High CEA Research Articles

The predictive value and role of stromal tumor-infiltrating lymphocytes in pancreatic ductal adenocarcinoma (PDAC)

ABSTRACTRecently, increasing evidence has indicated that the presence of tumor infiltrating immune cells has shown predictive significance for many solid tumors. Present study was performed to evaluate the predictive value of stromal tumor-infiltrating lymphocytes (TILs) for the presence of liver metastasis and overall survival in PDAC (pancreatic ductal adenocarcinoma) patients after complete resection and to explore the potential role of lymphocytes in PDAC. A total of 155 resectable patients with PDAC were enrolled in our study. Stromal TIL density was investigated in hematoxylin and eosin-stained sections of surgical specimens and scored. The effect and possible mechanism of lymphocytes on cancer cells was evaluated using co-culture techniques and ELISA test. Stromal TIL negative status (HR = 2.80, 95% CI 1.75-4.48, P < 0.01) was not only an independent predictor of worse OS (HR = 2.7, 95% CI 1.80-4.06, P = <0.01) but also a significant independent predictor of liver metastasis. Higher CEA (P = 0.01) or CA19-9 (P = 0.01) levels were associated with low stromal TIL density. Stromal TIL negative patients appeared to develop tumors with a higher CEA (P = 0.01), larger diameter (P = 0.05) and advanced stage (P = 0.02). The co-culture experiment suggests that lymphocytes can inhibit pancreatic cancer cell proliferation. Further ELISA and cell culture test indicate that lymphocytes may cause pancreatic cancer cells apoptosis through TNF-alpha secretion. Our data suggest a potential favorable role of stromal TILs in predicting liver metastasis and overall survival of patients with PDAC after complete resection. Lymphocytes may inhibit the growth of PDAC through TNF-alpha secretion, which suggest a potential therapeutic approach against PDAC.

Clinical baseline and prognostic difference of platelet lymphocyte ratio (PLR) in right-sided and let-sided colon cancers

BackgroundRight-sided colon cancer (RCC) and left-sided colon cancer (LCC) differ with respect to their biology and genomic patterns, but inflammatory index variation did not fully investigate. This study aimed to examine the difference of inflammatory indexes and its value between RCC and LCC.MethodsThe differences of common clinicopathologic factors, inflammatory indexes including PLR (Platelet lymphocyte ratio) between LCC and RCC were analyzed in the training cohort with logistic regression model, subsequently, confirmed in validation cohort. Kaplan-Meier analysis was applied for the analysis of the survival difference distinguished by the PLR and the Nonparametric Test was adopted to demonstrate the difference of PLR variation with the standard TNM classification between RCC and LCC.ResultsA total of 1846 CRC patients entered the study, 744 (40.3%) patients were RCC, 1102 (59.7%) were LCC. The patients’ number in both cohorts was 923. It was found that LCC patients in the training cohort significantly to be with higher CEA, adenocarcinoma, early UICC/AJCC stage, p-MMR (mismatch-repair proficient), and lower PLR, and the later four features were confirm in validation cohort. Higher PLR, the unique inflammatory index, was significantly associated with poorer OS in LCC cohort (P = 0.002) and was elevated with the TNM stage in the LCC patients (P < 0.001), however, the two relationships did not sustain in RCC patients.ConclusionExpect the classical characteristics, PLR, an inexpensive and easily assessable inflammatory index was found first time to be significant differ between LCC and RCC. Further, elevated PLR associated with poor OS (overall survival) in the LCC and more common in advanced TNM stage.

