High CEA Level Research Articles

Low Body Mass Index Is an Independent Predictive Factor after Surgical Resection in Patients with Non-Small Cell Lung Cancer

Background:The effect of body mass index (BMI) on postoperative survival in non-small cell lung cancer (NSCLC) has been controversial. We retrospectively analysed the effect of preoperative BMI on postoperative outcomes of NSCLC surgery.Methods:Consecutive 384 NSCLC patients were enrolled. Patients were subdivided into 3 groups: low BMI group (BMI<18.5 kg/m2), normal BMI group (BMI=18.5-24.0 kg/m2) and high BMI group (BMI>24.0 kg/m2). The prognostic significance of BMI was examined retrospectively.Results:The 5-year survival of patients with low, normal and high BMI groups were 46.3%, 74.3% and 84.3%, respectively. The low BMI group had a poorer prognosis than the other groups (p<0.001). The survival of high BMI group had a more favorable trend than that of normal BMI group, but this did not reach statistical significance (p=0.057). On multivariate analysis, significant risk factors for cancer-specific survival were male gender (p=0.0061), non-adenocarcinoma histology (p=0.0003), pN1-2 status (p=0.0007), high serum CEA level (p<0.0001) and low BMI (low vs. others: p <0.0001).Conclusions:Preoperative BMI is an independent prognostic factor for NSCLC patients after surgical resection, with low BMI patients having an unfavorable prognosis.

Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and their dynamic changes during chemotherapy is useful to predict a more accurate prognosis of advanced biliary tract cancer.

Background and PurposeSystemic inflammation is known to promote carcinogenesis in biliary tract cancer (BTC). Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are indicative of systemic inflammation. We evaluated the clinical significance of systemic inflammation measured by NLR and PLR in patients with advanced BTC. Additionally, we also co-analyzed the dynamics of NLR and PLR during chemotherapy.MethodsWe reviewed 450 patients with unresectable BTC receiving palliative chemotherapy. NLR and PLR were obtained before initiation of palliative chemotherapy. Changes in NLR, PLR were obtained by subtracting the initial value from the value obtained after progression of chemotherapy.ResultsHigher systemic inflammation status also had relation with a primary tumor site (p = 0.003) and higher levels of CEA (p = 0.038). The ROC cut-off values of NLR and PLR for predicting overall survival (OS) were 3.8 and 121, respectively. Patients with a high NLR or PLR had worse OS independently in multivariate analysis (6.90 vs. 9.80 months, p =0.002; 7.83 vs. 9.90 months, p =0.041, respectively). High NLR with increased NLR after chemotherapy is associated with worse OS and progression-free survival (PFS) (p < 0.001, p = 0.013 respectively). Results are similar for PLR.ConclusionSystemic inflammation represented by NLR and PLR, predicts the OS of patients with advanced BTC who are receiving palliative chemotherapy. In addition, considering NLR/PLR with a dynamic change of NLR/PLR during chemotherapy might help to predict a more accurate prognosis.

A case of adenocarcinoma arising in an ileal diverticulum resected by laparoscopic surgery.

Adenocarcinoma arising in an ileal diverticulum are very rare. A 66-year-old man was recognized to have high serum CEA level and periappendiceal polycystic tumor in CT findings. Colonoscopy showed no abnormality in the ileocecal mucosa. However, the patient was suspected of appendiceal adenocarcinoma by PET/CT, which revealed FDG uptake with SUVmax of 3.9 in the tumor, and underwent radial surgery by single-incision laparoscopic surgery. Intraoperative findings showed the mass in the mesenterium of the terminal ileum but not the abnormality of the appendix. The resected specimen revealed a cystic tumor of 45 mm on the back side of the intestinal tract. Pathological findings showed that the tumor lesion mainly consisted of mucinous adenocarcinoma was developing from the base of the ileal diverticula. The postoperative process was going well, and the patient left the hospital 14 days after the operation. The recurrence has not been evident 10 months after the operation.

