1
|
Ten Hoorn S, Waasdorp C, van Oijen MGH, Damhofer H, Trinh A, Zhao L, Smits LJH, Bootsma S, van Pelt GW, Mesker WE, Mol L, Goey KKH, Koopman M, Medema JP, Tuynman JB, Zlobec I, Punt CJA, Vermeulen L, Bijlsma MF. Serum-based measurements of stromal activation through ADAM12 associate with poor prognosis in colorectal cancer. BMC Cancer 2022; 22:394. [PMID: 35413826 PMCID: PMC9004139 DOI: 10.1186/s12885-022-09436-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Recently it has been recognized that stromal markers could be used as a clinically relevant biomarker for therapy response and prognosis. Here, we report on a serum marker for stromal activation, A Disintegrin and Metalloprotease 12 (ADAM12) in colorectal cancer (CRC). Methods Using gene expression databases we investigated ADAM12 expression in CRC and delineated the source of ADAM12 expression. The clinical value of ADAM12 was retrospectively assessed in the CAIRO2 trial in metastatic CRC with 235 patients (31% of total cohort), and an independent rectal cancer cohort (n = 20). Results ADAM12 is expressed by activated CRC associated fibroblasts. In the CAIRO2 trial cohort, ADAM12 serum levels were prognostic (ADAM12 low versus ADAM12 high; median OS 25.3 vs. 17.1 months, HR 1.48 [95% CI 1.11–1.96], P = 0.007). The prognostic potential was specifically high for metastatic rectal cancer (HR 1.78 [95% CI 1.06–3.00], P = 0.030) and mesenchymal subtype tumors (HR 2.12 [95% CI 1.25–3.60], P = 0.004). ADAM12 also showed potential for predicting recurrence in an exploratory analysis of non-metastatic rectal cancers. Conclusions Here we describe a non-invasive marker for activated stroma in CRC which associates with poor outcome, especially for primary cancers located in the rectum. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09436-0.
Collapse
Affiliation(s)
- Sanne Ten Hoorn
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Cynthia Waasdorp
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Martijn G H van Oijen
- Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Helene Damhofer
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Cell Biology Program, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Anne Trinh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Lan Zhao
- Department of Electronic Engineering, City University of Hong Kong, Kowloon, Hong Kong
| | - Lisanne J H Smits
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Sanne Bootsma
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Mol
- Department of Data Management, Netherlands Comprehensive Cancer Center (IKNL), Nijmegen, The Netherlands
| | - Kaitlyn K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Paul Medema
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands
| | - Jurriaan B Tuynman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Surgery, Cancer Center Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
| | - Inti Zlobec
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Cornelis J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Louis Vermeulen
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands.,Oncode Institute, Amsterdam, The Netherlands.,Amsterdam UMC location University of Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten F Bijlsma
- Amsterdam UMC location University of Amsterdam, Center for Experimental and Molecular Medicine, Laboratory for Experimental Oncology and Radiobiology, Cancer Center Amsterdam, Imaging and Biomarkers, Meibergdreef 9, Amsterdam, the Netherlands. .,Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands. .,Oncode Institute, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Smit MA, van Pelt GW, Dequeker EM, Al Dieri R, Tollenaar RA, van Krieken JHJ, Mesker WE. e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study. JMIR Form Res 2021; 5:e19408. [PMID: 33739293 PMCID: PMC8122297 DOI: 10.2196/19408] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/14/2020] [Accepted: 03/03/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement. OBJECTIVE The Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool (UNITED) study was developed to bring the TSR to clinical implementation. As part of the study, an e-Learning module was constructed to confirm the reproducibility of scoring the TSR after proper instruction. METHODS The e-Learning module consists of an autoinstruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training, test, and repetition sets). Scoring the TSR is performed on hematoxylin and eosin-stained sections and takes only 1-2 minutes. Cases are considered stroma-low if the amount of stroma is ≤50%, whereas a stroma-high case is defined as >50% stroma. Inter- and intraobserver agreements were determined based on the Cohen κ score after each set to evaluate the reproducibility. RESULTS Pathologists and pathology residents (N=63) with special interest in colorectal cancer participated in the e-Learning. Forty-nine participants started the e-Learning and 31 (63%) finished the whole cycle (3 sets). A significant improvement was observed from the training set to the test set; the median κ score improved from 0.72 to 0.77 (P=.002). CONCLUSIONS e-Learning is an effective method to instruct pathologists and pathology residents for scoring the TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method. TRIAL REGISTRATION The Netherlands Trial Registry NTR7270; https://www.trialregister.nl/trial/7072. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13464.
Collapse
Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Elisabeth Mc Dequeker
- Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium
| | | | - Rob Aem Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - J Han Jm van Krieken
- Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| | -
- Department of Surgery, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
3
|
Smit MA, van Pelt GW, Terpstra V, Putter H, Tollenaar RAEM, Mesker WE, van Krieken JHJM. Tumour-stroma ratio outperforms tumour budding as biomarker in colon cancer: a cohort study. Int J Colorectal Dis 2021; 36:2729-2737. [PMID: 34533595 PMCID: PMC8589816 DOI: 10.1007/s00384-021-04023-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
The tumour-stroma ratio (TSR) and tumour budding (TB) are two high-risk factors with potential to be implemented in the next TNM classification. The aim of the current study was to evaluate the practical application of the two biomarkers based on reproducibility, independency and prognostic value. Patients diagnosed with stage II or III colon cancer who underwent surgery between 2005 and 2016 were included. Both TSR and TB were scored on haematoxylin and eosin-stained tissue sections. The TSR, based on the relative amount of stroma, was scored in increments of 10%. TB was scored following the consensus guidelines; a bud was defined as ≤ 4 tumour cells. For analysis, three categories were used. Cohen's kappa was used for reproducibility. The prognostic value was determined with survival analysis. In total, 246 patients were included. The TSR distribution was N = 137 (56%) stroma-low and N = 109 (44%) stroma-high. The TB distribution was TB-low N = 194 (79%), TB-intermediate N = 35 (14%) and TB-high N = 17 (7%). The reproducibility of the TSR was good (interobserver agreement kappa = 0.83 and intraobserver agreement kappa = 0.82), whereas the inter- and intraobserver agreement for scoring TB was moderate (kappa 0.47 and 0.45, respectively). The survival analysis showed an independent prognostic value for disease-free survival for TSR (HR 1.57; 95% CI 1.01-2.44; p = 0.048) and for TB-high (HR 2.01; 95% CI 1.02-3.96; p = 0.043). Based on current results, we suggest the TSR is a more reliable parameter in daily practice due to better reproducibility and independent prognostic value for disease-free survival.
