Fighting on the border

Abstract

Colorectal cancer (CRC) is a public healthproblem inmost develped countries. It is potentially curable in its early stages, but a elevant proportion of patients still presents with or ultimately evelops metastatic disease. Over the past 10 years, significant advances have been made in he molecular profiling and clinico-pathological characterization f CRC. In particular, the expanding body of information on cancer iology may provide the biological rationale for new therapeutic trategies. The interesting manuscript published in this issue of igestive and Liver Disease by Cianchi et al. further demonstrates ow molecular studies may help therapy to be tailored to cancer’s iology [1]. COX2 gene expression is virtually undetectable in the normal ntestine, but frequently upregulated in CRC [2]. In vivo and in itro studies have demonstrated that COX2 gene product promotes ngiogenesis, supporting both tumour growth and metastatic mplants [3]. A direct correlation between COX2 expression and icrovessel density has also been documented. As in several ther epithelial malignancies, COX2 protein over-expression conistently correlates with an unfavourable prognosis. In a study on large cohort of CRC patients, Soumaoro et al. associated COX2ositive cancers with a significantly shorter overall survival, and his unfavourable outcomewas also confirmedwhen different caner stages were considered separately [4]. In the Soumaoro study, OX2 over-expression was consistently found in primary tumours, s well in all liver metastases and almost in all metastatic regional ymph nodes. Vascular endothelial growth factor (VEGF) is a glycoproteinwith itogenic effects on endothelium and its activation results in sigalling cascades that promote both new endothelial cell growth nd the survival of existing vessels. The role of VEGF in cancer has een extensively studied and a higher expression of VEGF has been ssociated with COX2 upregulation [2]. Cianchi et al. provide original, interesting data on this hot issue 1]. They tested the expression of a panel of well-known angio-