Clinical impact of colonoscopy for patients with early gastric cancer treated by endoscopic submucosal dissection: A matched case–control study

BackgroundGastric cancer frequently occurs synchronously with colorectal cancer (CRC). AimsThe aim of the present study was to assess the value of colonoscopy in patients with primariy early gastric cancer (EGC) indicated for endoscopic submucosal dissection (ESD) and to identify predictors for the risk of high-risk adenomas. MethodsA total of 130 patients with EGC, who underwent both colonoscopy and gastric ESD, and 260 controls matched for age and sex, who underwent a colonoscopy as part of our institutional health check-up program.The prevalence of high-risk adenomas in EGC patients vs. controls was evaluated. ResultsHigh-risk adenomas were found in 43 (33%) EGC patients and 37 (14%) controls (P<0.01). Multivariate analysis showed the presence of EGC was significantly associated with high-risk adenoma [odds ratio (OR) 2.8, 95% confidence interval (CI): 1.7–4.9]. Among EGC patients, high serum CEA level (OR 2.4, 95% CI: 1.2–5.0) was an independent predictor for high-risk adenoma. ConclusionsPatients with EGC had a significant risk for colorectal cancer. When endoscopists detected an early gastric cancer indicated for ESD, colonoscopy should be considered for EGC patients with high serum CEA levels.

Outcomes after resection of pulmonary metastases in patients with colorectal cancer.

757 Background: Surgical resection of liver metastases provides a significant survival benefit, and potential for cure, in selected patients with metastatic colorectal cancer. There are very limited data on resection of lung metastases in patients with colorectal lung metastases. We evaluated outcomes after resection of lung metastases in patients with colorectal cancer. Methods: We conducted a retrospective cohort study in patients who underwent resection of pulmonary metastases between 2/2006 and 6/2013 at Cleveland Clinic. Clinical, pathologic, and outcome data were collected by electronic medical records review. Overall survival (OS) as the primary endpoint was summarized by Kaplan-Meier method and analyzed by log-rank tests. Results: The study population comprised 32 patients. Overall, 20 patients were male and median age at diagnosis of lung metastasis was 60.0 years (range 30.4-81.9). All patients had resection of primary tumor. Eleven patients had preoperative chemotherapy and 12 had adjuvant chemotherapy. Patients with unilateral metastases comprised the majority of patients (N = 22, 68.8%); 59% (N = 19) had a solitary metastasis. The median diameter of lung metastases was 20.5 mm (range 7.0 -50.0). Ten patients had concurrent liver metastases, eight of whom had liver resection as well. Overall, 31% (10/32) of patients recurred, with 50% (16/32) of recurrences in the lung, and 28% died. Estimated median OS was 55.0 months. Estimated 5-year OS was 32% ± 17%. Higher CEA level ( ≥ 4.5 ng/mL) at the time of diagnosis of lung metastasis was associated with worsened OS (p = 0.026). Other potential prognostic factors, such as laterality, number of lung metastases, and extrapulmonary lesions, were not associated with overall survival in this study population. Conclusions: Our study showed resection of lung metastases in select patients with colorectal cancer can be associated with prolonged survival in the range seen with resection of liver metastases. Higher CEA level at time of diagnosis of lung metastasis is associated with poorer prognosis. More data are necessary to identify approaches to patient selection in the metastatic colorectal setting.

