3% vs 20% and 4% vs 10.5% compared with BRAF wild-type (wt) and MSS, respectively), but KRAS status did not predict anatomical spread pattern. Patients with KRAS wt and MSI-H showed superior RFS compared with KRAS mt and MSS patients, respectively, whereas BRAF status did not affect RFS. Differences exist in the anatomical pattern of invaded LN in accordance with the molecular status of stage III CC. Patients with MSI-H CC have less invaded and skipped LN, suggesting that a tailored surgical approach is possible.
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Affiliation(s)
- Jihyung Song
- Department of Gastroenterological Surgery, Division of Lower GI, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kozo Kataoka
- Department of Gastroenterological Surgery, Division of Lower GI, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal Surgery, Nippon Medical School, Tokyo, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomohiro Sonoyama
- Department of Pharmacy, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Naohito Beppu
- Department of Gastroenterological Surgery, Division of Lower GI, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koji Ueda
- Department of Gastrointestinal Surgery, Nippon Medical School, Tokyo, Japan
| | - Sho Kuriyama
- Department of Gastrointestinal Surgery, Nippon Medical School, Tokyo, Japan
| | - Akiyoshi Kanazawa
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Masataka Ikeda
- Department of Gastroenterological Surgery, Division of Lower GI, Hyogo College of Medicine, Nishinomiya, Japan
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
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Quantitative analysis of CDX2 protein expression improves its clinical utility as a prognostic biomarker in stage II and III colon cancer. Eur J Cancer 2020; 144:91-100. [PMID: 33341450 DOI: 10.1016/j.ejca.2020.10.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 01/18/2023]
Abstract
AIM Better stratification of patients with stage II and stage III colon cancer for risk of recurrence is urgently needed. The present study aimed to validate the prognostic value of CDX2 protein expression in colon cancer tissue by routine immunohistochemistry and to evaluate its performance in a head-to-head comparison with tandem mass spectrometry-based proteomics. PATIENT AND METHODS CDX2 protein expression was evaluated in 386 stage II and III primary colon cancers by immunohistochemical staining of tissue microarrays and by liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis using formalin-fixed paraffin-embedded tissue sections of a matched subset of 23 recurrent and 23 non-recurrent colon cancers. Association between CDX2 expression and disease-specific survival (DSS) was investigated. RESULTS Low levels of CDX2 protein expression in stage II and III colon cancer as determined by immunohistochemistry was associated with poor DSS (hazard ratio [HR] = 1.97 (95% confidence interval [CI]: 1.26-3.06); p = 0.002). Based on analysis of a selected sample subset, CDX2 prognostic value was more pronounced when detected by LC-MS/MS (HR = 7.56 (95% CI: 2.49-22.95); p < 0.001) compared to detection by immunohistochemistry (HR = 1.60 (95% CI: 0.61-4.22); p = 0.34). CONCLUSION This study validated CDX2 protein expression as a prognostic biomarker in stage II and III colon cancer, conform previous publications. CDX2 prognostic value appeared to be underestimated when detected by routine immunohistochemistry, probably due to the semiquantitative and subjective nature of this methodology. Quantitative analysis of CDX2 substantially improved its clinical utility as a prognostic biomarker. Therefore, development of routinely applicable quantitative assays for CDX2 expression is needed to facilitate its clinical implementation.
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20
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De Souza ALPB. Finding the hot spot: identifying immune sensitive gastrointestinal tumors. Transl Gastroenterol Hepatol 2020; 5:48. [PMID: 33073043 DOI: 10.21037/tgh.2019.12.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/06/2019] [Indexed: 12/16/2022] Open
Abstract
Although researchers have been trying to harness the immune system for over 100 years, the advent of immune checkpoint blockers (ICB) marks an era of significant clinical outcomes in various metastatic solid tumors, characterized by complete and durable responses. ICBs are monoclonal antibodies that target either of a pair of transmembrane molecules in tumors or T-cells involved in immune evasion. Currently 2 ICBs targeting the checkpoint program death 1 (PD-1), nivolumab and pembrolizumab, and one cytotoxic lymphocyte antigen-4 (CTLA-4) inhibitor (ipilimumab) are approved in gastrointestinal malignancies. We review herein the current evidence on predictive biomarkers for ICB response in gastrointestinal tumors. A review of literature based on the National Cancer Institute list of FDA-approved drugs for neoplasms and FDA-approved therapies at the FDA website was performed. An initial literature review was based on the American Association for Clinical Research meeting 2019, the American Society of Clinical Oncology meeting 2019 and the European Society of Medical Oncology 2019 proceedings. A systematic search of PubMed was performed involving MeSH browser terms such as biomarkers, immunotherapy, gastrointestinal diseases and neoplasms. When appropriate, American and British terms were used in the search. The most relevant predictor of response to ICBs is microsatellite instability (MSI) and the data is strongest for colorectal cancer. At least 3 prospective trials show evidence of PD-L1 as a predictive biomarker for ICB response in gastroesophageal malignancies. At least one prospective trial has described tumor mutational burden high (TMB-H), independent of MSI, as predictive of response in anal and biliary tract carcinomas. DNA Polymerase Epsilon (POLE) or delta (POL-D) mutations have been implicated in a subset of MSS colorectal cancer with TMB-H but this biomarker requires prospective validation. There is evolving data based on retrospective observations that gene alterations predicting acquired resistance and hyper-progression. Ongoing clinical research is assessing the role of the human microbiome and RNA-editing complex mutations as predictive biomarkers of response to ICBs. MSI has the strongest predictive power among current biomarkers for ICB response in gastrointestinal cancers. Data continue to accumulate from ongoing clinical trials and new biomarkers are emerging from pre-clinical studies, suggesting that drug combinations targeting pathways complimentary to the PD-1/PD-L1 axis inhibition will define a robust field of clinical research.
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Hong T, Cai D, Jin L, Zhang Y, Lu T, Hua D, Wu X. Development and validation of a nomogram to predict survival after curative resection of nonmetastatic colorectal cancer. Cancer Med 2020; 9:4126-4136. [PMID: 32314876 PMCID: PMC7300391 DOI: 10.1002/cam4.3010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background We aimed to develop a clinical applicable nomogram to predict overall survival (OS) for patients with curatively resected nonmetastatic colorectal cancer. Methods Records from a retrospective cohort of 846 patients with complete information were used to construct the nomogram. The nomogram was validated in a prospective cohort of 379 patients. The performance of the nomogram was evaluated with concordance index (c‐index), time‐dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analyses for discrimination, accuracy, calibration ability, and clinical net benefits respectively, and further compared with AJCC 8th TNM staging and the MSKCC nomogram. Risk stratification based on nomogram scores was performed with recursive partitioning analysis. Results The nomogram incorporated age, Glasgow prognostic score, pretreatment carcinoembryonic antigen levels, T staging, N staging, number of harvested lymph nodes, and histological grade. Compared with the 8th AJCC staging and MSKCC model, the nomogram had a statistically higher c‐index (0.77, 95% CI: 0.73‐0.80), bigger areas under the time‐dependent ROC curves (AUC at 3 years: 79; at 5 years: 79), and improved clinical net benefits. Calibration plots revealed no deviations from reference lines. All results were reproducible in the validation cohort. Nomogram‐based risk stratification successfully discriminated patients within each AJCC stage (all log‐rank P < .05). Conclusion We established an accurate, reliable, and easy‐to‐use nomogram to predict OS after curative resection for nonmetastatic colorectal cancer (CRC). The nomogram outperformed the 8th AJCC staging and the MSKCC model and could aid in personalized treatment and follow‐up strategy for CRC patients.
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Affiliation(s)
- Tingting Hong
- Department of Medical Oncology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
| | - Dongyan Cai
- Department of Medical Oncology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
| | - Linfang Jin
- Department of Pathology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
| | - Ying Zhang
- Department of Medical Oncology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
| | - Tingxun Lu
- Department of Medical Oncology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
| | - Dong Hua
- Department of Medical Oncology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
| | - Xiaohong Wu
- Department of Medical Oncology, The Affiliated Hospital of Jiangnan University and Wuxi 4th People's Hospital, Wuxi, China
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Foo CC, Ku C, Wei R, Yip J, Tsang J, Chan TY, Lo O, Law WL. How does lymph node yield affect survival outcomes of stage I and II colon cancer? World J Surg Oncol 2020; 18:22. [PMID: 31996214 PMCID: PMC6990535 DOI: 10.1186/s12957-020-1802-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/21/2020] [Indexed: 01/07/2023] Open
Abstract
Background According to the American Joint Committee on Cancer staging for cancer of the colon, a minimum of 12 lymph nodes (LN) has to be sampled for accurate staging. This has bearing on the long-term prognosis and the need for adjuvant chemotherapy. The aim of this study was to revisit the association of lymph node yield and the long-term survival in patients with stages I and II, i.e. node-negative, colon cancer. Method Consecutive patients who underwent elective or emergency curative resections for cancer of colon between the years 2003 and 2012 were retrospectively reviewed. Only patients with stage I or II diseases (AJCC 8th edition) were included. They were analysed in three groups, LN<12, LN12-19 and LN≥20. Their clinic-pathological characteristics were compared. The disease-free (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Results There was a total of 659 patients included in the analysis. Twelve or more LN were found in 65.6% of the specimens. The mean follow-up was 83.9 months. LN≥20 had significantly better DFS (p = 0.015) and OS (p = 0.036), whereas LN<12 had similar DFS and OS when compared to LN12-19. The advantage in DFS and OS were mainly seen in those with stage II diseases. A lymph node yield of greater than 20 was one of the predictors of favourable DFS, hazard ratio 0.358; 95% CI 0.170–.756, p = 0.007. Conclusion The lymph node yield had a significant association with survival outcomes. A lymph node yield of 20 or more was associated with better survival outcomes. On the other hand, lymph node yield less than 12 was not shown to have inferior survival outcomes when compared to those between 12 and 19.