High CEA levels in a case of resected colorectal cancer: delayed diagnosis of metachronous medullary thyroid cancer

BackgroundCarcinoembryonic antigen (CEA) is one of the most widely used tumor markers, and its value in the surveillance of post-operative colorectal cancer is well established. Fluorodeoxyglucose-positron emission tomography (FDG-PET) has been clinically used in colorectal cancer imaging including preoperative staging, evaluation of therapeutic response, detection of disease recurrence, and investigation of unexplained rising tumor markers.Case presentationWe report a case of resected colorectal cancer presented with rising CEA levels in 5 years, and FDG-PET revealed no definitive evidence of recurrence except abnormal focal FDG uptake in the right thyroid lobe. However, fine needle aspiration cytology (FNAC) of the thyroid nodule showed negative for malignancy. Progressively rising CEA levels were noted over the following 5 years, but serial follow-up examinations did not find evidence of recurrence. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) was performed subsequently and again showed focal FDG uptake in the right thyroid lobe. This time, FNAC revealed positive for malignancy, in favor of medullary thyroid carcinoma (MTC). The patient underwent total thyroidectomy and modified radical neck dissection, and MTC with cervical nodal metastasis (pT3N1) was diagnosed. He had cervical lymph nodes recurrence 2 years later, which was resected.ConclusionsThis case reminded us that FDG-PET/CT may detect occult tumors resulting in CEA elevation other than colorectal cancer. Moreover, FNA has a higher false negative rate in detecting MTC than other forms of thyroid cancer. Repeat FNAC for the initial negative cytology result and measure of serum calcitonin for the early MTC detection could be more helpful to avoid the delay in MTC diagnosis.

The prognostic impact of serum bilirubin in stage IV colorectal cancer patients.

Bilirubin played a great role in antioxidation and anticancer and has been considered as a promising prognostic factor of non-liver disease-related death in various cancers. The aim of this study was to assess the prognostic value of pre-treatment serum bilirubin in stage IV CRC patients. Serum bilirubin including TBIL, DBIL, and IBI which were tested at pre-treatment were investigated in 154 stage IV CRC patients in Zhongda Hospital, Nanjing, China, from July 2005 to July 2011. X-tile program was used to determine the optimal cut-off values of these three biomarkers. Kaplan-Meier analysis, univariate, and multivariate cox regression as well as time-dependent ROC curve analysis were performed to evaluate the relations between serum bilirubin and survival outcomes. We got the results that the optimal cut-off points of serum TBIL, DBIL, and IBI levels were 12.9, 6.1, and 4.8μmol/L, respectively. Univariate analysis showed that elevated TBIL, DBIL, and CEA were significantly associated with poor 5-year OS in stage IV CRC patients. Multivariate cox analysis indicated that the high DBIL (HR=1.603, 95%CI=1.053-2.442, P<.028) and CEA (HR=1.785, 95%CI=1.123-2.837, P=.014) could be identified as independent factors for poor OS. Furthermore, time-dependent ROC curves demonstrated that high DBIL had similar prognostic efficacy as elevated CEA for poor OS (AUC=0.63 and 0.61, respectively). Pre-treatment elevated TBIL and DBIL levels were associated with poor OS in stage IV CRC patients. Moreover, DBIL could be considered as an independent prognostic biomarker for OS. Furthermore, DBIL had similar prognostic efficacy as CEA for OS.

Invasive micropapillary carcinoma component is an independent prognosticator of poorer survival in Stage III colorectal cancer patients.

Invasive micropapillary carcinoma (IMPC) is an aggressive variant of adenocarcinoma found in several organs. Recent studies showed that IMPC in colorectal cancer leads to poorer prognosis than conventional colorectal cancer; however, the influence of IMPC on outcomes remains unclear. The present study aimed to identify the clinicopathological characteristics of colorectal cancers with IMPCs, and to evaluate the prognostic significance of IMPCs per se. We retrospectively analyzed data from 837 patients with colorectal cancer who underwent surgical treatment. We compared the clinicopathological characteristics and survival outcomes of colorectal cancer patients with IMPCs to those without. Among 837 patients, 130 (16%) had an IMPC component, including 0 (0%) of 18, 9 (4.2%) of 215, 34 (13%) of 254, 59 (24%) of 249 and 28 (27%) of 101 patients with TNM Stages 0, I, II, III and IV, respectively. The 3-year disease-free survival (DFS) rates were significantly worse for Stage III patients with IMPC than for those without (55.3% vs. 78.7% respectively, P < 0.001), but not in patients with other stages. Multivariate analyses of patients with Stage III colorectal cancer found IMPC to be associated with significantly worse DFS (P = 0.026), as were high CEA levels, tumor budding and TNM staging. IMPC was only significantly associated with tumor invasion (P = 0.045) and venous invasion (P = 0.045) in Stage III tumors. Identifying IMPC components in Stage III colorectal cancer is crucial, as their presence is significantly associated with poorer survival.

