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Pan Z, Wang Y, Li S, Cai H, Guan G. The prognostic role of the change in albumin-derived neutrophil-to-lymphocyte ratio during neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. Biomol Biomed 2024; 24:612-624. [PMID: 38041687 PMCID: PMC11088900 DOI: 10.17305/bb.2023.9787] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/12/2023] [Indexed: 12/03/2023]
Abstract
The prognosis of patients with locally advanced rectal cancer (LARC) has improved with the adoption of a multidisciplinary treatment approach combining neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME). Developing real-time, sensitive biomarkers to monitor systemic changes during nCRT is of paramount importance. Although the association between albumin-derived neutrophil-to-lymphocyte ratio (Alb-dNLR) and prognosis in various cancers is established, its prognostic value in LARC patients undergoing nCRT is not well-studied. This study enrolled a cohort of 618 LARC patients, stratifying them into two groups according to their change in Alb-dNLR (∆Alb-dNLR) values, using an optimal cut-off point: a low ∆Alb-dNLR group (≤ 0.90) and a high ∆Alb-dNLR group (> 0.90). The prognostic significance of ∆Alb-dNLR was evaluated using a Cox proportional hazards model. The 5-year overall survival (OS) rates were 75.2% in the low ∆Alb-dNLR group (≤ 0.90) and 85.9% in the high ∆Alb-dNLR group (>0.90) (P < 0.001). The 5-year disease-free survival (DFS) rates were 71.2% and 80.6%, respectively (P = 0.016). Multivariate analyses demonstrated that both ∆Alb-dNLR and pre-Alb-dNLR were independent prognostic factors for OS (P ≤ 0.001), while ∆Alb-dNLR was demonstrated as an independent prognostic factor for DFS (P = 0.016). A predictive nomogram, incorporating the ∆Alb-dNLR subgroup, demonstrated enhanced performance (concordance index [C-index] of 0.720 for OS and 0.690 for DFS) compared to the pre-treatment Alb-dNLR subgroup (C-index of 0.700 for OS and of 0.680 for DFS). Therefore, ∆Alb-dNLR shows significant potential as a usable and prognostic biomarker for predicting OS and DFS in LARC patients undergoing nCRT.
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Affiliation(s)
- Zhen Pan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ye Wang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shoufeng Li
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Huajun Cai
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fuzhou, China
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Koukourakis IM, Xanthopoulou E, Koukourakis MI, Tiniakos D, Kouloulias V, Zygogianni A. IFN-Type-I Response and Systemic Immunity in Rectal Adenocarcinoma Patients Treated with Conventional or Hypofractionated Neoadjuvant Radiotherapy. Biomolecules 2024; 14:448. [PMID: 38672465 PMCID: PMC11048635 DOI: 10.3390/biom14040448] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
The IFN-type-I pathway is involved in radiotherapy (RT)-mediated immune responses. Large RT fractions have been suggested to potently induce this pathway. Neoadjuvant hypofractionated short-course (scRT) and conventional long-course (lcRT) RT applied for the treatment of locally advanced rectal adenocarcinoma patients provides a unique model to address the immuno-stimulatory properties of RT on a systemic level. We prospectively analyzed the IFNβ plasma levels and lymphocyte counts (LCs) of rectal adenocarcinoma patients before and after treatment with scRT (n = 22) and lcRT (n = 40). Flow cytometry was conducted to assess the effects on lymphocytic subpopulations in a subset of 20 patients. A statistically significant increase in the post-RT IFNβ plasma levels was noted in patients undergoing scRT (p = 0.004). Improved pathological tumor regression was associated with elevated post-RT IFNβ levels (p = 0.003). Although all patients experienced substantial lymphopenia after treatment, the post-RT LC of patients treated with scRT were significantly higher compared to lcRT (p = 0.001). Patients undergoing scRT displayed significantly lower percentages of regulatory CD4+/CD25+ T-cells after therapy (p = 0.02). scRT enables effective stimulation of the IFN-type-I pathway on a systemic level and confers decreased lymphocytic cytotoxicity and limited regulatory T-cell activation compared to lcRT, supporting its increasing role in immuno-RT trials.
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Affiliation(s)
- Ioannis M. Koukourakis
- Radiation Oncology Unit, 1st Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens (NKUOA), 11528 Athens, Greece;
| | - Erasmia Xanthopoulou
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.X.); (M.I.K.)
| | - Michael I. Koukourakis
- Department of Radiotherapy/Oncology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.X.); (M.I.K.)
| | - Dina Tiniakos
- Department of Pathology, Aretaieion University Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece;
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Vassilis Kouloulias
- Radiotherapy Unit, 2nd Department of Radiology, Attikon Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens (NKUOA), 11528 Athens, Greece;
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Parigger T, Gassner FJ, Drothler S, Scherhäufl C, Hödlmoser A, Schultheis L, Bakar AA, Huemer F, Greil R, Geisberger R, Weiss L, Zaborsky N. Combined DNA Analysis from Stool and Blood Samples Improves Tumor Tracking and Assessment of Clonal Heterogeneity in Localized Rectal Cancer Patients. Technol Cancer Res Treat 2024; 23:15330338241252706. [PMID: 38766867 DOI: 10.1177/15330338241252706] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Objectives: In this study, stool samples were evaluated for tumor mutation analysis via a targeted next generation sequencing (NGS) approach in a small patient cohort suffering from localized rectal cancer. Introduction: Colorectal cancer (CRC) causes the second highest cancer-related death rate worldwide. Thus, improvements in disease assessment and monitoring that may facilitate treatment allocation and allow organ-sparing "watch-and-wait" treatment strategies are highly relevant for a significant number of CRC patients. Methods: Stool-based results were compared with mutation profiles derived from liquid biopsies and the gold standard procedure of tumor biopsy from the same patients. A workflow was established that enables the detection of de-novo tumor mutations in stool samples of CRC patients via ultra-sensitive cell-free tumor DNA target enrichment. Results: Notably, only a 19% overall concordance was found in mutational profiles across the compared sample specimens of stool, tumor, and liquid biopsies. Conclusion: Based on these results, the analysis of stool and liquid biopsy samples can provide important additional information on tumor heterogeneity and potentially on the assessment of minimal residual disease and clonal tumor evolution.
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Affiliation(s)
- Thomas Parigger
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Franz Josef Gassner
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Stephan Drothler
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Department of Biosciences, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Christian Scherhäufl
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Department of Biosciences, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Alexandra Hödlmoser
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Lena Schultheis
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Aryunni Abu Bakar
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
- Department of Biosciences, Paris-Lodron-University Salzburg, Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Richard Greil
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Roland Geisberger
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | - Nadja Zaborsky
- Department Laboratory of Immunological and Molecular Cancer Research-Salzburg Cancer Research Institute, Cancer Cluster Salzburg, Salzburg, Austria
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
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Hamid HKS, Emile SH, Davis GN. Prognostic Significance of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression. Dis Colon Rectum 2022; 65:178-187. [PMID: 34775400 DOI: 10.1097/dcr.0000000000002291] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The low lymphocyte-to-monocyte ratio and high platelet-to-lymphocyte ratio have been reported to be poor prognostic indicators in various solid tumors, but the prognostic significance in rectal cancer remains controversial. OBJECTIVES We sought to determine the prognostic value of the lymphocyte-to-monocyte ratio and the platelet-to-lymphocyte ratio following curative-intent surgery for rectal cancer. DATA SOURCES Following PRISMA guidelines (PROSPERO, ID: CRD42020190880), PubMed and Embase databases were searched through January 2021 including 3 other registered medical databases. STUDY SELECTION Studies evaluating the impact of pretreatment lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio on overall or disease-free survival in patients undergoing curative rectal cancer resection were selected. MAIN OUTCOMES MEASURES The main outcome measures were overall and disease-free survival. RESULTS A total of 23 studies (6683 patients) were included; lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio were evaluated in 14 and 16 studies. A low lymphocyte-to-monocyte ratio was associated with poorer overall survival (HR, 1.57; 95% CI, 1.29-1.90; p < 0.001) and disease-free survival (HR, 1.29; 95% CI, 1.13-1.46; p < 0.001). However, when the analysis was limited to patients treated with surgery alone or to those with stage I to III tumors, lymphocyte-to-monocyte ratio was not a predictor of overall survival and disease-free survival. The platelet-to-lymphocyte ratio did not predict for overall or disease-free survival, regardless of the treatment modality, studied population, tumor stage, or cutoff value. Finally, a low lymphocyte-to-monocyte ratio, but not a high platelet-to-lymphocyte ratio, was inversely correlated with complete pathologic response rate. LIMITATIONS The retrospective nature of most included studies was a limitation. CONCLUSIONS Pretreatment lymphocyte-to-monocyte ratio, but not platelet-to-lymphocyte ratio, correlates with tumor response to neoadjuvant chemoradiotherapy and poorer prognosis after curative-intent surgery for rectal cancer, and it potentially represents a simple and reliable biomarker that could help optimize individualized clinical decision-making in high-risk patients. REGISTRATION https://www.crd.york.ac.uk/prospero/; ID: CRD42020190880.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | - Sameh H Emile
- Colorectal Surgery Unit, Department of General Surgery, Mansoura University Hospitals, Mansoura University, Mansoura, Egypt
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, United Kingdom
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Chen C, Yi W, Zeng ZF, Wang QX, Jiang W, Gao YH, Chang H. Serum apolipoprotein B to apolipoprotein A-I ratio is an independent predictor of liver metastasis from locally advanced rectal cancer in patients receiving neoadjuvant chemoradiotherapy plus surgery. BMC Cancer 2022; 22:7. [PMID: 34979995 PMCID: PMC8722169 DOI: 10.1186/s12885-021-09101-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The ratio of serum apolipoprotein B (apoB) to apolipoprotein A-I (apoAI) had been reported as a prognostic factor in colorectal cancer. This retrospective study aimed to assess the implication of apoB-to-apoAI ratio in predicting liver metastasis from rectal cancer (RC). METHODS The clinical data of 599 locally advanced RC patients treated with chemoradiotherapy followed by surgery were reviewed. Serum apoAI, apoB and apoB-to-apoAI ratio were analyzed for their correlation with the liver-metastasis-free, other-metastasis-free and overall survivals, together with the pretreatment and postsurgical pathoclinical features of the patients. Univariate and multivariate survival analyses were realized through the Kaplan-Meier approach and Cox model, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for independent predictors. RESULTS Carbohydrate antigen 19 - 9 ≥ 26.3 U/ml, apoB-to-apoAI ratio ≥ 0.63, tumor regression grade 5 - 3, pT4 and pN + stage emerged as independent predictors of poorer liver-metastasis-free survival. The hazard ratios were 1.656 (95% CI, 1.094-2.506), 1.919 (95% CI, 1.174-3.145), 1.686 (95% CI, 1.053-2.703), 1.890 (95% CI, 1.110-3.226) and 2.012 (95% CI, 1.314-2.077), respectively. Except apoB-to-apoAI ratio, the other 4 factors were also independent predictors of poorer other-metastasis-free and overall survivals. And the independent predictors of poorer overall survival also included age ≥ 67 years old, distance to anal verge < 5 cm. CONCLUSIONS Serum apoB-to-apoAI ratio could be used as a biomarker for prediction of liver metastasis risk in locally advanced RC.
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Affiliation(s)
- Chen Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Yi
- Department of Radiation Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Fan Zeng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qiao-Xuan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wu Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuan-Hong Gao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - Hui Chang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Lucchetti D, Zurlo IV, Colella F, Ricciardi-Tenore C, Di Salvatore M, Tortora G, De Maria R, Giuliante F, Cassano A, Basso M, Crucitti A, Laurenzana I, Artemi G, Sgambato A. Mutational status of plasma exosomal KRAS predicts outcome in patients with metastatic colorectal cancer. Sci Rep 2021; 11:22686. [PMID: 34811396 PMCID: PMC8608842 DOI: 10.1038/s41598-021-01668-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/14/2021] [Indexed: 02/08/2023] Open
Abstract
Liquid biopsy has become a useful alternative in metastatic colorectal cancer (mCRC) patients when tissue biopsy of metastatic sites is not feasible. In this study we aimed to investigate the clinical utility of circulating exosomes DNA in the management of mCRC patients. Exosomes level and KRAS mutational status in exosomal DNA was assesed in 70 mCRC patients and 29 CRC primary tumor and were analysed at different disease steps evaluating serial blood samples (240 blood samples). There was a significant correlation between the extension of disease and exosomes level and the resection of primary localized tumor was correlated with a decrease of KRAS G12V/ D copies and fractional abundance in metastatic disease. CEA expression and liver metastasis correlated with a higher number of KRAS G12V/D copies/ml and a higher fractional abundance; in the subgroup of mCRC patients eligible for surgery, the size of tumor and the radiological response were related to exosomes level but only the size was related to the number of KRAS WT copies; both KRAS wild-type and mutated levels were identified as a prognostic factor related to OS. Finally, we found that 91% of mutated mCRC patients became wild type after the first line chemotherapy but this status reverted in mutated one at progression in 80% of cases. In a prospective cohort of mCRC patients, we show how longitudinal monitoring using exosome-based liquid biopsy provides clinical information relevant to therapeutic stratification.