EGFR mutation status in plasma and tumor tissues in non-small cell lung cancer serves as a predictor of response to EGFR-TKI treatment

ABSTRACTObjective: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) can effectively control non-small cell lung cancer (NSCLC). Therefore, EGFR mutations should be detected before lung cancer patients undergo EGFR-TKI therapy. This study assessed the feasibility and predictive value of EGFR mutations in peripheral blood samples.Methods: EGFR mutations in exons 19 and 21 were analyzed in tumor tissue and plasma DNA samples from 121 NSCLC patients using amplification refractory mutation system (ARMS) and the integrated technique of mutant enriched PCR (me-PCR) and denaturing high performance liquid chromatography (DHPLC), respectively.Results: EGFR mutations were detected in 36.4% of tumor tissues and 34.7% of the plasma at a concordance rate of 85.1% (103/121). The sensitivity and specificity of plasma EGFR mutations were 77.3% and 89.6%, respectively. The gender and tumor histology of patients served as independent predictors of EGFR mutations in both tumor tissues and plasma, while CEA level was an independent predictor of EGFR mutations in the plasma. Furthermore, EGFR-TKI treatment showed a significantly higher objective response rate (ORR), median progression-free survival (mPFS), and overall survival (mOS) in patients harboring EGFR mutation than those that did not exhibit EGFR mutation (ORR: 69.4% versus 13.0% in tissues, P < 0.001; 64.5 % vs. 28.6% in the plasma, P = 0.006. mPFS: 10.4 months versus 4.1 months in tissues, P<0.001; 10.5 months vs. 5.2 months in the plasma, P=0.001. mOS: 25.7 months versus 8.3 months in tissues, P=0.005; 25.7 months vs. 13.5 months in the plasma, P=0.038).Conclusions: EGFR mutations can be detected in the plasma using the integrated technique of me-PCR and DHPLC, which enables us to predict patient response to EGFR-TKI therapy. High serum CEA levels served as an independent predictor for plasma EGFR mutations.

THE RELATIONSHIP BETWEEN K-RAS GENE MUTATION, SOME DEGREE OF DIFFERENTIATION AND TUMOR MARKERS IN ADVANCED COLORECTAL CANCER

K-ras gene mutation is common in non-hereditary colorectal cancer. Although the role as a predictive biomarker to anti-EGFR therapy is well defined, its role as a prognostic marker is uncertain. We studied the relationship between the incidence of k-ras gene mutation, the degree of differentiation and the status of tumor markers in patients with advanced colorectal cancer resistant to complex cancer treatment. METHOD: Multicenter, retrospective study done in three oncology clinics in Bucharest from 2010 to 2014. The study included 71 stage III and IV colorectal cancer patients, which underwent surgery and adjuvant polychemotherapy. Under treatment they had an unfavourable evolution, the disease evolved worst in the first year of treatment. We analysed the K-ras gene status, the degree of tumor differentiation and the CEA and CA19-9 tumor markers, in all these patients. RESULTS: Of the 71 studied patients, 27 (38%) had the K-ras mutation. From this, 20 (74.1%) had high levels of CEA, and 16 (59.3%) had significant increases of CA19-9. By comparison, the 44 patients (62%) who had the wild gene, had elevated CEA in 28 (63.6%) of the cases and in 23 (52.3%) of the cases the CA19-9 was elevated. The G1 degree of differentiation was present in 28 patients; 11 (39%) were k-ras(+) and 17 (6%) k- ras(–), G2 was present in 36 patients; 14(39%) k- ras(+) and 22 (61%) k- ras(–), and the G3 was present in 7 patients; 2 (29%) k- ras(+) and 5 (71%) k- ras(–). CONCLUSION: K-ras gene mutations in patients with advanced colorectal cancer are not associated with increased prognostic tumor markers values or with the degree of tumor differentiation. The incidence does not differ significantly from that of the patients without the mutation. Keywords: colorectal cancer, genetic mutation, K-ras, tumor markers.