Collapse
Affiliation(s)
- Marloes A Smit
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Valeska Terpstra
- Department of Pathology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Han J M van Krieken
- Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| |
Collapse
|
4
|
Dang H, van Pelt GW, Haasnoot KJC, Backes Y, Elias SG, Seerden TCJ, Schwartz MP, Spanier BWM, de Vos tot Nederveen Cappel WH, van Bergeijk JD, Kessels K, Geesing JMJ, Groen JN, ter Borg F, Wolfhagen FHJ, Seldenrijk CA, Raicu MG, Milne AN, van Lent AUG, Brosens LAA, Johan A. Offerhaus G, Siersema PD, Tollenaar RAEM, Hardwick JCH, Hawinkels LJAC, Moons LMG, Lacle MM, Mesker WE, Boonstra JJ. Tumour-stroma ratio has poor prognostic value in non-pedunculated T1 colorectal cancer: A multi-centre case-cohort study. United European Gastroenterol J 2020; 9:2050640620975324. [PMID: 33210982 PMCID: PMC8259249 DOI: 10.1177/2050640620975324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Current risk stratification models for early invasive (T1) colorectal cancer are not able to discriminate accurately between prognostic favourable and unfavourable tumours, resulting in over-treatment of a large (>80%) proportion of T1 colorectal cancer patients. The tumour-stroma ratio (TSR), which is a measure for the relative amount of desmoplastic tumour stroma, is reported to be a strong independent prognostic factor in advanced-stage colorectal cancer, with a high stromal content being associated with worse prognosis and survival. We aimed to investigate whether the TSR predicts clinical outcome in patients with non-pedunculated T1 colorectal cancer. METHODS Hematoxylin and eosin (H&E)-stained tumour tissue slides from a retrospective multi-centre case cohort of patients with non-pedunculated surgically treated T1 colorectal cancer were assessed for TSR by two independent observers who were blinded for clinical outcomes. The primary end point was adverse outcome, which was defined as the presence of lymph node metastasis in the resection specimen or colorectal cancer recurrence during follow-up. RESULTS All 261 patients in the case cohort had H&E slides available for TSR scoring. Of these, 183 were scored as stroma-low, and 78 were scored as stroma-high. There was moderate inter-observer agreement (κ = 0.42). In total, 41 patients had lymph node metastasis, 17 patients had recurrent cancer and five had both. Stroma-high tumours were not associated with an increased risk for an adverse outcome (adjusted hazard ratio = 0.66, 95% confidence interval 0.37-1.18; p = 0.163). CONCLUSIONS Our study emphasises that existing prognosticators may not be simply extrapolated to T1 colorectal cancers, even though their prognostic value has been widely validated in more advanced-stage tumours.
Collapse
Affiliation(s)
- Hao Dang
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Gabi W. van Pelt
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Krijn J. C. Haasnoot
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Yara Backes
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Sjoerd G. Elias
- Julius Centre for Health Sciences and Primary CareUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Tom C. J. Seerden
- Department of Gastroenterology and HepatologyAmphia HospitalBredaThe Netherlands
| | - Matthijs P. Schwartz
- Department of Gastroenterology and HepatologyMeander Medical CentreAmersfoortThe Netherlands
| | | | | | | | - Koen Kessels
- Department of Gastroenterology and HepatologySint Antonius HospitalNieuwegeinThe Netherlands
| | - Joost M. J. Geesing
- Department of Gastroenterology and HepatologyDiakonessenhuisUtrechtThe Netherlands
| | - John N. Groen
- Department of Gastroenterology and HepatologySint JansdalHarderwijkThe Netherlands
| | - Frank ter Borg
- Department of Gastroenterology and HepatologyDeventer HospitalDeventerThe Netherlands
| | - Frank H. J. Wolfhagen
- Department of Gastroenterology and HepatologyAlbert Schweitzer HospitalDordrechtThe Netherlands
| | | | | | - Anya N. Milne
- Pathology DNASint Antonius HospitalNieuwegeinThe Netherlands
| | - Anja U. G. van Lent
- Department of Gastroenterology and HepatologyOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Lodewijk A. A. Brosens
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - G. Johan A. Offerhaus
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud University Medical CentreNijmegenThe Netherlands
| | | | - James C. H. Hardwick
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Lukas J. A. C. Hawinkels
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Leon M. G. Moons
- Department of Gastroenterology and HepatologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Miangela M. Lacle
- Department of PathologyUniversity Medical Centre UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Wilma E. Mesker
- Department of SurgeryLeiden University Medical CentreLeidenThe Netherlands
| | - Jurjen J. Boonstra
- Department of Gastroenterology and HepatologyLeiden University Medical CentreLeidenThe Netherlands
| | | |
Collapse
|
5
|
Zunder SM, Perez-Lopez R, de Kok BM, Raciti MV, van Pelt GW, Dienstmann R, Garcia-Ruiz A, Meijer CA, Gelderblom H, Tollenaar RA, Nuciforo P, Wasser MN, Mesker WE. Correlation of the tumour-stroma ratio with diffusion weighted MRI in rectal cancer. Eur J Radiol 2020; 133:109345. [PMID: 33120239 DOI: 10.1016/j.ejrad.2020.109345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/06/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study evaluated the correlation between intratumoural stroma proportion, expressed as tumour-stroma ratio (TSR), and apparent diffusion coefficient (ADC) values in patients with rectal cancer. METHODS This multicentre retrospective study included all consecutive patients with rectal cancer, diagnostically confirmed by biopsy and MRI. The training cohort (LUMC, Netherlands) included 33 patients and the validation cohort (VHIO, Spain) 69 patients. Two observers measured the mean and minimum ADCs based on single-slice and whole-volume segmentations. The TSR was determined on diagnostic haematoxylin & eosin stained slides of rectal tumour biopsies. The correlation between TSR and ADC was assessed by Spearman correlation (rs). RESULTS The ADC values between stroma-low and stroma-high tumours were not significantly different. Intra-class correlation (ICC) demonstrated a good level of agreement for the ADC measurements, ranging from 0.84-0.86 for single slice and 0.86-0.90 for the whole-volume protocol. No correlation was observed between the TSR and ADC values, with ADCmeanrs= -0.162 (p= 0.38) and ADCminrs= 0.041 (p= 0.82) for the single-slice and rs= -0.108 (p= 0.55) and rs= 0.019 (p= 0.92) for the whole-volume measurements in the training cohort, respectively. Results from the validation cohort were consistent; ADCmeanrs= -0.022 (p= 0.86) and ADCminrs = 0.049 (p= 0.69) for the single-slice and rs= -0.064 (p= 0.59) and rs= -0.063 (p= 0.61) for the whole-volume measurements. CONCLUSIONS Reproducibility of ADC values is good. Despite positive reports on the correlation between TSR and ADC values in other tumours, this could not be confirmed for rectal cancer.