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Affiliation(s)
- Chi Chung Foo
- Department of Surgery, University of Hong Kong, Hong Kong, China.
| | - Clement Ku
- Department of Surgery, University of Hong Kong, Hong Kong, China
| | - Rockson Wei
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Jeremy Yip
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Julian Tsang
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Toi Yin Chan
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Oswens Lo
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Wai Lun Law
- Department of Surgery, University of Hong Kong, Hong Kong, China
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Allan RE, Luis RP, Juan P. Microsatellite instability in Costa Rican patients with colorectal adenocarcinoma and its association with overall survival and response to fluoropyrimidine-based chemotherapy. Cancer Epidemiol 2020; 65:101680. [PMID: 31986316 DOI: 10.1016/j.canep.2020.101680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Microsatellite instability (MSI) is a prognostic and predictive factor in colorectal cancer (CRC). Previous trials have acknowledged that MSI prevalence varies according to ethnicity. The aim of this study was to determine the prevalence of MSI among CRC patients from Costa Rica and to analyze its influence on overall survival (OS) and response to fluoropyrimidine-based chemotherapy. METHODS We conducted a retrospective cohort study with all diagnosed CRC cases from 2010 to 2015 in a referral center in San José, Costa Rica. MSI was determined by immunohistochemical analysis. Clinical and epidemiological variables were retrieved from medical records. An univariate and multivariate COX regression analysis was performed to evaluate the association between MSI and mortality in the overall population and in those patients treated or not with fluoropyrimidine-based chemotherapy. RESULTS 553 CRC patients were identified during the study timeframe, and 165 of them were diagnosed with MSI (29.84 %; 95 % Confidence Interval CI: 26.02-33.65%). MSI was associated with M1 disease, and right-sided tumor location. After adjusting for potential confounders, MSI was an independent prognostic factor for OS (Hazard Ratio (HR): 0.56; 95 %CI: 0.43-0.67; Log-rankp = 0.03). MSI status did not modify the response to fluoropyrimidine-based chemotherapy (HR: 0.56; 95 %CI: 0.18-1.80; Log-rank: p = 0.33). CONCLUSIONS MSI was detected in a higher proportion of CRC patients than previously reported for other non-Hispanic populations. MSI was an independent prognostic factor for OS, but did not predict the efficacy of cytotoxic treatment with Fluoropyrimidine-based chemotherapy.
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Affiliation(s)
- Ramos-Esquivel Allan
- Centro de Investigaciones en Hematología y Trastornos Afines CIHATA, Universidad de Costa Rica, Costa Rica; Escuela de Medicina. Departamento Clínico Hospital San Juan de Dios. Universidad de Costa Rica Costa Rica.
| | - Rodríguez-Porras Luis
- Escuela de Medicina. Departamento Clínico Hospital San Juan de Dios. Universidad de Costa Rica Costa Rica
| | - Porras Juan
- Centro de Investigaciones en Hematología y Trastornos Afines CIHATA, Universidad de Costa Rica, Costa Rica; Escuela de Medicina. Departamento Clínico Hospital San Juan de Dios. Universidad de Costa Rica Costa Rica
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Meillan N, Vernerey D, Lefèvre JH, Manceau G, Svrcek M, Augustin J, Fléjou JF, Lascols O, Simon JM, Cohen R, Maingon P, Bachet JB, Huguet F. Mismatch Repair System Deficiency Is Associated With Response to Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer. Int J Radiat Oncol Biol Phys 2019; 105:824-833. [PMID: 31404579 DOI: 10.1016/j.ijrobp.2019.07.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Defective mismatch repair system (dMMR) has been shown to have a favorable impact on outcome in patients with colorectal cancer treated with surgery or immunotherapy, with adjuvant chemotherapy being discouraged unless there is nodal involvement. Its impact on radiosensitivity is unknown in patients with colorectal cancer. METHODS AND MATERIALS Patients treated for locally advanced rectal cancer between 2000 and 2016 were studied. Reported points included age, sex, clinical and radiologic tumor stages at diagnosis, modalities of neoadjuvant treatment, posttreatment pathologic staging, tumor regression score, and local, distant relapse-free, and overall survival. An inverse probability of treatment weighting propensity score analysis was performed to evaluate the association of mismatch repair proficiency with surgical and clinical outcomes. RESULTS Among the 296 patients included, 23 (7.8%) had dMMR. Median follow-up was 43.0 months (interquartile range, 27.9-66.7). Patients with dMMR were significantly younger than the others. After inverse probability of treatment weighting propensity score matching, dMMR patients had higher pathologic downstaging rate (P < .0001), higher tumor regression grade (P = .024), and a longer recurrence-free survival (P < .0001). CONCLUSIONS dMRR was associated with significant tumor downstaging after neoadjuvant chemoradiation and with increased recurrence-free survival. dMMR patients may have more radiosensitive tumors.
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Affiliation(s)
- Nicolas Meillan
- Department of Radiation Oncology, Tenon Hospital, Hôpitaux Universitaires Paris Est, APHP, Paris, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, Besançon, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, Saint-Antoine Hospital, APHP, Paris, France; Sorbonne Université, Paris, France
| | - Gilles Manceau
- Sorbonne Université, Paris, France; Department of Digestive and Hepato-Pancreato-Biliary Surgery, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Magali Svrcek
- Sorbonne Université, Paris, France; Department of Pathology, Saint-Antoine Hospital, APHP, Paris, France
| | - Jeremy Augustin
- Department of Pathology, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Jean-François Fléjou
- Sorbonne Université, Paris, France; Department of Pathology, Saint-Antoine Hospital, APHP, Paris, France
| | - Olivier Lascols
- Department of Biology and Molecular Genetics, Saint-Antoine Hospital, APHP, Paris, France
| | - Jean-Marc Simon
- Department of Radiation Oncology, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Romain Cohen
- Sorbonne Université, Paris, France; Department of Medical Oncology, Saint-Antoine Hospital, APHP, Paris, France
| | - Philippe Maingon
- Sorbonne Université, Paris, France; Department of Radiation Oncology, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Jean-Baptiste Bachet
- Sorbonne Université, Paris, France; Department of Hepato-Gastroenterology, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Florence Huguet
- Department of Radiation Oncology, Tenon Hospital, Hôpitaux Universitaires Paris Est, APHP, Paris, France; Sorbonne Université, Paris, France.
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Pinto JC, Rosa I, Martins C, Marques I, da Silva JP, Fonseca R, Freire J, Pereira AD. Colon Adenocarcinoma Stage IIA-Can We Predict Relapse? J Gastrointest Cancer 2019; 51:116-120. [PMID: 30834501 DOI: 10.1007/s12029-019-00218-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine prognostic factors for stage IIA colon cancer (CC) recurrence in patients undergoing curative intent surgery without adjuvant treatment. METHODS Single-centre cohort study. All patients with stage IIA CC discussed in a multidisciplinary colorectal cancer clinic from January 2010 to December 2012 were evaluated. Clinical data, laboratory data and tumour features, including expression of DNA repair proteins (EDRP), were analysed. Assessment of overall and disease free survival, recurrence, recurrence site and recurrence's method of diagnosis was performed. The associations between variables were tested through the Fisher's exact test (SPSS 23). RESULTS Fifty-five patients were included (55% male gender; mean age at diagnosis was 70.3 years (42-88)). CC was in the left colon in 62%, high grade in 7% and had lymphovascular invasion in 7% of the cases. Only one patient was submitted to emergent surgery for obstructive symptoms. In 55% of cases ≥ 12 lymph nodes were collected. There was EDRP loss in nine patients (MLH1/PMS2: six; MSH2/MSH6: three)-only two fulfilled revised Bethesda criteria. Recurrence occurred in five patients (8.9%), and it was diagnosed through surveillance in all of them. No variable showed a statistically significant association with recurrence; however, there were no recurrences in patients with EPRD loss (p = 0.209). Mean follow-up time was 43 months (2-70). In those with recurrence, mean disease-free survival was 23.4 months. CONCLUSIONS The overall good prognosis and absence of recurrence predictive factors were confirmed, validating the decision of not to submit stage IIA CC patients to chemotherapy risks.