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Affiliation(s)
- Donatella Lucchetti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Ina Valeria Zurlo
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Filomena Colella
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Claudio Ricciardi-Tenore
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Mariantonietta Di Salvatore
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Giampaolo Tortora
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Ruggero De Maria
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Felice Giuliante
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Alessandra Cassano
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Michele Basso
- Department of Translational Medicine and Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Antonio Crucitti
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
- Division of General Surgery, Cristo Re Hospital, Rome, Italy
| | - Ilaria Laurenzana
- Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, PZ, Italy
| | - Giulia Artemi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Alessandro Sgambato
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
- Centro Di Riferimento Oncologico Della Basilicata (IRCCS-CROB), Rionero in Vulture, PZ, Italy.
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Zhai Z, Wang Z, Jin M, Zhang K. Peripheral blood CD45RO+T cells is a predictor of the effectiveness of neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Medicine (Baltimore) 2021; 100:e26214. [PMID: 34160385 PMCID: PMC8238272 DOI: 10.1097/md.0000000000026214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate the relationship between the changes in circulating CD45RO+T lymphocyte subsets following neoadjuvant therapy for rectal cancer in patients with locally advanced rectal cancer.The clinicopathological data of 185 patients with rectal cancer who received neoadjuvant therapy in the General Surgery Department of Beijing Chaoyang Hospital affiliated to Capital Medical University from June 2015 to June 2017 were analyzed. Venous blood samples were collected 1 week before neoadjuvant therapy and 1 week before surgery, and the expression of CD45RO+T was detected by flow cytometry. The receiver operating characteristic curve analysis was used to determine the optimal cut-off point of CD45RO+ratio. Log-rank test and multivariate Cox regression were used to analyze the overall survival rate (OS) and disease-free survival rate (DFS) associated with CD45RO+ratio.Circulating CD45RO+ratio of 1.07 was determined as the optimal cut-off point and CD45RO+ratio-high was associated with lower tumor regression grade grading (P = .031), T stage (P = .001), and tumor node metastasis (TNM) stage (P = .012). The 3-year DFS and OS rate in the CD45RO+ratio-high group was significantly higher than that in the CD45RO+ratio-low group (89.2% vs 60.1%, P<.001; 94.4% vs 73.2%, P<.001). The multivariate Cox analysis revealed that elevated CD45RO+ratio was an independent factor for better DFS (OR, 0.339; 95% CI, 0.153-0.752; P = .008) and OS (OR, 0.244; 95% CI,0.082-0.726; P = .011).Circulating CD45RO+ratio could predict the tumor regression grade of neoadjuvant therapy for rectal cancer, as well as long-term prognosis. These findings could be used to stratify patients and develop alternative strategies for adjuvant therapy.
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Affiliation(s)
| | | | - Mulan Jin
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Kunning Zhang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Wang H, Chen X, Chen X, Zhang W, Liu K, Wang Y, Tang H, Hu J. Associations between hepatitis B virus exposure and the risk of extrahepatic digestive system cancers: A hospital-based, case-control study (SIGES). Cancer Med 2021; 10:3741-3755. [PMID: 33934530 PMCID: PMC8178500 DOI: 10.1002/cam4.3901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/29/2020] [Accepted: 03/14/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This case-control study was aimed to investigate associations between HBV infection and extrahepatic digestive system cancers. METHODS The patients of gastric, small intestinal, colonic, rectal, anal, biliary tract, and pancreatic cancers were retrospectively collected between 2016.5 and 2017.12. Simultaneously, the healthy controls were collected from the health check-up registry, and cancer-free status was confirmed based on medical records. Propensity score matching was performed to reduce bias. Multinomial logit model and conditional logistic regression model were used to assess the risk of individual cancer according to HBV serological markers and classifications. RESULTS Totally, 4748 patients involving seven cancers, and 57,499 controls were included. After matching, HBsAg was associated with increased risk of gastric cancer (aOR = 1.39, 95% CI: 1.05-1.85), and anti-HBs served as a protective factor for gastric (aOR = 0.72, 95% CI: 0.61-0.85), colonic (aOR = 0.73, 95% CI: 0.60-0.89), rectal (aOR = 0.73, 95% CI: 0.63-0.85), and pancreatic (aOR = 0.58, 95% CI: 0.42-0.82) cancers. Compared to subgroups with non-infection and vaccination status, inactive HBsAg carriers and active HBV infection subgroup were correlated with gastric carcinogenesis (aOR = 1.41, 95% CI: 1.03-1.93). However, no clear association was found between HBV infection and other cancers. CONCLUSIONS HBV infection was potentially associated with an increased risk of gastric cancer. The development mechanism of HBV-associated gastric cancer needs to investigate further.
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Affiliation(s)
- Hui Wang
- Department of Gastrointestinal Surgery and Laboratory of Gastric CancerState Key Laboratory of BiotherapyWest China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
- Department of Gastrointestinal SurgeryThe Central Hospital of WuhanTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xin‐Zu Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric CancerState Key Laboratory of BiotherapyWest China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
- Department of Gastrointestinal and Hernia SurgerySecond People’s Hospital of Yibin City West China Yibin HospitalSichuan UniversityYibinChina
| | - Xiao‐Long Chen
- Department of Gastrointestinal Surgery and Laboratory of Gastric CancerState Key Laboratory of BiotherapyWest China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
| | - Wei‐Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric CancerState Key Laboratory of BiotherapyWest China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
| | - Kai Liu
- Department of Gastrointestinal Surgery and Laboratory of Gastric CancerState Key Laboratory of BiotherapyWest China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
| | - You‐Juan Wang
- Health Management CenterWest China HospitalSichuan UniversityChengduChina
| | - Huai‐Rong Tang
- Health Management CenterWest China HospitalSichuan UniversityChengduChina
| | - Jian‐Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric CancerState Key Laboratory of BiotherapyWest China HospitalSichuan University, and Collaborative Innovation Center for BiotherapyChengduChina
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Sun Y, Zhang Y, Huang Z, Lin H, Lu X, Huang Y, Chi P. Combination of Preoperative Plasma Fibrinogen and Neutrophil-to-Lymphocyte Ratio (the F-NLR Score) as a Prognostic Marker of Locally Advanced Rectal Cancer Following Preoperative Chemoradiotherapy. World J Surg 2021; 44:1975-1984. [PMID: 32020327 DOI: 10.1007/s00268-020-05407-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/18/2022]
Abstract
BACKGROUND Coagulation and inflammation play important roles in tumor progression. This study aimed to explore the prognostic impact of combined analysis of fibrinogen and neutrophil-to-lymphocyte (NLR) ratio (F-NLR score) in locally advanced rectal cancer (LARC) receiving preoperative chemoradiotherapy (pCRT) and radical surgery. METHOD Totally 317 patients were included. X-tile analysis was used to determine the optimal cutoff values of preoperative fibrinogen and NLR. F-NLR scores were defined as 2 (both high fibrinogen and NLR), 1 (one of these abnormalities), or 0 (neither abnormality). Time-dependent ROC analysis was used to evaluate the predictive accuracy of fibrinogen, NLR, and F-NLR score. Cox regression analysis was performed to evaluate the prognostic impact of the F-NLR score. A predictive nomogram for disease-free survival (DFS) was developed and validated internally. RESULTS One hundred and seventeen (36.9%), 156 (49.2%), and 44 (13.9%) patients had F-NLR score of 0, 1, and 2, respectively. Higher F-NLR score was associated with poorly differentiated tumors, deeper tumor invasion, lymph node metastasis, and more advanced pTNM stage (all P < 0.05). The 5-year OS rates in the F-NLR 0, 1, and 2 groups were 93.6%, 87.3%, and 68.4%, respectively (P < 0.001), while the 5-year DFS rates were 91.8%, 76.8%, and 56.1%, respectively (P < 0.001). Cox regression analysis demonstrated that F-NLR score (F-NLR 1, HR = 2.021, P = 0.046; F-NLR 2, HR = 3.356, P = 0.002), pTNM stage III (HR = 3.109, P = 0.009), and circumferential resection margin (CRM) involvement (HR = 3.120, P = 0.021) were independently associated with DFS. A nomogram for DFS was developed (C-index 0.708). CONCLUSION F-NLR score is a promising predictor for disease recurrence in LARC patients after pCRT.
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Affiliation(s)
- Yanwu Sun
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yiyi Zhang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Zhekun Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Huiming Lin
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xingrong Lu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
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10
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Dasari A, Morris VK, Allegra CJ, Atreya C, Benson AB, Boland P, Chung K, Copur MS, Corcoran RB, Deming DA, Dwyer A, Diehn M, Eng C, George TJ, Gollub MJ, Goodwin RA, Hamilton SR, Hechtman JF, Hochster H, Hong TS, Innocenti F, Iqbal A, Jacobs SA, Kennecke HF, Lee JJ, Lieu CH, Lenz HJ, Lindwasser OW, Montagut C, Odisio B, Ou FS, Porter L, Raghav K, Schrag D, Scott AJ, Shi Q, Strickler JH, Venook A, Yaeger R, Yothers G, You YN, Zell JA, Kopetz S. ctDNA applications and integration in colorectal cancer: an NCI Colon and Rectal-Anal Task Forces whitepaper. Nat Rev Clin Oncol 2020; 17:757-770. [PMID: 32632268 PMCID: PMC7790747 DOI: 10.1038/s41571-020-0392-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 02/07/2023]
Abstract
An increasing number of studies are describing potential uses of circulating tumour DNA (ctDNA) in the care of patients with colorectal cancer. Owing to this rapidly developing area of research, the Colon and Rectal-Anal Task Forces of the United States National Cancer Institute convened a panel of multidisciplinary experts to summarize current data on the utility of ctDNA in the management of colorectal cancer and to provide guidance in promoting the efficient development and integration of this technology into clinical care. The panel focused on four key areas in which ctDNA has the potential to change clinical practice, including the detection of minimal residual disease, the management of patients with rectal cancer, monitoring responses to therapy, and tracking clonal dynamics in response to targeted therapies and other systemic treatments. The panel also provides general guidelines with relevance for ctDNA-related research efforts, irrespective of indication.
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Affiliation(s)
- Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Van K Morris
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Chloe Atreya
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Al B Benson
- Division of Hematology/Oncology, Northwestern University, Chicago, IL, USA
| | - Patrick Boland
- Department of Medicine, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Ki Chung
- Division of Hematology & Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Mehmet S Copur
- CHI Health St Francis Cancer Treatment Center, Grand Island, NE, USA
| | - Ryan B Corcoran
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Dustin A Deming
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas J George
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Stanley R Hamilton
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard Hochster
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MD, USA
| | - Federico Innocenti
- Center for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Atif Iqbal
- Section of Colorectal Surgery, Division of Surgery, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Samuel A Jacobs
- National Adjuvant Surgical and Bowel Project Foundation/NRG Oncology, Pittsburgh, PA, USA
| | - Hagen F Kennecke
- Department of Oncology, Virginia Mason Cancer Institute, Seattle, WA, USA
| | - James J Lee
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Hillman Cancer Center, Pittsburgh, PA, USA
| | - Christopher H Lieu
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, CO, USA
| | - Heinz-Josef Lenz
- Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - O Wolf Lindwasser
- Coordinating Center for Clinical Trials, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Clara Montagut
- Hospital del Mar-Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Pompeu Fabra, Barcelona, Spain
| | - Bruno Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Fang-Shu Ou
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura Porter
- Patient Advocate, NCI Colon Task Force, Boston, MA, USA
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Deborah Schrag
- Division of Population Sciences, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Aaron J Scott
- Division of Hematology and Oncology, Banner University of Arizona Cancer Center, Tucson, AZ, USA
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John H Strickler
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Rona Yaeger
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Greg Yothers
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason A Zell
- Department of Epidemiology, Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, CA, USA
| | - Scott Kopetz
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Akgor U, Kuru O, Soyak B, Gunes AC, Uyanık E, Gultekin M, Ozgul N, Salman C. Adnexal masses in patients with colorectal cancer. J Gynecol Obstet Hum Reprod 2020; 50:101898. [PMID: 32827838 DOI: 10.1016/j.jogoh.2020.101898] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the clinicopathological features and outcomes of patients undergone surgery for benign and metastatic adnexal masses during the surveillance of colorectal cancer (CRC). METHODS A single institute retrospective study involving 90 patients diagnosed with CRC that undergone surgery at Hacettepe University Hospital between 2000-2018. Clinicopathological and survival data was obtained from hospital records. RESULTS Elevated blood levels of CEA (HR, 1.23; 95 % CI: 1.03-1.24; p = 0.01), adnexal masses larger than 5 cm (HR, 3.296; 95 % CI: 1.527-7.076; p = 0.002), bilaterality of adnexal mass (HR, 2.200; 95 % CI: 2.464-11.969; p = 0.001) and high PCI score (HR, 0.150; 95 % CI: 0.044-0.479; p = 0.01) were found to be significantly associated with ovarian metastasis. There was a significant difference in overall survival (OS), with respect to complete and incomplete resection in adnexal surgery of ovarian metastasis (46.6 vs. 29.6 months; p = 0.004). The median survival time was 32.8 months for patients with ≤ 24 months interval time to adnexal metastasis surgery, and 48.5 months for patients with >24 months interval time to adnexal metastasis surgery (p = 0.001). CONCLUSION This study showed that numerous clinicopathological variables such as bilaterality and size of adnexal mass, serum blood levels of CEA and PCI score may have a significant impact on the prediction and management of ovarian masses diagnosed during CRC surveillance. Complete resection and interval time to adnexal surgery is significantly associated with OS.