Collapse
Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands; Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Bente M de Kok
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Maria Vittoria Raciti
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rodrigo Dienstmann
- Department of Oncology Data Science, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institute of Oncology, Natzaret 115-117. 08035 Barcelona, Spain
| | - C Arnoud Meijer
- Department of Radiology, Martini Hospital, Van Swietenplein 1, 9728 NT Groningen The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Paolo Nuciforo
- Department of Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Cellex Center, Natzaret 115-117 08035 Barcelona, Spain
| | - Martin N Wasser
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| |
Collapse
|
6
|
Vangangelt KMH, Green AR, Heemskerk IMF, Cohen D, van Pelt GW, Sobral-Leite M, Schmidt MK, Putter H, Rakha EA, Tollenaar RAEM, Mesker WE. The prognostic value of the tumor-stroma ratio is most discriminative in patients with grade III or triple-negative breast cancer. Int J Cancer 2020; 146:2296-2304. [PMID: 31901133 PMCID: PMC7065011 DOI: 10.1002/ijc.32857] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/11/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022]
Abstract
The tumor-stroma ratio (TSR) was evaluated as a promising parameter for breast cancer prognostication in clinically relevant subgroups of patients. The TSR was assessed on hematoxylin and eosin-stained tissue slides of 1,794 breast cancer patients from the Nottingham City Hospital. An independent second cohort of 737 patients from the Netherlands Cancer Institute to Antoni van Leeuwenhoek was used for evaluation. In the Nottingham Breast Cancer series, the TSR was an independent prognostic parameter for recurrence-free survival (RFS; HR 1.35, 95% CI 1.10-1.66, p = 0.004). The interaction term was statistically significant for grade and triple-negative status. Multivariate Cox regression analysis showed a more pronounced effect of the TSR for RFS in grade III tumors (HR 1.89, 95% CI 1.43-2.51, p < 0.001) and triple-negative tumors (HR 1.86, 95% CI 1.10-3.14, p = 0.020). Comparable hazard ratios and confidence intervals were observed for grade and triple-negative status in the ONCOPOOL study. The prognostic value of TSR was not modified by age, tumor size, histology, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status or lymph node status. In conclusion, patients with a stroma-high tumor had a worse prognosis compared to patients with a stroma-low tumor. The prognostic value of the TSR is most discriminative in grade III tumors and triple-negative tumors. The TSR was not modified by other clinically relevant parameters making it a potential factor to be included for improved risk stratification.
Collapse
Affiliation(s)
- Kiki M H Vangangelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew R Green
- Nottingham Breast Cancer Research Center, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom
| | | | - Danielle Cohen
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcelo Sobral-Leite
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Emad A Rakha
- Nottingham Breast Cancer Research Center, Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham City Hospital, Nottingham, United Kingdom
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
7
|
Sandberg TP, Oosting J, van Pelt GW, Mesker WE, Tollenaar RAEM, Morreau H. Erratum: Molecular profiling of colorectal tumors stratified by the histological tumor-stroma ratio - Increased expression of galectin-1 in tumors with high stromal content. Oncotarget 2019; 10:2416. [PMID: 31040931 PMCID: PMC6481328 DOI: 10.18632/oncotarget.26820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
[This corrects the article DOI: 10.18632/oncotarget.25845.].
Collapse
Affiliation(s)
- Tessa P Sandberg
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
8
|
Sandberg TP, Sweere I, van Pelt GW, Putter H, Vermeulen L, Kuppen PJ, Tollenaar RAEM, Mesker WE. Prognostic value of low CDX2 expression in colorectal cancers with a high stromal content - a short report. Cell Oncol (Dordr) 2019; 42:397-403. [PMID: 30847807 DOI: 10.1007/s13402-019-00436-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Lack of expression of the intestinal transcription factor CDX2 in colorectal cancer (CRC) identifies patients with a poor prognosis. This biomarker has previously been suggested to be prognostic in CRCs with a high stromal content based on mRNA expression data. We investigated the prognostic value of CDX2 expression in microsatellite stable CRC stratified by stromal content using microscopy-based techniques. METHODS AND RESULTS The study included a cohort of 236 patients with stage I-IV CRC. We assessed by microscopy the tumour-stroma ratio (TSR) and the immunohistochemical CDX2 intensity. We found that patients of the stroma-high group had a worse prognosis compared to those of the stroma-low group [disease-free survival in a multivariate analysis (DFSmultivariate) HR 1.52 (95% CI 1.05-2.21)]. In our cohort, low CDX2 expression (14.6%) showed prognostic value for DFSmultivariate [HR 1.93 (95% CI 1.16-3.23)]. Interestingly, when stratifying the cohort by TSR, no prognostic difference was observed related to CDX2 expression in stroma-low tumours. However, CDX2 expression was found to be prognostic within the stroma-high group [DFSmultivariate HR 3.02 (95% CI 1.49-6.13)]. The p value for interaction between TSR and CDX2 status was borderline significant in DFS (p = 0.071). CONCLUSIONS The present study confirms a poor outcome of patients with stroma-high tumours. Low CDX2 expression in tumours with a high stromal content identified patients with a particularly poor prognosis. The present study did not reveal a clear difference in TSR associated with CDX2 status and survival. This method, solely based on microscopy, identifies patients who have a high risk of relapse and a poor outcome, and who may benefit from targeted therapy.
Collapse
Affiliation(s)
- Tessa P Sandberg
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands. .,Department of Pathology, Leiden University Medical Centrum, Leiden, The Netherlands.
| | - Iris Sweere
- Department of Pathology, Leiden University Medical Centrum, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centrum, Leiden, The Netherlands
| | - Louis Vermeulen
- Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center & Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peter J Kuppen
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centrum, Albinusdreef 2, 2333ZA, Leiden, The Netherlands
| |
Collapse
|
9
|
Vangangelt KMH, Tollenaar LSA, van Pelt GW, de Kruijf EM, Dekker TJA, Kuppen PJK, Tollenaar RAEM, Mesker WE. The prognostic value of tumor-stroma ratio in tumor-positive axillary lymph nodes of breast cancer patients. Int J Cancer 2018; 143:3194-3200. [PMID: 29978463 DOI: 10.1002/ijc.31658] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
Abstract
The tumor-stroma ratio (TSR) has previously been found to be a strong prognostic parameter in primary breast cancer tumors. Since the presence of tumor cells in lymph nodes is important for clinical decision making, the influence of TSR in the primary breast tumor combined with the TSR in tumor-positive lymph nodes on prognosis was evaluated. Women with invasive breast cancer without distant metastasis who underwent an axillary lymph node dissection between 1985 and 1994 at the Leiden University Medical Center were retrospectively analyzed. TSR assessment was performed on hematoxylin and eosin stained tissue slides. In total, 87 (45.5%) primary tumors were scored as stroma-low and 104 (54.5%) as stroma-high. Patients with a high stromal percentage in the primary tumors had a statistically significant worse relapse free period (RFP) compared to stroma-low tumors (HR 1.97, 95% CI 1.37-2.82, p < 0.001). A total number of 915 lymph nodes were assessed for TSR. In 101 (52.9%) patients, heterogeneity was observed between stroma percentage category in primary tumor and lymph nodes. The combination of TSR of the primary tumor combined with TSR of tumor-positive lymph nodes strengthened each other as independent prognostic parameter for RFP (p = 0.019). Patients with primary tumor stroma-low/lymph nodes stroma-low tumors showed strongly improved RFP rates compared to patients with primary tumor stroma-high/lymph node stroma-high tumors with 10-year percentages of 58 versus 8%, respectively. Assessing the TSR on tumor-positive lymph nodes can provide additional prognostic information. Stromal activation strongly differs between primary tumors and lymph node metastasis.