Correlation between Serum Tumor Markers and Efficacy of First-line EGFR-TKIs in Patients with Advanced Lung Adenocarcinoma

背景与目的表皮生长因子受体酪氨酸激酶抑制剂（epidermal growth factor receptor tyrosine kinase inhibitors, EGFR-TKIs）在EGFR突变型肺腺癌人群中能显著提高生存，从而改变了晚期肺癌的治疗模式，但并不是所有EGFR敏感突变者均能从EGFR-TKIs治疗中获益。本研究欲通过外周血肿瘤标志物的检测对突变型肺腺癌患者的靶向治疗进行预测及指导。方法回顾性分析2009年6月-2014年6月于北京大学肿瘤医院胸部肿瘤内一科一线接受EGFR-TKIs治疗的EGFR突变型Ⅲb期-Ⅳ期肺腺癌患者的临床资料，分析其基线肿瘤标志物与EGFR-TKIs疗效及生存的关系。结果总体人群客观有效率（objective response rate, ORR）52.8%，疾病控制率（disease control rate, DCR）89.3%。基线癌胚抗原（carcino-embryonic antigen, CEA）水平升高者对EGFR-TKIs疗效更佳（ORR 61.3% vs 35.9%, DCR 95.2% vs 74.4%, P < 0.001），治疗1个月后CEA、细胞角蛋白19片段（cytokeratin 19 fragments, CYFRA21-1）以及CA125水平下降者有效率更高（ORR分别是61.5% vs 25%，P=0.002；58.5% vs 37.5%，P=0.004；61.8% vs 20%，P=0.027）。生存分析中，基线CEA水平正常者较高水平者无进展生存期（progression-free survival, PFS）明显缩短（中位PFS 5.9个月vs 9.8个月，P=0.027），而基线CYFRA21-1、CA125水平升高者PFS明显缩短（中位PFS 9.0个月vs 11.4个月，P=0.029；9.0个月vs 11.5个月，P=0.023）。多因素分析显示，美国东部肿瘤协作组（Eastern Cooperative Oncology Group, ECOG）评分0-1分、基线CYFRA21-1正常水平、治疗1月后CEA下降阳性患者PFS更长。总生存期（overall survival, OS）与CYFRA21-1、CA125升高有关（中位OS分别为25.1个月vs 52.5个月，P=0.003；22.7个月vs 55.0个月，P < 0.001），而多因素分析中总生存与CEA下降有关（P=0.046）。结论治疗前高水平CEA以及治疗后CEA下降可以预测晚期肺腺癌患者一线接受EGFR-TKIs的疗效，而治疗前高水平CYFRA21-1以及CA125则预示着生存期缩短。

Oncological outcomes in a cohort of patients with biliary tract carcinoma in a Mexican reference center.