Serum CEA and CYFRA21-1 correlates with EGFR mutation and EGFR-TKI effectiveness in untreated NSCLC patients

Objective To explore the predictive value of serum CEA and cytokeratin-19 fragments(CYFRA21-1)prior treatment for the epidermal growth factor receptor (EGFR) mutation and efficacy of tyrosine kinase inhibitors (TKI) in patients with non-small cell lung cancer. Methods The study was a clinical research.Totally 101 matched tissue and plasma samples were collected from Peking University People's Hospital from 2012 to 2013. All clinical specimens were analyzed for EGFR mutations in exons of 18, 19, 20 and 21 by ADx-ARMS and direct sequencing, and the serum levels of CEA and CYFRA21-1 were analyzed by ECLI. The correlation between EGFR mutant status and efficacy of EGFR-TKI and clinicopathological parameters were analyzed by χ2 test, Log-rank text and Cox proportional hazards regression model. Results The mutation rate was 60.4% (61/101) by ADx-ARMS and 33.7% (34/101) by direct sequencing. Mutations were more frequently observed in the higher serum CEA level patients(≥5 μg/L, 78.8%). However, the rates of EGFR mutations of different CEA levels were similar. Among the patients receiving TKI therapy, the efficacy of EGFR-TKI was closely related to serum CYFRA21-1 level prior treatment and EGFR mutation (χ2=8.903, P=0.003; χ2=28.590, P<0.001). And serum CYFRA21-1 level prior treatment and EGFR mutation were independent factors for EGFR-TKI treatment affecting PFS (RR=0.298, P<0.001; RR=0.086, P<0.001). Conclusion The mutation rate of EGFR was significantly related with the expression level of CEA prior treatment, and serum CEA and CYFRA21-1 levels prior treatment could be potential predictors of EGFR-TKI efficacy. (Chin J Lab Med, 2015, 38: 407-411) Key words: Carcinoma, non-small-cell lung; Carcinoembryonic antigen; Antigens, neoplasm; Keratin-19; Receptor, epidermal growth factor

D-dimer and international normalized ratio (INR) are correlated with tumor markers and disease stage in colorectal cancer patients.

The aim of this study is to evaluate the correlation of coagulation tests with various clinicopathological variables and tumor markers among colorectal cancer (CRC) patients. Ninety-four CRC patients were included for evaluation of clinicopathological factors, coagulation assays and tumor marker levels. Metastatic disease was related with elevated INR (p= 0.03). Stage III patients had higher D-dimer values compared with stage II patients (p= 0.03). Correlation of tumor markers indicated a tendency towards elevated D-dimer levels for CEA values higher than median (p= 0.01). High CA 19-9 levels were also associated with higher INR (p= 0.007). Elderly age, distant metastasis, high CEA, CA-19-9 and LDH levels were associated with poorer overall-survival. CEA level was the only independent prognostic factor in multivariate analysis. Coagulation assays can be utilized as predictors of disease extent in CRC. Elevated D-dimer and INR values may indicate higher disease stage. Correlation of D-dimer levels with CEA supports their value for assessing tumor burden.

Circulating tumor cell levels are elevated in colorectal cancer patients with high tumor burden in the liver

Background: Metastatic spread is the most common cause of cancer-related death in colorectal cancer (CRC) patients, with the liver being the mostly affected organ. Circulating tumor cells (CTCs) are a prognostic marker in stage IV CRC. We hypothesized that tumor burden in the liver correlates with CTC quantity. Methods: Blood (7.5 ml) was prospectively collected from 24 patients with novel stage IV CRC diagnosis. Baseline EpCAM+ CTCs were analyzed with the FDA-approved CellSearch® system. Clinicopathological data were collected, and hepatic tumor burden was determined by radiographic liver volumetry with contrast-enhanced CT scans. CRC primary tumors were immunohistochemically stained for EpCAM expression with BerEP4 monoclonal antibody. Statistical analyses were performed using 2-sample T-test, non-parametric Wilcoxon Rank-Sum test, and Fisher's exact test. Results: CTCs were detected n 17 (71%) of 24 patients. The overall mean CTC number as determined by EpCAM-based CellSearch® detection was 6.3 (SEM 2.9). High baseline CTC numbers (≥3) correlated significantly with a high tumor/liver ratio (≥30%), and with high serum CEA levels, as determined by two-sample T-test on log-transformed data and by Fisher's Exact test on categorical data analysis (P < 0.05). The CRC primary tumors were consistently expressing EpCAM by immunostaining. Conclusions: High tumor burden in the liver and high baseline serum CEA levels are associated with high number of baseline CTCs in stage IV CRC patients. Future studies should further investigate the biological role and expression patterns of single CTCs in cancer patients to further improve personalized treatment strategies.

