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Sandonà D, Grossi U, Vittadello F, Frasson A, Sarzo G, Zucchella M, Mammano E, Passuello N. Laparoscopic resection of a retrorectal cystic tumor. Tech Coloproctol 2023; 27:1405-1406. [PMID: 37131115 DOI: 10.1007/s10151-023-02806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Affiliation(s)
- D Sandonà
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - U Grossi
- Surgery Unit 2, Regional Hospital Treviso, Piazzale dell'Ospedale 1, 31100, Treviso, Italy.
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, Padua, Italy.
| | - F Vittadello
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - A Frasson
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - G Sarzo
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - M Zucchella
- Surgery Unit 2, Regional Hospital Treviso, Piazzale dell'Ospedale 1, 31100, Treviso, Italy
| | - E Mammano
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
| | - N Passuello
- Department of Surgery, Hospital Sant' Antonio, University of Padua, Padua, Italy
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2
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Passuello N, Polese L, Ometto G, Grossi U, Mammano E, Vittadello F, Frasson A, Tessari E, Bartolotta P, Gregori D, Sarzo G. Outcomes of Laparoscopic Surgery in Very Elderly Patients with Colorectal Cancer: A Survival Analysis and Comparative Study. J Clin Med 2023; 12:7122. [PMID: 38002734 PMCID: PMC10672623 DOI: 10.3390/jcm12227122] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Colorectal cancer (CRC) is a global health concern, particularly among the elderly population. This study aimed to assess the impact of laparoscopic surgery on CRC patients aged ≥80 years. (2) Methods: We conducted a retrospective analysis of prospectively collected data from consecutive CRC patients who underwent surgery at our institution between July 2018 and July 2023. The patients were categorized into three groups: those aged over 80 who underwent laparoscopic surgery (Group A), those aged over 80 who underwent open surgery (Group B), and those under 80 who underwent laparoscopic surgery (Group C). We examined various clinical and surgical parameters, including demographic data, medical history, surgical outcomes, and survival. (3) Results: Group A (N = 113) had shorter hospital stays than Group B (N = 23; p = 0.042), with no significant differences in complications or 30-day outcomes. Compared to Group C (N = 269), Group A had higher comorbidity indices (p < 0.001), more emergency admissions, anemia, low hemoglobin levels, colonic obstruction (p < 0.001), longer hospital stays (p < 0.001), and more medical complications (p = 0.003). Laparotomic conversion was associated with obstructive neoplasms (p < 0.001), and medical complications with ASA scores (p < 0.001). Both the medical and surgical complications predicted adverse 30-day outcomes (p = 0.007 and p < 0.001). Survival analysis revealed superior overall survival (OS) in Group A vs. Group B (p < 0.0001) and inferior OS vs. Group C (p < 0.0001). After a landmark analysis, the OS for patients aged 80 or older and those under 80 appeared to be similar (HR 2.55 [0.75-8.72], p = 0.136). (4) Conclusions: Laparoscopic surgery in very elderly CRC patients shows comparable oncological outcomes and surgical complications to younger populations. Survival benefits are influenced by age, comorbidities, and medical complications. Further prospective multicenter studies are needed in order to validate these findings.
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Affiliation(s)
- Nicola Passuello
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
| | - Giulia Ometto
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
- Surgery Unit 2, Regional Hospital Treviso, 31100 Treviso, Italy
| | - Enzo Mammano
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Fabrizio Vittadello
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Alvise Frasson
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Emanuela Tessari
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (P.B.); (D.G.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (P.B.); (D.G.)
| | - Giacomo Sarzo
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
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3
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Nicoletto MO, Baldoni A, Cavallin F, Grego A, Falci C, Nardin M, Mammano E, Lai E, Torri V. Oxaliplatin prior to PARP inhibitor in BRCA-mutated ovarian cancer. Ther Adv Med Oncol 2023; 15:17588359231173181. [PMID: 37360767 PMCID: PMC10288417 DOI: 10.1177/17588359231173181] [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: 04/22/2022] [Accepted: 04/13/2023] [Indexed: 06/28/2023] Open
Abstract
Background The use of PARP inhibitor (PARPi) has shown a considerable benefit in progression-free survival (PFS) in relapsed, platinum-sensitive epithelial ovarian cancer (OC). Objective Our study aimed to investigate the impact of the last platinum-based chemotherapy treatment in response to PARPi. Design Retrospective cohort study. Patients and methods The study involved 96 consecutive, pretreated, platinum-sensitive advanced OC patients. Demographics and clinical data were retrieved from clinical records. PFS and overall survival (OS) were calculated from the start of PARPi. Results Germline BRCA mutation was investigated in all cases. Platinum-based chemotherapy before PARPi maintenance therapy included pegylated liposomal doxorubicin-oxaliplatin (PLD-Ox) in 46 patients (48%) and other platinum-based chemotherapy in 50 patients (52%). During a median follow-up of 22 months from the beginning of PARPi therapy, 57 patients relapsed (median PFS: 12 months) and 64 patients died (median OS: 23 months). During multivariable analysis, receiving PLD-Ox before PARPi was associated with improved PFS [hazard ratio (HR): 0.46, 95% CI: 0.26-0.82] and OS (HR: 0.48, 95% CI: 0.27-0.83). In 36 BRCA-mutated patients, PLD-Ox was associated with improved PFS (2-year PFS: 70.0% versus 25.0%, p = 0.02). Conclusion Receiving PLD-Ox before PARPi may improve prognosis in platinum-sensitive advanced OC patients and may provide advantages in the BRCA-mutated subgroup.
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Affiliation(s)
| | - Alessandra Baldoni
- Department of Medical Oncology, AULSS 3 Serenissima, Mirano Hospital, Mirano, (VE), Italy
| | | | - Andrea Grego
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Cristina Falci
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Margherita Nardin
- Radiology department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Enzo Mammano
- Department of Surgery, Ospedale Sant’Antonio, Padova, Italy
| | - Eleonora Lai
- Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Valter Torri
- Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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4
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Monsellato I, Garibaldi E, Cassinotti E, Baldari L, Boni L, Elmore U, Delpini R, Rosati R, Perinotti R, Alongi F, Bertocchi E, Gori S, Ruffo G, Pernazza G, Pulighe F, De Nisco C, Morpurgo E, Contardo T, Mammano E, Perna F, Menegatti B, Coratti A, Buccianti P, Balestri R, Ceccarelli C, Cavaliere D, Solaini L, Ercolani G, Traverso E, Fusco V, Torri V, Orecchia S. Expression levels of circulating miRNAs as biomarkers during multimodal treatment of rectal cancer - TiMiSNAR-mirna: a substudy of the TiMiSNAR Trial (NCT03962088). Trials 2020; 21:678. [PMID: 32711544 PMCID: PMC7382047 DOI: 10.1186/s13063-020-04568-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 07/02/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy followed by surgery is the mainstay treatment for locally advanced rectal cancer, leading to significant decrease in tumor size (downsizing) and a shift towards earlier disease stage (downstaging). Extensive histopathological work-up of the tumor specimen after surgery including tumor regression grading and lymph node status helped to visualize individual tumor sensitivity to chemoradiotherapy, retrospectively. As the response to neoadjuvant chemoradiotherapy is heterogeneous, however, valid biomarkers are needed to monitor tumor response. A relevant number of studies aimed to identify molecular markers retrieved from tumor tissue while the relevance of blood-based biomarkers is less stringent assessed. MicroRNAs are currently under investigation to serve as blood-based biomarkers. To date, no screening approach to identify relevant miRNAs as biomarkers in blood of patients with rectal cancer was undertaken. The aim of the study is to investigate the role of circulating miRNAs as biomarkers in those patients included in the TiMiSNAR Trial (NCT03465982). This is a biomolecular substudy of TiMiSNAR Trial (NCT03962088). METHODS All included patients in the TiMiSNAR Trial are supposed to undergo blood collection at the time of diagnosis, after neoadjuvant treatment, after 1 month from surgery, and after adjuvant chemotherapy whenever indicated. DISCUSSION TiMiSNAR-MIRNA will evaluate the association of variation between preneoadjuvant and postneoadjuvant expression levels of miRNA with pathological complete response. Moreover, the study will evaluate the role of liquid biopsies in the monitoring of treatment, correlate changes in expression levels of miRNA following complete surgical resection with disease-free survival, and evaluate the relation between changes in miRNA during surveillance and tumor relapse. TRIAL REGISTRATION Clinicaltrials.gov NCT03962088 . Registered on 23 May 2019.
