Abstract
Cancers of the colon and rectum, which rank among the most frequent human tumors, are currently treated by surgical resection in locally restricted tumor stages. However, disease recurrence and formation of local and distant metastasis frequently occur even in cases with successful curative resection of the primary tumor (R0). Recent technological advances in molecular diagnostic analysis have led to a wealth of knowledge about the changes in gene transcription in all stages of colorectal tumors. Differential gene expression, or transcriptome analysis, has been proposed by many groups to predict disease recurrence, clinical outcome, and also response to therapy, in addition to the well-established clinico-pathological factors. However, the clinical usability of gene expression profiling as a reliable and robust prognostic tool that allows evidence-based clinical decisions is currently under debate. In this review, we will discuss the most recent data on the prognostic significance and potential clinical application of genome wide expression analysis in colorectal cancer.
Highlights
Colorectal cancer (CRC) is one of the most common cancers and the second leading cause of cancer-related death worldwide [1,2]
Several types of staging systems have been developed for colorectal cancer, such as the Dukes' system, the modified Astler-Coller staging system and the TNM system introduced by the American Joint
We focused on original studies on colorectal cancer investigating the mRNA based gene-expression signature with a special emphasis on the prognosis, and not on the expression differences between various cancer stages, or between carcinoma and normal tissue
Summary
Colorectal cancer (CRC) is one of the most common cancers and the second leading cause of cancer-related death worldwide [1,2]. Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) [3,4,5,6]. These staging systems rely on the size and extent of the primary tumor, on the metastatic spread to lymph nodes and distant organ sites, and on lymphatic and vascular invasion (TNM system). Metastasis formation is the major cause of death in patients with colorectal cancer, and depending on tumor stage, liver metastases occur in 20% to 70% of patients, and lung metastases in 10% to 20% of cases. For patients with locally restricted colon tumors without lymph node metastasis, surgical tumor resection is the current standard therapy. To state an example of high clinical relevance: it is not possible to prospectively identify the high-risk group of 20–30% of patients with locally restricted stage II (UICC)
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