e15618 Background: In Mexico there is scarce information about oncological outcomes of biliary tract carcinomas (BTC). Methods: we retrospectively reviewed medical records from 150 patients with histologically confirmed BTC (excluding gallbladder cancer) treated in our institution from January 2005 to December 2015.Clinical and pathological information was recorded. Survival was estimated by Kaplan Meir method and compared by Log rank test. Results: we found 63.3% women and 36.7% men, with a median age of 62 years (23 - 88). Tumor localization was intrahepatic in 34.7%, hilar in 43.3% and distal in 22%. Clinical stage was advanced in 71%, regional in 13% and local in 16%. Diagnostic delay was 3.7 months (0.37 - 32.9). For patients with localized disease (which included local and regional disease, n=43), a potentially curative surgery was attempted in 64% (n=27), achieving a R0 resection in 59% (n=16) of cases. There was a 3.9 months (0.83-29.63) treatment initiation delay. There were 7 surgical deaths. For advanced disease (n=107), treatment initiation delay was 4.2 months (0.5 - 34.5), 59% (n=63) of patients did not received oncological active treatment, and 26% (n=28) of patients received a systemic palliative chemotherapy, more frequently gemcitabine (n=20). At progression just eleven patients received a second chemotherapy line. In localized disease resected patients by univariate analysis high levels of CA 19.9 (p=0.04) and CEA (0.03) were associated with decreased survival. For patients with advanced disease prognostic factors included poorly differentiated histology (p=0.04), high bilirrubin level (p=0.04), low albumin level (p=0.001), abscense of chemotherapy (p=0.000) and high CEA levels (p=0.03). Conclusions: Survival is poor in this Mexican cohort of patients with BTC possibly related to diagnostic and therapeutic delay and advanced disease at presentation. [Table: see text]

Peritoneal recurrence in gastric cancer following curative resection can be predicted by postoperative but not preoperative biomarkers: a single-institution study of 320 cases.

To determine the risk factors for peritoneal recurrence in gastric cancer patients after curative resection, we included 320 patients with stage I-III primary gastric cancer between January 2008 and June 2012. Data on each patient's surgical and pathological information, preoperative and postoperative tumor markers were collected and analyzed retrospectively. The risk factors for peritoneal recurrence were investigated by univariate and multivariate analysis. In patients with peritoneal recurrence, advanced T or N stage, low differentiation, vascular/lymphatic invasion, perineural invasion, and elevated postoperative CEA/CA19-9 were more common than in patients without peritoneal recurrence. Patients with peritoneal recurrence showed a worse overall survival (OS) compared to those without peritoneal recurrence. In addition, patients with peritoneal recurrence within the first year had a worse OS compared to those with recurrence after 1 year. The univariate and multivariate analyses revealed that elevated number of metastatic lymph nodes and elevated postoperative CEA and CA19-9 were three independent risk factors for peritoneal recurrence in gastric cancer patients. For patients with N3 stage and high postoperative CEA and CA19-9, we found an initial steep slope within approximately 1 year and a subsequent gentle slope in the risk curve. Combined receiver operating characteristic curve analysis using the three independent risk factors for peritoneal recurrence yielded an area under the curve value of 0.73 with 73.7% sensitivity and 64.2% specificity. Therefore, the risk factors may be associated with peritoneal recurrence after curative resection in selected gastric cancer patients.

EP-1270: Clinical outcome of non-metastatic rectal cancer patients with extremely high CEA level

EP-1270: Clinical outcome of non-metastatic rectal cancer patients with extremely high CEA level

Prognostic impact of preoperative albumin to globulin ratio in curative colon cancer patients.

647 Background: Albumin to globulin ratio (AGR) has been reported to predict long term mortality in patients with several cancers. However, prognostic impact of preoperative AGR in colon cancer patients with curative intent has not yet been fully addressed. Therefore, we, for the first time, investigated the association between AGR and clinico-pathological findings including overall survival (OS) and disease free survival (DFS) in stage I-III colon cancer patients. Methods: Clinicopathological findings including preoperative laboratory data (carcinoembryonic antigen [CEA] and AGR) from 251 curative colon cancer patients were assessed as indicators of early recurrence and poor prognosis in this retrospective study. AGR was calculated as [AGR = albumin/ (total protein - albumin)]. The cut-off value of AGR was 1.32 in current study. Results: Several clinicopathological categories related with tumor progression such as lymph node metastasis, T4 tumor, large tumor size, undifferentiated tumor, venous and lymphatic invasion, and high CEA were significantly associated with low AGR level. The patients with low AGR were significantly poorer OS (P = 0.001) and DFS (P = 0.003) than those with high AGR, respectively. In addition, multivariate analyses demonstrated that low AGR was independently associated with early recurrence (HR = 2.87, P = 0.007) and poor prognosis (HR = 2.56, P = 0.008), respectively. On the other hand, sub analysis of survival curves revealed that stage III colon cancer patients with low AGR were significantly poorer OS (P = 0.007) and DFS (P = 0.02) than those with high AGR, respectively. Furthermore, significantly poorer OS and DFS were also shown in stage I-II colon cancer patients with low AGR, respectively (OS: P = 0.02, DFS: P = 0.01). Conclusions: Preoperative AGR was an independent predictor of early recurrence and poor prognosis in curative colon cancer patients. AGR may represent a simple, potentially useful predictive biomarker for selecting stage I-II colon cancer patients who might need adjuvant chemotherapy. Furthermore, AGR may select candidates who are better to introduce more intensive adjuvant chemotherapy after curative operation in stage III colon cancer patients.