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Affiliation(s)
- Igor Monsellato
- Department of Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy
| | - Elisabetta Garibaldi
- Department of Radiation Oncology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ludovica Baldari
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ugo Elmore
- Ospedale San raffaele IRCCS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | - Emilio Morpurgo
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Tania Contardo
- Ospedale Civile Pietro Cosma, Camposampiero, Padova, Italy
| | - Enzo Mammano
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Federico Perna
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Andrea Coratti
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | | | | | | | | | | | - Elena Traverso
- Department of Oncology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Vittorio Fusco
- Department of Oncology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Valter Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Sara Orecchia
- Department of Pathology, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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Monsellato I, Alongi F, Bertocchi E, Gori S, Ruffo G, Cassinotti E, Baldari L, Boni L, Pernazza G, Pulighe F, De Nisco C, Perinotti R, Morpurgo E, Contardo T, Mammano E, Elmore U, Delpini R, Rosati R, Perna F, Coratti A, Menegatti B, Gentilli S, Baroffio P, Buccianti P, Balestri R, Ceccarelli C, Torri V, Cavaliere D, Solaini L, Ercolani G, Traverso E, Fusco V, Rossi M, Priora F, Numico G, Franzone P, Orecchia S. Correction to: Standard (8 weeks) vs long (12 weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR). BMC Cancer 2020; 20:128. [PMID: 32066408 PMCID: PMC7026949 DOI: 10.1186/s12885-020-6632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Igor Monsellato
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | | | | | | | | | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ludovica Baldari
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | - Emilio Morpurgo
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant'Antonio, Padova, Italy
| | - Tania Contardo
- Ospedale Civile Pietro Cosma, Padova, Camposampiero, Italy
| | - Enzo Mammano
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant'Antonio, Padova, Italy
| | - Ugo Elmore
- Ospedale San raffaele IRCCS, Milan, Italy
| | | | | | - Federico Perna
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Coratti
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Sergio Gentilli
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | - Paolo Baroffio
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | | | | | | | - Valter Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | - Elena Traverso
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Vittorio Fusco
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maura Rossi
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Priora
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G Numico
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paola Franzone
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Orecchia
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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6
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Monsellato I, Alongi F, Bertocchi E, Gori S, Ruffo G, Cassinotti E, Baldarti L, Boni L, Pernazza G, Pulighe F, De Nisco C, Perinotti R, Morpurgo E, Contardo T, Mammano E, Elmore U, Delpini R, Rosati R, Perna F, Coratti A, Menegatti B, Gentilli S, Baroffio P, Buccianti P, Balestri R, Ceccarelli C, Torri V, Cavaliere D, Solaini L, Ercolani G, Traverso E, Fusco V, Rossi M, Priora F, Numico G, Franzone P, Orecchia S. Standard (8 weeks) vs long (12 weeks) timing to minimally-invasive surgery after NeoAdjuvant Chemoradiotherapy for rectal cancer: a multicenter randomized controlled parallel group trial (TiMiSNAR). BMC Cancer 2019; 19:1215. [PMID: 31842784 PMCID: PMC6912945 DOI: 10.1186/s12885-019-6271-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal timing of surgery in relation to chemoradiation is still controversial. Retrospective analysis has demonstrated in the recent decades that the regression of adenocarcinoma can be slow and not complete until after several months. More recently, increasing pathologic Complete Response rates have been demonstrated to be correlated with longer time interval. The purpose of the trial is to demonstrate if delayed timing of surgery after neoadjuvant chemoradiotherapy actually affects pathologic Complete Response and reflects on disease-free survival and overall survival rather than standard timing. METHODS The trial is a multicenter, prospective, randomized controlled, unblinded, parallel-group trial comparing standard and delayed surgery after neoadjuvant chemoradiotherapy for the curative treatment of rectal cancer. Three-hundred and forty patients will be randomized on an equal basis to either robotic-assisted/standard laparoscopic rectal cancer surgery after 8 weeks or robotic-assisted/standard laparoscopic rectal cancer surgery after 12 weeks. DISCUSSION To date, it is well-know that pathologic Complete Response is associated with excellent prognosis and an overall survival of 90%. In the Lyon trial the rate of pCR or near pathologic Complete Response increased from 10.3 to 26% and in retrospective studies the increase rate was about 23-30%. These results may be explained on the relationship between radiation therapy and tumor regression: DNA damage occurs during irradiation, but cellular lysis occurs within the next weeks. Study results, whether confirmed that performing surgery after 12 weeks from neoadjuvant treatment is advantageous from a technical and oncological point of view, may change the current pathway of the treatment in those patient suffering from rectal cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT3465982.
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Affiliation(s)
- Igor Monsellato
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | | | | | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ludovica Baldarti
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | | | - Emilio Morpurgo
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Tania Contardo
- Ospedale Civile Pietro Cosma, Padova, Camposampiero Italy
| | - Enzo Mammano
- Ospedale Civile Pietro Cosma, Camposampiero/Ospedale Sant’Antonio, Padova, Italy
| | - Ugo Elmore
- Ospedale San raffaele IRCCS, Milan, Italy
| | | | | | - Federico Perna
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Andrea Coratti
- Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Sergio Gentilli
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | - Paolo Baroffio
- Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara, Italy
| | | | | | | | - Valter Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | - Elena Traverso
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Vittorio Fusco
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Maura Rossi
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabio Priora
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - G. Numico
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paola Franzone
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Sara Orecchia
- Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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7
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Piccoli M, D'Angelo E, Crotti S, Sensi F, Urbani L, Maghin E, Burns A, De Coppi P, Fassan M, Rugge M, Rizzolio F, Giordano A, Pilati P, Mammano E, Pucciarelli S, Agostini M. Decellularized colorectal cancer matrix as bioactive microenvironment for in vitro 3D cancer research. J Cell Physiol 2018; 233:5937-5948. [PMID: 29244195 DOI: 10.1002/jcp.26403] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 12/25/2022]
Abstract
Three-dimensional (3D) cancer models are overlooking the scientific landscape with the primary goal of bridging the gaps between two-dimensional (2D) cell lines, animal models and clinical research. Here, we describe an innovative tissue engineering approach applied to colorectal cancer (CRC) starting from decellularized human biopsies in order to generate an organotypic 3D-bioactive model. This in vitro 3D system recapitulates the ultrastructural environment of native tissue as demonstrated by histology, immunohistochemistry, immunofluorescence and scanning electron microscopy analyses. Mass spectrometry of proteome and secretome confirmed a different stromal composition between decellularized healthy mucosa and CRC in terms of structural and secreted proteins. Importantly, we proved that our 3D acellular matrices retained their biological properties: using CAM assay, we observed a decreased angiogenic potential in decellularized CRC compared with healthy tissue, caused by direct effect of DEFA3. We demonstrated that following a 5 days of recellularization with HT-29 cell line, the 3D tumor matrices induced an over-expression of IL-8, a DEFA3-mediated pathway and a mandatory chemokine in cancer growth and proliferation. Given the biological activity maintained by the scaffolds after decellularization, we believe this approach is a powerful tool for future pre-clinical research and screenings.