Collapse
Affiliation(s)
- Kiki M H Vangangelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther M de Kruijf
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Tim J A Dekker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter J K Kuppen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
10
|
Sandberg TP, Oosting J, van Pelt GW, Mesker WE, Tollenaar RAEM, Morreau H. Molecular profiling of colorectal tumors stratified by the histological tumor-stroma ratio - Increased expression of galectin-1 in tumors with high stromal content. Oncotarget 2018; 9:31502-31515. [PMID: 30140386 PMCID: PMC6101138 DOI: 10.18632/oncotarget.25845] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022] Open
Abstract
The tumor microenvironment is a dominant determinant of cancer cell behavior. Reactive tumor stroma is associated with poor outcome perspective. The tumor-stroma ratio (TSR) is a strong independent prognostic factor in colorectal cancer and is easily assessed using conventional hematoxylin and eosin (H&E) stained paraffin sections at the invasive margin of the tumor. We aim to understand the biology of the tumor stroma in colorectal cancer by investigating the transcriptomic profiles of tumors classified by the TSR method. The TSR was assessed in a cohort of 71 colorectal cancer patients undergoing surgery without (neo)adjuvant therapy. In the cohort, stroma-high tumors were distinguished from stroma-low tumors at gene expression level in the upregulation of biological pathways related to extracellular matrix (ECM) remodeling and myogenesis. The activated microenvironment in stroma-high tumors overexpressed different types of collagen genes, THBS2 and 4 as well as INHBA, COX71A and LGALS1/galectin-1. The upregulation of THBS2, COX7A1 and LGALS1/galectin-1. The upregulation of THBS2, COX7A1 and LGALS1/galectin-1 in stroma-high tumors was validated in The Cancer Genome Atlas. In conclusion, the gene expression data reflects the high stromal content of tumors assessed based on the histological method, the TSR. The composition of the microenvironment suggests an altered proteolysis resulting in ECM remodeling and invasive capacity of tumor cells.
Collapse
Affiliation(s)
- Tessa P Sandberg
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan Oosting
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
11
|
Paauwe M, Schoonderwoerd MJA, Helderman RFCP, Harryvan TJ, Groenewoud A, van Pelt GW, Bor R, Hemmer DM, Versteeg HH, Snaar-Jagalska BE, Theuer CP, Hardwick JCH, Sier CFM, Ten Dijke P, Hawinkels LJAC. Endoglin Expression on Cancer-Associated Fibroblasts Regulates Invasion and Stimulates Colorectal Cancer Metastasis. Clin Cancer Res 2018; 24:6331-6344. [PMID: 29945992 DOI: 10.1158/1078-0432.ccr-18-0329] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/23/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Cancer-associated fibroblasts (CAF) are a major component of the colorectal cancer tumor microenvironment. CAFs play an important role in tumor progression and metastasis, partly through TGF-β signaling pathway. We investigated whether the TGF-β family coreceptor endoglin is involved in CAF-mediated invasion and metastasis. EXPERIMENTAL DESIGN CAF-specific endoglin expression was studied in colorectal cancer resection specimens using IHC and related to metastases-free survival. Endoglin-mediated invasion was assessed in vitro by transwell invasion, using primary colorectal cancer-derived CAFs. Effects of CAF-specific endoglin expression on tumor cell invasion were investigated in a colorectal cancer zebrafish model, whereas liver metastases were assessed in a mouse model. RESULTS CAFs specifically at invasive borders of colorectal cancer express endoglin and increased expression intensity correlated with increased disease stage. Endoglin-expressing CAFs were also detected in lymph node and liver metastases, suggesting a role in colorectal cancer metastasis formation. In stage II colorectal cancer, CAF-specific endoglin expression at invasive borders correlated with poor metastasis-free survival. In vitro experiments revealed that endoglin is indispensable for bone morphogenetic protein (BMP)-9-induced signaling and CAF survival. Targeting endoglin using the neutralizing antibody TRC105 inhibited CAF invasion in vitro. In zebrafish, endoglin-expressing fibroblasts enhanced colorectal tumor cell infiltration into the liver and decreased survival. Finally, CAF-specific endoglin targeting with TRC105 decreased metastatic spread of colorectal cancer cells to the mouse liver. CONCLUSIONS Endoglin-expressing CAFs contribute to colorectal cancer progression and metastasis. TRC105 treatment inhibits CAF invasion and tumor metastasis, indicating an additional target beyond the angiogenic endothelium, possibly contributing to beneficial effects reported during clinical evaluations.See related commentary by Becker and LeBleu, p. 6110.
Collapse
Affiliation(s)
- Madelon Paauwe
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark J A Schoonderwoerd
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roxan F C P Helderman
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom J Harryvan
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arwin Groenewoud
- Institute of Biology, Leiden University, Leiden, the Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rosalie Bor
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Danielle M Hemmer
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henri H Versteeg
- Department of Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - James C H Hardwick
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Ten Dijke
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands.,Oncode Institute, the Netherlands
| | - Lukas J A C Hawinkels
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, the Netherlands. .,Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
12
|
Zunder SM, van Pelt GW, Gelderblom HJ, Mancao C, Putter H, Tollenaar RA, Mesker WE. Predictive potential of tumour-stroma ratio on benefit from adjuvant bevacizumab in high-risk stage II and stage III colon cancer. Br J Cancer 2018; 119:164-169. [PMID: 29755119 PMCID: PMC6048031 DOI: 10.1038/s41416-018-0083-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 12/28/2022] Open
Abstract
Background The tumour–stroma ratio (TSR) has proven to be an independent prognostic factor in colon cancer. methods Haematoxylin eosin tissue slides of patients from the AVANT trial were microscopically scored for TSR and categorised as stroma -low or stroma -high. Scores were correlated to the primary and secondary endpoint disease-free survival (DFS) and overall survival (OS). Results Patients with stroma-high tumours (N = 339, 28%) had a significantly shorter DFS (p < 0.001) compared to stroma-low tumours (N = 824, 68%). In the bevacizumab-FOLFOX-4 arm, DFS was significantly shorter compared to FOLFOX-4 in stroma-low tumours, with a hazard ratio (HR) of 1.94 (95% CI 1.24–3.04; p = 0.004). In stroma-high tumours a trend for better DFS was seen in bevacizumab-FOLFOX-4 vs. FOLFOX-4 (HR 0.61 (95% CI 0.35–1.07; p = 0.08)). For bevacizumab-XELOX vs. FOLFOX-4, this was not seen (stroma-low HR 1.07 (95% CI 0.64–1.77; p = 0.80); stroma-high HR 0.78 (95% CI 0.47–1.30; p = 0.35)). OS showed the same pattern for bevacizumab-FOLFOX-4 vs. FOLFOX-4 with a HR of 2.53 (95% CI 1.36–4.71; p = 0.003) for stroma-low and HR 0.50 (95% CI 0.22–1.14; p = 0.10) for stroma-high tumours. For bevacizumab-XELOX vs. FOLFOX-4, HR 1.13 (95% CI 0.55–2.31; p = 0.74) for stroma-low tumours and HR 0.74 (95% CI 0.37–1.51; p = 0.41) for stroma-high tumours. Conclusions This exploratory analysis suggests a significantly shorter DFS and OS in stroma-low tumours with addition of bevacizumab to intravenous oxaliplatin-based chemotherapy, contrary to stroma-high tumours, where a beneficial trend is observed.