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Affiliation(s)
- Utku Akgor
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Oguzhan Kuru
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Burcu Soyak
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Can Gunes
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Esra Uyanık
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Gultekin
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nejat Ozgul
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Coskun Salman
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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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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13
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Belge G, Bilgin C, Ozkaya G, Kandemirli SG, Alper E. Prognostic value of pretreatment tumor-to-blood standardized uptake ratio (SUR) in rectal cancer. Ann Nucl Med 2020; 34:432-440. [PMID: 32297136 DOI: 10.1007/s12149-020-01465-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The prognostic value of SUV on pretreatment F-18 FDG PET/CT imaging in patients with rectal cancer is a matter of debate. SUR is of prognostic value for survival in different cancers. In this study, we aimed to examine the potential prognostic value of SUR and other parameters in pretreatment F-18 FDG PET/CT for non-metastatic rectal cancer. METHODS One hundred four non-metastatic rectal cancer patients who underwent pretreatment PET/CT between March 2012 and January 2018 were included in the study. Firstly, SUVmax, SUVmean, MTV, and TLG were calculated semi-automatically at the workstation. SUR was calculated as the ratio of tumor SUVmax to thoracic aorta blood SUVmean. Univariate Cox regression and Kaplan-Meier analysis were used to evaluate overall survival (OS), progression free survival (PFS), and local recurrence (LR). Then, multivariate Cox regression analysis, which included the parameters that were significant in the univariate analysis, was performed. RESULTS Multivariate Cox regression analysis revealed that SUR was a prognostic factor for PFS. Age and T stage were prognostic factors for both OS and PFS. MTV was found to be independent risk factors for OS. CONCLUSIONS In our study, SUR was the only F-18 FDG PET/CT parameter found to be significant for PFS. The development of new parameters can increase the prognostic value of F-18 FDG PET/CT.
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Affiliation(s)
- Gokce Belge
- Department of Nuclear Medicine, Uludag University School of Medicine, 16059, Bursa, Turkey.
| | - Cem Bilgin
- Department of Radiology, Uludag University School of Medicine, Bursa, Turkey
| | - Guven Ozkaya
- Department of Statistics, Uludag University School of Medicine, Bursa, Turkey
| | | | - Eray Alper
- Department of Nuclear Medicine, Uludag University School of Medicine, 16059, Bursa, Turkey
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14
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Huang Z, Wang X, Zou Q, Zhuang Z, Xie Y, Cai D, Bai L, Tang G, Huang M, Luo Y, Yu H. High platelet-to-lymphocyte ratio predicts improved survival outcome for perioperative NSAID use in patients with rectal cancer. Int J Colorectal Dis 2020; 35:695-704. [PMID: 32040733 DOI: 10.1007/s00384-020-03528-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to block tumor-associated inflammation in rectal cancer. However, the perioperative use of NSAIDs remains controversial. This study was designed to investigate whether the perioperative use of NSAIDs influences outcomes and to provide a predictive marker to identify patients who would benefit from NSAIDs. METHODS We enrolled 515 patients with stage I to III rectal cancer in this retrospective study. Patients were classified into the NSAID and non-NSAID groups according to their perioperative use of NSAIDs. The whole cohort was stratified by platelet-to-lymphocyte ratio (PLR). The primary endpoints were disease-free survival (DFS) and overall survival (OS). RESULTS The NSAID group had a 12.6% lower risk of recurrence than the non-NSAID group (P = 0.015), while the association with survival was nonsignificant. In the high-PLR subset, the NSAID group had a 17.3% lower risk of recurrence (P = 0.003) and a better DFS (P = 0.033) outcome than the non-NSAID group. Multivariate analysis confirmed this independent significant association with DFS (P = 0.023). In the low-PLR subset, the association of NSAID use with survival was nonsignificant. CONCLUSION Perioperative use of NSAIDs was associated with improved survival outcomes in rectal cancer patients with high PLR.
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Affiliation(s)
- Zenghong Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Xiaolin Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Qi Zou
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
- Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Zhuokai Zhuang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Yumo Xie
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Du Cai
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Liangliang Bai
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Guannan Tang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China
| | - Meijin Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Yanxin Luo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China
| | - Huichuan Yu
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, 510655, Guangdong, China.
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15
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Ke TM, Lin LC, Huang CC, Chien YW, Ting WC, Yang CC. High neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio predict poor survival in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy. Medicine (Baltimore) 2020; 99:e19877. [PMID: 32332656 PMCID: PMC7220521 DOI: 10.1097/md.0000000000019877] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study explored the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy (CCRT).Between January 2006 and December 2016, 184 patients with newly-diagnosed rectal cancer receiving neoadjuvant CCRT were enrolled. Risk of overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method and Cox proportional hazard models. Stratified survival analyses were also performed between post-neoadjuvant pathological (yp) stage.The mean follow-up time was 72.73 ± 36.82 months. High- and low-NLR patients differed significantly in both 5-year DFS (P = .026) and OS (P = .016). High- and low-PLR patients differed significantly in 5-year DFS (P = .011) but not OS (P = .185). Multivariate analyses revealed worse 5-year DFS (adjusted HR [aHR] = 2.8; 95% CI: 1.473-5.41; P = .002) and 5-year OS (aHR = 1.871; 95%CI: 1.029-3.4; P = .04) in the high-NLR group after adjusting for covariates. After adjustments, the high-PLR group had inferior 5-year DFS (aHR = 2.274; 95%CI: 1.473-5.419; P = .038) but not 5-year OS (aHR = 1.156; 95%CI: 0.650-2.056; P = .622). Further stratified analysis indicated that yp stage II and III patients with high NLR had worse 5-year DFS (aHR = 2.334; 95% CI: 1.158-4.725; P = .018) and OS (aHR = 2.226; 95% CI: 1.165-4.251; P = .015). Additionally, yp stage II and III patients with high PLR had inferior 5-year DFS (aHR = 2.012; 95% CI: 1.049-3.861; P = .036).Pre-CCRT NLR and PLR are independent prognostic factors for rectal cancer patients and could be used as a potential biomarker to identify high-risk patients for more intense treatment and care.
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Affiliation(s)
- Te-Min Ke
- Dali District public health center, Taichung
- Department of Public Health College of Medicine, National Cheng Kung University
| | - Li-Ching Lin
- Department of Radiation Oncology, Chi Mei Medical Center
- Department of Optometry, Chung Hwa University of Medical Technology, Tainan
- School of Medicine, Taipei Medical University, Taipei
| | - Chun-Che Huang
- Department of Healthcare Administration, I-Shou University, Kaohsiung
| | - Yu-Wen Chien
- Department of Public Health College of Medicine, National Cheng Kung University
| | - Wei-Chen Ting
- Department of radiation oncology, Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital, Pingtung
| | - Ching-Chieh Yang
- Department of Radiation Oncology, Chi Mei Medical Center
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan Taiwan
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Khakoo S, Carter PD, Brown G, Valeri N, Picchia S, Bali MA, Shaikh R, Jones T, Begum R, Rana I, Wotherspoon A, Terlizzo M, von Loga K, Kalaitzaki E, Saffery C, Watkins D, Tait D, Chau I, Starling N, Hubank M, Cunningham D. MRI Tumor Regression Grade and Circulating Tumor DNA as Complementary Tools to Assess Response and Guide Therapy Adaptation in Rectal Cancer. Clin Cancer Res 2020; 26:183-192. [PMID: 31852830 DOI: 10.1158/1078-0432.ccr-19-1996] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [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: 07/22/2019] [Revised: 08/30/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Response to preoperative chemo-radiotherapy (CRT) varies. We assessed whether circulating tumor DNA (ctDNA) might be an early indicator of tumor response or progression to guide therapy adaptation in rectal cancer. EXPERIMENTAL DESIGN A total of 243 serial plasma samples were analyzed from 47 patients with localized rectal cancer undergoing CRT. Up to three somatic variants were tracked in plasma using droplet digital PCR. RECIST and MRI tumor regression grade (mrTRG) evaluated response. Survival analyses applied Kaplan-Meier method and Cox regression. RESULTS ctDNA detection rates were: 74% (n = 35/47) pretreatment, 21% (n = 10/47) mid CRT, 21% (n = 10/47) after completing CRT, and 13% (n = 3/23) after surgery. ctDNA status after CRT was associated with primary tumor response by mrTRG (P = 0.03). With a median follow-up of 26.4 months, metastases-free survival was shorter in patients with detectable ctDNA after completing CRT [HR 7.1; 95% confidence interval (CI), 2.4-21.5; P < 0.001], persistently detectable ctDNA pre and mid CRT (HR 3.8; 95% CI, 1.2-11.7; P = 0.02), and pre, mid, and after CRT (HR 11.5; 95% CI, 3.3-40.4; P < 0.001) compared with patients with undetectable or nonpersistent ctDNA. In patients with detectable ctDNA, a fractional abundance threshold of ≥0.07% mid CRT or ≥0.13% after completing CRT predicted for metastases with 100% sensitivity and 83.3% specificity for mid CRT and 66.7% for CRT completion. All 3 patients with detectable ctDNA post-surgery relapsed compared with none of the 20 patients with undetectable ctDNA (P = 0.001). CONCLUSIONS ctDNA identified patients at risk of developing metastases during the neoadjuvant period and post-surgery, and could be used to tailor treatment.
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Affiliation(s)
- Shelize Khakoo
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Paul David Carter
- Clinical Genomics, The Royal Marsden Hospital NHS Foundation Trust, Sutton, United Kingdom
| | - Gina Brown
- Department of Radiology, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Nicola Valeri
- Molecular Pathology, The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Simona Picchia
- Department of Radiology, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Maria Antonietta Bali
- Department of Radiology, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Ridwan Shaikh
- Clinical Genomics, The Royal Marsden Hospital NHS Foundation Trust, Sutton, United Kingdom
| | - Thomas Jones
- Clinical Genomics, The Royal Marsden Hospital NHS Foundation Trust, Sutton, United Kingdom
| | - Ruwaida Begum
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Isma Rana
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Andrew Wotherspoon
- Department of Histopathology, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Monica Terlizzo
- Department of Histopathology, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Katharina von Loga
- Department of Histopathology, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Eleftheria Kalaitzaki
- Clinical Research and Development, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Claire Saffery
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Watkins
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Diana Tait
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Ian Chau
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Naureen Starling
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Michael Hubank
- Clinical Genomics, The Royal Marsden Hospital NHS Foundation Trust, Sutton, United Kingdom
| | - David Cunningham
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom.
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Li R, Jia F, Zhang W, Shi F, Fang Z, Zhao H, Hu Z, Wei Z. Device for whole genome sequencing single circulating tumor cells from whole blood. Lab Chip 2019; 19:3168-3178. [PMID: 31455953 DOI: 10.1039/c9lc00473d] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Whole-genome sequencing on circulating tumor cells (CTCs) at the single cell level has recently been found helpful for precision medicine, as the oncogenic profiles of single CTCs are useful for discovering oncogenic mutation heterogeneities and guiding/adjusting cancer treatment. To overcome the limits of existing methods of single CTC sequencing, in which CTC enrichment, identification and gene amplification are performed by discrete modules, this study presents a novel method in which all processing steps from blood sample collection to preparation of gene amplification products for sequencers are finished in a single microfluidic chip. This microfluidic chip comprehensively performs blood filtering, CTC enrichment, CTC identification/isolation, CTC lysis and whole genome amplification (WGA) at the single cell level. By sequencing single CTCs from clinical blood samples with pointing key driver and drug-resistance mutations, the novel microfluidic chip was validated to be capable of genetically profiling single CTCs with minimum cell loss/human labor, and more importantly, high accuracy and repeatability, which are crucial factors for promoting clinical application of single CTC sequencing.
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Affiliation(s)
- Ren Li
- CAS Key Laboratory of Standardization and Measurement for Nanotechnology, CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology of China, Beijing 100190, China.
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Cai D, Huang ZH, Yu HC, Wang XL, Bai LL, Tang GN, Peng SY, Li YJ, Huang MJ, Cao GW, Wang JP, Luo YX. Prognostic value of preoperative carcinoembryonic antigen/tumor size in rectal cancer. World J Gastroenterol 2019; 25:4945-4958. [PMID: 31543685 PMCID: PMC6737319 DOI: 10.3748/wjg.v25.i33.4945] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/04/2019] [Accepted: 05/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Carcinoembryonic antigen (CEA) is a commonly used biomarker in colorectal cancer. However, controversy exists regarding the insufficient prognostic value of preoperative serum CEA alone in rectal cancer. Here, we combined preoperative serum CEA and the maximum tumor diameter to correct the CEA level, which may better reflect the malignancy of rectal cancer.