Gray scale and contrast‐enhanced ultrasound imaging of malignant liver tumors of vascular origin

Malignant vascular tumors of the liver are rare. The aim of this study was to investigate the applicability of gray scale and contrast-enhanced ultrasonography in patients with epithelioid hemangioendothelioma (EHE) of the liver and hepatic angiosarcoma (HA) and to describe the clinical presentation. We retrospectively analyzed all patients with epithelioid hemangioendothelioma or hemangiosarcoma of the liver from 1998 to 2011, who underwent ultrasound investigation. We describe the findings in gray scale and contrast-enhanced ultrasound and the clinical course of the disease of seven patients with EHE and five patients with HA. Ultrasound investigation in EHE showed mostly multiple hypoechoic irregular lesions close to the liver capsule and with a halo in some cases. Contrast enhancement revealed inhomogeneously and through all contrast phases vascularized tumors with a rim enhancement in 50%, with or without early wash out. All tumors had avascular parts. HA presented as multiple and irregular hypo-, iso- or hyperechoic lesions. After contrast enhancement, hypervascularization with individual patterns was evident in all patients. Of five, three had liquid parts. Patients with HA were significantly older (58 vs. 37 years, p = 0.014) and presented with lower thrombocyte counts (84 vs. 264, p = 0.0025) and with higher CEA levels (4.6 vs. 1.5, p = 0.03). EHE and HA are inhomogeneous tumors, explaining the high inter-individual variability and heterogeneity in ultrasound examination. The presence of multifocal lesions, heterogeneity and undefined margins may differentiate EHE or HA from hemangioma. A biopsy is essential in the diagnosis of vascular tumors.

Comprehensive analysis of predictive biomarkers for patients with curative colorectal cancer patients and high risk of recurrence.

607 Background: Preoperative serum systemic inflammatory response (SIR) has been reported in patients with various cancers including colorectal cancer (CRC) as predictive biomarker of early recurrence. Molecular phenotypes of CRC including microsatellite instability (MSI) status and tumor infiltrating lymphocytes (TILs) have also known to be associated with recurrence in curative CRC patients. We comprehensively evaluated SIR status, MSI status and TILs in curative CRC patients and investigated which can be promising as high risk markers of recurrence in these patients. Methods: This retrospective study enrolled 157 CRC patients with stage I-III undergoing curative operation for whom preoperative neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and CRP were available as indicators of SIR status. For analysis of molecular phenotypes, we evaluated TILs by counting the number of intra-tumor Foxp3 and CD8 positive T cells by IHC analysis. Next, MSI status was determined in using 5 mononucleotide repeat microsatellite markers. Finally, we investigated the impact of SIR status, TILs and MSI status on the recurrence of these patients. Results: This study included a total of 90 males and 67 females, with an average age of 66.9 years. Twenty-nine patients (18.4%) developed recurrence. Kaplan-Meier analysis using SIR indicators revealed that patients with high CRP, NLR and PLR levels were significantly poorer disease free survival (DFS) than those with low levels. Low infiltrating CD8-positive T cells were significantly predictive factors for poor DFS, but there was no correlation between MSI status and recurrence, In univariate analysis, low infiltrating CD8-positive T cells, high CEA, CRP, NLR and PLR levels in serum were significantly predictive factors for poor DFS, respectively. Multivariate analysis showed that low infiltrating CD8-positive T cells and high serum CRP levels were independent predictive markers for recurrence in curative CRC patients. Conclusions: We demonstrated that evaluation of both CRP levels in preoperative serum and tumor infiltrating CD8 lymphocytes in CRC tissues are useful to predict the curative CRC patients with early relapse.