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Affiliation(s)
- João Cortez Pinto
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal.
| | - Isadora Rosa
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
| | - Catarina Martins
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
| | - Inês Marques
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
| | - João Pereira da Silva
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
| | - Ricardo Fonseca
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
| | - João Freire
- Serviço de Oncologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
| | - António Dias Pereira
- Serviço de Gastrenterologia, Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG) EPE, 1099-023, Lisbon, Portugal
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Quan Q, Zhu M, Liu S, Chen P, He W, Huang Y, Rong Y, Qiu H, Zhang B, Xia L. Positive impact of the negative lymph node count on the survival rate of stage III colon cancer with pN1 and right-side disease. J Cancer 2019; 10:1052-1059. [PMID: 30854111 PMCID: PMC6400801 DOI: 10.7150/jca.23763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 10/24/2018] [Indexed: 01/04/2023] Open
Abstract
Background: We aimed to investigate the role of the negative lymph node count (NLN) as a predictor of prognosis in patients with stage III colon cancer. Methods: We conducted a retrospective study on patients who were diagnosed with stage III colon cancer at Sun Yat-sen University Cancer Center. According to the number of negative lymph nodes, all patients were divided into the low or high NLN group. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method and log-rank test between the two groups. Univariate and multivariate Cox proportional hazards models were used to evaluate the risk factors for survival. Results: The time-dependent receiver operating characteristic (ROC) curve showed that the optimal cutoff value of NLN was nine. In total, 167 and 298 patients were distributed into the low and high NLN groups, respectively. Patients in the high NLN group tended to present with a greater proportion of right-side colon cancer and pN1 stage disease, superior DFS (P < 0.001) and OS (P = 0.001) than those in the low NLN group. Multivariable analyses confirmed increased NLN as a positive prognostic variable, independent of other potential confounding factors. Subgroup analysis showed that in patients with a right-side location, those with 9 or fewer negative lymph nodes had a 5-year OS rate of 35.4% versus 77.1% in those with more than 9 negative lymph nodes evaluated (P < 0.001). For patients with stage pN1, those with NLN ≤9 exhibited an inferior 5-year OS rate than those with NLN > 9 (71.1% vs 84.8%, respectively; P = 0.009). There was no association between the number of negative lymph nodes identified and survival for patients with stage pN2 and left-side disease. Conclusion: NLN is an important prognostic factor for stage III colon cancer patients with right-side and stage pN1 disease other than for patients with stage pN2 and left-side disease, which can be partly explained in terms of inflammation and immunity.
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Affiliation(s)
- Qi Quan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Mingshu Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shousheng Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ping Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wenzhuo He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yuanyuan Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yuming Rong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Huijuan Qiu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Bei Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Liangping Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,VIP Region, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Dawson H, Kirsch R, Messenger D, Driman D. A Review of Current Challenges in Colorectal Cancer Reporting. Arch Pathol Lab Med 2019; 143:869-882. [DOI: 10.5858/arpa.2017-0475-ra] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Pathologic assessment of colorectal cancer resection specimens plays an important role in postsurgical management and prognostication in patients with colorectal cancer. Challenges exist in the evaluation and reporting of these specimens, either because of difficulties in applying existing guidelines or related to newer concepts.
Objective.—
To address challenging areas in colorectal cancer pathology and to provide an overview of the literature, current guidelines, and expert recommendations for the handling of colorectal cancer resection specimens in everyday practice.
Data Sources.—
PubMed (US National Library of Medicine, Bethesda, Maryland) literature review; reporting protocols of the College of American Pathologists, the Royal College of Pathologists of the United Kingdom, and the Japanese Society for Cancer of the Colon and Rectum; and classification manuals of the American Joint Committee on Cancer and the Union for International Cancer Control.
Conclusions.—
This review has addressed issues and challenges affecting quality of colorectal cancer pathology reporting. High-quality pathology reporting is essential for prognostication and management of patients with colorectal cancer.
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Affiliation(s)
- Heather Dawson
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - Richard Kirsch
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - David Messenger
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
| | - David Driman
- From the Institute of Pathology, University of Bern, Bern, Switzerland (Dr Dawson); Pathology and Laboratory Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada (Drs Dawson and Kirsch); the Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom (Dr Messenger); and Pathology and Laboratory Medicine, Western Univer
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28
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Clinicopathological Factors Influencing Lymph Node Yield in Colorectal Cancer: A Retrospective Study. Gastroenterol Res Pract 2019; 2019:5197914. [PMID: 30804995 PMCID: PMC6362492 DOI: 10.1155/2019/5197914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022] Open
Abstract
Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy). The factors influencing lymph node retrieval were subjected to uni- and multivariate analyses. Moreover, a survival analysis was carried out to verify the prognostic implications of nodal counts. The mean number of evaluated nodes was 24.08 ± 11.4, 20.34 ± 11.8, and 15.33 ± 9.64 in surgically treated right-sided colon cancer, left-sided colon cancer, and rectal tumors, respectively. More than 12 lymph nodes were reported in surgical specimens in 1094 (86.9%) cases in the colon cohort and in 425 (63%) cases in the rectal cohort, and patients who underwent neoadjuvant chemoradiation were analysed separately. On univariate analysis of the colon cancer group, higher LNs counts were associated with female sex, right colon cancer, emergency surgery, pT3-T4 diseases, higher tumor size, and resected specimen length. On multivariate analysis right colon tumors, larger mean size of tumor, length of specimen, pT3-T4 disease, and female sex were found to significantly affect lymph node retrieval. Colon cancer patients with 12 or more lymph nodes removed had a significantly better long-term survival than those with 11 or fewer nodes (P = 0.002, log-rank test). Rectal cancer patients with 12 or more lymph nodes removed approached but did not reach a statistically different survival (P = 0.055, log-rank test). Multiple tumor and patients' factors are associated with lymph node yield, but only the removal of at least 12 lymph nodes will reliably determine lymph node status.
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29
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Komor MA, Bosch LJ, Bounova G, Bolijn AS, Delis-van Diemen PM, Rausch C, Hoogstrate Y, Stubbs AP, de Jong M, Jenster G, van Grieken NC, Carvalho B, Wessels LF, Jimenez CR, Fijneman RJ, Meijer GA. Consensus molecular subtype classification of colorectal adenomas. J Pathol 2018; 246:266-276. [PMID: 29968252 PMCID: PMC6221003 DOI: 10.1002/path.5129] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/08/2018] [Accepted: 06/20/2018] [Indexed: 01/15/2023]
Abstract
Consensus molecular subtyping is an RNA expression‐based classification system for colorectal cancer (CRC). Genomic alterations accumulate during CRC pathogenesis, including the premalignant adenoma stage, leading to changes in RNA expression. Only a minority of adenomas progress to malignancies, a transition that is associated with specific DNA copy number aberrations or microsatellite instability (MSI). We aimed to investigate whether colorectal adenomas can already be stratified into consensus molecular subtype (CMS) classes, and whether specific CMS classes are related to the presence of specific DNA copy number aberrations associated with progression to malignancy. RNA sequencing was performed on 62 adenomas and 59 CRCs. MSI status was determined with polymerase chain reaction‐based methodology. DNA copy number was assessed by low‐coverage DNA sequencing (n = 30) or array‐comparative genomic hybridisation (n = 32). Adenomas were classified into CMS classes together with CRCs from the study cohort and from The Cancer Genome Atlas (n = 556), by use of the established CMS classifier. As a result, 54 of 62 (87%) adenomas were classified according to the CMS. The CMS3 ‘metabolic subtype’, which was least common among CRCs, was most prevalent among adenomas (n = 45; 73%). One of the two adenomas showing MSI was classified as CMS1 (2%), the ‘MSI immune’ subtype. Eight adenomas (13%) were classified as the ‘canonical’ CMS2. No adenomas were classified as the ‘mesenchymal’ CMS4, consistent with the fact that adenomas lack invasion‐associated stroma. The distribution of the CMS classes among adenomas was confirmed in an independent series. CMS3 was enriched with adenomas at low risk of progressing to CRC, whereas relatively more high‐risk adenomas were observed in CMS2. We conclude that adenomas can be stratified into the CMS classes. Considering that CMS1 and CMS2 expression signatures may mark adenomas at increased risk of progression, the distribution of the CMS classes among adenomas is consistent with the proportion of adenomas expected to progress to CRC. © 2018 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Malgorzata A Komor
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Oncoproteomics Laboratory, Department of Medical Oncology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Linda Jw Bosch
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gergana Bounova
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anne S Bolijn
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pien M Delis-van Diemen
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christian Rausch
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Youri Hoogstrate
- Department of Urology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Andrew P Stubbs
- Department of Bioinformatics, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Guido Jenster
- Department of Urology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | - Beatriz Carvalho
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lodewyk Fa Wessels
- Division of Molecular Carcinogenesis, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands
| | - Connie R Jimenez
- Oncoproteomics Laboratory, Department of Medical Oncology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Remond Ja Fijneman
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerrit A Meijer
- Translational Gastrointestinal Oncology, Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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30
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Bertolin G, Bulteau AL, Alves-Guerra MC, Burel A, Lavault MT, Gavard O, Le Bras S, Gagné JP, Poirier GG, Le Borgne R, Prigent C, Tramier M. Aurora kinase A localises to mitochondria to control organelle dynamics and energy production. eLife 2018; 7:38111. [PMID: 30070631 PMCID: PMC6140714 DOI: 10.7554/elife.38111] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/01/2018] [Indexed: 12/18/2022] Open
Abstract
Many epithelial cancers show cell cycle dysfunction tightly correlated with the overexpression of the serine/threonine kinase Aurora A (AURKA). Its role in mitotic progression has been extensively characterised, and evidence for new AURKA functions emerges. Here, we reveal that AURKA is located and imported in mitochondria in several human cancer cell lines. Mitochondrial AURKA impacts on two organelle functions: mitochondrial dynamics and energy production. When AURKA is expressed at endogenous levels during interphase, it induces mitochondrial fragmentation independently from RALA. Conversely, AURKA enhances mitochondrial fusion and ATP production when it is over-expressed. We demonstrate that AURKA directly regulates mitochondrial functions and that AURKA over-expression promotes metabolic reprogramming by increasing mitochondrial interconnectivity. Our work paves the way to anti-cancer therapeutics based on the simultaneous targeting of mitochondrial functions and AURKA inhibition. Structures called mitochondria power cells by turning oxygen and sugar into chemical energy. Each cell can have thousands of mitochondria, which work together to supply changing energy demands. They can fuse together or break apart, forming networks that change size and produce different amounts of energy. Getting the balance right is crucial; if energy levels are too low, the cell will not be able to grow and divide. If energy levels are too high, the cell can grow at a faster rate, which can contribute to the cell becoming cancerous. Although we know that mitochondria provide energy, it is not clear how they communicate to fine-tune the supply. Some clues come from cancer cells that seem dependent on their mitochondria for survival. In these cells, levels of a protein called AURKA are higher than normal. AURKA helps cells to divide, and it interacts with many different proteins. This complexity makes it difficult to work out exactly what AURKA does, but it is possible that it plays a role in energy supply. Bertolin et al. have now investigated whether mitochondria use AURKA to communicate inside human breast cancer cells. Tagging AURKA proteins with a fluorescent marker revealed that it accumulates inside mitochondria. Once it gets there, AURKA changes the shape of the mitochondria, which has dramatic effects on their capacity to produce energy. At normal levels, AURKA causes the mitochondria to fragment, breaking apart into smaller pieces. This maintains their energy output at a normal level. If AURKA levels are too high, the mitochondria fuse together and produce more energy. This means AURKA could help to fuel fast-growing cancer cells. Current drugs that aim to treat cancer by blocking the activity of AURKA show poor results. This is partly due to the fact that the protein has so many different roles in the cell. Finding that AURKA affects mitochondria is the first step in understanding one of its unknown roles. It also suggests the possibility of developing new drugs to change how mitochondria make energy in cancer cells that contain high levels of AURKA.