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Affiliation(s)
- Martina Piccoli
- Stem Cells and Regenerative Medicine Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy.,Department of Biomedical Sciences, University of Padua, Padua, Italy
| | - Edoardo D'Angelo
- Nanoinspired Biomedicine Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy.,First Surgical Clinic Section, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Sara Crotti
- Nanoinspired Biomedicine Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy
| | - Francesca Sensi
- Nanoinspired Biomedicine Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy.,Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Luca Urbani
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Institute of Hepatology, Foundation for Liver Research, London, United Kingdom
| | - Edoardo Maghin
- Stem Cells and Regenerative Medicine Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy
| | - Alan Burns
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Paolo De Coppi
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy
| | - Massimo Rugge
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua, Padua, Italy.,Veneto Tumor Registry, Padua, Italy
| | - Flavio Rizzolio
- Department of Translational Research, Pathology Unit, IRCCS-National Cancer Institute, Aviano, Italy.,Department of Molecular Sciences and Nanosystems at Ca' Foscari University, Venice, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | | | | | - Salvatore Pucciarelli
- First Surgical Clinic Section, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Marco Agostini
- Nanoinspired Biomedicine Lab, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padua, Italy.,First Surgical Clinic Section, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
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Bergamo F, Lonardi S, Battaglin F, Marsico VA, Paladina I, Crivellari G, Galiano A, Rumano' L, Bellu L, Carcea E, Bortoletto G, Fiduccia P, Bertorelle R, Mammano E, Rugge M, Cillo U, Nitti D, Zagonel V. Metastatic colorectal cancer (mCRC) treatment: A high-volume, single-center, real-life experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.733] [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
733 Background: Few data are available on outcome of clinical practice unselected patients (pts) with mCRC. Methods: We retrospectively collected data of pts with mCRC followed at our Institution from January 2010 to December 2013 evaluating the clinical characteristics, treatments and survival outcomes. Results: A total of 584 pts were evaluated, 461 were followed at our Center while 123 were seen for a second opinion. Median age was 66 ys (25-94), 59% were male, 63% had an ECOG PS = 0 while 11% ≥2. 33% had right colon primary, 68% synchronous metastatic (mts) disease and 70% a single mts site. 81% underwent surgery on primary and 41% on metastases. 51% were RAS mutated (mut) and 5% BRAF mut. 57 pts didn't receive any systemic treatment, 33 due to frail clinical conditions and 24 due to radical surgical approach (R0). Among 404 treated pts, 239 received all 3 available cytotoxic agents (oxaliplatin, irinotecan, 5FU), 324 bevacizumab and 98 anti-EGFR; 153 (38%) were enrolled in clinical trials. Median overall survival (OS) was 27.6 months (mo) for the entire mCRC population, 3.7 mo for untreated frail pts, 28.7 mo for treated pts while it is still not reached for untreated R0 pts. OS was significantly longer for pts receiving first line combination therapy (29 vs 17 mo, p < 0.01) while a poor prognosis was confirmed for BRAF mut pts (p < 0.001). In a multivariate analysis age < 70, PS 0 and R0 surgery on mts disease showed a positive prognostic impact on OS while a right site of primary was a negative predictor of outcome. At logistic regression older age, low PS and peritoneal disease negatively affected the possibility to receive all 3 active drugs. Conclusions: Despite being an unselected population our outcomes are comparable with results of clinical trials in the corresponding period. We feel that such positive evidence derives from a personalization of treatment and a multidisciplinary approach to mts disease.
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Affiliation(s)
- Francesca Bergamo
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Sara Lonardi
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Francesca Battaglin
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Valentina Angela Marsico
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Isabella Paladina
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Gino Crivellari
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Antonella Galiano
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Laura Rumano'
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Luisa Bellu
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Elena Carcea
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - Gladis Bortoletto
- Unità Sperimentazioni Cliniche e Biostatistica, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Pasquale Fiduccia
- Unità Sperimentazioni Cliniche e Biostatistica, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Roberta Bertorelle
- Molecular Immunology and Oncology, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | | | - Massimo Rugge
- Department of Medicine, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation, Padua University Hospital, Padova, Italy
| | - Donato Nitti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Vittorina Zagonel
- Dipartimento di Oncologia Clinica e Sperimentale, UOC Oncologia Medica I, Istituto Oncologico Veneto-IRCCS, Padova, Italy
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Silvestri A, Calvert V, Belluco C, Lipsky M, De Maria R, Deng J, Colombatti A, De Marchi F, Nitti D, Mammano E, Liotta L, Petricoin E, Pierobon M. Protein pathway activation mapping of colorectal metastatic progression reveals metastasis-specific network alterations. Clin Exp Metastasis 2012; 30:309-16. [PMID: 23053743 DOI: 10.1007/s10585-012-9538-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/14/2012] [Indexed: 02/08/2023]
Abstract
The mechanism by which tissue microecology influences invasion and metastasis is largely unknown. Recent studies have indicated differences in the molecular architecture of the metastatic lesion compared to the primary tumor, however, systemic analysis of the alterations within the activated protein signaling network has not been described. Using laser capture microdissection, protein microarray technology, and a unique specimen collection of 34 matched primary colorectal cancers (CRC) and synchronous hepatic metastasis, the quantitative measurement of the total and activated/phosphorylated levels of 86 key signaling proteins was performed. Activation of the EGFR-PDGFR-cKIT network, in addition to PI3K/AKT pathway, was found uniquely activated in the hepatic metastatic lesions compared to the matched primary tumors. If validated in larger study sets, these findings may have potential clinical relevance since many of these activated signaling proteins are current targets for molecularly targeted therapeutics. Thus, these findings could lead to liver metastasis specific molecular therapies for CRC.
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Affiliation(s)
- Alessandra Silvestri
- Center for Applied Proteomics and Molecular Medicine, George Mason University, 10900 University Blvd., Manassas, VA, 20110, USA
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10
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Mammano E, Galdi F, Pierobon M, Tessari E, Deng J, Pucciarelli S, Agostini M, De Marchi F, Canzonieri V, De Paoli A, Belluco C, Liotta L, Petricoin E, Pilati P, Nitti D. Multiplexed protein signal pathway mapping identifies patients with rectal cancer that responds to neoadjuvant treatment. Clin Colorectal Cancer 2012; 11:268-74. [PMID: 22658458 DOI: 10.1016/j.clcc.2012.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 03/05/2012] [Accepted: 05/02/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Currently there is no reliable technique for predicting clinical or pathologic complete tumor response after radiochemotherapy (RCT) in patients with rectal cancer. We applied reverse phase protein microarray (RPMA) technology to find a signal pathway that may predict the response to preoperative treatment. PATIENTS AND METHODS Fifteen rectal cancer samples were collected during preoperative RCT. Seven patients had a good response to preoperative therapy (Mandard grade I-II) and 8 patients had a poor response (Mandard grade III-V). Using laser capture microdissection (LCM) and RPMA analysis, we measured the phosphorylation level of nearly 80 end points and analyzed the signaling pathways. RESULTS We identified 4 signaling proteins whose phosphorylation levels were significantly different (P < .05) between the good vs. poor responders; CHK2 and β-catenin were more highly phosphorylated in poor responders, whereas PDK1 and glycogen synthase kinase (GSK)-3α/β had lower phosphorylation levels in poor responders. Interestingly GSK-3α/β, β-catenin, and PDK1 are all present in the phosphatidylinositol-3-kinase (PI3K)-AKT signaling pathway. CONCLUSIONS Based on our results, we hypothesize that the activating state of the PI3K-AKT pathway can stratify patients who could benefit most from neoadjuvant treatment. Moreover, identification of theranostic targets has the potential to pinpoint new therapeutic strategies for the nonresponsive population.
