High preoperative serum ferritin predicted poor prognosis in non-metastatic colorectal cancer

Prognostic value of post-operative iron biomarkers in colorectal cancer: population-based patient cohort

BACKGROUND

Post-operative anaemia is linked to iron deficiency. We investigated the prognostic value of post-operative iron biomarkers in colorectal cancer (CRC).

METHODS

Ferritin, transferrin, iron, and transferrin saturation (TS%) were measured from blood collected at a single time-point post-surgery in 2769 CRC patients. Associations between iron biomarkers with cancer-specific survival (CSS) and overall survival (OS) were assessed using Cox regression with hazard ratios (HR), stratified by post-operative time of blood collection (<1-month/≥1-month).

RESULTS

After a median follow-up of 9.5 years, 52.6% of patients had died. For iron biomarkers assessed <1-month post-surgery, higher compared to normal TS% was associated with shorter CSS (HR [95% CI] = 2.36 [1.25-4.46]), and higher iron levels with better OS (upper vs. median tertile: HR [95% CI] = 0.79 [0.65-0.97]). When assessed ≥1-month post-surgery, elevated ferritin was associated with poor CSS (high vs. normal: HR [95% CI] = 1.44 [1.10-1.87]), and low TS% with worse CSS (low vs. normal: HR [95% CI] = 1.60 [1.24-2.06]). Similar but weaker associations were observed for OS.

CONCLUSION

Monitoring of serum ferritin and TS% beyond 1-month post-surgery may be relevant for risk stratification of patients with operable CRC. Future studies should validate our findings.

Serum ferritin and the risk of early-onset colorectal cancer

BACKGROUND

The incidence of early-onset colorectal cancer (EO-CRC) is rising in the United States, and is often diagnosed at advanced stages. Low serum ferritin is often incidentally discovered in young adults, however, the indication for endoscopy in EO-CRC is unclear.

AIM

To compare serum ferritin between patients with EO-CRC and healthy controls (HCs), and examine the association of serum ferritin in EO-CRC with patient- and disease-specific characteristics.

METHODS

A retrospective study of patients < 50 years with newly-diagnosed EO-CRC was conducted from 1/2013-12/2023. Patients were included if serum ferritin was measured within 2 years prior to 1 year following CRC histologic diagnosis. To supplement the analysis, a cohort of HCs meeting similar inclusion and exclusion criteria were identified for comparison. A sensitivity analysis including only patients with serum ferritin obtained at or before diagnosis was separately performed to minimize risk of confounding.

RESULTS

Among 85 patients identified with EO-CRC (48 females), the median serum ferritin level was 26 ng/mL (range < 1-2759 ng/mL). Compared to HCs (n = 80211), there were a higher proportion of individuals with EO-CRC with serum ferritin < 20 ng/mL (female 65%, male 40%) versus HCs (female 32.1%, male 7.2%) age 29-39 years (P = 0.002 and P < 0.00001, respectively). Stage IV disease was associated with significantly higher serum ferritin compared to less advanced stages (P < 0.001). Serum ferritin obtained before or at the time of diagnosis was lower than levels obtained after diagnosis. Similar findings were confirmed in the sensitivity analysis.

CONCLUSION

Severe iron deficiency may indicate an increased risk of EO-CRC, particularly at earlier stages. Further studies defining the optimal serum ferritin threshold and routine incorporation of serum ferritin in screening algorithms is essential to develop more effective screening strategies for EO-CRC.

Can serum ferritin serve as a biomarker for the prognosis of gynecological malignant tumors? A retrospective cohort study

PURPOSE

It is widely accepted that there is a strong relationship between iron levels and cancer. This study aimed to investigate the relationship between serum ferritin levels and the severity and prognosis of gynecological malignant tumors.

METHODS

This retrospective study included patients with gynecological malignant tumors at Sir Run Run Shaw Hospital in the Department of Obstetrics and Gynecology from January 2013 to June 2019. Patients were grouped according to their serum ferritin level: low (< 13 μg/L), normal (13-150 μg/L), and high (> 150 μg/L). Correlation analyses were performed between serum ferritin level and other factors. Cox univariable and multivariable analysis and Kaplan-Meier survival curves were used to assess the impact of ferritin on survival in patients with gynecologic tumors.

RESULTS

The 402 total patients were divided into a low (n= 37), normal (n= 182), and high (n= 183) ferritin level group. Correlation analyses were performed that WBC, MCV, CRP, CA125, and CA153 were significantly positively correlated with serum ferritin level. The Kaplan-Meier survival curves revealed that of the three groups analyzed, the high serum ferritin level group had a significantly shorter survival time versus the normal and low serum ferritin level groups (log-rank P= 0.003). Univariable Cox regression analysis identified that patients with high serum ferritin levels had a significant correlation with risk of death compared to the patients with lower and normal serum ferritin levels. Serum ferritin was not found to be significant (HR = 0.792, 95% CI: 0.351-1.787, P= 0.574) in the multivariable Cox analysis.

CONCLUSION

Although this study did not find serum ferritin to be a significant independent prognosis indicator in gynecological malignant tumors, this study did identify that gynecological malignant tumor patients with high serum ferritin levels have significantly less survival time than patients with low or normal serum ferritin levels.