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Affiliation(s)
- Giulia Bertolin
- CNRS, UMR 6290, Rennes, France.,Université de Rennes 1, UBL, Genetics and Development Institute of Rennes (IGDR), Rennes, France
| | - Anne-Laure Bulteau
- ENS de Lyon, Lyon, France.,CNRS UMR 5242, Lyon, France.,INRA USC 1370, Lyon, France
| | - Marie-Clotilde Alves-Guerra
- Inserm, U1016, Institut Cochin, Paris, France.,CNRS, UMR 8104, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Agnes Burel
- Microscopy Rennes Imaging Centre, SFR Biosit, UMS CNRS 3480- US INSERM 018, Université de Rennes, Rennes, France
| | - Marie-Thérèse Lavault
- Microscopy Rennes Imaging Centre, SFR Biosit, UMS CNRS 3480- US INSERM 018, Université de Rennes, Rennes, France
| | - Olivia Gavard
- CNRS, UMR 6290, Rennes, France.,Université de Rennes 1, UBL, Genetics and Development Institute of Rennes (IGDR), Rennes, France.,Equipes labélisées Ligue Contre Le Cancer, Rennes, France.,Centre de recherche du CHU de Québec, Faculté de Médecine, Université Laval, Québec, Canada
| | - Stephanie Le Bras
- CNRS, UMR 6290, Rennes, France.,Université de Rennes 1, UBL, Genetics and Development Institute of Rennes (IGDR), Rennes, France
| | - Jean-Philippe Gagné
- Centre de recherche du CHU de Québec, Faculté de Médecine, Université Laval, Québec, Canada
| | - Guy G Poirier
- Centre de recherche du CHU de Québec, Faculté de Médecine, Université Laval, Québec, Canada
| | - Roland Le Borgne
- CNRS, UMR 6290, Rennes, France.,Université de Rennes 1, UBL, Genetics and Development Institute of Rennes (IGDR), Rennes, France.,Equipes labélisées Ligue Contre Le Cancer, Rennes, France
| | - Claude Prigent
- CNRS, UMR 6290, Rennes, France.,Université de Rennes 1, UBL, Genetics and Development Institute of Rennes (IGDR), Rennes, France.,Equipes labélisées Ligue Contre Le Cancer, Rennes, France
| | - Marc Tramier
- CNRS, UMR 6290, Rennes, France.,Université de Rennes 1, UBL, Genetics and Development Institute of Rennes (IGDR), Rennes, France.,Microscopy Rennes Imaging Centre, SFR Biosit, UMS CNRS 3480- US INSERM 018, Université de Rennes, Rennes, France
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31
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Jacobsen A, Bosch LJW, Martens-de Kemp SR, Carvalho B, Sillars-Hardebol AH, Dobson RJ, de Rinaldis E, Meijer GA, Abeln S, Heringa J, Fijneman RJA, Feenstra KA. Aurora kinase A (AURKA) interaction with Wnt and Ras-MAPK signalling pathways in colorectal cancer. Sci Rep 2018; 8:7522. [PMID: 29760449 PMCID: PMC5951826 DOI: 10.1038/s41598-018-24982-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/12/2018] [Indexed: 12/16/2022] Open
Abstract
Hyperactivation of Wnt and Ras-MAPK signalling are common events in development of colorectal adenomas. Further progression from adenoma-to-carcinoma is frequently associated with 20q gain and overexpression of Aurora kinase A (AURKA). Interestingly, AURKA has been shown to further enhance Wnt and Ras-MAPK signalling. However, the molecular details of these interactions in driving colorectal carcinogenesis remain poorly understood. Here we first performed differential expression analysis (DEA) of AURKA knockdown in two colorectal cancer (CRC) cell lines with 20q gain and AURKA overexpression. Next, using an exact algorithm, Heinz, we computed the largest connected protein-protein interaction (PPI) network module of significantly deregulated genes in the two CRC cell lines. The DEA and the Heinz analyses suggest 20 Wnt and Ras-MAPK signalling genes being deregulated by AURKA, whereof β-catenin and KRAS occurred in both cell lines. Finally, shortest path analysis over the PPI network revealed eight 'connecting genes' between AURKA and these Wnt and Ras-MAPK signalling genes, of which UBE2D1, DICER1, CDK6 and RACGAP1 occurred in both cell lines. This study, first, confirms that AURKA influences deregulation of Wnt and Ras-MAPK signalling genes, and second, suggests mechanisms in CRC cell lines describing these interactions.
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Affiliation(s)
- Annika Jacobsen
- Centre for Integrative Bioinformatics (IBIVU), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda J W Bosch
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Beatriz Carvalho
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Richard J Dobson
- Bioinformatics group at the NIHR Biomedical Research Centre for Mental Health (IOP) and the South London and Maudsley NHS Trust, London, UK
| | - Emanuele de Rinaldis
- The BRC Translational Bioinformatics Unit at the NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Gerrit A Meijer
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sanne Abeln
- Centre for Integrative Bioinformatics (IBIVU), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap Heringa
- Centre for Integrative Bioinformatics (IBIVU), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Remond J A Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - K Anton Feenstra
- Centre for Integrative Bioinformatics (IBIVU), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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32
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Kang S, Na Y, Joung SY, Lee SI, Oh SC, Min BW. The significance of microsatellite instability in colorectal cancer after controlling for clinicopathological factors. Medicine (Baltimore) 2018; 97:e0019. [PMID: 29489646 PMCID: PMC5851768 DOI: 10.1097/md.0000000000010019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The colorectal cancer (CRC) patients with microsatellite instability (MSI) have distinct clinicopathological characteristics consisting of factors predicting positive and negative outcomes, such as a high lymph node harvest and poor differentiation. In this study, we measured the value of MSI as a prognostic factor after controlling for these discrepant factors. A total of 603 patients who underwent curative surgery for stages I to III colorectal cancer were enrolled. The patients were divided into microsatellite instability high (MSI-H) and microsatellite stable/microsatellite instability low (MSS/MSI-L) groups. Propensity score matching was used to match clinicopathological factors between the 2 groups. MSI-H patients had a high lymph node harvest (median: 31.0 vs 23.0, P < .001), earlier-stage tumors (P < .001), advanced T stage (89.3% vs 74.0%, P = .018), and poor differentiation (19.6% vs 2.0%, P < .001). Survival analysis showed better survival in the MSI-H group, but the difference was not statistically significant (P = .126). Propensity score matching was performed for significant prognostic factors identified by Cox hazard regression. After the matching, the survival difference by MSI status was estimated to be larger than before, and reached statistical significance (P = .045). In conclusion, after controlling for pathological characteristics, MSI-H could be a potent prognostic factor regarding patient survival.