High expression of ROR2 in cancer cell correlates with unfavorable prognosis in colorectal cancer

The receptor tyrosine kinase-like orphan receptor 2 (ROR2) is a transmembrane protein that belongs to a conserved family of tyrosine kinase receptors involved in several functional processes. ROR2 is overexpressed in various types of solid tumors; however, the expression of ROR2, as well as its functional and prognostic significance has yet to be evaluated in colorectal cancer (CRC). In this study, one-step quantitative reverse transcription-polymerase chain reaction and immunohistochemical analysis using tissue microarrays were used to evaluate ROR2 expression in CRC and to investigate the association between ROR2 expression and patient prognosis. We observed that the expression of ROR2 mRNA and protein was significantly higher in CRC specimens compared with normal, tumor-adjacent tissues (both p<0.05). Cytoplasmic ROR2 expression was related to TNM stage (p=0.041) and lymph node metastasis (N) (p=0.015). Kaplan–Meier and multivariate analyses suggested that high cytoplasmic ROR2 expression (p=0.001), poor tumor differentiation (p=0.001), and advanced TNM stage (p=0.001) and high preoperative CEA level (p<0.001) were significantly associated with unfavorable survival of CRC patients. These results suggest that ROR2 expression is correlated with malignant attributes of CRC and may serve as an indicator for poor prognosis in patients with CRC.

726P - Natural History of Untreated Patients Who Had Metastatic Biliary Tract Cancer (Btc) with Good Performance Status (Ps)

ABSTRACT Aim: Although chemotherapy is widely recommended for patients with metastatic biliary tract cancer (BTC), the natural course of these patients, especially those with good performance status (PS) who are indicated for chemotherapy, is not known. Methods: We retrospectively reviewed patients with metastatic or locally advanced BTC who were examined between January 2005 and September 2013 at six cancer centers. Patients were eligible if they had good PS (Eastern Cooperative Oncology Group score 0-2) and no history of any treatment for cancer. The primary objective was to evaluate the survival time of patients with advanced BTC with good PS who were untreated. Results: Of the 1,677 screened patients, 204 met the inclusion criteria. The median age was 70.1 years and median overall survival (OS) was 7.1 months. OS by disease location was 4.7 months for intrahepatic, 9.7 months for extrahepatic, 4.4 months for gallbladder, and 11.2 months for ampulla of Vater cancer. In subgroup analysis, OS of locally advanced BTC was 13.8 months and that of patients with normal CEA/CA 19-9 was 10.6 months. In multivariate analysis, variables that were associated with poor prognosis were disease extent (metastatic disease) [HR 2.19 (95% CI 1.39-3.45 p = 0.001)], high baseline CEA level (defined as > 4.0 ng/mL) [HR 1.51 (95% CI 1.06-2.17 p = 0.024)], and high baseline CA 19-9 level (defined as > 100 U/mL) [HR 1.93 (95% CI 1.33-2.91 p = 0.001)]. Conclusions: Metastatic BTC with good PS showed modest survival without any treatment for primary cancer. Furthermore, subgroup analysis showed that patients with normal CA19-9 or CEA level or locally advanced status had favorable survival. Further studies comparing the outcome of chemotherapy with that of best supportive care in patients with unresectable BTC are warranted. Disclosure: All authors have declared no conflicts of interest.

The prognostic role of EZH2 expression in rectal cancer patients treated with neoadjuvant chemoradiotherapy.