Markers of inflammation in invasive treatment of coloractal cancer liver metastases

Background. In 25–30% of patients with colorectal cancer (CRC) who have no visible signs of metastasis at the time of surgery, metastases are detected within 5 years. Among the options for local treatment of metastatic liver lesions in patients with CRC, various resection options and minimally invasive methods, in particular radiofrequency ablation (RFA), occupy a prominent place. The inflammatory response caused by surgery is a factor that can negatively affect the course of tumor disease. The inflammatory responses of the body, as well as markers for their evaluation and prognosis in the treatment of CRC metastases, have not yet been sufficiently studied. Purpose – to study the dynamics of inflammatory markers in the invasive treatment of colorectal cancer liver metastases to select the most informative markers for assessing and predicting the degree of inflammatory response. Materials and methods. Clinical and laboratory examination was carried out in 18 patients with CRC during the treatment of metastases in the liver, adenocarcinoma was determined in all patients during histological examination. The examination was carried out in three stages: the day before RFA or resection, on days 3 and 14 after the intervention. Serum levels of insulin and IL-6 were measured using an enzyme-linked immunosorbent assay, and levels of C-reactive protein and ferritin were determined using an automatic biochemical analyser. Results and discussion. Markers of inflammation in patients with CRC with liver metastases after invasive intervention were identified. A significant increase in the levels of circulating C-reactive protein (CRP), IL-6 and ferritin was detected along with an increase in the insulin resistance index (HOMA-IR) on day 3 after RFA and resection. The increase in IL-6 was 2-fold higher and the HOMA-IR index was 1.5-fold higher after resection compared with RFA. Patients after RFA showed an approach of indicators to baseline values on day 14 of the study, while CRP, ferritin, IL-6 and insulin levels in patients after resection decreased by only 20–30% at the same time same period. This is consistent with other studies. In particular, elevated CRP levels are considered as a risk factor for the appearance and progression of CRC.There is also evidence that in patients with operable CRC, preoperative IL-6 levels affect the risk of recurrence. Strong evidence suggests that ferritin is a key mediator of immune dysregulation through direct immunosuppressive and pro-inflammatory effects. The accumulated data from the literature and our own results suggest the role of CRP, IL-6 and ferritin in postoperative inflammatory states as mediators and biomarkers of the further course of CRС, since their appearance identifies patients with a high risk of mortality, and timely or preventive correction of the inflammatory response improves their survival. Conclusions. The results of the study show that the most informative markers of the level of inflammatory response after RFA or surgical resection are the levels of C-reactive protein, IL-6 and ferritin. Moderate inflammatory reaction is shown in the early stages after RFA and pronounced and longer-lasting reaction after surgical treatment. Prediction, assessment of the degree of inflammatory reaction and the feasibility of anti-inflammatory therapy in the early stages after intervention can be determined by the complex of immunological, haematological and biochemical markers studied by us.

Meta-analysis of the prognostic value of pretreatment serum ferritin in hepatobiliary and pancreas (HBP) cancers

BACKGROUND AND OBJECTIVES

Studies have shown that serum ferritin (SF) has unfavourable prognostic value in hepatobiliary and pancreas (HBP) cancers. This meta-analysis aimed to comprehensively assess the prognostic role of pretreatment SF in patients with HBP cancers.

METHODS

Eligible studies published before January 2020 were obtained through a comprehensive search in the PubMed, Web of Science, Cochrane Library and EMBASE databases. Pooled HRs and 95% CIs were then employed as effect sizes.

RESULTS

Seven studies comprising 1244 patients were pooled. Elevated pretreatment SF was associated with worse overall survival (OS) (HR 1.60, 95% CI 1.36 to 1.88, p<0.001) and recurrence-free survival/progression-free survival/time to recurrence (HR 1.70, 95% CI 1.15 to 2.52, p=0.008). Significant prognostic value of elevated pretreatment SF on OS was detected in the subgroups regardless of the cancer type, race, SF cut-off value, tumour-node-metastasis stage and Newcastle-Ottawa Scale score.

CONCLUSION

Elevated pretreatment SF was associated with worse survival outcome of patients with HBP cancers. As such, it may serve as a novel prognostic biomarker for HBP cancers.

Can conventional clinical chemistry tests help doctors in the monitoring of oncology patients?

The use of laboratory assays in the diagnostic care of oncology patients can markedly increase the efficacy of cancer treatments. Many cancer-specific biomarker assays have been developed. However, the use of these has some limitations due to their cost. Moreover, not every diagnostic laboratory can perform a complete set of these assays. On the other hand, the smart use of conventional clinical chemistry tests could improve the management of cancer. They could be especially valuable tools in the long-term care of patients with a verified diagnosis. In this review, we discuss the utilization of the conventional clinical chemistry assays for the diagnosis, monitoring and prognosis of various oncological diseases. The use of conventional blood tests to assess the levels of chemical elements, metabolites and proteins (including enzymatic activity measurements) in the care of oncology patients is discussed. We have shown that some clinical chemistry assays could be used in the management of distinct kinds of cancer.

Inflammatory Markers and MicroRNAs: The Backstage Actors Influencing Prognosis in Colorectal Cancer Patients

BACKGROUND

Colorectal cancer (CRC) remains a deadly disease, afflicting the lives of millions worldwide. The prognosis of CRC patients is best predicted by surgical resection and pathological analysis of specimens. Emerging evidence has attributed a significant role to inflammatory markers and microRNAs (miRNAs) in the prognosis and survival of CRC patients.

AIM

Here, we review the literature on inflammatory markers and miRNAs with an established role on survival rates, response to systemic chemotherapy, and other clinic-pathological parameters in CRC patients.

RESULTS

Our literature review revealed a critical role of inflammatory markers—specifically, the acute-phase proteins, inflammatory cytokines, and blood cell ratios—on prognostic outcomes in CRC patients. MiRNAs, on the other hand, were useful in predicting prognosis and clinical response and accordingly stratifying CRC patients for optimal drug selection.

CONCLUSION

These biomarkers are easily measured in routine blood exams and can be used in adjunct to the tumor-node-metastasis (TNM) staging system to identify high-risk patients and those who are more likely to benefit from chemotherapy and other targeted therapies. However, more prospective studies are needed for the validation of these discussed prognostic and predictive biomarkers.