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Affiliation(s)
- Sanghee Kang
- Department of Surgery, Korea University Guro Hospital, Gurodong-gil, Guro-gu, Seoul, Korea
| | - Younghyun Na
- Department of Surgery, Korea University Guro Hospital, Gurodong-gil, Guro-gu, Seoul, Korea
| | - Sung Yup Joung
- Department of Surgery, Korea University Guro Hospital, Gurodong-gil, Guro-gu, Seoul, Korea
| | - Sun Il Lee
- Department of Surgery, Korea University Guro Hospital, Gurodong-gil, Guro-gu, Seoul, Korea
| | - Sang Cheul Oh
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Wook Min
- Department of Surgery, Korea University Guro Hospital, Gurodong-gil, Guro-gu, Seoul, Korea
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33
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Arnold A, Kloor M, Jansen L, Chang-Claude J, Brenner H, von Winterfeld M, Hoffmeister M, Bläker H. The association between microsatellite instability and lymph node count in colorectal cancer. Virchows Arch 2017; 471:57-64. [DOI: 10.1007/s00428-017-2150-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/26/2017] [Accepted: 05/12/2017] [Indexed: 12/12/2022]
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34
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Del Paggio JC, Nanji S, Wei X, MacDonald PH, Booth CM. Lymph node evaluation for colon cancer in routine clinical practice: a population-based study. ACTA ACUST UNITED AC 2017; 24:e35-e43. [PMID: 28270730 DOI: 10.3747/co.24.3210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Guidelines recommend that 12 or more lymph nodes (lns) be evaluated during surgical resection of colon cancer. Here, we report ln yield and its association with survival in routine practice. METHODS Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients with colon cancer treated during 2002-2008. The study population (n = 5508) included a 25% random sample of patients with stage ii or iii disease. Modified Poisson regression was used to identify factors associated with ln yield; Cox models were used to explore the association between ln yield and overall (os) and cancer-specific survival (css). RESULTS During 2002-2008, median ln yield increased to 17 from 11 nodes (p < 0.001), and the proportion of patients with 12 or more nodes evaluated increased to 86% from 45% (p < 0.001). Lymph node positivity did not change over time (to 53% from 54%, p = 0.357). Greater ln yield was associated with younger age (p < 0.001), less comorbidity (p = 0.004), higher socioeconomic status (p = 0.001), right-sided tumours (p < 0.001), and higher hospital volume (p < 0.001). In adjusted analyses, a ln yield of less than 12 nodes was associated with inferior os and css for stages ii and iii disease [stage ii os hazard ratio (hr): 1.36; 95% confidence interval (ci): 1.19 to 1.56; stage ii css hr: 1.52; 95% ci: 1.26 to 1.83; and stage iii os hr: 1.45; 95% ci: 1.30 to 1.61; stage iii css hr: 1.54; 95% ci: 1.36 to 1.75]. CONCLUSIONS Despite a temporal increase in ln yield, the proportion of cases with ln positivity has not changed. Lymph node yield is associated with survival in patients with stages ii and iii colon cancer. The association between ln yield and survival is unlikely to be a result of stage migration.
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Affiliation(s)
- J C Del Paggio
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute
| | - S Nanji
- Departments of Oncology; Surgery
| | - X Wei
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute
| | | | - C M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute; Departments of Oncology; Public Health Sciences, Queen's University, Kingston, ON
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35
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Copija A, Waniczek D, Witkoś A, Walkiewicz K, Nowakowska-Zajdel E. Clinical Significance and Prognostic Relevance of Microsatellite Instability in Sporadic Colorectal Cancer Patients. Int J Mol Sci 2017; 18:ijms18010107. [PMID: 28067827 PMCID: PMC5297741 DOI: 10.3390/ijms18010107] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/26/2016] [Accepted: 12/30/2016] [Indexed: 02/06/2023] Open
Abstract
Microsatellite instability (MSI) is a marker of the replication error phenotype. It is caused by impaired DNA mismatch repair processes (MMR), resulting in ineffectiveness of the mechanisms responsible for the DNA replication precision and postreplicative DNA repair. MSI underlies the pathogenesis of 10%-20% of colorectal cancer (CRC) cases. The data about the potential value of MMR status as a predictive factor for 5-fluorouracil (FU)-based chemotherapy remain unclear. According to National Comprehensive Cancer Network updated guidelines, MSI testing is recommended for all patients with stage II CRC because patients with MSI-H (high-frequency MSI) tumour may have a good prognosis and obtain no benefit from 5-FU-based adjuvant chemotherapy. The significance of the MSI status as a predictive factor for patients with metastatic disease was not confirmed. The association between the MSI status and the efficacy of the therapy based on anti-programmed death-1 receptor inhibitors requires further studies.
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Affiliation(s)
- Angelika Copija
- Department of Nutrition Related Disease Prevention, School of Public Health in Bytom, Medical University of Silesia, 41-902 Bytom, Poland.
- Department of Clinical Oncology, Regional Specialised Hospital No. 4 in Bytom, 41-900 Bytom, Poland.
| | - Dariusz Waniczek
- Department of Propaedeutics Surgery, Chair of General, Colorectal and Polytrauma Surgery, School of Health Sciences in Katowice, Medical University of Silesia, 41-902 Bytom, Poland.
| | - Andrzej Witkoś
- Department of Clinical Oncology, Regional Specialised Hospital No. 4 in Bytom, 41-900 Bytom, Poland.
| | - Katarzyna Walkiewicz
- Department of Internal Medicine, School of Public Health in Bytom, Medical University of Silesia, 41-902 Bytom, Poland.
| | - Ewa Nowakowska-Zajdel
- Department of Nutrition Related Disease Prevention, School of Public Health in Bytom, Medical University of Silesia, 41-902 Bytom, Poland.
- Department of Clinical Oncology, Regional Specialised Hospital No. 4 in Bytom, 41-900 Bytom, Poland.
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36
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A Nomogram to Predict Adequate Lymph Node Recovery before Resection of Colorectal Cancer. PLoS One 2016; 11:e0168156. [PMID: 27992611 PMCID: PMC5161509 DOI: 10.1371/journal.pone.0168156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/25/2016] [Indexed: 12/15/2022] Open
Abstract
Increased lymph node count (LNC) has been associated with prolonged survival in colorectal cancer (CRC), but the underlying mechanisms are still poorly understood. The study aims to identify new predictors and develop a preoperative nomogram for predicting the probability of adequate LNC (≥ 12). 501 eligible patients were retrospectively selected to identify clinical-pathological factors associated with LNC ≥ 12 through univariate and multivariate logistic regression analyses. The nomogram was built according to multivariate analyses of preoperative factors. Model performance was assessed with concordance index (c-index) and area under the receiver operating characteristic curve (AUC), followed by internal validation and calibration using 1000-resample bootstrapping. Clinical validity of the nomogram and LNC impact on stage migration were also evaluated. Multivariate analyses showed patient age, CA19-9, circulating lymphocytes, neutrophils, platelets, tumor diameter, histology and deposit significantly correlated with LNC (P < 0.05). The effects were marginal for CEA, anemia and CRC location (0.05 < P < 0.1). The multivariate analyses of preoperative factors suggested decreased age, CEA, CA19-9, neutrophils, proximal location, and increased platelets and diameter were significantly associated with increased probability of LNC ≥ 12 (P < 0.05). The nomogram achieved c-indexes of 0.75 and 0.73 before and after correction for overfitting. The AUC was 0.75 (95% CI, 0.70–0.79) and the clinically valid threshold probabilities were between 10% and 60% for the nomogram to predict LNC < 12. Additionally, increased probability of adequate LNC before surgery was associated with increased LNC and negative lymph nodes rather than increased positive lymph nodes, lymph node ratio, pN stages or AJCC stages. Collectively, the results indicate the LNC is multifactorial and irrelevant to stage migration. The significant correlations with preoperative circulating markers may provide new explanations for LNC-related survival advantage which is reflected by the implication of regional and systemic antitumor immune responses.
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37
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Clinical, histological, and molecular risk factors for cancer recurrence in patients with stage II colon cancer. Eur J Gastroenterol Hepatol 2016; 28:1394-1399. [PMID: 27606947 DOI: 10.1097/meg.0000000000000725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The assessment of risk factors of cancer recurrence in patients with stage II colon cancer (CC) is crucial. Our aim was to study the clinical, histological, and molecular features associated with 3-year disease-free survival in a series of consecutive patients with stage II CC treated in three regional digestive oncology centers. METHODS Clinical and histological data of all patients after curative surgery for stage II CC, treated from 2001 until 2009, were collected retrospectively. Histological samples were obtained and tested prospectively for microsatellite instability using fluorescent PCR amplification. Cox proportional hazards regression models were used to calculate P values, hazard ratios (HRs), and 95% confidence intervals (CIs). RESULTS Among 195 patients studied, 22 (11%) had disease recurrence during the 3-year period following diagnosis. On multivariate analysis, only low number of lymph nodes (HR=3.81, 95% CI: 1.19-12.19, P=0.02) and T4 status (HR=5.49, 95% CI: 1.06-28.43, P=0.04) were associated significantly with an increased risk of relapse. CONCLUSION In this series of stage II CC patients, only T4 status and low number of lymph nodes were independent risk factors for poor 3-year disease-free survival, suggesting that patients with these features should be considered for adjuvant chemotherapy.