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Affiliation(s)
- Enzo Mammano
- Clinica Chirurgica II, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy.
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11
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Pilati P, Mocellin S, Bertazza L, Galdi F, Briarava M, Mammano E, Tessari E, Zavagno G, Nitti D. Prognostic Value of Putative Circulating Cancer Stem Cells in Patients Undergoing Hepatic Resection for Colorectal Liver Metastasis. Ann Surg Oncol 2011; 19:402-8. [DOI: 10.1245/s10434-011-2132-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Indexed: 12/11/2022]
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12
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Ferro A, Pilati P, Miotto D, Tessari E, Mammano E, Nitti D. 6034 POSTER Hypoxie Antiblastic Stop-flow Pelvic Perfusion – a Step in the Therapeutic Flow-chart of Recurrent Colorectal Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Zupa A, Improta G, Deng J, Aieta M, Musto P, Liotta LA, Belluco C, Mammano E, Wulfkuhle JD, Petricoin E. Use of protein pathway activation mapping of NSCLC to identify distinct molecular subtypes and a prognostic signature for aggressive node-negative tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Silvestri A, Colombatti A, Calvert VS, Deng J, Mammano E, Belluco C, De Marchi F, Nitti D, Liotta LA, Petricoin EF, Pierobon M. Protein pathway biomarker analysis of human cancer reveals requirement for upfront cellular-enrichment processing. J Transl Med 2010; 90:787-96. [PMID: 20195244 DOI: 10.1038/labinvest.2010.47] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tissues are complex structures composed of different cell types, each of which present specific functions and characteristics. To better understand and measure the effect of tumor cell enrichment on protein pathway profiling and drug target activation measurements, the signaling activation portraits of laser capture microdissected (LCM) cancer epithelium and tumor stroma were compared with patient-matched whole-tissue specimens from 53 primary colorectal cancer samples. Microdissected material and whole-tissue lysate from contiguous cryostat sections were subjected to reverse-phase protein microarray analysis to determine the level of phopshorylation and expression of 75 different proteins known to be involved in cancer progression. The results revealed distinct differences in the protein activation portraits of cancer epithelium and stroma. Moreover, we found that the signaling activation profiles of the undissected whole-tissue specimens are profoundly different from the matched LCM material. Attempts to rescale the undissected pathway information based on percent endogenous tumor epithelium content were unsuccessful in recapitulating the LCM tumor epithelial signatures. Analysis of epidermal growth factor receptor phosphorylation and COX2 expression in these same sample sets revealed wholesale differences in the rank ordering of patient determination when LCM was compared with undissected samples. On the basis of these data, we conclude that accurate protein pathway activation status, which is under evaluation as a basis for patient selection and stratification for personalized therapy, must include upfront cellular-enrichment techniques such as LCM to generate accurate drug target activation status.
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Affiliation(s)
- Alessandra Silvestri
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA, USA
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15
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Pilati P, Mammano E, Mocellin S, Tessari E, Lise M, Nitti D. Hepatic arterial infusion for unresectable colorectal liver metastases combined or not with systemic chemotherapy. Anticancer Res 2009; 29:4139-4144. [PMID: 19846962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The hypothesis was tested that systemic chemotherapy might contribute to improving overall survival (OS) of patients with unresectable colorectal liver metastases treated with hepatic arterial infusion (HAI). PATIENTS AND METHODS We considered 153 consecutive patients retrospectively divided into group A (n=72) treated with HAI alone (floxuridine [FUDR] + leucovorin [LV]), and group B (n=81) treated with HAI combined with systemic chemotherapy (5-fluorouracil [5FU] + LV). RESULTS No significant difference in OS was observed between the two groups. Median OS was better in patients with <50% of liver involvement (21.3 vs. 13.2 months; p<0.0001) and in responders vs. non-responders (24.4 vs. 13.4 months; p<0.0001). The combination of low tumor load with good tumor response to HAI was the only variable retained on multivariate survival analysis, associated with a better clinical outcome (median OS: 34.2 months). CONCLUSION Our study does not support the use of FUDR-based HAI combined or not with 5FU-based systemic chemotherapy as the first-line therapeutic approach to unresectable colorectal cancer liver metastases. The identification of responsive patients would improve the therapeutic index of this HAI regimen.
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Affiliation(s)
- Pierluigi Pilati
- Clinica Chirurgica II, Department of Oncological and Surgical Sciences, University of Padova, 35128 Padova, Italy
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16
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Mammano E, Pilati P, Tessari E, Cosci M, Mocellin S, Nitti D. [Adjuvant chemotherapy after radical liver resection in the treatment of metastases from colorectal carcinoma]. MINERVA CHIR 2009; 64:457-463. [PMID: 19859036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Liver metastases are the leading cause of death in patients with colorectal carcinoma: approximately 25% present with metastases at diagnosis of the primary tumor and 30-50% will eventually develop metastases. Surgical therapy for metastases is the only curative treatment that will ensure five-year survival in 30-60% of patients; however, in 30-50% of these patients liver disease will recur. To improve these rates, various different studies have investigated the efficacy of postsurgical adjuvant therapy. The majority of randomized studies evaluated the efficacy of intra-arterial infusion associated or not with postsurgical systemic adjuvant treatment: this approach demonstrated benefit in terms of control of recurrent of liver disease but not in terms of overall survival. A reduction in the recurrence of liver disease was found in the two randomized studies published to date on the efficacy of systemic adjuvant therapy, and an improvement in survival in one trial. Given these data and the results obtained with the use of last generation chemotherapeutic agents (oxaliplatin and irinotecan) in the treatment of unresectable liver metastases from colorectal carcinoma, it can be conjectured that ongoing randomized clinical trials may confirm a significant advantage of adjuvant chemotherapy in the control of recurrence of liver disease and overall survival.
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Affiliation(s)
- E Mammano
- Clinica Chirurgica II, Dipartimento di Scienze Oncologiche e Chirurgiche, Università di Padova, Padova, Italia.