AIM To assess the prognostic impact of preoperative CEA/tumor size in rectal cancer.
METHODS We retrospectively reviewed 696 stage I to III rectal cancer patients who underwent curative tumor resection from 2007 to 2012. These patients were randomly divided into two cohorts for cross-validation: training cohort and validation cohort. The training cohort was used to generate an optimal cutoff point and the validation cohort was used to further validate the model. Maximally selected rank statistics were used to identify the optimum cutoff for CEA/tumor size. The Kaplan-Meier method and log-rank test were used to plot the survival curve and to compare the survival data. Univariate and multivariate Cox regression analyses were used to determine the prognostic value of CEA/tumor size. The primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively.
RESULTS In all, 556 patients who satisfied both the inclusion and exclusion criteria were included and randomly divided into the training cohort (2/3 of 556, n = 371) and the validation cohort (1/3 of 556, n = 185). The cutoff was 2.429 ng/mL per cm. Comparison of the baseline data showed that high CEA/tumor size was correlated with older age, high TNM stage, the presence of perineural invasion, high CEA, and high carbohydrate antigen 19-9 (CA 19-9). Kaplan-Meier curves showed a manifest reduction in 5-year OS (training cohort: 56.7% vs 81.1%, P < 0.001; validation cohort: 58.8% vs 85.6%, P < 0.001) and DFS (training cohort: 52.5% vs 71.9%, P = 0.02; validation cohort: 50.3% vs 79.3%, P = 0.002) in the high CEA/tumor size group compared with the low CEA/tumor size group. Univariate and multivariate analyses identified CEA/tumor size as an independent prognostic factor for OS (training cohort: hazard ratio (HR) = 2.18, 95% confidence interval (CI): 1.28-3.73, P = 0.004; validation cohort: HR = 4.83, 95%CI: 2.21-10.52, P < 0.001) as well as DFS (training cohort: HR = 1.47, 95%CI: 0.93-2.33, P = 0.096; validation cohort: HR = 2.61, 95%CI: 1.38-4.95, P = 0.003).
CONCLUSION Preoperative CEA/tumor size is an independent prognostic factor for patients with stage I-III rectal cancer. Higher CEA/tumor size is associated with worse OS and DFS.
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Affiliation(s)
- Du Cai
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Zeng-Hong Huang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817, United States
| | - Hui-Chuan Yu
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Xiao-Lin Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Liang-Liang Bai
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Guan-Nan Tang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Shao-Yong Peng
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Ying-Jie Li
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Mei-Jin Huang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Guang-Wen Cao
- Department of Epidemiology, Second Military Medical University, Shanghai 200433, China
| | - Jian-Ping Wang
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
| | - Yan-Xin Luo
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease (Supported by National Key Clinical Discipline), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
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Florescu A, Branisteanu D, Bilha S, Scripcariu D, Florescu I, Scripcariu V, Dimofte G, Grigoras I. Leptin and adiponectin dynamics at patients with rectal neoplasm - Gender differences. PLoS One 2019; 14:e0212471. [PMID: 31425509 PMCID: PMC6699797 DOI: 10.1371/journal.pone.0212471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 07/30/2019] [Indexed: 12/29/2022] Open
Abstract
Background Numerous studies associate adipokines with colorectal malignancy, but few data deal with patients suffering exclusively of rectal carcinoma (RC). Aims We evaluated leptin and adiponectin levels in RC patients compared to healthy population and their dynamics after surgery. Material and methods Serum leptin and adiponectin were evaluated before surgery in 59 RC consecutive patients (38 males and 21 females), and in age and weight matched healthy controls. Measurements were repeated at 24, 72 hours and 7 days after surgery. Results Adipokine levels were higher in women. Controls had higher leptin (32.±4.34 vs 9.51±1.73 ng/ml in women and 11±2.66 vs 2.54±0.39 ng/ml in men, p = 0.00048 and 0.0032) and lower adiponectin (9±0.64 vs 11.85±1.02 μg/ml in women and 7.39±0.51 vs 8.5±0.62 μg/ml in men, p = 0.017 and 0.019) than RC patients. Surgery caused an increase of leptin from 5.11±0.8 to 18.7±2.42 ng/ml, p = 6.85 x 10¨8, and a decrease of adiponectin from 9.71±0.58 to 7.87±0.47 μg/ml, p = 1.4 x 10¨10 for all RC patients and returned thereafter to the initial range at 7 days. Adipokines were correlated with body weight (BW). The significance of correlation persisted after surgery only in males, but disappeared in females. Adipokines were not modified by tumor position, presurgical chemoradiotherapy or surgical technique. Women with RC experiencing weight loss had higher adiponectin than women without weight modifications (p<0.05 at all time points). Conclusions Adipokine levels of patients with RC differ from the healthy population, possibly reflecting an adaptation to disease. Adipokine modifications after surgery may be related to acute surgical stress. Whether leptin and adiponectin directly interact is not clear. Women have higher adipokine levels, more so after significant weight loss, but the strength of their correlation with BW decreases after surgery. These data suggest gender differences in the adipokine profile of RC patients which may find clinical applications.
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Affiliation(s)
- Alexandru Florescu
- Department of Endocrinology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Dumitru Branisteanu
- Department of Endocrinology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- * E-mail:
| | - Stefana Bilha
- Department of Endocrinology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Dragos Scripcariu
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ioana Florescu
- Department of Intensive Care, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Viorel Scripcariu
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Gabriel Dimofte
- Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Ioana Grigoras
- Department of Intensive Care, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
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Abstract
To identify the value of predictors of poor prognosis of elderly patients with rectal cancer who underwent surgery, we investigated the relations between albumin to globulin ratio (AGR) and clinicopathological findings.We conducted a retrospective cohort study of clinicopathological characteristics (general status, pathological features of tumors, preoperative laboratory data, disease free, and overall survival) for elderly patients with stage I-III rectal cancer. The AGR is calculated as albumin/(total protein - albumin).According to the optimal cut-off point of AGR (1.43), the enrolled patients were divided into low AGR (n = 83) and high AGR (n = 136) groups. Meanwhile, age, hemoglobin, tumor size, and differentiation degree were the independent risk factors of low preoperative AGR value. Compared to patients with high AGR, those with low AGR were related to worse disease-free survival (DFS) (P = .0008) and overall survival (OS) (P = .0003). Moreover, in multivariate analysis, low AGR and poor TNM stage were the independent predictor of poor DFS and OS. Finally, the nomograms illustrated the effect of prognostic factors on DFS and OS.Preoperative AGR has a significant prognostic value and was identified as an independent predictor of DFS and OS in elderly rectal cancer patients.
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Braun LH, Baumann D, Zwirner K, Eipper E, Hauth F, Peter A, Zips D, Gani C. Neutrophil-to-Lymphocyte Ratio in Rectal Cancer-Novel Biomarker of Tumor Immunogenicity During Radiotherapy or Confounding Variable? Int J Mol Sci 2019; 20:ijms20102448. [PMID: 31108935 PMCID: PMC6566677 DOI: 10.3390/ijms20102448] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 04/15/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to investigate the predictive value of blood-derived makers of local and systemic inflammatory responses on early and long-term oncological outcomes. A retrospective analysis of patients with locally advanced rectal cancer treated with preoperative long-course 5-fluorouracil-based radiochemotherapy was performed. Differential blood counts before neoadjuvant treatment were extracted from the patients' electronic charts. Optimal cut-off values for neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were determined. Potential clinical and hematological prognostic factors for disease-free survival (DFS) were studied using uni- and multivariate analysis. A total of 220 patients were included in the analysis. Median follow-up was 67 months. Five-year DFS and overall survival (OS) were 70% and 85%, respectively. NLR with a cut-off value of 4.06 was identified as optimal to predict DFS events. In multivariate analysis, only tumor volume (HR 0.33, 95% CI (0.14-0.83), p = 0.017) and NLR (HR 0.3, 95% CI (0.11-0.81), p = 0.017) remained significant predictors of DFS. Patients with a good histological response (Dworak 3 and 4) to radiotherapy also had a lower NLR than patients with less pronounced tumor regression (3.0 vs. 4.2, p = 0.015). A strong correlation between primary tumor volume and NLR was seen (Pearson's r = 0.64, p < 0.001). Moreover, patients with T4 tumors had a significantly higher NLR than patients with T1-T3 tumors (6.6 vs. 3.3, p < 0.001). An elevated pretherapeutic NLR was associated with higher T stage, inferior DFS, and poor pathological response to neoadjuvant radiochemotherapy. A strong correlation between NLR and primary tumor volume was seen. This association is important for the interpretation of study results and for the design of translational studies which are warranted.
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Affiliation(s)
- Lore Helene Braun
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - David Baumann
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - Kerstin Zwirner
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - Ewald Eipper
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany.
| | - Franziska Hauth
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
| | - Andreas Peter
- Institute for Clinical Chemistry and Pathobiochemistry, University Hospital Tübingen, 72076 Tübingen, Germany.
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
- German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
- Gastrointestinal Cancer Center, Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany.
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany.
- German Cancer Research Center (DKFZ), Heidelberg and German Cancer Consortium (DKTK), 69120 Heidelberg, Germany.
- Gastrointestinal Cancer Center, Comprehensive Cancer Center Tübingen-Stuttgart, 72076 Tübingen, Germany.
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Macháčková T, Grolich T, Fiala L, Procházka V, Škrovina M, Kala Z, Slabý O. Utilization of Next Generation Sequencing in Analysis of Circulating MicroRNAs as Predictive Biomarkers for Patients with Locally Advanced Rectal Carcinoma. Klin Onkol 2019; 32:157-159. [PMID: 31064188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND MicroRNAs (miRNA) are short non-coding RNAs involved in post-transcriptional regulation of gene expression. MiRNAs are essential regulators of both physiological processes as of pathogeneses of many diseases, and their dysregulation was observed in many malignancies including rectal cancer. Circulating miRNAs presented in blood plasma could be potential candidates for non-invasive predictive biomarkers of the response of patients with locally advanced rectal cancer to chemoradiotherapy. Presented study aims to evaluate the potential of next-generation sequencing in the analysis of circulating miRNAs. MATERIAL AND METHODS MiRNA expression profiles were done using samples of RNA isolated from blood plasma collected during TNM restaging and paired samples collected before initiation of neoadjuvant chemoradiotherapy. Sequencing libraries were prepared using kit which implements universal molecular indices that help to sensitively filter biological bias during data analysis. Sequencing data were processed by multidimensional biostatistical approaches. CONCLUSION We identified specific miRNA profile enabling to distinguish the patients accordingly to their response to chemoradiotherapy. This work was supported by the Czech Ministry of Health grant No. 16-31765A. The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 22. 2. 2019 Accepted: 27. 2. 2019.
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Andras D, Crisan D, Avram L, Caziuc A, Bintintan V, Coman RT, Portik D, Ionescu B, Hopartan C, Crisan N, Eniu D, Coman I, Dindelegan G. Organ sparing management in rectal cancer. Are we there yet? Ann Ital Chir 2019; 90:532-538. [PMID: 31355776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The "watch and wait" approach has recently been proposed as an alternative to surgery in locally-advanced rectal cancer patients that respond to neo-adjuvant chemoradiotherapy, in order to decrease its negative functional consequences upon the quality of life of these patients. Current methods show low accuracy for the identification of complete responders. MATERIALS AND METHODS A review of the literature was conducted for articles published up to March 31th, 2019. Relevant studies were identified using bibliographic searches of Pubmed database. The keywords that were used in various combinations were: "neoadjuvant chemoradiotherapy", "non-operative management", "complete pathological response", "rectal cancer", "biomarkers", "staging". RESULTS Magnetic resonance imaging can identify complete responders with a high accuracy using new protocols like diffusion weighted imaging. Positron emission tomography with 18-fluoro-deoxy-glucose shows a sensitivity of 90.9% and specificity of 80.3% for the prediction of complete pathologic response using the change in standardized uptake value. A panel of 15 metabolites was identified and shows potential to discriminate patient resistance and sensitivity to neo-adjuvant therapy (Area Under the Curve 0.80). Furthermore, pre-treatment peripheral blood neutrophil to lymphocyte ratio below 2 and platelet to lymphocyte ratio below 133.4 are significantly correlated with good tumor response (OR 2.49). Analysis of the pattern of carcinoembryonic antigen (CEA) clearance after neoadjuvant treatment conclude that an exponential decrease of the CEA levels is associated with significant tumor down staging and complete pathologic response. CONCLUSION New methods of assessing the response to neo-adjuvant therapy in locally-advanced rectal cancer have emerged, showing promising results. Further studies need to assess the best combination between imaging and these biomarkers in order to increase the accuracy and standardize the criteria for non-operative management. KEY WORDS Biomarkers, Complete pathologic response, Non-Operative management, Rectal cancer, Staging.
