Molecular correlates and prognostic value of tmTNF-α expression in colorectal cancer of 5-Fluorouracil-Based Adjuvant Therapy

Transmembrane tumor necrosis factor-α (tmTNF-α) is known to induce the activation of NF-κB to protect tumor cells. Upregulation of tmTNF-α leads to resistance to apoptosis and induces drug resistance in breast cancer. However, the expression of tmTNF-α in colorectal cancer (CRC) and its association with clinical outcome in CRC have remained unclear. In this study, we examined the tmTNF-α expression in CRC by immunohistochemistry and western blotting, assessed the prognostic value of tmTNF-α related to the recurrence/metastasis and survival of stage II/III CRC by the Kaplan-Meier survival curve and Cox regression model, and also explored the role of tmTNF-α expression on the chemotherapeutic efficacy of 5-Fluorouracil by flow cytometry assay and cell counting kit-8 (CCK-8) in vitro. Overall, we found that 77 (78.6%) out of 98 patients exhibited higher tmTNF-α expression in the CRC tissues comparing with the adjacent tissues. The tmTNF-α expression was correlated with Differentiation (P = 0.019), TNM stage (P = 0.039), Lymph nodes metastasis (P = 0.024) and Lymphovascular invasion (P = 0.027) but not related with Age (P = 0.617), Gender (P = 0.625), Tumor location (P = 0.138), Perforation/Obstruction (P = 1.000), Depth of invasion (P = 0.327), and microsatellite instability status (P = 0.150). The prognostic analyses showed that high tmTNF-α expression patients was significantly associated with decreased Disease-Free Survival (P = 0.0209) and Overall Survival (P = 0.0163). CCK-8 results suggested that the tmTNF-α influenced the chemotherapeutic effect of 5-Fluorouracil on colon cancer cells. Altogether, these data indicated the stageII/III CRC patients with high tmTNF-α expression were more likely to have a worse prognosis than patients with low tmTNF-α expression and tmTNF-α may influence the chemotherapeutic effect of 5-Fluorouracil. The mechanism for these observations warrants further study.

Occult neoplastic cells in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer

In the present study, we investigated the correlation between the presence of occult neoplastic cells (ONCs) in lymph node sinuses and recurrence/metastasis of stage II/III gastric cancer in 164 patients who underwent radical curative resection. We calculated the five-year relapse-free survival rate (5Y-RFS) and five-year overall survival rate (5Y-OS) of the ONC(+) and ONC(-) groups. The 5Y-RFS was 71.4% in the ONC(-) group and 47.5% in the ONC(+) group (P=0.003). The 5Y-OS was 68.8 and 48.4%, respectively (P=0.008). ONCs were found in 34.8% of stage II patients and were also detected in 66.7% of stage III patients. For distinguishing between the recurrence and non-recurrence groups, the sensitivity of ONC(+) was 64.5% (40/62; P=0.003), the positive predictive value (PPV) was 49.4% (40/81), the specificity was 59.8% (61/102) and the negative predictive value (NPV) was 73.5% (61/83). This high sensitivity indicates that ONC positivity may be a significant indicator for high-risk patients in the early postoperative period, and a lack of ONCs may be a useful indicator for identifying low-risk patients, as patients without ONCs had a high NPV.

Prognostic effect of CEA, AFP, CA19‑9 and CA242 for recurrence/metastasis of gastric cancer following radical gastrectomy

The present study aimed to determine the potential of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen (CA)19-9 and CA242 in predicting recurrence/metastasis of gastric cancer in patients following radical gastrectomy. The clinical data of 368 patients with stage I-III gastric cancer who underwent radical gastrectomy were analyzed, and CEA, AFP, CA19-9 and CA242 levels were detected prior to surgery and 6-12 months following surgery. Univariate and multivariate analyses were used to evaluate the potential risk factors for post-operative recurrence/metastasis of gastric cancer, and the predictive value of CEA, AFP, CA19-9 and CA242 levels was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC). Cumulative survival rates were calculated using Kaplan-Meier analysis, and statistical significance was evaluated using a log-rank test. Results of the univariate analysis demonstrated that open surgery, age ≥70, total gastrectomy, disease stage III, and pre-operative CA19-9 and CA242 positivity were risk factors for recurrence/metastasis. ROC curve analysis revealed that the AUC values of postoperative CA19-9 were higher than other values. According to the Kaplan-Meier survival analysis, patients with negative CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a higher five-year survival rate than those who exhibited positive levels of these tumor markers. In addition, patients with positive CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a significantly worse prognosis. Collectively, the results of the present study indicated that CEA, AFP, CA19-9 and CA242 exhibited potential as predictive biomarkers for recurrence/metastasis following radical gastrectomy in patients with gastric cancer. Notably, CA19-9 and CA242 may exhibit the highest potential in predicting recurrence/metastasis.

Psychological Adjustment and Related Factors in Patients with Recurrence/Metastatic Lung Cancer after Curative Surgery

The purpose of study was to clarify the psychological adjustment and related factors in lung cancer patients with recurrence/metastasis after curative surgery. Forty-one with lung cancer who were informed of a recurrence/metastasis after curative surgery completed a questionnaire comprised of the Mental Adjustment to Cancer Scale (MAC), Psychological Adjustment scale for Cancer Survivors (PACS), and information pertaining to demographic variables. When healthcare providers intervene in patients with lung cancer that has recurred/metastasized after curative surgery, it is necessary to assess patients' psychological adjustment based on demographic information, such as age, sex, marital status, and employment status, and to provide effective support promptly. Factors associated with psychological adjustment with recurrent/metastatic lung cancer after curative surgery were 1) female, 2) having a job, 3) over 65 years of age, 4) having a spouse, and 5) advanced-stage cancer. There was no difference in psychological adjustment between treatment and the period from cancer incidence to recurrence/metastatic. J. Med. Invest. 70 : 200-207, February, 2023.