Collapse
Affiliation(s)
- Stéphanie M Zunder
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands.,Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Hans J Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Christoph Mancao
- Oncology Biomarker Development, Genentech Inc., CH-4070, Basel, Switzerland
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, Netherlands.
| |
Collapse
|
13
|
Huijbers A, van Pelt GW, Kerr RS, Johnstone EC, Tollenaar RAEM, Kerr DJ, Mesker WE. The value of additional bevacizumab in patients with high-risk stroma-high colon cancer. A study within the QUASAR2 trial, an open-label randomized phase 3 trial. J Surg Oncol 2018; 117:1043-1048. [PMID: 29448309 DOI: 10.1002/jso.24998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/29/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Patients with a high stroma percentage within the primary tumor have a poor prognosis. In this study, we investigate whether anti-angiogenic therapy might improve survival of patients with a stroma-high profile with potentially increased angiogenesis. MATERIALS AND METHODS Tissue samples of the primary tumor of 965 colon cancer patients participating in the QUASAR2 trial were analyzed for tumor-stroma ratio (TSR). Stroma-high (>50%) and stroma-low (≤50%) groups were evaluated with respect to survival. RESULTS Disease free survival (DFS) was significantly lower in the stroma-high group (HR 1.53, 95%CI 1.19-1.95, P = 0.001). No difference in DFS was seen with respect to treatment with capecitabine alone (CAP) or capecitabine with bevacizumab (CAPBEV) (Stroma-high HR 1.00, 95%CI 0.69-1.46, P = 0.996; stroma-low HR 1.02, 95%CI 0.75-1.41, P = 0.883). A significant difference in survival was seen comparing groups with or without vascular invasion (DFS P < 0.001). A correlation between vascular invasion and stroma-high was seen (χ2 -test P = 0.043). DISCUSSION AND CONCLUSIONS The TSR confirmed to be a strong prognosticator for disease-free survival in a selected high-risk patient population. No benefit was found in response to treatment with bevacizumab when stratified for TSR. TSR showed to have an additional prognostic value in patients with vascular invasion present in the primary tumor.
Collapse
Affiliation(s)
- Anouck Huijbers
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| | - Gabi W van Pelt
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| | - Rachel S Kerr
- Department of Oncology, University of Oxford, Oxford, United Kingdom
| | | | - Rob A E M Tollenaar
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| | - David J Kerr
- Nuffield Division of Clinical and Laboratory Sciences, University of Oxford, Oxford, United Kingdom
| | - Wilma E Mesker
- Department of Surgery, Leiden Universal Medical Centre (LUMC), Leiden, The Netherlands
| |
Collapse
|
14
|
van Pelt GW, Sandberg TP, Morreau H, Gelderblom H, van Krieken JHJM, Tollenaar RAEM, Mesker WE. The tumour-stroma ratio in colon cancer: the biological role and its prognostic impact. Histopathology 2018; 73:197-206. [PMID: 29457843 DOI: 10.1111/his.13489] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The tumour microenvironment consists of a complex mixture of non-neoplastic cells, including fibroblasts, immune cells and endothelial cells embedded in the proteins of the extracellular matrix. The tumour microenvironment plays an active role in tumour behaviour. By interacting with cancer cells, it influences disease progression and the metastatic capacity of the tumour. Tumours with a high amount of stroma correspond to poor patient prognosis. The tumour-stroma ratio (TSR) is a strong independent prognostic tool in colon cancer and provides additional value to the current clinically used tumour-node-metastasis classification. The TSR is assessed on conventional haematoxylin and eosin-stained paraffin sections at the invasive front of the tumour. Here we review studies demonstrating the prognostic significance of the TSR in solid epithelial tumours with a focus on colon cancer. Moreover, the biological role of the tumour microenvironment during tumour progression and invasion will be discussed, as well as the attempts to target the tumour stroma for therapeutic purposes. We suggest that the TSR can be implemented with little effort and without additional costs in current routine pathology diagnostics owing to its simplicity and reliability.
Collapse
Affiliation(s)
- Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tessa P Sandberg
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Hans Gelderblom
- Department of Clinical Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Han J M van Krieken
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
15
|
van Pelt GW, Huijbers A, Tollenaar RAEM, Mesker WE. In reply to Hynes et al.: 'Back to the future: routine morphological assessment of the tumour microenvironment is prognostic in stages II/III colon cancer in a large population-based study'. Histopathology 2017; 72:531-532. [PMID: 28898449 DOI: 10.1111/his.13396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gabi W van Pelt
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anouck Huijbers
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
16
|
Holst S, van Pelt GW, Mesker WE, Tollenaar RA, Belo AI, van Die I, Rombouts Y, Wuhrer M. High-Throughput and High-Sensitivity Mass Spectrometry-Based N-Glycomics of Mammalian Cells. Methods Mol Biol 2017; 1503:185-196. [PMID: 27743367 DOI: 10.1007/978-1-4939-6493-2_14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The current protocols for glycomic analysis of cells often require a large quantity of material (5-20 million cells). In order to analyze the N-glycosylation from small amounts of cells (≤1 million) as obtained from, for example, primary cell lines or cell sorting, and in a higher throughput approach, we set up a robust 96-well format PVDF-membrane based N-glycan release protocol followed by linkage-specific sialic acid stabilization, cleanup, and MALDI-TOF-MS analysis. We further evaluated the influence of PNGase F incubation time on the N-glycan profile.
Collapse
Affiliation(s)
- Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Postzone S3, Postbus 9600, 2300, RC, Leiden, The Netherlands.
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center, Postbus 9600, RC, 2300, Leiden, The Netherlands
| | - Ana I Belo
- Department of Molecular Cell Biology and Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Irma van Die
- Department of Molecular Cell Biology and Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Yoann Rombouts
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Postzone S3, Postbus 9600, 2300, RC, Leiden, The Netherlands
- University Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59 000, Lille, France
| | - Manfred Wuhrer
- Division of BioAnalytical Chemistry, VU University Amsterdam, De Boelelaan 1083, Amsterdam, 1081, HV, The Netherlands
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333, ZA, The Netherlands
| |
Collapse
|
17
|
Heijs B, Holst S, Briaire-de Bruijn IH, van Pelt GW, de Ru AH, van Veelen PA, Drake RR, Mehta AS, Mesker WE, Tollenaar RA, Bovée JVMG, Wuhrer M, McDonnell LA. Multimodal Mass Spectrometry Imaging of N-Glycans and Proteins from the Same Tissue Section. Anal Chem 2016; 88:7745-53. [PMID: 27373711 DOI: 10.1021/acs.analchem.6b01739] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
On-tissue digestion matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) can be used to record spatially correlated molecular information from formalin-fixed, paraffin-embedded (FFPE) tissue sections. In this work, we present the in situ multimodal analysis of N-linked glycans and proteins from the same FFPE tissue section. The robustness and applicability of the method are demonstrated for several tumors, including epithelial and mesenchymal tumor types. Major analytical aspects, such as lateral diffusion of the analyte molecules and differences in measurement sensitivity due to the additional sample preparation methods, have been investigated for both N-glycans and proteolytic peptides. By combining the MSI approach with extract analysis, we were also able to assess which mass spectral peaks generated by MALDI-MSI could be assigned to unique N-glycan and peptide identities.
