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Yu J, Lee SH, Jeung TS, Chang H. Expression of vascular endothelial growth factor as a predictor of complete response for preoperative chemoradiotherapy in rectal cancer. Medicine (Baltimore) 2019; 98:e16190. [PMID: 31261557 PMCID: PMC6617461 DOI: 10.1097/md.0000000000016190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/30/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022] Open
Abstract
Biomarkers that predict tumor response before surgical treatment are necessary to help select patients for preoperative chemoradiotherapy for rectal cancer. However, no definite predictive biomarker has been established. This study explored programmed death-ligand 1 (PD-L1), epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), p-signal transducer and activator of transcription 3 (p-STAT3), and death-domain associated protein as predictive biomarkers with regard to preoperative chemoradiotherapy in rectal cancer.Formalin-fixed paraffin-embedded cancer tissues from pretreatment biopsies from 31 patients who underwent preoperative chemoradiotherapy were studied. The biomarkers were evaluated by immunohistochemistry.PD-L1 positivity was found in 22.6% of 31 patients and complete response (CR) showed 33.3% and non-CR showed 18.2%. EGFR positivity was found in 71.0% of 31 patients and CR showed 88.9% and non-CR showed 73.6%. VEGF positivity was found in 83.9% of 31 patients and CR showed 88.9% and non-CR showed 81.8%. p-STAT3 positivity was found in 80.6% of 31 patients and CR showed 88.9% and non-CR showed 77.3%. On multiple logistic regression analysis, only VEGF expression was found to be a significant predictive factor for CR (P = .001). VEGF expression in pretreatment biopsies might be a predictive marker for CR after preoperative chemoradiation in rectal cancer.Although there is a restriction of small sample size, our finding suggested that this study can be foundation for a larger further study for biomarkers which can predict neoadjuvant therapy response of specimens obtained for diagnosis before surgery.
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Affiliation(s)
- Jesang Yu
- Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul
| | - Seung-Hyun Lee
- Department of Surgery, Kosin University Gospel Hospital, Busan
| | - Tae Sig Jeung
- Department of Radiation Oncology, Good Sunlin Hospital, Gyeongsangbuk-do
| | - HeeKyung Chang
- Department of Pathology, Kosin University Gospel Hospital, Busan, South Korea
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Poynter L, Galea D, Veselkov K, Mirnezami A, Kinross J, Nicholson J, Takáts Z, Darzi A, Mirnezami R. Network Mapping of Molecular Biomarkers Influencing Radiation Response in Rectal Cancer. Clin Colorectal Cancer 2019; 18:e210-e222. [PMID: 30928329 DOI: 10.1016/j.clcc.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/12/2018] [Accepted: 01/23/2019] [Indexed: 02/07/2023]
Abstract
Preoperative radiotherapy (RT) plays an important role in the management of locally advanced rectal cancer (RC). Tumor regression after RT shows marked variability, and robust molecular methods are needed to help predict likely response. The aim of this study was to review the current published literature and use Gene Ontology (GO) analysis to define key molecular biomarkers governing radiation response in RC. A systematic review of electronic bibliographic databases (Medline, Embase) was performed for original articles published between 2000 and 2015. Biomarkers were then classified according to biological function and incorporated into a hierarchical GO tree. Both significant and nonsignificant results were included in the analysis. Significance was binarized on the basis of univariate and multivariate statistics. Significance scores were calculated for each biological domain (or node), and a direct acyclic graph was generated for intuitive mapping of biological pathways and markers involved in RC radiation response. Seventy-two individual biomarkers across 74 studies were identified. On highest-order classification, molecular biomarkers falling within the domains of response to stress, cellular metabolism, and pathways inhibiting apoptosis were found to be the most influential in predicting radiosensitivity. Homogenizing biomarker data from original articles using controlled GO terminology demonstrated that cellular mechanisms of response to RT in RC-in particular the metabolic response to RT-may hold promise in developing radiotherapeutic biomarkers to help predict, and in the future modulate, radiation response.