Prognostic value of circulating tumor cells in advanced gastric cancer patients receiving chemotherapy.

The identification of circulating tumor cells (CTCs) may provide important prognostic information in several types of solid tumors, including gastric cancer. The aim of this study was to investigate whether CTC count may be used to predict survival in patients with advanced gastric cancer treated with chemotherapy. The CELLection™ Epithelial Enrich kit was used to isolate and purify CTCs from samples of peripheral blood. Immunofluorescent staining was used for CTC counting. High CTC counts were associated with poor tumor differentiation and high serum CEA levels (P=0.021 and 0.005, respectively). After 3 months, 16 patients with decreasing CTC counts after the first cycle of chemotherapy obtained complete response, partial response or stable disease, while 13 patients with increasing CTC counts developed progressive disease. The patients with decreasing CTC counts also exhibited longer progression-free survival (PFS) (P≤0.001) and overall survival (OS) (P=0.002) compared with those with increasing CTC counts. Among all 59 patients, those with a CTC count of ≤2 cells/5 ml blood exhibited longer PFS (P≤0.001) and OS (P≤0.001) compared with those with a CTC count of >2 cells/5 ml blood. The multivariate analysis suggested that an increase of the CTC count after the first cycle of chemotherapy was only an independent prognostic marker of poor PFS (P=0.019). However, a baseline CTC count of >2 cells/5 ml blood was an independent poor prognostic marker for PFS (P=0.008) and OS (P=0.001) in all 59 patients. Our study suggested that patients with a low baseline CTC count or decrease of the CTC count after the first cycle of chemotherapy may benefit significantly from palliative chemotherapy. In conclusion, CTC count may be a good chemotherapy monitoring marker and an ideal prognostic marker for patients receiving palliative chemotherapy.

全周性食道ESDの狭窄予防に局注/経口ステロイド併用が奏功した1例

Patient was a 50-year-old man with anemia and high CEA. Esophagogastroduodenoscopy (EGD) showed a 0-IIb lesion in the middle thoracic esophagus. Narrow band imaging (NBI) revealed a brownish area, and magnifying endoscopy with NBI showed an intrapapillary capillary loop with mild dilation. After iodine spraying, the lesion showed partial circularity. Whole-body contrast CT showed no metastasis. Lesion was removed by ESD on post admission day (PAD) 1. 100mg triamcinolone acetonide (TA) was injected to the resected site to prevent postoperative stricture. Oral prednisolone (PSL) 20mg/day was started from PAD 2 and decreased to 10mg/day within 2 weeks after ESD. EGD was done bi-weekly, with confirmation of healing on PAD 68. PSL was finally stopped on PAD 89. No postoperative stricture was observed during follow up.