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den Uil SH, Coupé VMH, Linnekamp JF, van den Broek E, Goos JACM, Delis-van Diemen PM, Belt EJT, van Grieken NCT, Scott PM, Vermeulen L, Medema JP, Bril H, Stockmann HBAC, Cormier RT, Meijer GA, Fijneman RJA. Loss of KCNQ1 expression in stage II and stage III colon cancer is a strong prognostic factor for disease recurrence. Br J Cancer 2016; 115:1565-1574. [PMID: 27855440 PMCID: PMC5155368 DOI: 10.1038/bjc.2016.376] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/29/2016] [Accepted: 10/17/2016] [Indexed: 01/04/2023] Open
Abstract
Background: Colorectal cancer (CRC) is the third most common cancer worldwide. Accurately identifying stage II CRC patients at risk for recurrence is an unmet clinical need. KCNQ1 was previously identified as a tumour suppressor gene and loss of expression was associated with poor survival in patients with CRC liver metastases. In this study the prognostic value of KCNQ1 in stage II and stage III colon cancer patients was examined. Methods: KCNQ1 mRNA expression was assessed in 90 stage II colon cancer patients (AMC-AJCCII-90) using microarray gene expression data. Subsequently, KCNQ1 protein expression was evaluated in an independent cohort of 386 stage II and stage III colon cancer patients by immunohistochemistry of tissue microarrays. Results: Low KCNQ1 mRNA expression in stage II microsatellite stable (MSS) colon cancers was associated with poor disease-free survival (DFS) (P=0.025). Loss of KCNQ1 protein expression from epithelial cells was strongly associated with poor DFS in stage II MSS (P<0.0001), stage III MSS (P=0.0001) and stage III microsatellite instable colon cancers (P=0.041). KCNQ1 seemed an independent prognostic value in addition to other high-risk parameters like angio-invasion, nodal stage and microsatellite instability-status. Conclusions: We conclude that KCNQ1 is a promising biomarker for prediction of disease recurrence and may aid stratification of patients with stage II MSS colon cancer for adjuvant chemotherapy.
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Affiliation(s)
- Sjoerd H den Uil
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands.,Department of Surgery, Spaarne Gasthuis, Haarlem 2035RC, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam 1081HV, The Netherlands
| | - Janneke F Linnekamp
- Laboratory of Experimental Oncology and Radiobiology, Center for Experimental Molecular Medicine, Academic Medical Center, Amsterdam 1100DD, The Netherlands
| | - Evert van den Broek
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands.,Department of Pathology, The Netherlands Cancer Institute, Amsterdam 1066CX, The Netherlands
| | - Jeroen A C M Goos
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands
| | - Pien M Delis-van Diemen
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands.,Department of Pathology, The Netherlands Cancer Institute, Amsterdam 1066CX, The Netherlands
| | - Eric J Th Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht 3300AK, The Netherlands
| | - Nicole C T van Grieken
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands
| | - Patricia M Scott
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, Minnesota, MN 55812, USA
| | - Louis Vermeulen
- Laboratory of Experimental Oncology and Radiobiology, Center for Experimental Molecular Medicine, Academic Medical Center, Amsterdam 1100DD, The Netherlands
| | - Jan Paul Medema
- Laboratory of Experimental Oncology and Radiobiology, Center for Experimental Molecular Medicine, Academic Medical Center, Amsterdam 1100DD, The Netherlands
| | - Herman Bril
- Department of Pathology, Spaarne Gasthuis, Haarlem 2035RC, The Netherlands
| | | | - Robert T Cormier
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, Minnesota, MN 55812, USA
| | - Gerrit A Meijer
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands.,Department of Pathology, The Netherlands Cancer Institute, Amsterdam 1066CX, The Netherlands
| | - Remond J A Fijneman
- Department of Pathology, VU University Medical Center, Amsterdam 1081HV, The Netherlands.,Department of Pathology, The Netherlands Cancer Institute, Amsterdam 1066CX, The Netherlands
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Lykke J, Jess P, Roikjær O. A high lymph node yield in colon cancer is associated with age, tumour stage, tumour sub-site and priority of surgery. Results from a prospective national cohort study. Int J Colorectal Dis 2016; 31:1299-305. [PMID: 27220610 DOI: 10.1007/s00384-016-2599-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 02/04/2023]
Abstract
AIM To determine the relation between patient-related and histopathological factors, as well as the influence of national programs for diagnosing and treatment of colon cancer and a lymph node yield (LNY) ≥ 12. METHOD An analysis was carried out of the LNY in a nationwide Danish cohort treated by curative resection of stage I-III colon cancer in the period 2003-2011. The association between a LNY ≥ 12 and age, sex, body mass index, open vs. laparoscopic surgery, acute vs. elective surgery, pT stage, tumour sub-site and year of diagnosis was analysed. RESULTS A total of 13,766 patients were eligible for the analysis. In total, 71.4 % of the patients had a LNY ≥ 12. In multivariate analysis, age, pT stage, tumour sub-site and priority of surgery were independently associated with the probability of a LNY ≥ 12. Odds ratios (ORs) were as follows: age <65 1, 65-75 0.685 (confidence interval (CI) 0.586-0.800), >75 0.517 (CI 0.439-0.609); T1 1, T2 2.750 (CI 2.168-3.487), T3 6.016 (CI 4.879-7.418), T4 6.317 (CI 4.950-8.063); right colon 1, left colon 0.568 (0.511-0.633); elective surgery 1, acute surgery 0.748 (CI 0.625-0.894). Moreover, year of diagnosis was associated with the probability of a LNY ≥ 12: OR 1.480 (CI 1.445-1.516) for each increasing year in the study period. CONCLUSION A LNY ≥ 12 is significantly associated with age, pT stage, tumour sub-site and priority of surgery. A significant increase in the LNY over the period of the study was observed, probably reflecting the effect of national programmes initiated by the Danish Colorectal Cancer Group.
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Affiliation(s)
- Jakob Lykke
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - Per Jess
- Department of Surgery, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Ole Roikjær
- Department of Surgery, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
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40
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Mohan HM, Ryan E, Balasubramanian I, Kennelly R, Geraghty R, Sclafani F, Fennelly D, McDermott R, Ryan EJ, O'Donoghue D, Hyland JMP, Martin ST, O'Connell PR, Gibbons D, Winter D, Sheahan K. Microsatellite instability is associated with reduced disease specific survival in stage III colon cancer. Eur J Surg Oncol 2016; 42:1680-1686. [PMID: 27370895 DOI: 10.1016/j.ejso.2016.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/19/2016] [Accepted: 05/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Up to 15% of colorectal cancers exhibit microsatellite instability (MSI), where errors in replication go unchecked due to defects in the mismatch repair system. This study aimed to determine survival in a large single-centre series of 1250 consecutive colorectal cancers subjected to universal MSI testing. METHODS Clinical and pathological features of patients with colorectal cancer identified on prospectively maintained colorectal and pathology databases at St. Vincent's University Hospital from 2004 to May 2012 were examined. Mismatch repair (MMR) status was determined by immunohistochemistry. Kaplan-Meier curves, the log-rank test and Cox regression were used to associate survival with clinical and pathological characteristics. RESULTS Of the 1250 colorectal cancers in the study period, 11% exhibited MSI (n = 138). Patients with MSI tumours had significantly lower rates of lymph node and distant metastases (MSI N+ rate: 24.8% compared with MSS N+ rate: 46.2%, p < 0.001). For Stage I and II disease MSI was associated with improved disease free survival (DSS) compared with MSS colon cancer. However, patients with Stage III MSI colon cancers had a worse DSS than those with MSS tumours. Stage III MSI tumours exhibited higher rates of lymphovascular invasion and perineural invasion than Stage I/II MSI tumours. CONCLUSION MSI is associated with a reduced risk of nodal and distant metastases, with an improved DSS in Stage I/II colon cancer. However, when MSI tumours progress to Stage III these patients had worse outcomes and pathological features. New strategies for this cohort of patients may be required to improve outcomes.
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Affiliation(s)
- H M Mohan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - E Ryan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - I Balasubramanian
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R Kennelly
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R Geraghty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Sclafani
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Fennelly
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - R McDermott
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - E J Ryan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - D O'Donoghue
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J M P Hyland
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S T Martin
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - P R O'Connell
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - D Gibbons
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Des Winter
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - K Sheahan
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Ireland.
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Märkl B, Wieberneit J, Kretsinger H, Mayr P, Anthuber M, Arnholdt HM, Schenkirsch G. Number of Intratumoral T Lymphocytes Is Associated With Lymph Node Size, Lymph Node Harvest, and Outcome in Node-Negative Colon Cancer. Am J Clin Pathol 2016; 145:826-36. [PMID: 27329640 DOI: 10.1093/ajcp/aqw074] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES We postulated that lymph node (LN) harvest and LN size are influenced by immunologic effects. METHODS To investigate this hypothesis, we performed a retrospective analysis of 170 node-negative colon cancer cases to evaluate the density of intratumoral T lymphocytes (ITLs). CD3- and CD8-positive T cells were counted using a digital system. RESULTS The ITL density was significantly increased in cases with sufficient LN harvest and high numbers of LNs larger than 5 mm (LN5). High ITL numbers were associated with improved cancer-specific survival. The analysis of the immune score revealed a significantly different cancer-specific outcome (P = .024), with no cancer-related death in the group with the highest score. The immune score and tumor budding were independently prognostic. CONCLUSIONS ITL density is independently prognostic and associated with LN harvest and LN size. The immune response is very likely the true explanation for the known prognostic effect of the LN harvest in colon cancer.