Collapse
Affiliation(s)
- Bram Heijs
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Arnoud H de Ru
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Peter A van Veelen
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Anand S Mehta
- Department of Microbiology and Immunology, College of Medicine, Drexel University , Philadelphia, Pennsylvania 19129, United States
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center , Leiden, The Netherlands
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center , Leiden, The Netherlands
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden, The Netherlands.,Department of Pathology, Leiden University Medical Center , Leiden, The Netherlands.,Fondazione Pisana per la Scienza ONLUS , Pisa, Italy
| |
Collapse
|
18
|
Holst S, Heijs B, de Haan N, van Zeijl RJM, Briaire-de Bruijn IH, van Pelt GW, Mehta AS, Angel PM, Mesker WE, Tollenaar RA, Drake RR, Bovée JVMG, McDonnell LA, Wuhrer M. Linkage-Specific in Situ Sialic Acid Derivatization for N-Glycan Mass Spectrometry Imaging of Formalin-Fixed Paraffin-Embedded Tissues. Anal Chem 2016; 88:5904-13. [PMID: 27145236 DOI: 10.1021/acs.analchem.6b00819] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging is a rapidly evolving field in which mass spectrometry techniques are applied directly on tissues to characterize the spatial distribution of various molecules such as lipids, protein/peptides, and recently also N-glycans. Glycans are involved in many biological processes and several glycan changes have been associated with different kinds of cancer, making them an interesting target group to study. An important analytical challenge for the study of glycans by MALDI mass spectrometry is the labile character of sialic acid groups which are prone to in-source/postsource decay, thereby biasing the recorded glycan profile. We therefore developed a linkage-specific sialic acid derivatization by dimethylamidation and subsequent amidation and transferred this onto formalin-fixed paraffin-embedded (FFPE) tissues for MALDI imaging of N-glycans. Our results show (i) the successful stabilization of sialic acids in a linkage specific manner, thereby not only increasing the detection range, but also adding biological meaning, (ii) that no noticeable lateral diffusion is induced during to sample preparation, (iii) the potential of mass spectrometry imaging to spatially characterize the N-glycan expression within heterogeneous tissues.
Collapse
Affiliation(s)
- Stephanie Holst
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Bram Heijs
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Noortje de Haan
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - René J M van Zeijl
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | | | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Anand S Mehta
- Department of Microbiology and Immunology, Drexel University College of Medicine , 245 N. 15th Street, Philadelphia, Pennsylvania 19102, United States
| | - Peggy M Angel
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina , Charleston, South Carolina 29425, United States
| | - Judith V M G Bovée
- Department of Pathology, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| | - Liam A McDonnell
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands.,Department of Pathology, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands.,Fondazione Pisana per la Scienza ONLUS, c/o Croce Rossa Italiana , via Panfilo Castaldi 2, 56121, Ospedaletto, Pisa, Italy
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center , Leiden 2333 ZA, The Netherlands
| |
Collapse
|
19
|
Kjaer-Frifeldt S, Pelt GWV, Christensen RD, Mesker WE, Jakobsen AKM, Smit VT, Tollenaar RA, Soerensen FB. Contribution of tumor stroma ratio to a better selection of stage II colon cancer patients into high and low risk groups: A population based study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sanne Kjaer-Frifeldt
- Department of Pathology, Odense University Hospital, and Danish Colorectal Cancer Group South, Odense, Denmark
| | | | - Rene dePont Christensen
- Research Unit of General Practice Odense, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | | |
Collapse
|
20
|
Li Y, Jin K, van Pelt GW, van Dam H, Yu X, Mesker WE, Ten Dijke P, Zhou F, Zhang L. c-Myb Enhances Breast Cancer Invasion and Metastasis through the Wnt/β-Catenin/Axin2 Pathway. Cancer Res 2016; 76:3364-75. [PMID: 27197202 DOI: 10.1158/0008-5472.can-15-2302] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 03/30/2016] [Indexed: 11/16/2022]
Abstract
The molecular underpinnings of aggressive breast cancers remain mainly obscure. Here we demonstrate that activation of the transcription factor c-Myb is required for the prometastatic character of basal breast cancers. An analysis of breast cancer patients led us to identify c-Myb as an activator of Wnt/β-catenin signaling. c-Myb interacted with the intracellular Wnt effector β-catenin and coactivated the Wnt/β-catenin target genes Cyclin D1 and Axin2 Moreover, c-Myb controlled metastasis in an Axin2-dependent manner. Expression microarray analyses revealed a positive association between Axin2 and c-Myb, a target of the proinflammatory cytokine IL1β that was found to be required for IL1β-induced breast cancer cell invasion. Overall, our results identified c-Myb as a promoter of breast cancer invasion and metastasis through its ability to activate Wnt/β-catenin/Axin2 signaling. Cancer Res; 76(11); 3364-75. ©2016 AACR.
Collapse
Affiliation(s)
- Yihao Li
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China. Department of Molecular Cell Biology, Cancer Genomics Centre Netherlands, Leiden University Medical Center, Leiden, the Netherlands
| | - Ke Jin
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China
| | - Gabi W van Pelt
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans van Dam
- Department of Molecular Cell Biology, Cancer Genomics Centre Netherlands, Leiden University Medical Center, Leiden, the Netherlands. Ludwig Institute for Cancer Research, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Xiao Yu
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Ten Dijke
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China. Department of Molecular Cell Biology, Cancer Genomics Centre Netherlands, Leiden University Medical Center, Leiden, the Netherlands. Ludwig Institute for Cancer Research, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Fangfang Zhou
- Institutes of Biology and Medical Science, Soochow University, Suzhou, P.R. China.
| | - Long Zhang
- Life Sciences Institute and Innovation Center for Cell Signaling Network, Zhejiang University, Hangzhou, China.