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Policicchio A, Mercier J, Digklia A, Voutsadakis IA. Platelet and Neutrophil Counts as Predictive Markers of Neoadjuvant Therapy Efficacy in Rectal Cancer. J Gastrointest Cancer 2018; 50:894-900. [PMID: 30353366 DOI: 10.1007/s12029-018-0173-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS To investigate pretreatment platelet and neutrophil counts as well as a combined platelet-neutrophil (PN) index for prognostic information in patients with rectal adenocarcinoma that received neoadjuvant treatment. PATIENTS AND METHODS Charts from 164 patients with localized rectal adenocarcinoma were retrospectively reviewed, and 112 patients with complete data were included in the study. Patients were stratified in groups according to their neutrophil counts, platelet counts, and a combined platelet/neutrophil (PN) index. Baseline parameters of the groups were compared using the x2 test. Pathologic responses on the surgical specimen of patients with lower platelet counts (≤ 350 × 109/L), lower neutrophil counts (≤ 7.5 × 109/L), and a lower PN index were compared with those of patients with higher platelet counts (> 350 × 109/L), higher neutrophil counts (> 7.5 × 109/L), and a higher PN index using the x2 test. Kaplan-Meier curves of overall and progression free survival were constructed and compared with the log-rank test. RESULTS A total of 33 (29.5%) patients belonged to the high-PN index group, and 79 (70.9%) patients belonged to the low-PN index group. A significant difference was present between the two groups with regard to pathologic response. Patients with both high platelet and high neutrophil counts were less likely to have a complete pathologic response than those in the low-PN index group (P = 0.039). Additionally, tumor location and tumor stage were significantly associated with complete pathologic response to neoadjuvant treatment. Patients with a complete response were more likely to present with a low tumor (≤ 5 cm from the anal verge). Likewise, patients diagnosed with stage II disease were more likely to experience complete response than those diagnosed with stage III (x2 test P = 0.016). There was no significant difference in overall and progression free survival between the two platelet groups (log-rank P = 0.73 and 0.40, respectively) and the two PN index groups (log-rank P = 0.92 and 0.43, respectively). CONCLUSION In this retrospective analysis, the combination of higher platelet and neutrophil counts at the time of diagnosis had predictive value with respect to complete pathologic response to neoadjuvant treatment in locally advanced rectal cancer.
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Affiliation(s)
- AnnaLee Policicchio
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Joey Mercier
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Antonia Digklia
- University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Ioannis A Voutsadakis
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON, Canada.
- Algoma District Cancer Program, Sault Area Hospital, 750 Great Northern Road, Sault Ste. Marie, ON, P6B0A8, Canada.
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Huh JW, Yun SH, Kim SH, Park YA, Cho YB, Kim HC, Lee WY, Park HC, Choi DH, Park JO, Park YS, Chun HK. Prognostic Role of Carcinoembryonic Antigen Level after Preoperative Chemoradiotherapy in Patients with Rectal Cancer. J Gastrointest Surg 2018; 22:1772-1778. [PMID: 29845570 DOI: 10.1007/s11605-018-3815-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/14/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognostic role of post-chemoradiotherapy (CRT) carcinoembryonic antigen (CEA) level is not clear. We evaluated the prognostic significance of post-CRT CEA level in patients with rectal cancer after preoperative CRT. METHODS We reviewed 659 consecutive patients who underwent preoperative CRT and total mesorectal excision for non-metastatic rectal cancer. Patients were categorized into two groups according to post-CRT serum CEA level: low CEA (< 5 ng/mL) and high CEA (≥ 5 ng/mL). RESULTS Median post-CRT CEA level was 1.7 ng/mL (range, 0.1-207.0). A high post-CRT level was significantly associated with ypStage, ypT category, tumor regression grade, and pre-CRT CEA level. The 5-year overall survival rate of the 659 patients was 87.8% with a median follow-up period of 57.0 months (range, 1.4-176.4). When the post-CRT CEA groups were divided into groups according to pre-CRT CEA level, the 5-year overall survival rates were significantly different (P < 0.001 and P = 0.001, respectively). Post-CRT CEA level was an independent prognostic factor for overall survival. Multivariate analysis revealed that operation method, differentiation, perineural invasion, postoperative chemotherapy, tumor regression grade, and post-CRT CEA level were independent prognostic factors for overall survival. CONCLUSION The level of serum CEA after preoperative CRT was an independent prognostic factor for overall survival in patients with rectal cancer.
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Affiliation(s)
- Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Seok Hyung Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon Oh Park
- Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Suk Park
- Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Wu Z, Zhang J, Cai Y, Deng R, Yang L, Li J, Deng Y. Reduction of circulating lymphocyte count is a predictor of good tumor response after neoadjuvant treatment for rectal cancer. Medicine (Baltimore) 2018; 97:e11435. [PMID: 30235653 PMCID: PMC6160071 DOI: 10.1097/md.0000000000011435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Systemic inflammatory indices are correlated with poor prognosis in cancer patients. The presence of lymphocytes in and around the tumor tissue is a predictor in rectal cancer. We aimed to explore the mechanism underlying the changes in circulating lymphocyte during neoadjuvant therapy and the way in which the count correlates with tumor response.Around 307 patients from FOWARC trial and 64 patients from FORTUNE trial were included in the training and validation group. Circulating lymphocyte count was recorded before neoadjuvant therapy and before rectal surgery. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off value of the reduction of lymphocytes. A logistic regression model was obtained in multivariate analysis.The blood absolute number of lymphocyte before and after therapy had no correlation with tumor response. However, total lymphocyte count (TLC) reduction was significantly higher in good response group (39.81% vs 33.31% P = .032) in the FOWARC cohort. The optimal cut-off value for TLC was 24.96%. Age, tumor length, and TLC reduction (P = .005, OR = 2.009, 95%CI 1.240-3.254) were significant factors for tumor regression in multivariate analysis. In the FORTUNE cohort, TLC reduction was the only significant factor for tumor regression in both univariate (P = .032, OR = 3.434, 95%CI 1.111-10.614) and multivariate analysis (P = .046, OR = 3.361, 95%CI 1.024-11.035).Circulating lymphocyte count decreases during neoadjuvant therapy for locally advanced rectal cancer, and it is associated with better tumor regression. It may be involved in the immune response provoked by radiotherapy and chemotherapy.
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Gurdal N, Fayda M, Alishev N, Bakir B, Tastekin D, Aykan F, Gezer U, Balik E, Saglam EK, Oral EN, Gulluoglu M, Kizir A. Neoadjuvant volumetric modulated arc therapy in rectal cancer and the correlation of pathological response with diffusion-weighted MRI and apoptotic markers. Tumori 2018; 104:266-272. [PMID: 29218690 DOI: 10.5301/tj.5000702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE In this prospective observational study, we aimed to report the applicability and tolerability of neoadjuvant volumetric modulated arc therapy with simultaneous integrated boost (SIB-VMAT) and concurrent chemotherapy in patients with locally advanced rectal cancer (LARC), and to evaluate the correlation of pathological response with apparent diffusion coefficient (ADC) measurements on diffusion-weighted magnetic resonance imaging (DW-MRI) and apoptotic markers. METHODS The study enrolled 30 patients with T3 to T4 and/or N+ rectal cancer who preoperatively received SIB-VMAT and concurrent chemotherapy. Before and after the neoadjuvant treatment, apoptotic markers including the nucleosomes and cell-free DNA fragments in the serum samples were examined; DNA integrity was assessed by amplifying the ACTB gene; and the ADC measurements on the DW-MRI were analyzed. RESULTS No patients had acute or chronic grade III-IV toxicity. Pathologic complete response (pCR) was achieved in 8 patients (27%), while in 10 patients (33%) near-complete pathological response was obtained. Posttreatment ADC was significantly higher in patients with pCR compared with the others (1.28 vs. 1.10, p = 0.017). ROC curve analysis showed that posttreatment ADC values had a sensitivity of 75% and a specificity of 77.3% for distinguishing the patients with pCR from other responders. On the other hand, posttreatment DNA integrity values were revealed lower than the pretreatment values (p = 0.36). Also, the results revealed an insignificant increase in the posttreatment serum level of nucleosomes (p = 0.72). CONCLUSIONS Neoadjuvant SIB-VMAT with concurrent chemotherapy was proved to be a feasible treatment regimen in LARC with tolerable side effects, and improved local control rate and pCR rate.
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Affiliation(s)
- Necla Gurdal
- 1 Department of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
| | - Merdan Fayda
- 2 Department of Radiation Oncology, Istinye University, Faculty of Medicine, Istanbul - Turkey
| | - Nijat Alishev
- 3 Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul - Turkey
| | - Baris Bakir
- 3 Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul - Turkey
| | - Didem Tastekin
- 4 Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
| | - Faruk Aykan
- 4 Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
| | - Ugur Gezer
- 5 Department of Basic Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
| | - Emre Balik
- 6 Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul - Turkey
| | - Esra Kaytan Saglam
- 1 Department of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
| | - Ethem Nezih Oral
- 1 Department of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
| | - Mine Gulluoglu
- 7 Deparment of Pathology, Istanbul University, Istanbul Faculty of Medicine, Istanbul - Turkey
| | - Ahmet Kizir
- 1 Department of Radiation Oncology, Institute of Oncology, Istanbul University, Istanbul - Turkey
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Zhang B, Sun Z, Song M, Ma S, Tian Y, Kong Q. Ultrasound/CT combined with serum CEA/CA19.9 in the diagnosis and prognosis of rectal cancer. J BUON 2018; 23:592-597. [PMID: 30003724] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To explore the significance of computed tomography (CT) and transrectal ultrasonography (TRUS) combined with serum CEA and CA19.9 in the staging, diagnosis and prognosis of rectal cancer. METHODS Fifty-six patients with rectal cancer were recruited from our oncology department. ELISA detected the expression level of CEA and CA19.9 in serum. The hemodynamic parameters of the rectal mucosa and tumor were detected by TRUS [resistance index (RI), pulse index (PI), peak systolic velocity (PSV), end-diastolic volume (EDV)]. All patients were pathologically examined to determine the disease stage and to compare the diagnostic accuracy of serum tumor markers, CT and TRUS. All patients were followed up for 24 months to assess the relationship between the combined examinations and the disease prognosis. RESULTS CEA and CA19.9 levels were significantly different in patients with different pathological stages (p<0.05). RI and PI decreased with increasing pathological stage, while PSV and EDV were increased with increasing pathological stage. The serum CEA+CA19.9 examination showed 12 cases of misdiagnosis, with an accuracy diagnostic rate of 78.57% (447sol;56). CT examination showed 8 cases of misdiagnosis, with an accuracy diagnostic rate of 85.71% (48/56). TRUS showed 6 cases of misdiagnosis, with an accuracy diagnostic rate of 89.28% (50/56). However, only 2 cases were misdiagnosed and 96.43% (54/56) were accurate, while no statistical difference was noticed between combined detection and pathology (p<0.05). Postoperative follow-up showed significant differences in T staging at 6 months, 1 year and 2 years after operation (p<0.05). CONCLUSION CT and TRUS combined with serum CEA and CA19.9 had great value in the diagnosis and prognosis in rectal cancer.
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Affiliation(s)
- Beibei Zhang
- Department of Ultrasonography, Τhe Second People's Hospital of Liaocheng, Liaocheng, China
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Abstract
Plasma levels and urinary excretion of oxypurines – hypoxanthine and xanthine – were evaluated by reverse-phase high-pressure liquid chromatography in 13 patients affected by gastric tumors and in 19 colorectal tumor-bearing patients. Preliminary results indicate higher values of urinary xanthine and an increase in the xanthine/hypoxanthine ratio in cancer patients. The increase was not generalized to all subjects, and did not appear related either to the stage of the disease or to CEA values. The limits within which the determination of urinary oxypurines can be employed as a tumor marker are discussed.
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Abstract
The monoclonal antibody serum test CA 19.9 after having been described as being colon tumor specific, was advertised as being more sensitive than CEA in the detection of both early and advanced colorectal carcinomas. Furthermore, the combined estimation of the two markers, CEA and CA 19.9 was said to improve the detection rate significantly. However, our own comparative studies as well as those of several other groups recently published have shown CA 19.9 measurements to be less valuable, because being less sensitive than those of CEA. This is especially true for the early stages of intestinal carcinomas. The parallel determinations of CA 19.9 and CEA improved the positivity rate insignificantly, because in only 3.5% of all cases C 19.9 was elevated in CEA negative cancer sera. However, CA 19.9 was found to have a much lower rate of (false) positive results than CEA in benign intestinal diseases.
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Affiliation(s)
- S von Kleist
- Institute of Immunobiology, University of Freiburg, F.R.G
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31
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Huang YT, Xu JM. [Circulating tumor DNA and targeted therapy in colorectal cancer]. Zhonghua Zhong Liu Za Zhi 2018; 40:161-165. [PMID: 29575832 DOI: 10.3760/cma.j.issn.0253-3766.2018.03.001] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The detection of circulating tumor DNA is a quick, low cost and reliable approach of liquid biopsy of cancer. It has a wide range of applications for tumor screening because of its noninvasive, convenient and highly repeatable features. In terms of the targeted therapy in patients with colorectal cancer, serial monitoring of circulating tumor DNA, especially for the specific genetic alterations, can be used for prognosis, monitoring resistance, evaluation of therapeutic effects and screening combined targeted therapy. Therefore, it will guide more precise treatment of colorectal cancer.