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Affiliation(s)
| | | | | | | | | | | | - Gerhard Schenkirsch
- Clinical and Population Based Cancer Registry Augsburg, Klinikum Augsburg, Augsburg, Germany
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42
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The Evaluation of More Lymph Nodes in Colon Cancer Is Associated with Improved Survival in Patients of All Ages. PLoS One 2016; 11:e0155608. [PMID: 27196666 PMCID: PMC4873179 DOI: 10.1371/journal.pone.0155608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/02/2016] [Indexed: 01/11/2023] Open
Abstract
Background Improvement in survival of patients with colon cancer is reduced in elderly patients compared to younger patients. The aim of this study was to investigate whether the removal of ≥ 12 lymph nodes can explain differences in survival rates between elderly and younger patients diagnosed with colon cancer. Methods In a population-based cohort study, all patients (N = 41,074) diagnosed with colon cancer stage I to III from 2003 through 2010 from the Netherlands Cancer Registry were included. Age groups were defined as < 66, 66–75 and > 75 years of age. Main outcome measures were overall and relative survival, the latter as a proxy for disease specific survival. Results Over an eight years time period there was a 41.2% increase in patients with ≥ 12 lymph nodes removed, whereas the percentage of patients with the presence of lymph node metastases remained stable (35.7% to 37.5%). After adjustment for patient and tumour characteristics and adjuvant chemotherapy, it was found that for patients in which ≥ 12 lymph nodes were removed compared to patients with < 12 lymph nodes removed, there was a statistically significant higher overall survival (< 66: HR: 0.858 (95% CI, 0.789–0.933); 66–75: HR: 0.763 (95% CI, 0.714–0.814); > 75: HR: 0.734 (95% CI, 0.700–0.771)) and relative survival (< 66: RER: 0.783 (95% CI, 0.708–0.865); 66–75: RER: 0.672 (95% CI, 0.611–0.739); > 75: RER: 0.621 (95% CI, 0.567–0.681)) in all three age groups. Conclusions The removal of ≥ 12 lymph nodes is associated with an improvement in both overall and relative survival in all patients. This association was stronger in the elderly patient. The biology of this association needs further clarification.
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Opportunities for immunotherapy in microsatellite instable colorectal cancer. Cancer Immunol Immunother 2016; 65:1249-59. [PMID: 27060000 PMCID: PMC5035655 DOI: 10.1007/s00262-016-1832-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/23/2016] [Indexed: 12/22/2022]
Abstract
Microsatellite instability (MSI), the somatic accumulation of length variations in repetitive DNA sequences called microsatellites, is frequently observed in both hereditary and sporadic colorectal cancer (CRC). It has been established that defects in the DNA mismatch repair (MMR) pathway underlie the development of MSI in CRC. After the inactivation of the DNA MMR pathway, misincorporations, insertions and deletions introduced by DNA polymerase slippage are not properly recognized and corrected. Specific genomic regions, including microsatellites, are more prone for DNA polymerase slippage and, therefore, more susceptible for the introduction of these mutations if the DNA MMR capacity is lost. Some of these susceptible genomic regions are located within the coding regions of genes. Insertions and deletions in these regions may alter their reading frame, potentially resulting in the transcription and translation of frameshift peptides with c-terminally altered amino acid sequences. These frameshift peptides are called neoantigens and are highly immunogenic, which explains the enhanced immunogenicity of MSI CRC. Neoantigens contribute to increased infiltration of tumor tissue with activated neoantigen-specific cytotoxic T lymphocytes, a hallmark of MSI tumors. Currently, neoantigen-based vaccination is being studied in a clinical trial for Lynch syndrome and in a trial for sporadic MSI CRC of advanced stage. In this Focussed Research Review, we summarize current knowledge on molecular mechanisms and address immunological features of tumors with MSI. Finally, we describe their implications for immunotherapeutic approaches and provide an outlook on next-generation immunotherapy involving neoantigens and combinatorial therapies in the setting of MSI CRC.
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Iachetta F, Domati F, Reggiani-Bonetti L, Barresi V, Magnani G, Marcheselli L, Cirilli C, Pedroni M. Prognostic relevance of microsatellite instability in pT3N0M0 colon cancer: a population-based study. Intern Emerg Med 2016. [PMID: 26224509 DOI: 10.1007/s11739-015-1285-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although surgery alone represents a curative approach for patients with pT3N0M0 colon cancer, about 15-20% of these patients develop a relapse of disease. Microsatellite instability (MSI) is one of the most important molecular markers in colorectal cancer. The aim of this study was to investigate the prognostic relevance of MSI in all pT3N0M0 tumors recorded in the Cancer Registry of the Province of Modena--(Northern Italy) within the 2002-2006 period in patients who showed a relapse of disease during the 5-year period of follow-up (59 cases). They were compared to 59 controls similar in clinical and pathological features but with good prognosis. None of the subjects received adjuvant chemotherapy. MSI status was tested using BAT25, BAT26, NR24, and CAT25 fluorescent-labeled mononucleotide markers. The overall prevalence of MSI was 12.7% (15 of 118 cases). MSI was detected mainly in mucinous adenocarcinoma (p < 0.003), in high-grade tumors (p < 0.008), in right-sided neoplasms (p < 0.005), and in patients with a better prognosis, though the difference was not statistically significant (11/59 patients -18.6% vs 4/59 patients -6.7%; OR 0.36 CI 95% 0.11-1.15; p = 0.08). However, in multivariate analysis, MSI status becomes the strongest independent factor associated with relapse (OR 0.21, CI 95% 0.06-0.81; p = 0.023), together with mucinous histological type (OR 0.40, CI 90% 0.18-0.92). MSI is a relevant prognostic factor in stage pT3N0M0 colon cancer suitable to discriminate those patients with a high risk of relapse.
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Affiliation(s)
- Francesco Iachetta
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Domati
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy.
- Department of Internal Medicine, Medicina I, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy.
| | - Luca Reggiani-Bonetti
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Barresi
- Department of Pathology, University of Messina, Messina, Italy
| | - Giulia Magnani
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Marcheselli
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Monica Pedroni
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Stracci F, Bianconi F, Leite S, Liso A, La Rosa F, Lancellotta V, van de Velde CJH, Aristei C. Linking surgical specimen length and examined lymph nodes in colorectal cancer patients. Eur J Surg Oncol 2015; 42:260-5. [PMID: 26723169 DOI: 10.1016/j.ejso.2015.11.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/28/2015] [Accepted: 11/20/2015] [Indexed: 12/18/2022] Open
Abstract
AIM The number of examined lymph nodes (NLN) was associated with survival of stages II and III colorectal cancer (CRC) patients. Guidelines recommend examining at least 12 lymph nodes. This study investigated the influence of surgical specimen length on lymph node harvest and compliance with international guidelines. MATERIALS AND METHODS This population-based study included 4,724 cases of surgically treated CRC that were diagnosed from 2002 to 2008. Multivariate analyses were performed for the main study variables (age, gender, diagnosis at screening or in symptomatic patients, cancer site, staging, grading, number of positive nodes, neo-adjuvant treatment for rectal cancer, hospital were surgery was performed). Fractional polynomial models investigated the relationship between continuous variables and outcomes. RESULTS The NLN increased over time reaching ≥12 NLN in 64% of cases at the end of the study period. More NLN were associated with young age, right colon cancer, pT3-T4 disease, stages II and III and high grade. Fewer NLN were associated with short surgical specimen length and neo-adjuvant treatment in rectal cancer patients. Use of laparoscopy increased sharply over time. CONCLUSIONS NLN increased over time in accordance with international guidelines. Surgical specimen length correlated with NLN which may determine therapeutic choices, particularly in stage II colon cancer. When harvested lymph nodes are under 10 in number and all are negative, chemotherapy is always recommended. As specimen lengths <20 cm were associated with a high risk of inadequate NLN counts, patients are at risk of over-treatment.
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Affiliation(s)
- F Stracci
- Department of Experimental Medicine, Public Health Section, University of Perugia, Italy; Umbria Cancer Registry, Italy
| | - F Bianconi
- Department of Experimental Medicine, Public Health Section, University of Perugia, Italy; Umbria Cancer Registry, Italy
| | - S Leite
- Umbria Cancer Registry, Italy
| | - A Liso
- Department of Medicine and Surgery, University of Foggia, Italy
| | | | - V Lancellotta
- Department of Surgical and Biomedical Science, Radiation Oncology Section, University of Perugia, Italy
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, The Netherlands
| | - C Aristei
- Department of Surgical and Biomedical Science, Radiation Oncology Section, University of Perugia, Italy; Radiation Oncology, Perugia General Hospital, Italy.
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Märkl B. Stage migration vs immunology: The lymph node count story in colon cancer. World J Gastroenterol 2015; 21:12218-12233. [PMID: 26604632 PMCID: PMC4649108 DOI: 10.3748/wjg.v21.i43.12218] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
Lymph node staging is of crucial importance for the therapy stratification and prognosis estimation in colon cancer. Beside the detection of metastases, the number of harvested lymph nodes itself has prognostic relevance in stage II/III cancers. A stage migration effect caused by missed lymph node metastases has been postulated as most likely explanation for that. In order to avoid false negative node staging reporting of at least 12 lymph nodes is recommended. However, this threshold is met only in a minority of cases in daily practice. Due to quality initiatives the situation has improved in the past. This, however, had no influence on staging in several studies. While the numbers of evaluated lymph nodes increased continuously during the last decades the rate of node positive cases remained relatively constant. This fact together with other indications raised doubts that understaging is indeed the correct explanation for the prognostic impact of lymph node harvest. Several authors assume that immune response could play a major role in this context influencing both the lymph node detectability and the tumor’s behavior. Further studies addressing this issue are need. Based on the findings the recommendations concerning minimal lymph node numbers and adjuvant chemotherapy should be reconsidered.