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Affiliation(s)
- Liam Poynter
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Dieter Galea
- Computational & Systems Medicine, Imperial College London, London, UK
| | - Kirill Veselkov
- Computational & Systems Medicine, Imperial College London, London, UK
| | | | - James Kinross
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Jeremy Nicholson
- Computational & Systems Medicine, Imperial College London, London, UK
| | - Zoltán Takáts
- Computational & Systems Medicine, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Reza Mirnezami
- Department of Surgery & Cancer, Imperial College London, London, UK; St Mark's Hospital and Academic Institute, Harrow, London, UK.
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Jia H, Shen X, Guan Y, Xu M, Tu J, Mo M, Xie L, Yuan J, Zhang Z, Cai S, Zhu J, Zhu Z. Predicting the pathological response to neoadjuvant chemoradiation using untargeted metabolomics in locally advanced rectal cancer. Radiother Oncol 2018; 128:548-556. [PMID: 30041962 DOI: 10.1016/j.radonc.2018.06.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/19/2018] [Accepted: 06/14/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE The present study aimed to identify a panel of potential metabolite biomarkers to predict tumor response to neoadjuvant chemo-radiation therapy (NCRT) in locally advanced rectal cancer (LARC). EXPERIMENTAL DESIGN Liquid chromatography-mass spectrometry (LC-MS)-based untargeted metabolomics was used to profile human serum samples (n = 106) from LARC patients treated with NCRT. The samples were collected from Fudan University Shanghai Cancer Center (FUSCC) from July 2014 to January 2016. Statistical methods, such as partial least squares (PLS) and Wilcoxon rank-sum test, were used to identify discriminative metabolites between NCRT-sensitive and NCRT-resistant patients according to their tumor regression grade (TRG). This trial is registered with Clinical Trials.gov, number NCT03149978. RESULTS A panel of metabolites was selected as potential predictive biomarkers of pathological response to NCRT. A total of 4810 metabolic peaks were detected, and 57 significantly dysregulated peaks were identified. These 57 metabolic peaks were used to differentiate patients using PLS in a dataset containing NCRT-sensitive (n = 56) and NCRT-resistant (n = 49) patients. The combination of 57 metabolic peaks had AUC values of 0.88, 0.81 and 0.84 in the prediction models using PLS, random forest, and support vector machine, respectively, suggesting that metabolomics has the potential ability to predict responses to NCRT. Furthermore, 15 metabolite biomarkers were identified and used to construct a logistic regression model and explore dysregulated metabolic pathways using untargeted metabolic profiling and data mining approaches. CONCLUSIONS A panel of metabolites has been identified to facilitate the prediction of tumor response to NCRT in LARC, which is promising for the generation of personalized treatment strategies for LARC patients.
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Affiliation(s)
- Huixun Jia
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, PR China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Xiaotao Shen
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | - Yun Guan
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, PR China
| | - Meimei Xu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | - Jia Tu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | - Miao Mo
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, PR China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Li Xie
- Clinical Research Center, Shanghai Jiao Tong University School of Medicine, PR China
| | - Jing Yuan
- Clinical Statistics Center, Fudan University Shanghai Cancer Center, PR China; Department of Oncology, Shanghai Medical College, Fudan University, PR China
| | - Zhen Zhang
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, PR China
| | - Sanjun Cai
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, PR China
| | - Ji Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, PR China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, PR China.
| | - ZhengJiang Zhu
- Interdisciplinary Research Center on Biology and Chemistry, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, PR China; University of Chinese Academy of Sciences, Beijing, PR China.