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17
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Pierobon M, Calvert V, Belluco C, Garaci E, Deng J, Lise M, Nitti D, Mammano E, De Marchi F, Liotta L, Petricoin E. Multiplexed cell signaling analysis of metastatic and nonmetastatic colorectal cancer reveals COX2-EGFR signaling activation as a potential prognostic pathway biomarker. Clin Colorectal Cancer 2009. [PMID: 19739273 DOI: 10.3816/ccc.2009.n] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The identification of prognostic determinants of colorectal cancer (CRC), including prediction of occult metastasis, is of urgent consideration, based on the tremendous differences in outcome and survival between patients who present with metastasis or develop metastasis versus those patients with organ-confined or nonrecurrent disease. Currently, a great deal of attention has been focused on using gene expression profiles of tumor specimens as a launch point for prognostic biomarker discovery. In our study, we chose to focus on functional protein-based pathway biomarkers as a new information archive because it is these proteins that form the functional signaling networks that control cell growth, motility, apoptosis, survival, and differentiation. We used reverse-phase protein microarray analysis of laser capture microdissected CRC tumor specimens to profile broad cell signaling pathways from patients who presented with liver metastasis versus patients who remained recurrence free after follow-up. Our results indicate that members of the EGFR and COX2 signaling pathways appear differentially activated in the primary tumors of patients with synchronous metastatic disease. If validated in larger study sets, this pathway defect might be useful as a prognostic clinical tool as well as a guide to potential therapeutic intervention strategies that target occult disease and/or preventative measure.
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Affiliation(s)
- Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA 20155, USA
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18
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Pierobon M, Silvestri A, Calvert V, Deng J, Belluco C, Nitti D, Colombatti A, Mammano E, Liotta L, Petricoin E. Use of a prognostic pathway signature for colorectal cancer comprised of EGFR/COX2 and imatinib drug target activation to predict occult metastasis in M0 CRC. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4042] [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
4042 Background: Development of distant metastasis is the main cause of death among CRC patients. Approximately 30% of CRC patients initially staged M0-N0 die from tumor recurrence. Previously, we determined that members of EGFR/PDGFR/cAbl/cKit pathways were hyperactivated in hepatic synchronous CRC metastasis compared to primary tumor. In order to determine if this signature was a distinguished repertoire of the early stage primary tumor, we analyzed 58 CRC M0 at the moment of the diagnosis that upon 5 yr follow-up had differing disease progressions. Methods: All tissues were immediately snap frozen after surgery. Reverse phase protein microarray (RPMA) was performed using microdissected material to generate multiplexed pathway profiling. For each sample 75 different endpoints were analyzed. Results: Statistical comparison of the 75 endpoints in 8 M0 patients who progressed to M1 and 50 patients who remained M0 regardless of initial staging, revealed a number of signaling proteins whose activation/phosphorylation were elevated and subsumed in a linked pathway. Specifically COX2 and c-Kit/PDGFR/Notch were highly activated in the 8 patients with occult metastasis. A prognostic pathway signature comprised of 13 interlinked molecules was developed. Univariate, ROC and Kaplan-Meier analysis of this signature revealed a statistically significant prognostic signature with an AUC of 0.87 and a 95% confidence interval. Conclusions: A signaling portrait of 13 interlinked proteins provided a strong prognostic indicator for metastasis regardless of stage. This signature was comprised of the phosphorylation/activation of growth factor receptors, including the entire suite of Gleevec targets. A large number of these prognostic signature components were previously found activated in the metastatic lesions themselves which indicates a potential functional role of this linked protein network in metastatic progression and maintenance. If validated in larger study sets, clinical trials to test Gleevec therapy combined with Cox2 /EGFR inhibitors to prevent/delay development of distant metastasis in patients with M0 should be considered. [Table: see text]
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Affiliation(s)
- M. Pierobon
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - A. Silvestri
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - V. Calvert
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - J. Deng
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - C. Belluco
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - D. Nitti
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - A. Colombatti
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - E. Mammano
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - L. Liotta
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
| | - E. Petricoin
- George Mason University, Manassas, VA; CRO–IRCCS, National Cancer Institute, Aviano, Italy; University of Padua, Padova, Italy
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19
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Pierobon M, Calvert V, Belluco C, Garaci E, Deng J, Lise M, Nitti D, Mammano E, Marchi FD, Liotta L, Petricoin E. Multiplexed Cell Signaling Analysis of Metastatic and Nonmetastatic Colorectal Cancer Reveals COX2-EGFR Signaling Activation as a Potential Prognostic Pathway Biomarker. Clin Colorectal Cancer 2009; 8:110-7. [PMID: 19423505 DOI: 10.3816/ccc.2009.n.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The identification of prognostic determinants of colorectal cancer (CRC), including prediction of occult metastasis, is of urgent consideration, based on the tremendous differences in outcome and survival between patients who present with metastasis or develop metastasis versus those patients with organ-confined or nonrecurrent disease. Currently, a great deal of attention has been focused on using gene expression profiles of tumor specimens as a launch point for prognostic biomarker discovery. In our study, we chose to focus on functional protein-based pathway biomarkers as a new information archive because it is these proteins that form the functional signaling networks that control cell growth, motility, apoptosis, survival, and differentiation. We used reverse-phase protein microarray analysis of laser capture microdissected CRC tumor specimens to profile broad cell signaling pathways from patients who presented with liver metastasis versus patients who remained recurrence free after follow-up. Our results indicate that members of the EGFR and COX2 signaling pathways appear differentially activated in the primary tumors of patients with synchronous metastatic disease. If validated in larger study sets, this pathway defect might be useful as a prognostic clinical tool as well as a guide to potential therapeutic intervention strategies that target occult disease and/or preventative measure.
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Affiliation(s)
- Mariaelena Pierobon
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, VA Clinica Chirurgica II, Department of Oncological and Surgical Sciences, University of Padova, Italy
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20
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Mammano E, Cosci M, Zanon A, Picchi G, Tessari E, Pilati P, Nitti D. Celiomesenteric trunk aneurysm. Ann Vasc Surg 2008; 23:257.e7-10. [PMID: 18809283 DOI: 10.1016/j.avsg.2008.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 05/11/2008] [Accepted: 08/11/2008] [Indexed: 11/29/2022]
Abstract
A celiomesenteric trunk (CMT) is an extremely rare anatomic variant that consists of celiac and superior mesenteric arteries having a common origin from the aorta. CMT accounts for less than 1% of all splanchnic artery anomalies. Aneurysm involving a CMT is an even rarer vascular abnormality, and, to our knowledge, only eight cases of CMT aneurysm have been reported in literature. We describe a case of the incidental finding of CMT aneurysm in an asymptomatic patient. It was found after dorsolumbar column radiography and successive computed tomography and arteriography confirmed the diagnosis. Even if asymptomatic, we decided to repair it surgically with aneurysmectomy and suture of the neck due to risk of rupture.
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Affiliation(s)
- Enzo Mammano
- Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
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21
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Mammano E, Belluco C, Bonafé M, Olivieri F, Mugianesi E, Barbi C, Mishto M, Cosci M, Franceschi C, Lise M, Nitti D. Association of p53 polymorphisms and colorectal cancer: modulation of risk and progression. Eur J Surg Oncol 2008; 35:415-9. [PMID: 18468835 DOI: 10.1016/j.ejso.2008.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Accepted: 03/13/2008] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES p53 Gene variants BstUI RFLP at codon 72 in exon 4, 16bp tandem repeat in intron 3 and MspI RFLP in intron 6, which code for two functionally different protein isoforms, have been shown to modulate susceptibility to different types of human neoplasms. METHODS p53 genotype was assessed in 90 CRC patients, 321 age-matched controls and 322 centenarians. RESULTS The p53 codon 72 arginine, the p53 16bp deletion, and the MspI RFLP were significantly more frequent in CRC patients in comparison to the controls and to the centenarians (odd ratio 1.44 and 1.93). In the CRC group, the BstUI RFLP polymorphism was the more frequent combination (62.2%), and it was significantly associated with highly infiltrating (p<0.01), poorly differentiated (p<0.01), and metastatic (p<0.05) tumours. Our findings indicate that the p53 codon 72 polymorphisms are associated with a higher risk of CRC and are associated with more advanced and undifferentiated tumours.