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47
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de Cuba EMV, Snaebjornsson P, Heideman DAM, van Grieken NCT, Bosch LJW, Fijneman RJA, Belt E, Bril H, Stockmann HBAC, Hooijberg E, Punt CJA, Koopman M, Nagtegaal ID, Coupé VHM, Carvalho B, Meijer GA. Prognostic value of BRAF and KRAS mutation status in stage II and III microsatellite instable colon cancers. Int J Cancer 2015; 138:1139-45. [PMID: 26376292 DOI: 10.1002/ijc.29855] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023]
Abstract
Microsatellite instability (MSI) has been associated with favourable survival in early stage colorectal cancer (CRC) compared to microsatellite stable (MSS) CRC. The BRAF V600E mutation has been associated with worse survival in MSS CRC. This mutation occurs in 40% of MSI CRC and it is unclear whether it confers worse survival in this setting. The prognostic value of KRAS mutations in both MSS and MSI CRC remains unclear. We examined the effect of BRAF and KRAS mutations on survival in stage II and III MSI colon cancer patients. BRAF exon 15 and KRAS exon 2-3 mutation status was assessed in 143 stage II (n = 85) and III (n = 58) MSI colon cancers by high resolution melting analysis and sequencing. The relation between mutation status and cancer-specific (CSS) and overall survival (OS) was analyzed using Kaplan-Meier and Cox regression analysis. BRAF V600E mutations were observed in 51% (n = 73) and KRAS mutations in 16% of cases (n = 23). Patients with double wild-type cancers (dWT; i.e., BRAF and KRAS wild-type) had a highly favourable survival with 5-year CSS of 93% (95% CI 84-100%), while patients with cancers harbouring mutations in either BRAF or KRAS, had 5-year CSS of 76% (95% CI 67-85%). In the subgroup of stage II patients with dWT cancers no cancer-specific deaths were observed. On multivariate analysis, mutation in either BRAF or KRAS vs. dWT remained significantly prognostic. Mutations in BRAF as well as KRAS should be analyzed when considering these genes as prognostic markers in MSI colon cancers.
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Affiliation(s)
- E M V de Cuba
- Department of Surgical Oncology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - P Snaebjornsson
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - N C T van Grieken
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - L J W Bosch
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - R J A Fijneman
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - E Belt
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - H Bril
- Department of Pathology, Kennemer Gasthuis, Haarlem, the Netherlands
| | | | - E Hooijberg
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - C J A Punt
- Department of Medical Oncology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - I D Nagtegaal
- Department of Pathology, University Medical Center St. Radboud, Nijmegen, the Netherlands
| | - V H M Coupé
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - B Carvalho
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - G A Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands.,Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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Abstract
BACKGROUND Lymph nodes play a critical role in the staging, treatment, and prognosis of colon cancer. However, the normal number and morphology of lymph nodes in the normal mesocolon is unknown. OBJECTIVE This study aimed to investigate the number and size of lymph nodes in the ascending and sigmoid mesocolons. DESIGN This is a descriptive anatomical cadaver study of 10 sigmoid mesocolons and 5 ascending mesocolons, resected in a standardized manner and examined systematically after serial histological sectioning. The number, maximum length, and appearance of lymph nodes were analyzed, and the 2 mesocolons were compared by using the Mann-Whitney U test, the Wilcoxon signed rank test, and the χ test. PATIENTS Ten cadavers (mean age, 82.9 years; 5 male) with no evidence of colorectal disease were examined. MAIN OUTCOME MEASURE The number, maximum length, and appearance of lymph nodes and fat-associated lymphoid clusters were the primary outcomes measured. RESULTS The median number of lymph nodes in the sigmoid and ascending mesocolons was 71 (range, 24-116) and 61 (range, 33-71). More than 90% of lymph nodes were less than 5 mm in maximum length. Sigmoid mesocolic nodes were significantly smaller than ascending mesocolic nodes (median maximum lymph nodes length, 1.6 mm vs 2.1 mm; p < 0.001), but there was no statistically significant difference in the density of lymph nodes between the sigmoid and ascending mesocolon. Fatty replacement was seen in almost 30% of lymph nodes. A few fat-associated lymphoid clusters were observed in both mesocolons. LIMITATIONS Only 15 mesocolic specimens could be examined because of the detailed labor-intensive methodology, and younger cadavers were not available for analysis. CONCLUSIONS In this descriptive anatomical study, the median number of lymph nodes in the sigmoid and ascending mesocolon was 71 and 61. Ascending mesocolic nodes were significantly larger than sigmoid mesocolic nodes. These anatomical findings are relevant to the interpretation of lymph node yields after the surgical resection of colon cancer.
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da Costa DW, van Dekken H, Witte BI, van Wagensveld BA, van Tets WF, Vrouenraets BC. Lymph Node Yield in Colon Cancer: Individuals Can Make the Difference. Dig Surg 2015; 32:269-74. [PMID: 26113047 DOI: 10.1159/000381863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/24/2015] [Indexed: 01/18/2023]
Abstract
AIM To investigate the influence of individual surgeons and pathologists on examining an adequate (i.e. ≥10) number of lymph nodes in colon cancer resection specimens. PATIENTS AND METHODS The number of lymph nodes was evaluated in surgically treated patients for colon cancer at our hospital from 2008 through 2010, excluding patients who had received neo-adjuvant treatment. The patient group consisted of 156 patients with a median age of 73 (interquartile range (IQR) 63-82 years) and a median of 12 lymph nodes per patient (IQR 8-15). In 106 patients (67.9%), 10 or more nodes were histopathologically examined. RESULTS At univariate analysis, the examination of ≥10 nodes was influenced by tumour size (p = 0.05), tumour location (p = 0.015), type of resection (p = 0.034), individual surgeon (p = 0.023), and pathologist (p = 0.005). Neither individual surgeons nor pathologists did statistically and significantly influence the chance of finding an N+ status. Age (p = 0.044), type of resection (p = 0.007), individual surgeon (p = 0.012) and pathologist (p = 0.004) were independent prognostic factors in a multivariate model for finding ≥10 nodes. CONCLUSION Though cancer staging was not affected in this study, individual efforts by surgeons and pathologists play a critical role in achieving optimal lymph node yield through conventional methods.
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Affiliation(s)
- David W da Costa
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
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50
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Seppälä TT, Böhm JP, Friman M, Lahtinen L, Väyrynen VMJ, Liipo TKE, Ristimäki AP, Kairaluoma MVJ, Kellokumpu IH, Kuopio THI, Mecklin JP. Combination of microsatellite instability and BRAF mutation status for subtyping colorectal cancer. Br J Cancer 2015; 112:1966-75. [PMID: 25973534 PMCID: PMC4580394 DOI: 10.1038/bjc.2015.160] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/14/2015] [Accepted: 04/21/2015] [Indexed: 12/15/2022] Open
Abstract
Background: The objective of the study was to examine the role of microsatellite instability (MSI) and BRAFV600Emutation in colorectal cancer (CRC) by categorising patients into more detailed subtypes based on tumour characteristics. Methods: Tumour samples from 762 population-based patients with sporadic CRC were analysed for MSI and BRAFV600E by immunohistochemistry. Patient survival was followed-up for a median of 5.2 years. Results: Compared with microsatellite stable (MSS) CRC, MSI was prognostic for better disease-free survival (DFS; 5 years: 85.8% vs 75.3%, 10 years: 85.8% vs 72.9%, P=0.027; HR 0.49, CI 0.30–0.80, P=0.005) and disease-specific survival (DSS; 5 years: 83.2% vs 70.5% 10 years: 83.2 vs 65.0%, P=0.004). Compared with BRAF wild type, BRAFV600E was a risk for poor survival (overall survival; 5 years: 62.3% vs 51.6%, P=0.014; HR 1.43, CI 1.07–1.90, P=0.009), especially in rectal cancer (for DSS, HR: 10.60, CI: 3.04–36.92, P<0.001). The MSS/BRAFV600E subtype was a risk for poor DSS (HR: 1.88, CI: 1.06–3.31, P=0.030), but MSI/BRAFV600E was a prognostic factor for DFS (HR: 0.42, CI: 0.18–0.96, P=0.039). Among stage I–II patients, the MSS/BRAFV600E subtype was independently associated with poor DSS (HR: 5.32, CI: 1.74–16.31, P=0.003). Conclusions: Microsatellite instable tumours were associated with better prognosis compared with MSS. BRAFV600E was associated with poor prognosis unless it occurred together with MSI. The MSI/BRAFV600E subtype was a favourable prognostic factor compared with the MSS/BRAF wild-type subtype. BRAFV600E rectal tumours showed particularly poor prognosis. The MSS/BRAFV600E subtype was associated with increased disease-specific mortality even in stage I–II CRC.
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Affiliation(s)
- T T Seppälä
- Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - J P Böhm
- Department of Pathology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - M Friman
- Department of Pathology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - L Lahtinen
- Department of Pathology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - V M J Väyrynen
- Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - T K E Liipo
- Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - A P Ristimäki
- 1] Unit of Pathology and Genetics, HUSLAB, Helsinki University Central Hospital, Haartmaninkatu 8, 00290 Helsinki, Finland [2] Department of Pathology and Research Programs Unit, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - M V J Kairaluoma
- Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - I H Kellokumpu
- Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - T H I Kuopio
- Department of Pathology, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - J-P Mecklin
- Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland
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