BackgroundNeoadjuvant chemoradiotherapy (nCRT) combined with surgery has been implemented as a standard treatment strategy in locally advanced rectal cancer (LARC). However, there is a wide spectrum of response to nCRT. The aim of this study was to determine whether enhancer of zeste homologue 2 (EZH2 ) expression could predict response to nCRT and outcomes for patients in LARC.MethodThe study examined the EZH2 expression in 112 biopsies by immohistochemistry. The associations between EZH2 and clinical characters were analyzed.ResultsEZH2 expression in biopsy tissue was significantly related to increased tumor cell proliferation, as assessed by Ki-67 expression with a cutoff value of 37% (p <0.001). High EZH2 expression was correlated closely with low differentiation (p = 0.029), high CEA level (p = 0.041), T4 status (p = 0.011) and node metastasis (p =0.045). By univariate and multivariate analysis, we observed low EZH2 expression could reliably and independently predict the good response to nCRT ( p = 0.026 and p = 0.023) and down-staging ( p = 0.021 and p = 0.027). In univariate analysis, high EZH2 expression was significantly associated with poor 5-year disease-free survival (p = 0.025) and 5-year overall survival (p = 0.032). In multivariate analysis, EZH2 was a prognostic factor for 5-year DFS (HR = 2.287; 95% CI 1.137-4.602, p = 0.020) but not for 5-year OS (HR = 2.182; 95% CI 0.940-5.364, p = 0.069).ConclusionOur study revealed that low EZH2 expression in biopsy tissue might be a useful predictive factor of good tumor response to nCRT and longer 5-year DFS in patients with LARC. However this is a relatively small retrospective study, to further validate the role of EZH2 in rectal cancer, large consistent cohort studies are needed.

IL-8 promote carcinogenesis of primary epithelial cells from familial adenomatous polyposis.

Accumulated evidences supported IL-8 play an important role during colorectal carcinogenesis. However, few direct-related evidences are available. In this paper, we found that high level of IL-8 was constitutively present both in familial adenomatous polyposis (FAP) tissue and carcinoma tissue. Using primary epithelial cells from FAP samples, we study IL-8 effect on their growth, migration, and colonies formation. The results showed that IL-8 stimulated cells proliferation, migration, and colonies formation. Furthermore, High level of CEA, CK20, and EGFR was detected after exposure to IL-8 in primary epithelial cells. In conclusion, our findings showed that IL-8 promotes the adenoma-carcinoma transition in primary epithelial cells from FAP. Targeting IL-8 at adenoma stage may prevent or reduce carcinogenesis.

NEDD9 overexpression correlates with poor prognosis in gastric cancer

In this study, the expression of neural precursor cell expressed developmentally downregulated 9 (NEDD9) in benign and malignant gastric tissues was investigated, and the significance of NEDD9 in gastric cancer prognosis was explored. Immunohistochemistry was used to detect NEDD9 expression in gastric cancer, nontumor gastric, and normal gastric tissues. The relationship between NEDD9 expression in gastric cancer tissues and the clinicopathologic factors was examined using the Mann-Whitney U test. The two factors between NEDD9 expression and tumor node metastasis (TNM) stage in gastric cancer patients were analyzed by Spearman rank correlation analysis. The Kaplan-Meier method and log-rank test were used to compare the overall survival of NEDD9 negative, weak positive expression, and strong positive expression group. NEDD9 expression rates were significantly higher (P < 0.001) in gastric cancer tissues (162 out of 187, 86.6 %) compared with normal (2 out of 11, 18.2 %) and nontumor (11 out of 58, 19.0 %) gastric tissues. The upregulated NEDD9 expression in gastric cancer tissue was significantly correlated with high preoperative CEA level (P = 0.044), poor differentiation (P = 0.007), tissue invasion (P = 0.015), present lymph node metastasis (P < 0.001), and high TNM stage (P < 0.001). NEDD9 expression was positively correlated with clinical TNM stage. Advancing clinical TNM stage corresponded with higher NEDD9 expression (r s = 0.289, P < 0.001). The overall 5-year survival of gastric cancer patients with strong positive NEDD9 expression was significantly shorter compared with the survival of NEDD9 negative and weakly positive expression group. NEDD9 may be used as a biomarker in the clinical setting to predict the prognosis of gastric cancer patients.