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Affiliation(s)
- E Mammano
- Surgical Oncology, IOV-IRCSS, Padova, Italy.
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22
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Wulfkuhle JD, Speer R, Pierobon M, Laird J, Espina V, Deng J, Mammano E, Yang SX, Swain SM, Nitti D, Esserman LJ, Belluco C, Liotta LA, Petricoin EF. Multiplexed cell signaling analysis of human breast cancer applications for personalized therapy. J Proteome Res 2008; 7:1508-17. [PMID: 18257519 DOI: 10.1021/pr7008127] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Phosphoprotein driven cellular signaling events represent most of the new molecular targets for cancer treatment. Application of reverse-phase protein microarray technology for the study of ongoing signaling activity within breast tumor specimens holds great potential for elucidating and profiling signaling activity in real-time for patient-tailored therapy. Analysis of laser capture microdissection primary human breast tumors and metastatic lesions reveals pathway specific profiles and a new way to classify cancer based on functional signaling portraits. Moreover, the data demonstrate the requirement of laser capture microdissection for analysis and reveal the metastasis-specific changes that occur within a new microenvironment. Analysis of biopsy material from clinical trials for targeted therapeutics demonstrates the feasibility and utility of comprehensive signal pathway activation profiling for molecular analysis.
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Affiliation(s)
- Julia D Wulfkuhle
- Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia 20110, USA.
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Mammano E, Zanon A, Picchi G, Rossi CR, Rossi G, Cosci M, Miotto D, Nitti D. Primary great saphenous vein leiomyosarcoma: Report of a case. Surg Today 2008; 38:161-2. [DOI: 10.1007/s00595-007-3588-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 04/23/2007] [Indexed: 11/30/2022]
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Belluco C, Petricoin EF, Mammano E, Facchiano F, Ross-Rucker S, Nitti D, Di Maggio C, Liu C, Lise M, Liotta LA, Whiteley G. Serum proteomic analysis identifies a highly sensitive and specific discriminatory pattern in stage 1 breast cancer. Ann Surg Oncol 2007; 14:2470-6. [PMID: 17594124 DOI: 10.1245/s10434-007-9354-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 01/05/2007] [Indexed: 01/14/2023]
Abstract
BACKGROUND Mass spectrometry (MS)-based profiling was used to determine whether ion fingerprints could distinguish women with stage 1 breast cancer from women without breast cancer. METHODS The initial study population consisted of 310 subjects: 155 women with yearly negative breast examination and negative mammography findings for at least 4 years, and 155 women undergoing surgery for pathology-proven stage 1 invasive ductal carcinoma. High-resolution SELDI-TOF (surface-enhanced laser desorption ionization-time of flight) analysis was performed on serum obtained from blood samples collected before mammography in controls, and before surgery in patients with breast cancer. Samples were divided into a training (109 controls and 109 cancers) and blinded (46 controls and 46 cancers) testing set; each group had similar age demographics. In addition, an independent study set of 46 serum samples was analyzed 14 months after the initial study to validate the robustness of the classifier. RESULTS A discriminatory profile consisting of seven ion peaks found in the training set, when applied to the blinded test set, achieved a sensitivity and specificity of 95.6% and 86.5%, respectively. This same seven-peak profile achieved a 96.5% sensitivity and 85.7% specificity, with correct identification of all of 17 T1a tumors when applied to the validation study set. CONCLUSIONS Mass spectrometry profiling of human serum generated a robust classifier composed of seven low-molecular-weight ions that yielded a highly sensitive and specific diagnostic procedure for the discrimination of women with stage 1 breast cancer compared with women without breast cancer in this research study set.
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Affiliation(s)
- Claudio Belluco
- Department of Surgery, CRO-IRCCS, National Cancer Institute, Via Franco Gallini, 2, 33081 Aviano (PN), Italy.
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Pierobon M, Calvert V, Lipsky M, Sheehan K, Speer R, Mammano E, Belluco C, Nitti D, Liotta L, Petricoin E. Personalized therapy for metastatic colorectal cancer: A closer possibility? J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4131] [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
4131 Background: Colorectal cancer (CRC) is the second leading cause of cancer related death in the Western world, and survival rate is closely associated with the development of metastases. Personalized targeted therapies promise to have a dramatic impact on the treatment of cancer over the next decade. The molecular fingerprint of a patient’s tumor is the basis for specific targeted therapy. Most often, we are not measuring what we are treating. If we choose therapy based on the primary tumor, but we are treating the metastasis, we are likely giving the wrong therapy if the two microenvironments are not equivalent. In this study we employed reverse phase protein microarrays (RPPA) to compare the protein kinases signal pathway derangements in the primary CRC and in its synchronous liver metastasis. Methods: Pure cell populations of 34 cases of patient-matched CRC and hepatic metastases (collected at the same surgical time) were isolated through laser capture microdissection and then lysed. The lysed cells were evaluated using RPPA technology that allowed us to analyze the activation status of 80 different kinases. Data analysis was performed using commercially available software. Results: Of the 80 kinases only 20 endpoints were significantly (p< 0.05) altered between the two populations. These endpoints were contained within just a few signaling pathways, including the PI3K-AKT prosurvival pathway and the c-kit/PDGFr/c-abl growth factor pathway. We noted a significant increase in phosphorylation of AKT along with a decrease in phosphorylation of PTEN in the liver metastasis compared to the matched primary tumors. This is in keeping with what is known about AKT since phosphorylation of PTEN serves to destabilize the protein, which serves as a natural upstream suppressor of AKT kinase. Conclusions: Specific cell signaling pathways, such as the PI3K-AKT and the c-kit/PDGFr/c-abl growth factor signaling pathway, are significantly altered and activated in hepatic metastasis compared to the primary colorectal site. Since the data reveals elevation in kinase activity increases on a pathway-wide level, a rational hypothesis can be developed whereby combinations of drugs such as an AKT- mTOR inhibitor and/or Gleevec may be an effective and novel therapeutic strategy for the treatment of metastatic CRC. No significant financial relationships to disclose.
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Affiliation(s)
- M. Pierobon
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - V. Calvert
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - M. Lipsky
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - K. Sheehan
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - R. Speer
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - E. Mammano
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - C. Belluco
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - D. Nitti
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - L. Liotta
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
| | - E. Petricoin
- George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; Padova University, Padova, Italy; Centro di Riferimento Oncologico, Aviano, Italy
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Marchet A, Mocellin S, Belluco C, Ambrosi A, DeMarchi F, Mammano E, Digito M, Leon A, D'Arrigo A, Lise M, Nitti D. Gene expression profile of primary gastric cancer: towards the prediction of lymph node status. Ann Surg Oncol 2006; 14:1058-64. [PMID: 17106627 DOI: 10.1245/s10434-006-9090-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 06/05/2006] [Accepted: 06/05/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND The identification of gastric tumors associated with a higher risk of lymph node metastasis could help surgeons select patients who may benefit from extended lymph node dissection. The aim of this study was to screen the genome in the search of primary gastric cancer gene expression profiles that might predict lymph node status. METHODS The gene expression profile was evaluated in frozen tumor samples obtained from 32 patients with primary gastric adenocarcinomas. The array consisted of a duplicated spot panel of 5,541 human genes. To classify node-positive (N+) and node-negative (N-) cases, a logistic regression model was fitted optimizing the Akaike Information Criteria after a stepwise gene selection. The accuracy was evaluated by means of leave-one-out cross validation. RESULTS All patients underwent radical gastrectomy and extended lymphadenectomy. Of all the cases, 21 were N+ and 11 demonstrated no lymph node involvement (N-). After quality filtering, the analysis of variance selected a set of 136 genes potentially correlated with nodal involvement (P value <.05). Of these 136 genes, 5 were differentially expressed (adjusted P value <.05). After a stepwise gene selection, only three genes (Bik, aurora kinase B, eIF5A2) were retained in the logistic model, which could correctly predict lymph node status in 30 of 32 cases. CONCLUSIONS If our findings were confirmed, the identified gene pattern might be used to tailor the extent of lymph node dissection on a single patient basis.