High Preoperative Fibrinogen Level is Closely Associated with Receipt of Chemotherapy and Advanced Disease in Patients with Colorectal Cancer

Background: There is still lack of a preoperative simple, reliable and non-invasive blood marker predicting the stage of the disease (luminal or extraluminal) and the need for chemotherapy at the time of diagnosis in patients with colorectal cancer (CRC). The study aimed to investigate any relationship between the preoperative fibrinogen level and CRC disease stage as well as the receipt of chemotherapy before surgery. Method: A total 297 CRC patients undergoing surgical resection for any reason (curative or palliative) enrolled in this study. The serum fibrinogen level was calculated in the preoperative period. The need for chemotherapy was assessed by two different expert oncologists. Comparisons were made between the fibrinogen level with disease stage as well as the chemotherapy. Results: The mean fibrinogen level was 455±128,5 mg/dL with high level in 77,4% of all CRC patients. The level of fibrinogen in both Duke’s C and D significantly were higher than Duke’s B (p<0,001). High preoperative fibrinogen level had a 27.9-fold increase the risk of receiving chemotherapy (Hazard Ratio:27.9, P<0.0001, 12.8-60.4; 95% C.I). The majority of CRC patients receiving chemotherapy (94,4%) had both high fibrinogen and CEA levels. Conclusion: High preoperative fibrinogen is closely linked with receipt of chemotherapy and advanced disease in patients with CRC. Notable, this association is more prominent when fibrinogen and CEA are both high.

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.

PUB032 Surgical Management of cN1 Non-Small Cell Lung Cancer: Histological Impact on Nodal Status and Survival Outcomes

Surgical resection is employed as a standard treatment for cN1 non-small cell lung cancer (NSCLC). In the resected cases, not a small population of unfavorable prognosis including pN2 cases is observed. Invasive mediastinal evaluations using endobronchial ultrasonography and/or mediastinoscopy are suggested for patients with radiological cN1 NSCLC in the several guidelines. However, practical benefits of those modalities remain unclear due to its heterogeneous population. We retrospectively reviewed clinicopathological factors of 161 patients who underwent surgical resection for radiologically diagnosed cN1 NSCLC treated from 2001 to 2013 in our institute. The patients without preoperative invasive mediastinal evaluation and induction treatment were enrolled. To identify the population who can benefit from invasive mediastinal staging, we analyzed predictive factors of pN2 status. Furthermore, disease free survival (DFS), overall survival (OS) and factors affecting them were also investigated. One hundred nineteen patients (73.9%) with pN0-1 and 42 patients (26.1%) of pN2 were identified. More patients of female sex, high serum CEA and adenocarcinoma (AD) histology were included in the pN2 group (p=0.044, 0.028 and 0.024, respectively). The univariate analyses showed that higher age and AD histology were potential predictor for pN2 status (p=0.048 and 0.01, respectively) and the multivariate analysis demonstrated AD histology was a significant predictor for pN2 status (HR: 2.445, p=0.015). Five-year OS rate of the pN0-1 and pN2 AD patients were 56.8% and 34.0%, respectively (p=0.46), those of non-AD patients were 70.2% and 64.9%, respectively (p=0.94). In AD patients, five-year DFS rate of the pN0-1 was 50.2%, which was significantly better than that of pN2 patients, 5.8% (p<0.001), while those of non-AD patients were not different, demonstrating 55.4% and 73.9%, respectively (p=0.48). Out of 26 AD patients with pN2 disease, 24 patients (92.6%) experienced recurrence. Twenty-one patients (80.8%) of them were accompanied with non-local disease. AD histology was the independent predictor for pN2 status in resected cN1 NSCLC. Surgical outcomes of cN1/pN2 AD patients were poor and the efficacies of surgery is considered to be limited for them. While those of non-AD patients was favorable being identical with pN1-0 patients. Mediastinal evaluation of invasive modalities may be more beneficial for AD patients in terms of prognostic distinction and decision of treatment strategies.

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.

Plasma Folate and Vitamin B12 Levels in Patients with Hepatocellular Carcinoma.