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Affiliation(s)
- Y T Huang
- Department of Gastrointestinal Oncology, the Affiliated Hospital Cancer Center, Military Academy of Medical Sciences, Beijing 100071, China
| | - J M Xu
- Department of Gastrointestinal Oncology, the Affiliated Hospital Cancer Center, Military Academy of Medical Sciences, Beijing 100071, China
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Rampazzo E, Del Bianco P, Bertorelle R, Boso C, Perin A, Spiro G, Bergamo F, Belluco C, Buonadonna A, Palazzari E, Leonardi S, De Paoli A, Pucciarelli S, De Rossi A. The predictive and prognostic potential of plasma telomerase reverse transcriptase (TERT) RNA in rectal cancer patients. Br J Cancer 2018; 118:878-886. [PMID: 29449673 PMCID: PMC5877438 DOI: 10.1038/bjc.2017.492] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/16/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Preoperative chemoradiotherapy (CRT) followed by surgery is the standard care for locally advanced rectal cancer, but tumour response to CRT and disease outcome are variable. The current study aimed to investigate the effectiveness of plasma telomerase reverse transcriptase (TERT) levels in predicting tumour response and clinical outcome. METHODS 176 rectal cancer patients were included. Plasma samples were collected at baseline (before CRT=T0), 2 weeks after CRT was initiated (T1), post-CRT and before surgery (T2), and 4-8 months after surgery (T3) time points. Plasma TERT mRNA levels and total cell-free RNA were determined using real-time PCR. RESULTS Plasma levels of TERT were significantly lower at T2 (P<0.0001) in responders than in non-responders. Post-CRT TERT levels and the differences between pre- and post-CRT TERT levels independently predicted tumour response, and the prediction model had an area under curve of 0.80 (95% confidence interval (CI) 0.73-0.87). Multiple analysis demonstrated that patients with detectable TERT levels at T2 and T3 time points had a risk of disease progression 2.13 (95% CI 1.10-4.11)-fold and 4.55 (95% CI 1.48-13.95)-fold higher, respectively, than those with undetectable plasma TERT levels. CONCLUSIONS Plasma TERT levels are independent markers of tumour response and are prognostic of disease progression in rectal cancer patients who undergo neoadjuvant therapy.
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Affiliation(s)
- Enrica Rampazzo
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Gattamelata 64, Padova 35128, Italy
| | - Paola Del Bianco
- Clinical Trials and Biostatistic Unit, Istituto Oncologico Veneto (IOV)-IRCCS, Via Gattamelata 64, Padova 35128, Italy
| | - Roberta Bertorelle
- Immunology and Molecular Oncology Unit, IOV- IRCCS, Via Gattamelata 64, Padova 35128, Italy
| | - Caterina Boso
- Radiotherapy and Nuclear Medicine Unit, IOV-IRCCS, Via Gattamelata 64, 35128 Padova, Italy
| | - Alessandro Perin
- Section of Surgery, Department of Surgery, Oncology and Gastroenterology, Via Giustiniani 1, University of Padova, Padova 35128, Italy
| | - Giovanna Spiro
- Section of Surgery, Department of Surgery, Oncology and Gastroenterology, Via Giustiniani 1, University of Padova, Padova 35128, Italy
| | - Francesca Bergamo
- Medical Oncology Unit 1, IOV-IRCCS, Via Gattamelata 64, Padova 35128, Italy
| | - Claudio Belluco
- Department of Surgical Oncology, Centro di Riferimento Oncologico (CRO)-IRCCS, Aviano, Italy
| | | | | | - Sara Leonardi
- Medical Oncology Unit 1, IOV-IRCCS, Via Gattamelata 64, Padova 35128, Italy
| | | | - Salvatore Pucciarelli
- Section of Surgery, Department of Surgery, Oncology and Gastroenterology, Via Giustiniani 1, University of Padova, Padova 35128, Italy
| | - Anita De Rossi
- Section of Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Via Gattamelata 64, Padova 35128, Italy
- Immunology and Molecular Oncology Unit, IOV- IRCCS, Via Gattamelata 64, Padova 35128, Italy
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Behbehani AI, Al-Sayer H, Farghaly M, Kanawati N, Mathew A, al-Bader A, Van Dalen A. Prognostic Significance of CEA and CA 19–9 inc Colorectal Cancer in Kuwait. Int J Biol Markers 2018; 15:51-5. [PMID: 10763141 DOI: 10.1177/172460080001500109] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Preoperative CEA and CA 19–9 levels have been used in the past as prognostic indicators in colorectal cancer, but Dukes’ stage is still considered to be the most important prognostic factor. Recent survival estimates may have been influenced by the fact that in the last decade adjuvant chemotherapy and postoperative irradiation have been included in the routine management of advanced-stage disease. In a heterogeneous Kuwaiti population higher reference levels (95th percentile) of CEA and CA 19–9 have been found than those usually employed. In the present study 62 patients with Dukes’ stage B + C could be analyzed for two-year disease-free survival (DFS). Relapse was observed in 19 patients, 28 patients were disease free and 15 patients with censored observations were included. No significant difference in DFS was observed in Dukes’ B (69%) versus Dukes’ C (48%) patients (p=0.09). On the other hand, Dukes’ stage B+C patients with elevated preoperative levels of CEA or CA 19–9 had a significantly poorer DFS than patients with normal levels. For CEA levels below or above the cutoff the DFS was 74% versus 23% (p=0.003); for CA 19–9 levels below or above the cutoff the DFS was 71% versus 33% (p=0.004). In 54 patients with Dukes’ stage B+C for whom preoperative levels of both CEA and CA 19–9 were available multivariate analysis revealed a decreasing risk of relapse in the following order: CEA and/or CA 19–9 elevated (chi-square 7.09; p=0.008), CA 19–9 elevated (chi-square 6.27; p=0.01), CEA elevated (chi-square 5.47; p=0.02), and Dukes’ C (chi-square 2.08; p=0.15 n.s.). Hence, novel treatment protocols may have improved the disease-free survival, but the use of adjuvant chemotherapy and/or radiotherapy is of questionable benefit in patients who have elevated levels of CEA and/or CA 19–9 prior to treatment.
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Affiliation(s)
- A I Behbehani
- Department of Surgery, Faculty of Medicine, Kuwait University
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Abstract
Serial carcinoembryonic antigen (CEA) levels were measured in 43 patients following incomplete excision of colorectal cancer. Twenty-seven patients received chemotherapy. In the majority the subsequent elevation of CEA could be related to clinical progression, but some patients receiving chemotherapy may have a suppressed rate of CEA rise and may have a more prolonged survival.The clinical application of serial CEA estimations remains of dubious value. However, one area which may be worthy of study is to determine whether suppression of the CEA slope by chemotherapy is attended by clinical control and an improved survival.
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Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Elevated red blood cell distribution width contributes to poor prognosis in patients undergoing resection for nonmetastatic rectal cancer. Medicine (Baltimore) 2018; 97:e9641. [PMID: 29504998 PMCID: PMC5779767 DOI: 10.1097/md.0000000000009641] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Several studies have reported that elevated red blood cell distribution width (RDW) was associated with the poor prognosis of different kinds of cancers. The aim of this study was to investigate the prognostic role of RDW in patients undergoing resection for nonmetastatic rectal cancer.We retrospectively reviewed a database of 625 consecutive patients who underwent curative resection for nonmetastatic rectal cancer at our institution from January 2009 to December 2014. The cutoff value of RDW was calculated by receiver-operating characteristic curve.The results demonstrated that patients in high RDW-cv group had a lower overall survival (OS) (P = .018) and disease-free survival (P = .004). We also observed that patients in high RDW-sd group were associated with significantly lower OS (P = .033), whereas the disease-free survival (DFS) was not significantly different (P = .179).In multivariate analysis, we found elevated RDW-cv was associated poor DFS (hazard ratio [HR] = 1.56, P = .010) and RDW-sd can predict a worse OS (HR = 1.70, P = .009).We confirmed that elevated RDW can be an independently prognostic factor in patients undergoing resection for nonmetastatic rectal cancer. So more intervention or surveillance might be paid to the patients with nonmetastatic rectal cancer and elevated RDW values in the future.
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Zhang YS, Jin LJ, Zhou X, Liu Y, Li Y, Wen LY. Effect of dexmedetomidine on stress reactions and cellular immune function of patients in perioperative period following radial resection for rectal carcinoma. J BIOL REG HOMEOS AG 2018; 32:139-145. [PMID: 29504378] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The study aimed to assess the effects and the further mechanism of action of dexmedetomidine with regard to stress reactions and cellular immune function of patients during the perioperative period following radical resection for rectal carcinoma. A total of 36 patients with rectal carcinoma were selected for radical resection under general anesthesia. The patients were divided into two groups, namely an experimental and a control group. In the experimental group (dexmedetomidine group) 1 μg/ kg/bw dexmedetomidine was injected intravenously 10 min prior to the induction of general anesthesia, and then infusion was carried out at a rate of 0.2 μg·kg-1·h-1 for 30 min prior to the end of surgery. With regard to the control group, the same amount of normal saline (NS) was infused with the same method as the experimental group. Controlled intravenous analgesia was conducted following surgery to all of the patients. Regarding the effect of dexmedetomidine on the reaction of stress, a decrease of VAS scores was noted in the experimental group following extubation compared with the control group (P less than 0.05). Furthermore, a significant decrease in the consumption of morphine in the first 24 h was observed that was accompanied by a decrease of plasma cortisol levels at 6 and 24 h following surgery compared with the control group. The levels of IFN-γ/IL-10 in the experimental group were lower than those of the control group (P less than 0.05). The percentages of CD8+ and CD4+/CD8+ cells in the experimental group were increased compared with those of the control group (P less than 0.05). By infusing dexmedetomidine continuously, stress reactions during the perioperative period were significantly decreased, whereas the analgesic effects of opioid were increased.
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Affiliation(s)
- Y S Zhang
- Department of Anesthesiology, Affiliated HongQi Hospital of MuDanJiang Medical University, Mudanjiang City, China
| | - L J Jin
- Department of Anesthesiology, Affiliated HongQi Hospital of MuDanJiang Medical University, Mudanjiang City, China
| | - X Zhou
- Department of Anesthesiology, Affiliated HongQi Hospital of MuDanJiang Medical University, Mudanjiang City, China
| | - Y Liu
- Department of Anesthesiology, Affiliated HongQi Hospital of MuDanJiang Medical University, Mudanjiang City, China
| | - Y Li
- Department of Anesthesiology, Affiliated HongQi Hospital of MuDanJiang Medical University, Mudanjiang City, China
| | - L Y Wen
- Department of Anesthesiology, Affiliated HongQi Hospital of MuDanJiang Medical University, Mudanjiang City, China
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Cui JH, Jiang WW, Liao YJ, Wang QH, Xu M, Li Y. Effects of oxycodone on immune function in patients undergoing radical resection of rectal cancer under general anesthesia. Medicine (Baltimore) 2017; 96:e7519. [PMID: 28767570 PMCID: PMC5626124 DOI: 10.1097/md.0000000000007519] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aims to explore the effect of oxycodone hydrochloride injection on the immune function of patients who underwent radical resection of rectal cancer under general anesthesia.Eighty patients were enrolled and randomly divided into group A and B (n = 40, each). All patients underwent general intravenous anesthesia. At the end of surgery, each patient in group A was injected with 5 mg (5 mL) of oxycodone hydrochloride, while 5 mg (5 mL) of morphine hydrochloride in group B. Venous blood was withdrawn in both groups at different time points. Changes in the numbers of T lymphocyte subsets and natural killer (NK) cells were determined by flow cytometry.First the numbers of T lymphocyte subsets and NK cells at T1, T2, T3, and T4 decreased in both groups, compared with those at T0, and the differences were statistically significant. Furthermore, the numbers reduced to a minimum at T2 and began to recover at T3. Second the differences between group A and B at T1, T2, T3, and T4 were statistically significant; and the numbers of T lymphocytes and NK cells were higher in group A than in group B at corresponding time points.Oxycodone hydrochloride and morphine hydrochloride both have inhibitory effects on immune function in patients undergoing radical resection of rectal cancer after surgery. However, oxycodone hydrochloride has a smaller effect compared to morphine hydrochloride.
