Abstract
BackgroundTreatment decisions in colorectal cancer subsequent to surgery are based mainly on the TNM system. There is a need to establish novel prognostic markers based on the molecular characterization of tumor cells. Evidence exists that sialyl LeX expression is correlated with an unfavorable outcome in colorectal cancer. The aim of this study was to establish a simple sialyl LeX staining score and to determine a potential correlation with the prognosis in a series of advanced colorectal carcinoma patients.MethodsIn order to implement routine use of sialyl LeX immunohistology, we established a new, easily reproducible score and defined a cutoff which discriminated groups with better or worse outcome, respectively. We then correlated sialyl LeX expression of 215 UICC stage III and IV patients with disease-free and cancer-related survival.ResultsA five-stage score could be established based on automated immunohistochemical stainings. Using a statistical model, we calculated a cutoff to discriminate between weak and strong staining positivity of sialyl LeX. Patients with strong positive specimens had a worse cancer-related survival (P = 0.004) but no difference was observed for disease-free survival (P = 0.352).ConclusionsThese results demonstrate a strong correlation between high sialyl LeX-expression in colorectal carcinomas and cancer-related survival. Our highly standardized and easy-to-use staining score is suitable for routine use and hence it could be recommended to evaluate sialyl LeX-expression as part of the standard histopathological analysis of colorectal carcinomas and to validate the score prospectively based on a larger population.
Highlights
Treatment decisions in colorectal cancer subsequent to surgery are based mainly on the tumor node metastasis (TNM) system
We separated our patients into two risk groups with a staining score from zero to two and three to four
Comparable to literature data, we found no correlation between sialyl LeX expression and other histopathological markers like TNM or grading [6,7,8]
Summary
Treatment decisions in colorectal cancer subsequent to surgery are based mainly on the TNM system. We correlated sialyl LeX expression of 215 UICC stage III and IV patients with disease-free and cancer-related survival. Patients without distant metastasis at the time of surgery (International Union Against Cancer (UICC) stages I to III) still have unsatisfying five-year survival rates between 41% and 96% [2,3]. The challenge lies in the definition of new prognostic markers for the identification of patients with a worse outcome. By identifying those patients, it would be possible to extend the indication for an adjuvant treatment to UICC stages I and II as well as for a more aggressive first-line adjuvant therapy in UICC stage III patients or palliative therapy in UICC stage IV patients
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