| |
Collapse
|
21
|
van Pelt GW, Hansen TF, Bastiaannet E, Frifeldt SK, van Krieken JHJM, AEM Tollenaar R, Sorensen FB, Mesker WE. Stroma-High Lymph Node Involvement Predicts Poor Survival More Accurately for Patients with Stage III Colon Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.4172/2472-4971.1000116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
22
|
Holst S, Deuss AJM, van Pelt GW, van Vliet SJ, Garcia-Vallejo JJ, Koeleman CAM, Deelder AM, Mesker WE, Tollenaar RA, Rombouts Y, Wuhrer M. N-glycosylation Profiling of Colorectal Cancer Cell Lines Reveals Association of Fucosylation with Differentiation and Caudal Type Homebox 1 (CDX1)/Villin mRNA Expression. Mol Cell Proteomics 2015; 15:124-40. [PMID: 26537799 PMCID: PMC4762531 DOI: 10.1074/mcp.m115.051235] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Indexed: 01/05/2023] Open
Abstract
Various cancers such as colorectal cancer (CRC) are associated with alterations in protein glycosylation. CRC cell lines are frequently used to study these (glyco)biological changes and their mechanisms. However, differences between CRC cell lines with regard to their glycosylation have hitherto been largely neglected. Here, we comprehensively characterized the N-glycan profiles of 25 different CRC cell lines, derived from primary tumors and metastatic sites, in order to investigate their potential as glycobiological tumor model systems and to reveal glycans associated with cell line phenotypes. We applied an optimized, high-throughput membrane-based enzymatic glycan release for small sample amounts. Released glycans were derivatized to stabilize and differentiate between α2,3- and α2,6-linked N-acetylneuraminic acids, followed by N-glycosylation analysis by MALDI-TOF(/TOF)-MS. Our results showed pronounced differences between the N-glycosylation patterns of CRC cell lines. CRC cell line profiles differed from tissue-derived N-glycan profiles with regard to their high-mannose N-glycan content but showed a large overlap for complex type N-glycans, supporting their use as a glycobiological cancer model system. Importantly, we could show that the high-mannose N-glycans did not only occur as intracellular precursors but were also present at the cell surface. The obtained CRC cell line N-glycan features were not clearly correlated with mRNA expression levels of glycosyltransferases, demonstrating the usefulness of performing the structural analysis of glycans. Finally, correlation of CRC cell line glycosylation features with cancer cell markers and phenotypes revealed an association between highly fucosylated glycans and CDX1 and/or villin mRNA expression that both correlate with cell differentiation. Together, our findings provide new insights into CRC-associated glycan changes and setting the basis for more in-depth experiments on glycan function and regulation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yoann Rombouts
- From the ‡Center for Proteomics and Metabolomics, ¶Department of RheumatologyLeiden University Medical Center, Leiden, The Netherlands; ‡‡Univ. Lille, CNRS, UMR 8576, UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, F 59 000 Lille, France
| | - Manfred Wuhrer
- From the ‡Center for Proteomics and Metabolomics, ‖Department of Molecular Cell Biology and Immunology and **Division of BioAnalytical Chemistry, VU University Medical Center, Amsterdam, The Netherlands;
| |
Collapse
|
23
|
Paauwe M, Heijkants RC, Oudt LH, van Pelt GW, Sier CF, Theuer CP, Hawinkels LJ. Abstract 4130: Dual targeting of VEGF and endoglin inhibits tumor angiogenesis and metastatic spread. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-4130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Endoglin, a co-receptor for TGF-β and BMP-9, is highly expressed on angiogenic endothelial cells and has been shown to be a predictive marker for patient survival in various solid tumors. TRC105 is a neutralizing antibody against endoglin which is currently being explored in clinical trials as anti-angiogenic therapy. Previously we have observed upregulation of the endoglin signaling pathway in endothelial cells upon anti-VEGF therapy in rectal cancer patients. In this project we have further explored the redundancy between VEGF and endoglin signaling in endothelial cells and angiogenesis. In addition, we assessed the effect of simultaneously targeting both pathways on breast cancer progression and metastasis.
In vitro, inhibition of endoglin signaling by TRC105 caused upregulation of VEGF signaling in human umbilical vein endothelial cells (HUVECs). Using in vitro angiogenesis assays we showed that combined targeting with TRC105 and the VEGF receptor kinase inhibitor SU5416 inhibited angiogenic capacity even further than targeting both pathways separately. To determine the effect of combined targeting in vivo, zebrafish embryos were treated with either TRC105, SU5416 or a combination. Both single treatments resulted in abnormal subintestinal vessel development, while treatment with TRC105 and SU5416 simultaneously increased this effect. Next, we determined whether combined targeting of the endoglin and VEGF pathway could affect tumor growth and metastasis. In a syngeneic model for invasive lobular carcinomas, KEP1-11 breast cancer cells were orthotopically transplanted in mice and tumor growth and metastasis formation were followed over time. Although TRC105 and SU5416 decreased tumor vascular density, tumor volume was not affected. Strikingly, we observed a strong inhibition of metastases in mice treated with TRC105 or a combination of TRC105 and SU5416. In a follow-up experiment, we observed that after resection of the primary tumor, which was accompanied by increased metastatic spread, TRC105 alone already showed a marked decrease in the number of metastases. To further establish the role of endoglin we assessed the effect of endoglin-Fc expression by the tumor cells on tumor growth and metastasis. The extracellular part of endoglin, coupled to the Fc tail of human IgG functions as a ligand trap for endoglin ligands in the circulation. Similar to treatment with TRC105, stable expression of endoglin-Fc significantly decreased vessel density, but did not result in decreased primary tumor formation. Resection of endoglin-Fc expressing tumors lead to drastically less tumor relapse compared to the Fc control group and a complete abrogation of distant metastases was observed.
These results imply that targeting endoglin signaling, either with a neutralizing antibody or ligand trap, reduces tumor vessel density or, importantly, inhibits the metastatic spread of breast cancer cells in vivo.
Citation Format: Madelon Paauwe, Renier C. Heijkants, Lotte H. Oudt, Gabi W. van Pelt, Cornelis F.M. Sier, Charles P. Theuer, Lukas J.A.C. Hawinkels. Dual targeting of VEGF and endoglin inhibits tumor angiogenesis and metastatic spread. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4130. doi:10.1158/1538-7445.AM2015-4130
Collapse
Affiliation(s)
| | | | - Lotte H. Oudt
- 1Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | | |
Collapse
|
24
|
Broersen LHA, van Pelt GW, Tollenaar RAEM, Mesker WE. Clinical application of circulating tumor cells in breast cancer. Cell Oncol (Dordr) 2013; 37:9-15. [PMID: 24249155 DOI: 10.1007/s13402-013-0160-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 01/05/2023] Open
Abstract
Circulating tumor cells (CTCs) play a major role in the metastatic spread of breast cancer. CTC detection has proven to be an important parameter for predicting progression free and overall survival. Collection of CTCs is minimally invasive and can be performed more often than disseminated tumor cell (DTC) collection from bone marrow, thus providing a real-time "liquid biopsy". In this review, the most important techniques for enrichment and detection of CTCs are discussed for clinical application in low and higher staged breast cancer, as well as the genetic and molecular characterization of CTCs. For CTCs, the use of immunology-based enrichment techniques with multiple antibodies is recommended in a clinical setting, as well as the use of cytometric detection techniques, combined with RT-PCR for confirmation. Special attention is given to the value of cancer stem cell (CSC) activity, which may be the main cause of ineffectiveness of the control over metastatic lesions due to intratumor heterogeneity. Accumulating information on CSCs offers new paradigms to generate effective targets for the treatment of metastatic disease. Genetic and molecular characterization of CTCs has potential to stratify patients for optimal personalized treatment regimens. CTCs can be used for monitoring patients during treatment schedules.