Relationship between Preoperative Serum CA15-3 and CEA Levels and Clinicopathological Parameters in Breast Cancer

CEA and CA 15.3 serum tumor markers are currently used in clinical practice for monitoring therapy. The aim of this study was to evaluate serum level of these markers among healthy females and invasive breast carcinoma (IBC) patients and to determine any relationships with clinicopathological factors. 60 Iranian females were enrolled in this study, 30 healthy and 30 diagnosed with breast cancer who had not received any preoperative chemotherapy or hormone therapy. Enzyme linked immunosorbent assays were used for the quantitative determination of the cancer associated antigens, CEA and MUC1 (CA 15- 3). The serological levels of CEA and CA 15-3 (5.0033 ± 0.49 μg/L and 178.1667 ± 15.11 U/ml) in the breast cancer patients were significantly higher (p=0.00) than the serum levels of normal controls (1.1237 ± 0.11 μg/L and 21.13 ± 3.058 U/ml). Regarding the CEA marker, a significant correlation with grade of tumor was shown. Furthermore, there was a low correlation between CA 15-3 and CEA marker with correlation coefficient r=0.08. Collectively, markedly high levels of CEA and CA 15-3 were found in our patients, pointing to their use as additional tools after clinical diagnosis.

Clinical characteristics and outcomes for gastric cancer patients aged 18–30 years

There is little known about the clinicopathological features and the predictors of survival in extremely young adult patients aged 18-30 years. The aim of this study was to identify clinicopathological features and clinical outcomes for the overall population and for a resectable subgroup of gastric cancer patients aged 18-30 years. From January 2004 to December 2010, 207 patients aged between 18 and 30 years old were diagnosed with gastric cancer and treated at the Asan Medical Center. Clinical findings, histopathological parameters and outcomes were reviewed retrospectively. Patients were further divided into 2 groups according to tumor resectability and then clinicopathological factors that affect tumor resectability and clinical outcomes were analyzed. Clinicopathological characteristics of study population showed a predominance of females, undifferentiated tumors, diffuse-type cancers, and advanced gastric cancer. The overall resectability rate was 70.0 % and the median follow-up period was significantly longer in the resectable tumor group (P < 0.001). Significant prognostic predictors for overall survival in overall patients were higher CEA levels (P = 0.016), larger tumor size (P < 0.001), unresectability (P = 0.006), and presence of lymphovascular invasion (P = 0.012) in a multivariate analysis. Significant prognostic factors for overall survival in patients with resectable disease included larger tumor size (>4 cm), lymphovascular invasion and higher CEA level in the multivariate analysis. Gastric adenocarcinomas in young adult patients aged 18-30 years have unique clinicopathological features. Early detection in a resectable state and subsequent complete resection could increase survival period in young patients with gastric cancer.

Five-Year Survivors of Non-Small Cell Lung Cancer Patients with Positive Pleural Lavage Cytology

Background: The pleural lavage cytology (PLC) for non-small cell lung cancer (NSCLC) patients has been reported as a significant prognostic factor. The aim of this study is to clarify the clinicopathological characteristics of 5-year survivors of patients with positive PLC. Methods: Among 401 resected NSCLC patients, 30 (7.48%) patients with positive PLC were reviewed retrospectively. Results: Only 7 of 30 patients (23.3%) survived more than 5-year. There were no differences in age, gender, histology, pT status and pN status between 5-year survivors and non-survivors. On the other hand, the serum carcinoembryonic antigen (CEA) level was significantly higher in non-survivors. Among these 5-year survivors, 4 of 7 patients died of NSCLC recurrences more than 5 years after surgery. Remaining 3 patients survived without cancer recurrences. Interestingly these 3 survivors had not received any adjuvant therapies after surgery. Conclusion: None of the 5-year survivor with positive PLC had high serum CEA level. Furthermore 5-year survival did not equal to cure in NSCLC patients with positive PLC.