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Carraro A, Trevellin E, Fassan M, Kotsafti A, Lunardi F, Porzionato A, Dall'Olmo L, Cagol M, Alfieri R, Macchi V, Tedeschi U, Calabrese F, Rugge M, Castoro C, Vettor R, Scarpa M. Esophageal adenocarcinoma microenvironment: Peritumoral adipose tissue effects associated with chemoresistance. Cancer Sci 2017; 108:2393-2404. [PMID: 28985034 PMCID: PMC5715298 DOI: 10.1111/cas.13415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/17/2022] Open
Abstract
Peritumoral microenvironment affects cancer development and chemoresistance, and visceral adipose tissue may play a critical role. We aimed to identify depot‐specific adipose characteristics associated with carcinogenesis and resistance to neoadjuvant therapy in esophageal adenocarcinoma (EAC). We analyzed: (i) the peritumoral adipose tissue of rats following the induction of esophageal carcinogenesis; (ii) the peritumoral and distal (omental) adipose tissue of patients affected by EAC; (iii) adipose‐derived stem cells (ADSC) isolated from healthy patients and treated with conditioned medium (CM), collected from tumoral and adipose tissue of patients with EAC. In peritumoral adipose tissue of rats, CD34, CD31 and vascular endothelial growth factor (VEGF) expression increased progressively during EAC development. In patients with EAC, expression of CD34, CD45, CD90 and nucleostemin (NSTM) was higher in peritumoral than in distal adipose tissue and decreased in the presence of neoadjuvant therapy. Moreover, expression of NSTM, octamer‐binding transcription factor 4 (OCT‐4) and VEGF was higher in peritumoral (but not in distal) adipose tissue of chemoresistant patients. In ADSC, treatment with peritumoral adipose tissue CM increased the adipogenic potential and the expression of CD34, CD90, NSTM and OCT‐4. These effects were similar to those induced by cancer‐derived CM, but were not observed in ADSC treated with distal adipose tissue CM and were partially reduced by a leptin antagonist. Last, ADSC treated with peritumoral CM of chemoresistant patients displayed increased expression of NSTM, OCT‐4, leptin, leptin receptor, alpha‐smooth muscle actin (α‐SMA), CD34 and VEGF. These results suggest that peritumoral adipose tissue may promote, by paracrine signaling, the expression of depot‐specific factors associated with therapeutic resistance.
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Affiliation(s)
- Amedeo Carraro
- Department of General Surgery and Odontoiatrics, University Hospital of Verona, Verona, Italy
| | - Elisabetta Trevellin
- Department of Medicine, Endocrine-Metabolic Laboratory, University of Padova, Padova, Italy
| | - Matteo Fassan
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
| | - Andromachi Kotsafti
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Francesca Lunardi
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Andrea Porzionato
- Department of Molecular Medicine, Normal Anatomy Unit, University of Padova, Padova, Italy
| | - Luigi Dall'Olmo
- Department of Emergency Medicine, "Santi Giovanni e Paolo" Hospital, Venice, Italy
| | - Matteo Cagol
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Rita Alfieri
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Veronica Macchi
- Department of Molecular Medicine, Normal Anatomy Unit, University of Padova, Padova, Italy
| | - Umberto Tedeschi
- Department of General Surgery and Odontoiatrics, University Hospital of Verona, Verona, Italy
| | - Fiorella Calabrese
- Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Massimo Rugge
- Department of Medicine, Surgical Pathology & Cytopathology Unit, University of Padova, Padova, Italy
| | - Carlo Castoro
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Roberto Vettor
- Department of Medicine, Endocrine-Metabolic Laboratory, University of Padova, Padova, Italy
| | - Marco Scarpa
- Esophageal and Digestive Tract Surgical Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
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Seven low-mass ions in pretreatment serum as potential predictive markers of the chemoradiotherapy response of rectal cancer. Anticancer Drugs 2016; 27:787-93. [PMID: 27272410 DOI: 10.1097/cad.0000000000000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Predictive and prognostic biomarkers for neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Crit Rev Oncol Hematol 2015; 96:67-80. [PMID: 26032919 DOI: 10.1016/j.critrevonc.2015.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 02/08/2023] Open
Abstract
Locally advanced rectal cancer is regularly treated with trimodality therapy consisting of neoadjuvant chemoradiation, surgery and adjuvant chemotherapy. There is a need for biomarkers to assess treatment response, and aid in stratification of patient risk to adapt and personalise components of the therapy. Currently, pathological stage and tumour regression grade are used to assess response. Experimental markers include proteins involved in cell proliferation, apoptosis, angiogenesis, the epithelial to mesenchymal transition and microsatellite instability. As yet, no single marker is sufficiently robust to have clinical utility. Microarrays that screen a tumour for multiple promising candidate markers, gene expression and microRNA profiling will likely have higher yield and it is expected that a combination or panel of markers would prove most useful. Moving forward, utilising serial samples of circulating tumour cells or circulating nucleic acids can potentially allow us to demonstrate tumour heterogeneity, document mutational changes and subsequently measure treatment response.