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Jiang H, Wang H, Li A, Tang E, Chen Y, Wang A, Deng X, Lin M. [Impact of neutrophil-to-lymphocyte ratio on the prognosis of patients with locally advanced colorectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:550-554. [PMID: 28534334] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the impact of neutrophil-to-lymphocyte ratio(NLR) on the prognosis of patients with locally advanced colorectal cancer (LACRC). METHODS Clinicopathological data of 684 patients with stage II(-III( CRC undergoing radical resection at Shanghai Ruijin Hospital from January 2008 to December 2010 were analyzed retrospectively. NLR was calculated from neutrophil and lymphocyte counts on routine blood tests prior to surgery. The optimal cutoff value of NLR for predicting 5-year overall survival (OS) was determined through receiver operating characteristic (ROC) curve analysis. According to the cut-off value, patients were divided into high NLR and low NLR groups. Clinicopathological characteristics and prognosis were compared between two groups. Univariate and multivariate analyses were performed with Cox proportional hazards model to evaluate the impact of clinical factors on prognosis. RESULTS A total of 396 male and 288 female patients were included in the study, with a median age of 62 years(range 21-92).Among these patients, 335 had rectal cancers and 349 had colonic cancers; 328 were TNM stage II( and 356 were stage III(. The end of follow-up was January 2016. ROC curve showed that the optimal cut-off value of NLR was 3.0, then patients were divided into low NLR group (NLR≤3.0, n=481) and high NLR group (NLR>3.0, n=203). Compared with low NLR group, the high NLR group was more likely to be older (median 64 vs. 61, t=-2.412, P=0.016), presented higher ratio of colonic cancer [66.0%(134/203) vs. 44.7%(215/481), χ2=25.945, P=0.000] and stage III( tumor [60.1%(122/203) vs. 48.6%(234/481), χ2=7.499, P=0.007], but lower ratio of first-degree relative cancer history [8.9%(18/203) vs. 15.6%(75/481); χ2=5.496, P=0.020]. However, no significant differences were observed between two groups in gender, smoking and drinking history, tumor differentiation grade, vessel invasion and nerve invasion (all P>0.05). The median follow-up time was 67 months (range 3-92), and the 5-year OS rates of high NLR and low NLR group were 59.6% and 73.2% respectively, with significant difference (P=0.001). Cox multivariate analysis revealed that age >65 years (HR=2.07, 95%CI=1.59-2.70, P=0.000), no first-degree relative cancer history (HR=2.01, 95%CI=1.23-3.28, P=0.005), poor differentiation grade (HR=1.65, 95%CI=1.26-2.15, P=0.000), positive vessel or nerve invasion (HR=1.92, 95%CI=1.35-2.71, P=0.000), high TNM stage(HR=2.10, 95%CI=1.59-2.77, P=0.000) and preoperative NLR>3.0(HR=1.51, 95%CI=1.14-2.00, P=0.004) were independent risk factors of prognosis for patients with LACRC. CONCLUSIONS Preoperative NLR can influence the prognosis of patients with LACRC receiving radical surgery. High NLR is associated with poor prognosis.
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Affiliation(s)
- Huihong Jiang
- Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Hui Wang
- Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Ajian Li
- Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Erjiang Tang
- Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Ying Chen
- Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Aili Wang
- Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Xiaxing Deng
- Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Moubin Lin
- Department of General Surgery, Center for Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China.
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Wƚodarczyk M, Kasprzyk J, Sobolewska-Wƚodarczyk A, Wƚodarczyk J, Tchórzewski M, Dziki A, Dziki Ƚ. Mean platelet volume as a possible biomarker of tumor progression in rectal cancer. Cancer Biomark 2017; 17:411-417. [PMID: 27802192 DOI: 10.3233/cbm-160657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Rectal cancer is a major cause of death and an early diagnosis is crucial in decreasing mortality. Previous studies found a relation between chronic inflammation and increased risk of rectal cancer. It was shown that mean platelet volume (MPV) level might be a marker of subclinical inflammatory process in gastrointestinal tract. OBJECTIVE To determinate whether MPV could be a useful biomarker of tumor progression in the rectal cancer. METHODS One hundred and three patients with rectal cancer who underwent surgical resection of tumor were enrolled in the study. The control group consisted of 98 healthy subjects. RESULTS The association between MPV, tumor stage and clinical status were assessed. The analysis proved that pre-operative MPV level was significantly lower in rectal cancer vs. healthy individuals (10.65 ± 0.79 vs. 11.41 ± 0.76 fL; p < 0.001).Receiver-operating characteristic curve analysis suggested 11.3 as the cut-off value for MPV (sensitivity = 83%; specificity = 54%; AUC = 0.745). Surgical resection of tumor resulted in the increase of the MPV level with statistical significance (10.65 ± 0.79 fL vs. 11.21 ± 0.82 fL; p < 0.001). No relationship was found between the post-operative MPV level in cancer patients and control subjects. CONLUSION MPV level may be potentially useful and easily available biomarker for monitoring subclinical inflammation related to rectal cancer and predicting tumor progression.
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Serbanescu GL, Gruia MI, Bara M, Anghel RM. The evaluation of the oxidative stress for patients receiving neoadjuvant chemoradiotherapy for locally advanced rectal cancer. J Med Life 2017; 10:99-103. [PMID: 28255388 PMCID: PMC5304384] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/17/2016] [Indexed: 11/17/2022] Open
Abstract
Hypothesis: Nowadays, rectal cancer is an important healthcare challenge that affects many thousands of people each year worldwide, being diagnosed especially after the age of 50 years. Objective: This study attempted to evaluate the oxidative stress in patients with rectal cancer. Methods and results: 30 patients from the "Prof. Dr. Al. Trestioreanu" Institute of Oncology in Bucharest were treated with neoadjuvant radiochemotherapy during 2014 and 2016 and were included in the clinical study. Blood samples were obtained in dynamics during the treatment. From the blood samples, the serum was separated and used to identify the biochemical oxidative stress parameters. Results: Regarding the determination of lipid peroxides, albumin thiols, the cuprum oxidase activity of ceruloplasmin, the values registered in the dynamic of the treatment highlighted their increase to a maximum at the treatment's endpoint due to an important oxidative stress. Regarding the serum values for total antioxidants, the results pointed out the activation of the natural protection systems, which in time were overwhelmed, due to the installed oxidative stress. Conclusion: Part of the cytotoxic effect of radiotherapy was due to the production of oxidative stress. The cell was constantly exposed to the cytotoxic action of the reactive oxygen species. The obtained results indicated the dual relation to which the tumoral cell exposed itself and the installed oxidative stress, respectively, the oxidative stress being a cause or a consequence of the malign transformation. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging, ESMO = European Society for Medical Oncology, ECOG = performance status scale.
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Affiliation(s)
- G L Serbanescu
- "Prof. Dr. Al.Trestioreanu" Institute of Oncology, Bucharest, Romania ; "Carol Davila'' University of Medicine and Pharmacy, Bucharest, Romania
| | - M I Gruia
- Research Department, "Prof. Dr. Al. Trestiorenu" Institute of Oncology, Bucharest, Romania
| | - M Bara
- "Prof. Dr. Al.Trestioreanu" Institute of Oncology, Bucharest, Romania ; "Carol Davila'' University of Medicine and Pharmacy, Bucharest, Romania
| | - R M Anghel
- "Prof. Dr. Al.Trestioreanu" Institute of Oncology, Bucharest, Romania ; "Carol Davila'' University of Medicine and Pharmacy, Bucharest, Romania
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Abstract
The aim of this study was to investigate the role of uric acid (UA) in assessing rectal cancer metastasis.There were 475 newly diagnosed patients with complete data in our study, a total of 475 cases were reviewed, and divided into patients with metastasis and without metastasis.There were several statistical differences in age, tumor diameter, carcino-embryonic antigen (CEA), and C-reactive protein (CRP) between the 2 groups. Importantly, serum concentrations of UA in patients with lymphatic metastasis were found to be increased compared with patients without lymphatic metastasis (270.9 ± 52.99 vs 215.8 ± 43.55; P < 0.001). There were positive correlations of serum UA with creatinine (Cr), CRP, and CEA (r = 0.281, P = 0.023; r = 0.312, P = 0.001; r = 0.294, P = 0.017) in rectal cancer patients with metastasis. Multivariate analysis model revealed that elevated serum levels of UA were significant prognostic marker for lymphatic metastasis in patients with rectal cancer, independently of CRP, CEA, and tumor diameter (odds ratio 1.035, 95% CI 1.013-1.057, P = 0.002). In receiver-operating characteristic curve analysis, the area under the curve of serum UA in assessing metastatic rectal cancer patients was 0.803, with sensitivity of 0.864 and specificity of 0.739.Our results suggest that serum UA may be a novel marker in assessing tumor metastasis in patients with rectal cancer.
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Affiliation(s)
- Cheng Yuan
- The First College of Clinical Medical Science
| | - Xin-Hua Xu
- Department of Oncology, China Three Gorges University and Yichang Central People's Hospital, Yichang, Hubei, China
| | - Xiao-Long Wang
- Klinikum rechts der Isar Technical University of Munich, München, Germany
| | - Lu Xu
- The First College of Clinical Medical Science
| | - Zhuo Chen
- The First College of Clinical Medical Science
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Abstract
Lymphocyte-to-monocyte ratio (LMR) was associated with survival benefit in some types of cancer. The relationship between LMR and rectal cancer has not been investigated. We conducted a retrospective cohort study to assess the prognostic significance of LMR in patients with nonmetastatic rectal cancer. Patients with rectal cancer who underwent potentially curative resection between January 2009 and December 2013 were enrolled. The LMR was calculated from preoperative blood test by dividing the absolute lymphocyte counts by the absolute monocyte counts. The optimal cut-off value for LMR was calculated as the median value. On the basis of the cut-off value, patients were divided into 2 groups: low group and high group. A total of 543 patients with rectal cancer were eligible for this study. The median follow-up time for all patients was 55 months (range 6-85 months). The cut-off value of LMR was 5.13 and patients were divided into 2 groups: low group (LMR < 5.13) and high group (LMR ≥ 5.13). In the univariate and multivariate analysis, the LMR was not significantly associated with overall survival (OS) [hazard ratio (HR): 1.034, 95% confidence intervals (CIs): 0.682-1.566, P = 0.876]. When disease-free survival (DFS) was compared, univariate and multivariate analysis also indicated that the LMR was not significantly associated with DFS (HR: 0.988, 95% CI: 0.671-1.453, P = 0.950). In addition, in the subgroup analysis by tumor-node-metastasis stage, there existed no significance between LMR and OS and DFS. Although as an easy access and highly efficient laboratorial inflammatory marker, LMR cannot predict the prognosis of nonmetastatic rectal cancer patients.
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Affiliation(s)
- Qing-Bin Wu
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Meng Wang
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wan-Bin He
- West China School of Medicine
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zi-Qiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Guo Xue Xiang No. 37, Chengdu 610041, China (e-mail: )
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Mularczyk A, Gonciarz M. [Neoadiuvant teleradiotherapy decreases cancer tissue and serum concentration of prostaglandin E2 and cyclooxygenase-2 expression in patients with rectal cancer]. Pol Merkur Lekarski 2016; 41:70-73. [PMID: 27591442] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED The carcinogenesis of colorectal cancer involves many factors, which modify the functioning of cells and can include prostaglandins. Resection of tumours and/or radiotherapy provide potentially curative therapy for cancer of the rectum. AIM The aim of the study was to asses the effects of neoadiuvant teleradiotherapy on PGE2 concentrations in the serum and in the resected bowel tissue as well as on COX-2 gene expression in patients with rectal cancer. MATERIALS AND METHODS Group I (n=20) included patients with resectable tumour (T1-2,No) treated exclusively by surgery, and group II (n=20) - patients with resectable tumours (T3) and nonresectable ones (T4). All the patients out of group II were put to the surgery after the previous teleradiotherapy applied to them. PGE2 concentrations were examined using the RIA method, while COX-2 mRNA expression was analyzed with the use of the PCR method. RESULTS PGE2 serum concentrations in the group I prior to the resection did not differ from PGE2 concentrations in the group II prior to the resection (p=0,9488). However, radiation had caused reduction of PGE2 serum concentration prior to the resection in patients from the group II in comparison with the group I (p=0,0115). PGE2 serum concentrations after resection in the group I did not differ significantly from PGE2 concentrations in group II after resection (p=0,4511) (two-factor analysis of variation with interaction, p=0,3117). Radiotherapy did not change significantly PGE2 concentrations in the tumour and margin (two-factor analysis of variations with interaction, p=0,3137). The comparison between the number of patients who showed higher COX-2 mRNA expression in tumour than in the margin in the group I and II, did not reveal differences (p=0,6614). CONCLUSIONS Neoadiuvant teleradiotherapy decreased PGE2 concentration in the serum, thus showed similar effect as tumour resection.
