Population Of Colorectal Cancer Patients Research Articles

Impact of EGFR expression on colorectal cancer patient prognosis and survival

BackgroundEpidermal growth factor receptor (EGFR) is overexpressed in many types of cancers, especially colorectal cancer (CRC), and seems to reflect more aggressive histological and clinical behaviors. The aim of this study was to evaluate EGFR immunohistochemical reactivity in CRC biopsies, and to analyze its relationship with various histological and clinical characteristics and survival. Patients and methodsA composite EGFR score, obtained by multiplying the grade (% positive cells) by the intensity of labeling (0–9) was used to define patients with low or high EGFR expression whose clinicopathological features were then compared. Univariate tests and multivariate Cox proportional hazards model were applied for data analysis. ResultsTissue sections from 150 CRC patients with a median follow-up of 40 months were examined. Median patient age at diagnosis was 70 years (range 38–89 years). EGFR reactivity was positive for 143 patients (97%) and high for 118 (80%). According to multivariate analysis, EGFR overexpression was significantly associated with tumor stage, with a higher percentage of EGFR overexpression in T3 than T4 (P=0.003) and not with overall survival. ConclusionsEGFR was overexpressed in this CRC patient population and was significantly associated with TNM (tumor–node–metastasis) stage T3. In the context of a new therapeutic strategy using EGFR-targeted therapies, although EGFR remains a controversial prognostic factor, this expression–stage association may play a crucial role in a decision to initiate an adjuvant treatment.

An evidence-based estimate of the appropriate radiotherapy utilization rate for colorectal cancer

Purpose Current estimates of the proportion of cancer patients who will require RT are based almost entirely on expert opinion. The objective of this study was to estimate the proportion of incident cases of colorectal cancer that should receive RT using an evidence-based approach. Methods and materials A systematic review of the literature was undertaken to identify indications for RT for colorectal cancer, and to ascertain the level of evidence that supported each indication. An epidemiologic approach was then used to estimate the incidence of each indication for RT in a typical North American population of colorectal cancer patients. The effect of sampling error on the estimated appropriate rate of RT was calculated mathematically, and the effect of systematic error was estimated by sensitivity analysis. Results It was estimated that 23.7% ± 1.0% of colorectal cancer cases develop one or more indications for RT at some point in the course of the illness: 20.9% ± 1.1% as part of their initial treatment, and 2.8% ± 0.5% later for recurrence or progression. We estimated that 7.1% ± 0.8% of colon carcinoma patients will require RT at some point in the course of the illness: 4.0% ± 0.7% as part of their initial treatment, and 3.1% ± 0.4% later for recurrence or progression. We estimated that 72.3% ± 1.0% of rectal carcinoma patients will require RT at some point in the course of the illness: 69.6% ± 0.9% as part of their initial treatment and 2.7% ± 0.2% later for recurrence or progression. Conclusions This method provides a rational starting point for the long-term planning of radiation services, and for the audit of access to RT at the population level. By completing such evaluations in the major cancer sites, it will be possible to estimate the appropriate RT treatment rate for the cancer population as a whole.

10. Positron Emission Tomography in the Presurgical Evaluation of Patients with Resectable Liver Metastases from Colorectal Carcinoma Detected by Computed Tomography with Arterial Portography: A Cost Analysis

Purpose: To assess the cost of implementing 18F-Fluorodeoxyglucose (18FDG) PET scan in the presurgical evaluation of patients with hepatic metastases from colorectal cancer (CRC) detected by Computed Tomography with arterial portography (CTAP).Methods: We performed a cost analysis of two diagnostic pathways based on a population of CRC patients with metastatic disease limited to the liver by (CTAP). The payers' perspective was utilized. The algorithms compared 18FDG-PET with Computed Tomography (CT) versus CT alone. Patients found to have extrahepatic disease by 18FDG-PET or CT were assigned to palliative care. Patients found to be negative for extrahepatic extension were assumed to be surgically resectable. The prevalence of extrahepatic disease, true and false positives and negatives for CT and 18FDG-PET were extracted from published reports (Medline, 1991 to 1999). Three possible outcomes for surgery were considered: uncomplicated, complicated, and death. Surgical complications considered were: urinary tract infection, wound sepsis, intra-abdominal abscess, septicemia, pneumonia, deep venous thrombosis, pulmonary embolism, anemia requiring transfusion, and myocardial infarction. Complication rates, costs for CT, CTAP, 18FDG-PET, surgery and post-surgical complications were obtained from HCFA published data (1997-2000). Palliative care costs were assumed to be identical in both branches.Results: Average expected cost per patient with 18FDG-PET was $16,921, compared to $21,693 for a patient without PET scan. This represents net savings of $4,772 if PET is included in the diagnostic work up.Conclusion: Integration of 18FDG-PET in the presurgical evaluation of patients with liver metastases from CRC by CTP would substantially reduce overall costs.

Frequency of replication errors in colorectal cancer and their association with family history

Background—Replication errors (RERs) characterise tumours of hereditary non-polyposis colorectal cancer (HNPCC). RER status may therefore improve identification of such families previously diagnosed by family history alone.Aims—To assess RER and HNPCC...

Intra-abdominal patterns of disease dissemination in colorectal cancer identified using radioimmunoguided surgery

Patterns of metastatic spread are difficult to determine with routine postoperative follow-up. This study was undertaken to evaluate two selected populations of colorectal cancer patients injected and screened with anti-tumor antibody. Eighty-six evaluable patients with colorectal cancer underwent exploratory laparotomy with both traditional surgical exploration and radioimmunoguided surgery (RIGS) following injection of 125I-labeled CC49 monoclonal antibody. RIGS-positive tissue detectable with a handheld gamma-detecting probe was defined as tissue involved with the disease process. Comparisons were made between extent of disease using traditional exploration and extent using RIGS. In 41 patients with primary disease, traditional exploration detected 45 sites of disease (1.1 sites/patient) compared with 153 RIGS-positive sites (3.7 sites/patient). In 45 patients with recurrent disease, traditional exploration found 116 sites (2.6 sites/patient) vs. 184 RIGS-positive sites (4.1 sites/patient). Involvement by selected anatomic sites is shown below [Table: see text]. RIGS detected more tissue involved in disease process for all sites in both primary and recurrent disease except liver metastases. Areas with highest proportion of RIGS-positive tissue, the gastrohepatic ligament and celiac nodes, are rarely resected and are not pathologically examined. Positive RIGS localization of tumor antigen in these areas suggests more extensive dissemination of disease process.

Role of CEA—A Challenge of a Verdict

To Editor.— The recent article by Moertel et al (239:1065, 1978) leaves reader with a pessimistic impression that the CEA [carcinoembryonic antigen] assay is not a sensitive test for early detection of recurrence of colorectal cancer. Furthermore, authors are also concerned about needless anxiety produced by premature knowledge of presence of a fatal disease in those (unfortunate?) cases where rising CEA levels may be helpful in early detection of recurrence because of our limited therapeutic accomplishments under these circumstances. It is clear from patient population studied by Moertel et al that only those with pelvic (local and regional) recurrence were selected for study. In all fairness, these patients represent no more than 50% of total population of colorectal cancer patients at risk after potentially curative surgery of primary lesion. In this regard, authors seem to ignore relevant observations made