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Affiliation(s)
- Alberto Marchet
- Clinica Chirurgica II, Dipartimento di Scienze Oncologiche e Chirurgiche, Istituto Oncologico Veneto IRCCS and University of Padova, Padova, Italy
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Mammano E, Belluco C, Sciro M, Mencarelli R, Agostini M, Michelotto M, Marchet A, Nitti D. Epidermal growth factor receptor (EGFR): mutational and protein expression analysis in gastric cancer. Anticancer Res 2006; 26:3547-50. [PMID: 17094480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Since specific epidermal growth factor receptor (EGFR) somatic mutations have been demonstrated to influence the response to anti-EGFR therapy in non-small cell lung cancer, EGFR gene mutational analysis of different types of neoplasm is under investigation. PATIENTS AND METHODS EGFR protein expression and gene mutations in exons 18, 19 and 21 were investigated in 49 gastric adenocarcinomas. RESULTS no specific EGFR gene mutations were detected, while EGFR positive staining was detected in 6% of the cases. CONCLUSION Our findings indicate that in gastric adenocarcinoma, specific EGFR gene mutations are very rare or absent and the rate of EGFR protein expression is low.
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Affiliation(s)
- Enzo Mammano
- Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
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Pierobon M, Calvert V, Lipsky M, Sheehan K, Speer R, Mammano E, Belluco C, Wulfkuhle J, Nitti D, Liotta L, Petricoin E. Alterations in molecular networks of metastatic colorectal carcinoma reveal organ-specific signatures: Implications for targeted therapy of metastatic disease. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3532] [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
3532 Background: Proteomic analysis of aberrant protein kinase activity is poised to provide crucial knowledge that could drive molecular-targeted therapeutics and personalized medicine. Many cancers are detected at late stages when metastasis has already occurred. Knowledge about the molecular derangements in the metastatic lesion is crucial for the rational selection of therapeutics. Very little is known about the signaling networks in the metastatic microenvironment. We employed reverse phase protein microarrays coupled to laser capture microdissection for a multiplexed phosphoproteomic fingerprint of colorectal metastatic disease to begin to understand the molecular functional changes that occur upon metastasis. Methods: 68 frozen cases of patient-matched colorectal cancer and hepatic metastasis, 15 cases of pulmonary metastasis, and 27 cases of hepatic metastasis of other primary cancers including breast, melanoma, pancreatic, ovarian, and stomach cancers (all taken at the same time at surgery), were subjected to laser capture microdissection. Procured tumor epithelia (20,000 cells per sample), were lysed and subjected to reverse phase protein microarray analysis. Using this technique, we measured the phosphorylation state of 75 kinase substrates. Molecular network analysis was performed using commercially available software. Results: Our results indicate that, unlike analysis of gene microarray data, we observe a significant difference between the molecular networks of activated kinase substrates within the metastatic lesion compared to the patient-matched primary tumor. In fact, despite overall patient-specific heterogeneity of the portraits, organ specific signatures that were independent of the primary origin of the tumor were identified. Conculsions: Effective treatment in the new era of personalized targeted therapeutics will require the ability to understand the functional activation of cellular signaling pathways since these are the drug targets themselves. Our results indicate that treatment of metastatic disease, and patient stratification for matching with the appropriate therapy may be organ-specific and not predicated upon the primary site of the disease. No significant financial relationships to disclose.
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Affiliation(s)
- M. Pierobon
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - V. Calvert
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - M. Lipsky
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - K. Sheehan
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - R. Speer
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - E. Mammano
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - C. Belluco
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - J. Wulfkuhle
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - D. Nitti
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - L. Liotta
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
| | - E. Petricoin
- University of Padova, Padova, Italy; George Mason University, Manassas, VA; University of Maryland, Baltimore, MD; National Cancer Institute, Bethesda, MD; CRO Aviano Hospital, Aviano, Italy
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Castaldi F, Marino M, Beneduce L, Belluco C, De Marchi F, Mammano E, Nitti D, Lise M, Fassina G. Detection of circulating CEA-IgM complexes in early stage colorectal cancer. Int J Biol Markers 2006; 20:204-8. [PMID: 16398401 DOI: 10.1177/172460080502000402] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We have recently shown that alpha fetoprotein (AFP) and squamous cell carcinoma antigen (SCCA), biomarkers associated with hepatocellular carcinoma, may be detected in patient sera as circulating immune complexes with IgM, and that assessment of serum levels of AFP-IgM and SCCA-IgM may be used for the detection of liver cancer. In this study we measured the levels of carcinoembryonic antigen (CEA) as free form (FCEA) and complexed to IgMs (CEA-IgM) in sera of patients affected by colorectal carcinoma (CRC) at different stages as well as in healthy subjects. FCEA levels were above the 5 ng/mL cutoff in 43% of CRC patients (31/72) and CEA-IgM levels were above the 200 AU/mL cutoff in 38% of CRC patients (27/72). Serum levels of CEA-IgM immune complexes (IC) and FCEA did not overlap and 64% of patients (46/72) were positive for at least one marker without compromising the detection specificity (94%). Early detection of CRC was significantly improved by CEA-IgM IC assay. CRC patients at an early stage (stage 1) had elevated CEA-IgM levels in 29% of cases (7/24), while FCEA levels were elevated in only 8% of cases (2/24). These results indicate that CEA-IgM is a complementary serological marker to FCEA which is much more sensitive for early stage CRC, and that the combination of these biomarkers may be useful in the early detection of colorectal cancer.
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Nitti D, Marchet A, Mammano E, Ambrosi A, Belluco C, Mencarelli R, Maino M, Marconato G, Farinati F, Lise M. Extended lymphadenectomy (D2) in patients with early gastric cancer. Eur J Surg Oncol 2005; 31:875-81. [PMID: 16051460 DOI: 10.1016/j.ejso.2005.05.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 05/12/2005] [Accepted: 05/18/2005] [Indexed: 02/06/2023] Open
Abstract
AIMS To investigate the survival benefit of extended lymphadenectomy (D2) in EGC patients in one European Institution. METHODS A review was made of our prospective gastric database from January 1980 to December 2001. Of 527 patients with primary gastric adenocarcinoma, 119 with EGC underwent potentially curative resection (R0) with D2 lymphadenectomy. RESULTS There were two post-operative deaths. Of the 117 evaluable cases, 96 were classified as N0 and 21 as N+, with metastases in the perigastric lymph nodes (level 1) in 13, and beyond this site (level 2) in eight. Five-year survival was 85.9 and 83.0% in N0 and N+ patients, respectively. During a median follow-up of 90 months, five of the eight patients with level 2 metastases died of recurrent disease and three were alive. The estimated survival benefit for 119 patients with EGC was 2.5% (3/119 cases). CONCLUSIONS In patients with EGC, metastases to level 2 are rare. Our results indicate that D2 lymphadenectomy has a limited survival benefit and that in these cases a less extensive lymphadenectomy (D1) could be performed.
