Clinicopathological Features Combined With Immune Infiltration Could Well Distinguish Outcomes in Stage II and Stage III Colorectal Cancer: A Retrospective Study

Risk factors for postoperative recurrence in patients with stage II colorectal cancer

BACKGROUND

Recurrences are the main reasons for unfavorable outcomes for patients with stage II colorectal cancer (CRC). To obtain a clear understanding of the high-risk factors, further investigation is warranted. The present study aimed to analyze the risk factors associated with postoperative recurrence in patients with stage II CRC.

METHODS

Eligible patients with pathologically confirmed stage II CRC were enrolled in the study retrospectively based on a prospectively maintained database from April 2008 to March 2019. The Kaplan-Meier method were used to calculate the overall survival (OS) rate and the cumulative recurrence rate. Univariate and multivariable Cox regression analyses were performed to identify risk factors for recurrence.

RESULTS

There were 2515 patients included, of whom 233 (9.3%) developed local or distant recurrence. Recurrence was associated with a significantly worse 5-year OS (45.4% vs. 95.5%, p < 0.0001). The 5-year cumulative recurrence rate was 13.0% in patients with stage II CRC. On multivariable Cox analysis, tumor size (Hazard Ratio (HR) [95% confidence interval (CI)] = 1.79[1.38, 2.33]), preoperative carbohydrate antigen (CA) 125 level (HR [95% CI] = 1.78[1.17, 2.70]), preoperative CA 199 level (HR [95% CI] = 1.56[1.09, 2.22]), and ulcerating tumor (HR [95% CI] = 1.61[1.19, 2.17]) were found to be associated with postoperative recurrence. Adjuvant chemotherapy was associated with a lower cumulative recurrence rate in patients with these risk factors (p = 0.00096).

CONCLUSION

The tumor diameter, preoperative CA125 level, preoperative CA199 level, and an ulcerative tumor can predict postoperative recurrence in patients with stage II CRC, and postoperative chemotherapy could reduce the cumulative recurrence rate in patients with these high-risk factors.

Analysis of gastrointestinal function and prognostic value of tumor markers in patients with laparoscopic radical resection of colorectal cancer

OBJECTIVE

To analyze the gastrointestinal function and prognostic value of tumor markers (TMs) in patients with laparoscopic radical resection of colorectal cancer (LRRCC).

METHODS

The research population of this retrospective study comprised 141 patients with CC who received treatment in the Zhongshan Hospital of Xiamen University between July 2017 and August 2018, including 74 cases (observation group, OG) treated with LRRCC and 67 cases (control group, CG) undergoing open surgery (OS). Postoperative gastrointestinal function and complications were recorded. Besides, alterations in serum TMs carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), and the 3-years survival of patients were observed. Receiver operating characteristic (ROC) curves were used to determine the prognostic value of TMs. Risk factors affecting the prognosis of LRRCC patients were analyzed by the Cox regression model.

RESULTS

Significantly higher levels of motilin (MOT) and gastrin (GT) were determined in OG compared with CG. The two groups showed no notable difference in the postoperative complication rate. Postoperative serum CEA and CA199 levels were obviously lower in OG as compared with CG. A higher 3-year survival rate was determined in OG. The areas under the receiver operating characteristic (ROC) curve (AUCs) of CEA and CA19-9 levels in predicting patients' 3-year survival were 0.826 and 0.867, respectively. According to the Cox regression analysis, tumor diameter, lymph node involvement, TNM staging, vascular invasion, CEA, and CA19-9 were independent risk factors for poor prognosis of LRRCC patients.

CONCLUSIONS

LRRCC is well-tolerated by patients with CC and contributes to favorable outcomes. Besides, CEA and CA19-9, the two TMs, may be candidate prognostic markers for patients undergoing LRRCC.

NAIRscore as a biomarker for the quality of immune response to neoantigens is related with an increased overall survival in multiple myeloma

Neoantigen provides a promising breakthrough in tumor immunotherapy, although only a subset of patients responds well due to the quality of their immune response. However, few biomarkers have been reported to measure the quality of immune response to neoantigens and to predict prognosis of patients with multiple myeloma (MM). Here, we first developed a neoantigen-prediction pipeline starting from outcomes of somatic mutations and gene-expression profiles. Given the expression of some specific marker genes, the human leukocyte antigen (HLA)-I score and the cytolytic score were evaluated respectively to reflect HLA-I molecular expression and CD8+ T/natural killer (NK) cell abundance. According to the process of the immune response to neoantigens, we comprehensively took neoantigen load, cytolytic score, and HLA-I score to construct a neoantigen immune response score (NAIRscore), in which the HLA-I score presented a hazard ratio (HR) of less than 1, while the cytolytic score and neoantigen load presented a HR of greater than 1. Meanwhile, NAIRscore presented a competitive advantage to stratify MM samples. Especially, those exhibiting high NAIRscore correlated with an increased overall survival (OS), echoing the underlying molecular signatures of lower driver-gene mutations and down-regulated immune response. Notably, an online tool based on this study is provided to identify neoantigens and predict OS.