New Artificial Intelligence Score and Immune Infiltrates as Prognostic Factors in Colorectal Cancer With Brain Metastases

The METACER national cohort study of brain metastases in gastrointestinal cancers prospectively establishes prognostic factors

PURPOSE

Availability data are scarce and primarily retrospective in patients with brain metastasis (BM) from gastrointestinal (GI) cancers. The objective of this cohort was to determine prognostic factors for survival outcomes in patients with BM from GI cancers.

METHODS

METACER is a national multicentric prospective cohort study which included patients with BM diagnosis during a histologically proven digestive cancer follow-up between 2010 and 2014. The primary endpoint was overall survival (OS). The secondary endpoints were Progression-Free survival (PFS), prognostic factors, and BM-free survival as time from disease diagnosis to BM diagnosis.

RESULTS

METACER included 130 patients, with colorectal cancer (CRC) (N = 105) and eso-gastric (N = 25) cancer (EGC). The median OS was 6.6 months: 7.1 months (95%CI: 4.7-9.7) in CRC patients and 5.2 months, (95%CI: 1.9-7.6) in EG patients (p = 0.827). In multivariate analysis, cerebral BM location (versus cerebellar), BM surgery, performance status (0-1 versus 2), and a unique BM were significantly associated with prolonged OS. BM-free survival were 30.8 months (95%CI:25.2-36.9) in CRC patients and 7.8 months (95%CI:3.8-13.6) in EGC patients (p < 0.001). In synchronous metastatic disease, BM-free survival were 18.6 months (95%CI:13.1-25.2) in CRC patients and 3.7 months (95%CI:0.03-7.8) in EGC patients (p < 0.001).

CONCLUSION

BM in GI cancers are of poor prognosis. BM surgery should be considered in case of unique brain lesion. In metastatic settings, EGC patients have shorter BM-free survival than CRC patients.

Immune cell infiltrates in peritoneal metastases from colorectal cancer

Background

The presence of peritoneal metastases (PMs) in patients with colorectal cancer (CRC) confers a poor prognosis and only a minority of patients will benefit from the available treatment options. In primary CRC tumors, it is well established that a high infiltration of CD8+ effector T cells correlates to a favorable patient outcome. In contrast, the immune response induced in PMs from CRC and how it relates to patient survival is still unknown. In this study, we characterized the immune infiltrates and the distribution of immune checkpoint receptors on T cells from PMs from CRC, in order to evaluate the potential benefit of checkpoint blockade immunotherapy for this patient group.

Methods

Surgically resected PM tissue from CRC patients (n=22) and synchronous primary tumors (n=8) were processed fresh to single cell suspensions using enzymatic digestion. Surface markers and cytokine production were analyzed using flow cytometry.

Results

T cells dominated the leukocyte infiltrate in the PM specimens analyzed, followed by monocytes and B cells. Comparing two different PMs from the same patient usually showed a similar distribution of immune cells in both samples. The T cell infiltrate was characterized by an activated phenotype and markers of exhaustion were enriched compared with matched circulating T cells, in particular the checkpoint receptors PD-1 and TIGIT. In functional assays most cytotoxic and helper T cells produced INF-γ and TNF following polyclonal stimulation, while few produced IL-17, indicating a dominance of Th1-type responses in the microenvironment of PMs.

Conclusion

Immune cells were present in all PMs from CRC examined. Although infiltrating T cells express markers of exhaustion, they produce Th1-type cytokines when stimulated. These results indicate the possibility to augment tumor-specific immune responses within PMs using checkpoint blockade inhibitors.

The Impact of Artificial Intelligence in Improving Polyp and Adenoma Detection Rate During Colonoscopy: Systematic-Review and Meta-Analysis

INTRODUCTION

Colonoscopy may detect colorectal polyp and facilitate its removal in order to prevent colorectal cancer. However, substantial miss rate for colorectal adenomas detection still occurred during screening colonoscopy procedure. Nowadays, artificial intelligence (AI) have been employed in trials to improve polyp detection rate (PDR) and adenoma detection rate (ADR). Therefore, we would like to determine the impact of AI in increasing PDR and ADR.

METHODS

The present study adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA 2020) statement. To identify relevant literature, comprehensive searches were conducted on major scientific databases, including Pubmed, EBSCO-host, and Proquest. The search was limited to articles published up to November 30, 2022. Inclusion criteria for the study encompassed full-text accessibility, articles written in the English language, and randomized controlled trials (RCTs) that reported both ADR and PDR values, comparing conventional diagnostic methods with AI-aided approaches. To synthesize the data, we computed the combined pooled odds ratio (OR) using a random-effects model. This model was chosen due to the expectation of considerable heterogeneity among the selected studies. To evaluate potential publication bias, the Begg's funnel diagram was employed.

RESULTS

A total of 13 studies were included in this study. Colonoscopy with AI had significantly higher PDR compared to without AI (pooled OR 1.46, 95% CI 1.13-1.89, p = 0.003) and higher ADR (pooled OR 1.58, 95% CI 1.37-1.82, p < 0.00001). PDR analysis showed moderate heterogeneity between included studies (p = 0.004; I2=63%). Furthermore, ADR analysis showed moderate heterogeneity (p < 0.007; I2 = 57%). Additionally, the funnels plot of ADR and PDR analysis showed an asymmetry plot and low publication bias.