Collapse
Affiliation(s)
- Leonie H A Broersen
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | | | | | | |
Collapse
|
25
|
Huijbers A, Pin E, Pierobon M, Pelt GWV, Belluco C, Silvestri A, Liotta LA, Tollenaar RA, Petricoin E, Mesker WE. Correlation of VEGFR activation within the tumor-associated stroma with an aggressive colon cancer phenotype. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14151 Background: The tumour microenvironment, and especially the stroma surrounding the tumor cells, is an important target for cancer therapy. Previous results published by our group showed that colon cancer (CC) patients with a high (>50%) intra-tumor stroma ratio had poor prognosis compared to patients with low intra-tumor stroma ratios. In order to evaluate the contribution of the underpinning signalling and molecular architecture of the tumor associated stroma (TAS) to this aggressive phenotype, we utilized laser capture microdissection (LCM) coupled to broad-scale protein pathway activation mapping using reverse phase protein microarrays (RPMA). Such analysis could identify new stromal-based targeted treatment options through the identification of activated pathways within the TAS of patients with aggressive CC. Methods: CC stage II and III tissue specimens were scored for the amount of stroma and a stroma-high and a stroma-low group were defined. Correspondent frozen tumor specimens were selected for a pilot study (n=30; 15 high and 15 low TAS) and subjected to LCM to enrich for TAS cells. RPMA was performed on the resultant lysates whereby an initial set of 30 total and phospho-proteins, known to be involved in stroma proliferation and activation, were analyzed. Results: Unsupervised hierarchical clustering analysis showed partial grouping of stroma high and stroma low samples with phosphorylation of VEGFR-2 being significantly higher in the stroma high group compared to the stroma low (p=0.030). Conclusions: These preliminary results reveal the potential presence of biochemical derangements in the TAS of tumors from patients with aggressive CC with increased activation of VEGFR-2. Considering the central role this protein plays in angiogenesis and cell migration, these results suggest that anti-VEGFR targeted therapy could be considered for a pre-stratified group of patients with aggressive tumors with high recurrence rates. Ongoing expanded pathway analysis with additional signalling proteins including downstream signalling components of VEGFR are being conducted in order to validate this pilot finding and identify new TAS related signalling derangements.
Collapse
Affiliation(s)
| | - Elisa Pin
- George Mason University, Manassas, VA
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Mesker WE, Johnstone EC, van Pelt GW, Midgley R, Liefers GJ, Smit VT, Kerr DJ, Tollenaar RA. Abstract 811: Stroma production within the primary tumor correlates with poor survival for stage I-II colon cancer patients. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Recent models on metastatic invasion focus on the tumor-“host” interface, in particular the role of the stromal tissue. The stromal compartments are thought to play a major role in the process of wound healing, but there is also strong emphasis that CAF's (cancer-associated fibroblasts) are important promotors for tumor growth and progression. Assuming these models are correct we hypothesized that changes in the proportion of stroma in the primary tumor could reflect progression. We therefore investigated if the amount of intra-tumor stroma could be used as a candidate marker to identify which patients should be selected for adjuvant therapy and furthermore if treatment with a COX-2 inhibitor might improve patient outcome in those patients with high percentage of stroma (with or without chemotherapy)
Methods We have investigated the proportion of intra-tumor stroma on heamatoxylin-eosin (H&E) stained histological sections and distinguished between patients with a high amount of stroma (stroma-high) and patients with lower levels of stroma (stroma-low).
We have analyzed 135 stage I-II colon cancer patients for the proportion of tumor related stroma and for TGFβ-R2, SMAD4 and β-catenin, markers involved in pathways related to stromal production and epithelial-to-mesenchymal transition (EMT).
A series of 596 patients treated either with placebo or COX-2 inhibitor was also analyzed for proportion of stroma (VICTOR-trial).
Results
Of 135 analyzed patients 35 (25.7%) patients were stroma-high and 101 (74.3%) stroma-low. Significant differences in survival were observed between the two groups, with stroma-high patients showing poor survival (OS p<0.0001, HZ 2.59; DFS p=0.0002, HZ 2.31).
A high-risk group (n=14) was identified with stroma-high and SMAD4 loss (OS p=0.008, HZ 7.98, CI 4.12-15.44, DFS p=0.005, HZ 6.57, CI 3.43-12.56); 12 of 14 (85.7%) patients died within 3 years. In a logistic-regression analysis a high proportion of stroma and SMAD4 loss were strongly related (HZ 5.42, CI 2.13-13.82, p<0.001).
Results of the COX-2 inhibitor study are currently under evaluation but will be presented at the conference.
Conclusions: Conventional haematoxylin-eosin stained tumor slides contain more prognostic information than previously fathomed. This can be utilized by assessing the tumor-stroma ratio. The combination of analyzing the tumor-stroma ratio and staining for SMAD4 results in an independent parameter for confident prediction of clinical outcome. The inclusion of this parameter into standard pathological reports should be considered, in addition to the TNM classification.
Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 811.
Collapse
Affiliation(s)
| | - Elaine C. Johnstone
- 2Department of Clinical Pharmacology, Oxford University, Oxford, United Kingdom
| | | | - Rachel Midgley
- 2Department of Clinical Pharmacology, Oxford University, Oxford, United Kingdom
| | | | | | - David J. Kerr
- 2Department of Clinical Pharmacology, Oxford University, Oxford, United Kingdom
| | | |
Collapse
|
27
|
Mesker WE, Liefers GJ, Junggeburt JMC, van Pelt GW, Alberici P, Kuppen PJK, Miranda NF, van Leeuwen KAM, Morreau H, Szuhai K, Tollenaar RAEM, Tanke HJ. Presence of a high amount of stroma and downregulation of SMAD4 predict for worse survival for stage I-II colon cancer patients. Cell Oncol 2009; 31:169-78. [PMID: 19478385 PMCID: PMC4618830 DOI: 10.3233/clo-2009-0478] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND For stage I-II colon cancer a significant number (5-25%) of patients has recurrent disease within 5 years. There is need to identify these high-risk patients as they might benefit from additional treatment. Stroma-tissue surrounding the cancer cells plays an important role in the tumor behavior. The proportion of intra-tumor stroma was evaluated for the identification of high-risk patients. In addition, protein expression of markers involved in pathways related to stroma production and epithelial-to-mesenchymal transition (EMT) was analyzed: beta-catenin, TGF-beta-R2 and SMAD4. METHODS In a retrospective study of 135 patients with stage I-II colon cancer, the amount of stroma was estimated on routine haematoxylin-eosin stained histological sections. Sections were also immunohistochemically stained for beta-catenin, TGF-beta-R2 and SMAD4. RESULTS Of 135 analyzed patients 34 (25.2%) showed a high proportion of stroma (stroma-high) and 101 (74.8%) a low proportion (stroma-low). Significant differences in overall-survival and disease-free-survival were observed between the two groups, with stroma-high patients showing poor survival (OS p<0.001, HZ 2.73, CI 1.73-4.30; DFS p<0.001, HZ 2.43, CI 1.55-3.82). A high-risk group was identified with stroma-high and SMAD4 loss (OS p=0.008, HZ 7.98, CI 4.12-15.44, DFS p=0.005, HZ 6.57, CI 3.43-12.56); 12 of 14 (85.7%) patients died within 3 years. In a logistic-regression analysis a high proportion of stroma and SMAD4 loss were strongly related (HZ 5.42, CI 2.13-13.82, p<0.001). CONCLUSIONS Conventional haematoxylin-eosin stained tumor slides contain more prognostic information than previously fathomed. This can be unleashed by assessing the tumor-stroma ratio. The combination of analyzing the tumor-stroma ratio and staining for SMAD4 results in an independent parameter for confident prediction of clinical outcome.
Collapse
Affiliation(s)
- Wilma E Mesker
- Department of Molecular Cell Biology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|