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Liu HC, Huang MY, Wang JY, Chang LS, Lin SR. The impact of white blood cell count and hemoglobin level on the response to radiotherapy in patients with colorectal cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.bgm.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Can a biomarker-based scoring system predict pathologic complete response after preoperative chemoradiotherapy for rectal cancer? Dis Colon Rectum 2014; 57:592-601. [PMID: 24819099 DOI: 10.1097/dcr.0000000000000109] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Numerous molecular markers have been investigated as potential predictors of tumor responses to preoperative chemoradiotherapy (preCRT) for rectal cancer. OBJECTIVE To develop a system in which biomarkers are used to predict the likelihood of a pathologic complete response (pCR) to preCRT. DESIGN & SETTING This is a retrospective analysis of tumor specimens collected prior to preCRT from 81 patients who underwent curative resection for primary rectal adenocarcinoma between June 2008 and February 2012. MAIN OUTCOME MEASURES Using tissue microarrays and immunohistochemistry, expression levels of twelve candidate biomarkers (p53, p21, Bcl2, Bax, EGFR, Cox-2, MLH-1, MSH-2, Ku70, VEGF, TS, Ki-67) were evaluated in paraffin-embedded tumor samples collected before preCRT. The correlation between biomarker expression levels and the pathologic response to preCRT was assessed based on histopathological staging (pTNM) and tumor regression grade (TRG). RESULTS Expression levels of 4 biomarkers (p53, VEGF, p21, Ki67) correlated with pCR. Patients showing low expression of p53 and/or high expression of VEGF, p21, and Ki67 exhibited a significantly greater pCR rate. A scoring system devised so that one point was given for each biomarker whose expression level correlated with pCR (score range: 0-4) showed that 1 of 26 patients with scores of 0 to 1 achieved pCR, whereas 26 of 55 patients with scores of 2 to 4 achieved pCR (3.8% vs. 47.3%, p < 0.001). For prediction of pCR, the scoring system showed 96.3% sensitivity, 46.3% specificity, a 47.3% positive predictive value, and a 96.2% negative predictive value. LIMITATIONS Immunohistochemistry has limitations related to reproducibility and the ability to provide quantitative information. In addition, this study lacks test and validation sets. CONCLUSIONS Expression levels of 4 biomarkers correlated with pCR after preCRT for rectal cancer. A scoring system based on levels of biomarker expression showed good sensitivity and negative predictive value for pCR.
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Solanki AA, Chang DT, Liauw SL. Future directions in combined modality therapy for rectal cancer: reevaluating the role of total mesorectal excision after chemoradiotherapy. Onco Targets Ther 2013; 6:1097-110. [PMID: 23983475 PMCID: PMC3747849 DOI: 10.2147/ott.s34869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Most patients who develop rectal cancer present with locoregionally advanced (T3 or node-positive) disease. The standard management of locoregionally advanced rectal cancer is neoadjuvant concurrent chemoradiotherapy (nCRT), followed by radical resection (low-anterior resection or abdominoperineal resection with total mesorectal excision). Approximately 15% of patients can have a pathologic complete response (pCR) at the time of surgery, indicating that some patients can have no detectable residual disease after nCRT. The actual benefit of surgery in this group of patients is unclear. It is possible that omission of surgery in these patients, termed selective nonoperative management, can limit the toxicities associated with standard, multimodal combined modality therapy without compromising disease control. In this review, we discuss the clinical experiences to date using selective nonoperative management and various attempts at escalation of nCRT to improve the number of patients who have a pCR. We also explore several clinical, laboratory, imaging, histopathologic, and genetic biomarkers that have been tested as tools to predict which patients are most likely to have a pCR after nCRT.
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Affiliation(s)
- Abhishek A Solanki
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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