Folate and vitamin B12 involved in the one-carbon metabolism may play a key role in carcinogenesis and progression of hepatocellular carcinoma (HCC) through influencing DNA integrity. The purpose of this study is to evaluate the association of plasma folate and vitamin B12 levels with HCC in a case-control study on 312 HCC patients and 325 cancer-free controls. Plasma concentrations of folate and vitamin B12 in all the subjects were measured by electrochemiluminescence immunoassay. Meanwhile, the information of HCC patients’ clinical characteristics including tumor-node-metastasis (TNM) stage, tumor size and tumor markers were collected. The patients of HCC had significantly lower folate levels than those of controls; there was no significant difference in the mean of plasma vitamin B12 levels. We also observed an inverse association between the levels of plasma folate and HCC: the adjusted odds ratios (OR) (95% confidence intervals (CI)) of HCC from the highest to lowest quartile of folate were 0.30 (0.15–0.60), 0.33 (0.17–0.65), and 0.19 (0.09–0.38). Compared to the subjects in the lowest quartile of plasma vitamin B12, only the subjects in the highest quartile of vitamin B12 exhibited a significant positive relationship with HCC, the adjusted OR was 2.01 (95% CI, 1.02–3.98). HCC patients with Stage III and IV or bigger tumor size had lower folate and higher vitamin B12 levels. There was no significant difference in the mean plasma folate levels of the HCC cases in tumor markers status (AFP, CEA and CA19-9 levels), whereas patients with higher CEA or CA19-9 levels retained significantly more plasma vitamin B12 than those with normal-CEA or CA19-9 level. In conclusion, plasma folate and vitamin B12 levels could be associated with HCC, and might be used as predictors of clinical characteristics of HCC patients. However, further prospective studies are essential to confirm the observed results.

Prognostic impact of carcinoembryonic antigen (CEA) on patients with metastatic pancreatic cancer: A retrospective cohort study

BackgroundCarcinoembryonic antigen (CEA) is one of the most widely used tumor markers, and its level is increased in 30–60% of patients with pancreatic cancer (PC). However, little is known about the implications of CEA as a prognostic marker in metastatic PC. The purpose of this study was to examine the usefulness of CEA levels as a prognostic marker in patients with metastatic PC. MethodsWe conducted a retrospective cohort study using data from a computerized database. A total of 433 patients with metastatic disease were analyzed. ResultsMedian overall survival (OS) was significantly shorter for patients with high CEA (>5 ng/ml) than with normal CEA (≤5 ng/ml) (6.8 vs. 10.3 months, respectively; p < 0.001). After adjustment, CEA level was an independent predictive factor for OS (hazard ratio [HR], 1.81; 95% confidence interval [CI], 1.45–2.26). In the high CEA group, OS in patients treated with combination chemotherapy was similar to that with single-agent chemotherapy (median, 7.1 vs. 6.8 months; HR for OS, 0.99; 95% CI, 0.71–1.40). ConclusionsThe present results show that CEA level is an independent prognostic factor in patients with metastatic PC. A combination chemotherapy regimen may offer modest survival benefit in patients with high CEA.

Frequency and Clinical Impact of KRAS Mutations in Patients with Colorectal Cancer from the Middle East

Background: Colorectal cancer (CRC) is a significant healthcare burden worldwide and in the Middle East (ME). KRAS mutation confers resistance to epidermal growth factor receptor (EGFR) inhibitors in the treatment of advanced CRC. Data regarding the rate of KRAS mutation from the ME are scattered and scarce. We aim to collect and review all sizable studies evaluating the frequency of KRAS mutations in CRC patients from the ME. Method: A Pubmed and Google Scholar search was conducted using keywords including KRAS, K-ras, colorectal cancer and Middle East, along with names of each ME country. Studies including over 90 patients were included in the review. Result: Eleven studies containing more than 90 patients were identified. Among all eleven studies, KRAS mutation rate ranged from 13 to 56%. Five studies reported KRAS mutation rate in M1 stage either exclusively or as part of subgroup analysis. In these studies, mutations were found in 8-45% of cases. KRAS mutations were associated with female gender, M1 stage and high CEA in 3, 2, and 1 studies respectively. Conclusion: There is a broad range of variability in KRAS mutation rate reported in different studies from the ME. This may have been due to small number of patients in the studies and lack of centralized testing for KRAS mutations. Larger and more coordinated studies from the ME population are required to ascertain the accuracy of KRAS mutation rate.