CONCLUSION

AI may improve colonoscopy result quality through improving PDR and ADR.

Neoadjuvant immunochemotherapy with pembrolizumab plus chemotherapy in resectable non-small cell lung cancer

Background

Neoadjuvant immunotherapy, the focus of current research and treatment modality for long-term survival, has become one of the main options in supporting primary treatment interventions in early NSCLC.

Methods

This was a retrospective analysis of patients with locally resectable NSCLC who received the neoadjuvant drug pembrolizumab combined with chemotherapy and underwent surgical resection. Pathological responses, PFS and OS in the whole sample and subgroups were analyzed.

Results

Of the 61 patients included in this retrospective analysis, 31 (50.82%) achieved a pCR, and 38 (62.30%) obtained an MPR. Patients with a pCR had significantly higher OS than the non-pCR group (HR = 0.093, P = 0.0227); patients with an MPR also had significantly elevated OS compared with the non-MPR group (HR = 0.05357, P = 0.0169). Patients with lymph node metastasis after surgery had significantly reduced OS (HR = 0.01607, p = 0.0004) and PFS (HR = 0.08757, p = 0.0004) than those without lymph node metastasis. There was no significant difference in OS and PFS between squamous cell carcinomas (SCC) group and adenocarcinomas (AD) group. No significant differences in OS and PFS were found between patients administered 2 and 3 cycles of neoadjuvant therapy before surgery, between those administered ≤5 and > 5 cycles of adjuvant therapy post-surgery, and between patients with TPS <50% and ≥50% (all P > 0.05).

Conclusion

Neoadjuvant immunochemotherapy with pembrolizumab plus chemotherapy in non-small cell lung cancer is safe and tolerable. Both pCR and MPR were closely associated with OS and PFS, reflecting a good response of tumor tissues to drug therapy. Lymph node metastasis after surgery was a poor prognostic factor, reducing OS and PFS.

Single-fraction SRS and multiple-fraction SRT for brain metastases from colorectal cancer

Objective

Brain metastasis from colorectal cancer (CRC) is rare. Although stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) are effective treatments for brain metastasis, reports on brain metastasis of CRC are limited. This study compared the efficacy of SRT and SRS for the treatment of brain metastases from CRC and analysed the related factors to reveal the specificity CRC-derived brain metastasis.

Methods

A retrospective analysis of 116 patients with brain metastases from colorectal cancer was performed and included 56 patients in the SRT group and 60 patients in the SRS group. The clinical characteristics of the two groups were analysed, and the local tumour control rate, overall survival time and radiation-induced brain injury were compared between the two groups.

Results

The objective response rates of the SRT and SRS groups were 76.8% and 66.7%, respectively, while the local control rates at 6 months were 87.5% and 81.6%, respectively, and no significant differences were observed between the groups (P=0.295). The median overall survival time was 10.3 months for all patients and was 10.9 months in the SRT group and 9.8 months in the SRS group, with no significant difference between the groups (P=0.123). A multivariate analysis showed that the main factors of poor prognosis were low GPA score (P=0.002), KRAS mutation (P=0.035), extracranial metastasis (P=0.005) and no bevacizumab treatment (P=0.001). No significant difference was observed in the incidence of acute and late radiation-induced injury between the two groups.

Conclusion

Both SRT and SRS are effective methods for the treatment of CRC-derived brain metastases. The simultaneous use of bevacizumab may be one of the most important factors that affects the survival of these patients.

Potential role of PRKCSH in lung cancer: bioinformatics analysis and a case study of Nano ZnO

PRKCSH, also known as glucosidase II beta, functions as a contributor to lung tumorigenesis by regulating the cell cycle in a p53-dependent manner under severe environmental stress. However, the prognostic value and molecular mechanisms by which the level of PRKCSH is significantly increased in cancer cells are not clearly understood. Here, we first generated a biological profile of PRKCSH expression changes in cancers by analysing bioinformatic data from cancer databases. We found that higher PRKCSH expression was correlated with a poorer prognosis and greater infiltration of most immune cell types in patients with lung cancer. In particular, PRKCSH expression showed significant negative correlations with the level of STAT6 (r = -0.31, p < 0.001) in lung cancer tissues. We further found that PRKCSH deficiency promoted G2/M arrest in response to zinc oxide nanoparticle (Nano ZnO) treatment in A549 cells. With regard to the mechanism, PRKCSH deficiency may induce STAT6 translocation to the nucleus to activate p53 expression through binding to the p53 promoter region from -365 bp to +126 bp. Eventually, activated p53 contributed to Nano-ZnO-induced G2/M arrest in lung cancer cells. Taken together, our data provide new insights into immunotherapy target choices and the prognostic value of PRKCSH. Since the G2/M cell cycle checkpoint is crucial for lung cancer prognosis, targeting PRKCSH expression to suppress the activation of the STAT6/p53 pathway is a potential therapeutic strategy for managing lung cancer.