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Affiliation(s)
- D Nitti
- Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
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Belluco C, Mammano E, Petricoin E, Prevedello L, Calvert V, Liotta L, Nitti D, Lise M. Kinase substrate protein microarray analysis of human colon cancer and hepatic metastasis. Clin Chim Acta 2005; 357:180-3. [PMID: 15921671 DOI: 10.1016/j.cccn.2005.03.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 03/09/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver metastases represent the major determinant of survival in patients with colorectal cancer (CRC). In cases with unresectable liver disease, more effective agents are needed, since chemotherapy achieves median survival of only 15 months. Protein kinases coordinate complex functions that are often disregulated in cancer and are therefore considered important targets for molecular therapeutics. In this study, we investigated the phosphoproteomic status of different protein kinases in primary CRC and in liver metastases. METHODS The status of 29 key endpoints was evaluated using reverse phase protein array on laser capture microdissected neoplastic cells from five primary CRCs without metastases, three patient-matched primary CRCs and synchronous liver metastases and five CRC metachronous liver metastases. RESULTS Unsupervised hierarchical two-way clustering analysis showed an entirely different phosphoproteomic profile in primary CRCs compared to liver metastases. This difference was observed also in primary and metastatic patient-matched lesions. CONCLUSIONS Our findings of different signaling pathways between primary and metastatic CRC suggest a possible microenvironment effect, and emphasize the need to perform molecular network analysis of metastatic tissue when molecular targeting is considered.
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Affiliation(s)
- Claudio Belluco
- Department of Oncological and Surgical Science, Surgery Branch, University of Padova, Padova, Italy.
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D'Arrigo A, Belluco C, Ambrosi A, Digito M, Esposito G, Bertola A, Fabris M, Nofrate V, Mammano E, Leon A, Nitti D, Lise M. Metastatic transcriptional pattern revealed by gene expression profiling in primary colorectal carcinoma. Int J Cancer 2005; 115:256-62. [PMID: 15688387 DOI: 10.1002/ijc.20883] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Metastatic spread to the liver is the major contributor to mortality in patients with colorectal carcinoma (CRC). In order to seek for gene expression patterns associated with metastatic potential in primary CRC, we compared the transcriptional profiles of 10 radically resected primary CRCs from patients who did not develop distant metastases within a 5-year follow-up period with those of 10 primary/metastatic tumor pairs from patients with synchronous liver metastases. To focus selectively on neoplastic cells, the study was conducted on laser-microdissected bioptic tissues. Arrays of 7,864 human cDNAs were utilized. While a striking transcriptional similarity was observed between the primary tumors and their distant metastases, the nonmetastasizing primary tumors were clearly distinct from the primary/metastatic tumor pairs. Of 37 gene expression differences found between the 2 groups of primary tumors, 29 also distinguished nonmetastasizing tumors from metastases. The gene encoding for mannosyl (alpha-1,3-)-glycoprotein beta-1,4-N-acetyl-glucosaminyl-transferase (GnT-IV) became significantly upregulated in primary/metastatic tumor pairs (p < 0.001). GnT-IV upregulation was confirmed by RT-PCR. These data support the existence of a specific transcriptional signature distinguishing primary colon adenocarcinomas with different metastatic potential, the further pursuit of which may lead to relevant clinical and therapeutic applications.
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Belluco C, D'Arrigo A, Digito M, Esposito G, Ambrost A, Bertola A, Mammano E, Leon A, Nitti D, Lise M. Gene expression profiling of primary and metastatic colorectal cancer. Ann Surg Oncol 2004. [DOI: 10.1007/bf02524153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Belluco C, Olivieri F, Bonafè M, Giovagnetti S, Mammano E, Scalerta R, Ambrosi A, Franceschi C, Nitti D, Lise M. -174 G>C polymorphism of interleukin 6 gene promoter affects interleukin 6 serum level in patients with colorectal cancer. Clin Cancer Res 2003; 9:2173-6. [PMID: 12796383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE Experimental data suggest that interleukin 6 (IL-6) plays an important role in the development and progression of metastasis from colorectal cancer (CRC), and -174 G>C polymorphism has been identified recently in the IL-6 gene promoter. Therefore, the aim of the present study was to investigate the significance of this type of polymorphism in patients with CRC. EXPERIMENTAL DESIGN Using enzyme immunoassay, IL-6 concentrations were measured in preoperative serum samples from 65 stage I-IV CRC patients. DNA was extracted from peripheral blood mononuclear cells, and -174 G>C polymorphism detected using PCR, followed by NlaIII restriction enzyme digestion and electrophoresis. RESULTS The median IL-6 serum level was 0.14 pg/ml in patients with stage I-III disease versus 0.41 pg/ml in patients with stage IV disease (P < 0.001). DNA amplification was possible in 62 cases. On grouping genotypes at the -174 G>C locus as C+ (CC and CG) and C- (GG), a significant association was observed between the type of polymorphism and IL-6 serum level: the median value for IL-6 was 0.14 pg/ml in C+ patients (n = 32) and 0.32 pg/ml in C- patients (n = 30; P = 0.034). Moreover, in patients with hepatic metastasis the median level of IL-6 was 0.23 pg/ml in C+ patients (n = 9) and 0.96 pg/ml in C- patients (n = 9; P = 0.004). CONCLUSIONS In patients with CRC, the -174 G>C polymorphism status of the IL-6 gene promoter affects the IL-6 serum level, particularly in the presence of hepatic metastasis.
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Affiliation(s)
- Claudio Belluco
- Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
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Nitti D, Belluco C, Mammano E, Marchet A, Ambrosi A, Mencarelli R, Segato P, Lise M. Low level of p27(Kip1) protein expression in gastric adenocarcinoma is associated with disease progression and poor outcome. J Surg Oncol 2002; 81:167-75; discussion 175-6. [PMID: 12451619 DOI: 10.1002/jso.10172] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Low tumor expression of the p27(Kip1) protein, which is involved in cell cycle control and apoptosis, is considered a negative prognostic factor in different types of cancer. The aim of this study was to evaluate the clinical and pathological significance of low p27(Kip1) protein expression in patients who had undergone resection for gastric adenocarcinoma. METHODS p27(Kip1) protein was studied by immunohistochemistry in formalin-fixed tumor sections from 95 patients who underwent resection for gastric adenocarcinoma between 1991 and 1996. Based on the median value of protein expression, p27(Kip1) protein expression was classified as low or high. RESULTS Low p27(Kip1) protein expression was significantly associated with tumor de-differentiation, increased penetration through the gastric wall, lymph node metastasis, and advanced tumor stage. In the group of 84 patients who underwent curative surgery, 5-year survival was 74% in cases with high p27(Kip1) protein expression and 38% in those with low p27(Kip1) protein expression (P < 0.001). At multivariate analysis, low p27(Kip1) protein expression was an independent negative prognostic factor for survival (RR = 3.671; P = 0.004). CONCLUSIONS In gastric adenocarcinoma, low p27(Kip1) protein expression is associated with poorly differentiated and advanced tumors and is a negative prognostic factor of potential clinical value.
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Affiliation(s)
- Donato Nitti
- Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy.
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