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Affiliation(s)
- Aldona Mularczyk
- Department of Gastroenterology and Oncology of the Digestive Tract, Main District Hospital, Sosnowiec, Poland
| | - Maciej Gonciarz
- Department of Gastroenterology and Oncology of the Digestive Tract, Main District Hospital, Sosnowiec, Poland
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Sung S, Son SH, Kay CS, Lee YS. Prognosis Can Be Predicted More Accurately Using Pre- and Postchemoradiotherapy Carcinoembryonic Antigen Levels Compared to Only Prechemoradiotherapy Carcinoembryonic Antigen Level in Locally Advanced Rectal Cancer Patients Who Received Neoadjuvant Chemoradiotherapy. Medicine (Baltimore) 2016; 95:e2965. [PMID: 26962798 PMCID: PMC4998879 DOI: 10.1097/md.0000000000002965] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We aimed to evaluate the prognostic value of a change in the carcinoembryonic antigen (CEA) level during neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer. A total of 110 patients with clinical T3/T4 or node-positive disease underwent nCRT and curative total mesorectal resection from February 2006 to December 2013. Serum CEA level was measured before nCRT, after nCRT, and then again after surgery. A cut-off value for CEA level to predict prognosis was determined using the maximally selected log-rank test. According to the test, patients were classified into 3 groups, based on their CEA levels (Group A: pre-CRT CEA ≤3.2; Group B: pre-CRT CEA level >3.2 and post-CRT CEA ≤2.8; and Group C: pre-CRT CEA >3.2 and post-CRT CEA >2.8). The median follow-up time was 31.1 months. The 3-year disease-free survival (DFS) rates of Group A and Group B were similar, while Group C showed a significantly lower 3-year DFS rate (82.5% vs. 89.5% vs. 55.1%, respectively, P = 0.001). Other clinicopathological factors that showed statistical significance on univariate analysis were pre-CRT CEA, post-CRT CEA, tumor distance from the anal verge, surgery type, downstage, pathologic N stage, margin status and perineural invasion. The CEA group (P = 0.001) and tumor distance from the anal verge (P = 0.044) were significant prognostic factors for DFS on multivariate analysis. Post-CRT CEA level may be a useful prognostic factor in patients whose prognosis cannot be predicted exactly by pre-CRT CEA levels alone in the neoadjuvant treatment era. Combined pre-CRT CEA and post-CRT CEA levels enable us to predict prognosis more accurately and determine treatment and follow-up policies. Further large-scale studies are necessary to validate the prognostic value of CEA levels.
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Affiliation(s)
- SooYoon Sung
- From the Department of Radiation Oncology (SYS, SHS, CSK); and Department of Surgery (YSL), Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Gao C, Fang L, Li JT, Zhao HC. Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients. World J Gastroenterol 2016; 22:2576-2584. [PMID: 26937145 PMCID: PMC4768203 DOI: 10.3748/wjg.v22.i8.2576] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/25/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis (LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded.
METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health (Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM (49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012.
RESULTS: The baseline serum direct bilirubin concentration was (median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin (2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin was independently associated with LNM (OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that: (1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification; (2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and (3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis.
CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.
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Suzuki T, Shimada H, Ushigome M, Koike J, Funahashi K, Nemoto T, Kaneko H. Three-year monitoring of serum p53 antibody during chemotherapy and surgery for stage IV rectal cancer. Clin J Gastroenterol 2016; 9:55-8. [PMID: 26919859 DOI: 10.1007/s12328-016-0633-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 02/13/2016] [Indexed: 01/13/2023]
Abstract
The overexpression of mutant p53 stimulates serum p53 antibody production in patients with colorectal carcinoma even in superficial tumors. Although the short-term perioperative monitoring of serum p53 antibody titers is reported to be useful in predicting tumor recurrence and patient survival in colorectal carcinoma, the clinical utility of the long-term monitoring of serum p53 antibody titers in patients with colorectal cancer remains unknown. Here, we report the 3-year monitoring of serum p53 antibody titers in a 60-year-old man with rectal cancer, clinical stage IV (T2N2M1b, lung and liver metastases), who was treated with chemotherapy and surgery. Screening tests for CEA (29.4 ng/ml), CA19-9 (41.1 U/ml), and serum p53 antibody (2170 U/ml) were positive before treatment. After chemotherapy with mFOLFOX6 + bevacizumab (B-mab), CEA and CA19-9 decreased to the normal range. However, serum p53 antibody titer remained positive (283 U/ml). After low anterior resection, the serum p53 antibody titer still remained positive (63.4 U/ml). Serum p53 antibody titer significantly changed and was associated with treatment response and tumor recurrence. In the last 6 months of the patient's life, serum p53 antibody titer gradually decreased, which possibly reflects the modification of the patient's immune response to p53 antigens.
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Affiliation(s)
- Takayuki Suzuki
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Mitsunori Ushigome
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Junichi Koike
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Kimihiko Funahashi
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tetsuo Nemoto
- Department of Pathology, Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hironori Kaneko
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Kit OK, Goroshinskaya IA, Tarnopolskaya OV, Gevorkayn UA, Maleiko ML, Snezhko AV, Nemashkalova LA, Abakumova SF. THE CONTENT OF TRANSFERRIN AND FERRITIN IN BLOOD OF PATIENTS WITH RECTAL CANCER IN THE FIRST WEEK AFTER SURGERY. Eksp Klin Gastroenterol 2016:40-45. [PMID: 29874434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY Examine the dynamics of the content of ferritin and other indicators of iron metabolism in the blood of patients with colorectal cancer before surgery and in the postoperative period to 7 days, and compare it with other known non-specific criteria of the acute phase of inflammation. Respond to the question whether changes in iron metabolism parameters in patients with colorectal cancer after surgery are specific. MATERIALS AND METHODS The content of ferritin, transferrin, iron and unsaturated iron binding capacity (TIBE) in the blood serurii of patients with coidrecral cancer before surgery and in the postoperative period of 1, 3 and 7 days was determined at the biochemical analyzer Cobas Integra 400. The values of parameters in the group of individuals without cancer pathology (control group) were used for comparison. RESULTS Before surgery, patients studied parameters were within normal limits. In the postoperative period (7 days) ferritin level was significantly increased by 88%, and transferrin level was reduced by 73% in relation to that of the control group (p <0.05; U-Mann-Whitney). Total iron binding capacity was significantly reduced by 250%. CONCLUSIONS Opposite changes of ferritin and transferrin, known as the acute-phase proteins, show predominance in the first week after surgery nonspecific reaction of patients to surgical stress. These metalioproteins are considered as one of the markers of the stress. We compared revealed changes in the studied parameters of iron system with the experimental data on the changes in the membrane potential of red blood cells and lymphocytes, and came to the conclusion that the identified synchronicity indicates their potential conditionality.
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Shi J, Xiong L, Li J, Cao H, Jiang W, Liu B, Chen X, Liu C, Liu K, Wang G, Cai K. A Linear Dose-Response Relationship between Fasting Plasma Glucose and Colorectal Cancer Risk: Systematic Review and Meta-analysis. Sci Rep 2015; 5:17591. [PMID: 26620869 PMCID: PMC4665197 DOI: 10.1038/srep17591] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
For many years, the question of whether hyperglycaemia, a manifestation of prediabetes, diabetes mellitus and metabolic syndrome, is a risk factor for colorectal cancer has been intensely studied. In fact, even after the conclusion of several prospective studies, the topic is still controversial. We conducted a systematic review and meta-analysis to investigate the dose-response relationship between blood glucose concentration and the incidence of colorectal cancer. A linear (P = 0.303 for non-linearity) dose-response relationship was observed between fasting plasma glucose (FPG) and colorectal cancer risk without significant heterogeneity. The relative risk (RR) for colorectal cancer per 20 mg/dL increase in FPG was 1.015 (95% CI: 1.012-1.019, P = 0.000). In subgroup analyses, the pooled RRs for colon cancer (CC) and rectal cancer (RC) studies were 1.035 (95% CI 1.008-1.062, P = 0.011) and 1.031 (95% CI: 0.189-5.628, P = 0.972), respectively; in the analysis comparing men and women, the pooled RRs were 1.016 (95% CI: 1.012-1.020, P = 0.000) and 1.011 (95% CI: 0.995-1.027, P = 0.164), respectively. Sensitivity analyses using two methods showed similar results. In conclusion, there is a significant linear dose-response relationship between FPG and the incidence risk of colorectal cancer. For people with diabetes or prediabetes, controlling blood glucose might be useful to prevent colorectal cancer.
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Affiliation(s)
- Jianguo Shi
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Lijuan Xiong
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Jiaoyuan Li
- State Key Laboratory of Environment Health (Incubation, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Ministry of Education) Key Laboratory of Environment & Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Ministry of Environmental Protection Key Laboratory of Environment and Health (Wuhan), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Heng Cao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Wen Jiang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Bo Liu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Xueqin Chen
- State Key Laboratory of Environment Health (Incubation, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Ministry of Education) Key Laboratory of Environment & Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Ministry of Environmental Protection Key Laboratory of Environment and Health (Wuhan), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Cheng Liu
- State Key Laboratory of Environment Health (Incubation, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Ministry of Education) Key Laboratory of Environment & Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Ministry of Environmental Protection Key Laboratory of Environment and Health (Wuhan), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Ke Liu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
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Zhang LN, OuYang PY, Xiao WW, Yu X, You KY, Zeng ZF, Xu RH, Gao YH. Elevated CA19-9 as the Most Significant Prognostic Factor in Locally Advanced Rectal Cancer Following Neoadjuvant Chemoradiotherapy. Medicine (Baltimore) 2015; 94:e1793. [PMID: 26559251 PMCID: PMC4912245 DOI: 10.1097/md.0000000000001793] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
It remains controversial regarding the prognostic significance of carbohydrate antigen 19-9 (CA19-9) for locally advanced rectal cancer (LARC) (T3-4/N+) patients with neoadjuvant chemoradiotherapy (neo-CRT). And it is unknown whether CA19-9 can identify patients who may benefit from adjuvant chemotherapy.Overall, 303 LARC patients with neo-CRT between 2004 and 2010 were recruited. Overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), and local recurrence-free survival across pretreatment CA19-9 were estimated by Kaplan-Meier method and Cox regression model.In univariate analysis, elevated CA19-9 (>35 U/mL) was significantly correlated with poor OS (P = 0.003), DFS (P = 0.001), and DMFS (P = 0.039). Adjusting for the known covariates, CA19-9 was significantly associated with OS (HR = 1.86, 95% CI 1.03-3.34, P = 0.039) and DFS (HR = 1.74, 95% CI 1.08-2.80, P = 0.024). In the elevated CA19-9 subgroup, patients with adjuvant chemotherapy got much better OS (P < 0.001) and DFS (P = 0.016) than those without. In consideration of both CA19-9 and carcinoembryonic antigen (CEA), we found that patients with both elevated CA19-9 and CEA (>5 ng/mL) got the worst OS (P = 0.021) and DFS (P = 0.006), and significantly benefited from adjuvant chemotherapy in OS (P < 0.001) and DFS (P = 0.026).Pretreatment CA19-9 level is a significant prognostic indicator in patients with LARC following neo-CRT. The addition of CA19-9 to CEA is valuable to discriminate the appropriate patients for adjuvant chemotherapy.
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Affiliation(s)
- Lu-Ning Zhang
- From the Department of Radiation Oncology (L-NZ, P-YOY, W-WX, XY, Z-FZ, Y-HG), Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong (R-HX) and Department of Oncology, The Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (K-YY)
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Han YD, Kim WR, Park SW, Cho MS, Hur H, Min BS, Baik SH, Lee KY, Kim NK. Predictors of Pathologic Complete Response in Rectal Cancer Patients Undergoing Total Mesorectal Excision After Preoperative Chemoradiation. Medicine (Baltimore) 2015; 94:e1971. [PMID: 26559272 PMCID: PMC4912266 DOI: 10.1097/md.0000000000001971] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Preoperative chemoradiotherapy (CRT) is the standard of care for patients with stage II and III rectal cancer. This strategy leads to pathologic complete response (pCR) in a significant number of patients. Factors predictive of pCR are currently being extensively investigated. The aim of this study was to analyze clinical factors that might be predictive of pCR.This study was a retrospective analysis of rectal cancer patients from January 2004 through December 2012. A total of 332 stage II and III patients with middle and low rectal cancer (≤10 cm) who received CRT and underwent curative total mesorectal excision were eligible. The median radiation dose was 50.4 Gy, and 72.6% of patients received infusional 5-fluorouracil with leucovorin, whereas 19.6% of patients received TS-1 with irinotecan, and 7.8% of patients received xeloda only. Pathologic complete response was confirmed by using pathologic specimens and analyzed based on predictive clinical factors.Among the 332 patients, 27.4% (n = 91) achieved pCR. Age, sex, body mass index, clinical T and N stages, tumor differentiation, the chemotherapy agent for CRT, and the time interval between CRT and surgery did not differ between the pCR and non-pCR groups. Carcinoembryogenic antigen (CEA) levels before CRT were 4.61 ± 7.38 ng/mL in the pCR group and 10.49 ± 23.83 ng/mL in the non-pCR group (P = 0.035). Post-CRT CEA levels were 1.4 ± 1.07 ng/mL in the pCR group and 2.16 ± 2.8 ng/mL in the non-pCR group (P = 0.014), and the proportion of middle rectal cancer patients was higher in pCR group (54.9%, P = 0.028). The results from multivariate logistic regression analysis indicated that higher tumor location (odds ratio 2.151; P = 0.003) and low post-CRT CEA level (odds ratio 0.789; P = 0.04) were independent predictive factors for pCR.Tumor location and post-CRT CEA level were predictive factors in pCR for rectal cancer patients. Therefore, these factors may be important determinants in achieving pCR, and may also be used to predict oncologic outcomes.
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Affiliation(s)
- Yoon Dae Han
- From the Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
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