Preoperative CEA Level Research Articles

Depth of Mesorectal Extension Has Prognostic Significance in Patients With T3 Rectal Cancer

More than half of all rectal cancers are T3 lesions, but they are classified as a single-stage category. The aim of this study was to validate prognostic significance of mesorectal extension depth in T3 rectal cancer. This study is a retrospective analysis of oncologic outcomes of patients with T3 rectal cancer grouped by mesorectal extension depth (T3a, <1 mm; T3b, 1-5 mm; T3c, 5-15 mm; T3d, >15 mm). This study was conducted at a tertiary referral cancer hospital. From 2003 to 2009, 291 patients who underwent a curative surgery were included. Oncologic outcomes in terms of disease-free survival were analyzed. The 5-year disease-free survival rate according to T3 subclassification was 86.5% for T3a, 74.2% for T3b, 58.3% for T3c, and 29.0% for T3d. It was significantly higher in T3a,b tumors than that in T3c,d tumors (77.6% vs 55.2%, p < 0.001). On univariate and multivariate analysis, prognostic factors affecting recurrence were preoperative CEA level ≥ 5 ng/mL (HR 2.617, 95% CI 1.620-4.226), lymph node metastasis (HR 3.347, 95% CI 1.834-6.566), and mesorectal extension depth >5 mm (HR 1.661, 95% CI 1.013-2.725). In subgroup analysis, independent prognostic factors were preoperative CEA level and mesorectal extension depth >5 mm for 200 patients with ypT3 rectal cancer and preoperative CEA level and lymph node metastasis for 91 patients with pT3 rectal cancer. This study lacks quality of surgery plane evaluation because of its retrospective nature. Moreover, pathologic examination was not done with a whole-mount section. Depth of mesorectal extension >5 mm is a significant prognostic factor in patients with T3 rectal cancer. Depth of mesorectal extension especially may be more important than the nodal status in predicting the oncologic outcome for patients who had received preoperative chemoradiotherapy.

Identification and functional screening of microRNAs highly deregulated in colorectal cancer.

MicroRNAs (miRNAs) constitute a robust regulatory network with post-transcriptional regulatory efficiency for almost one half of human coding genes, including oncogenes and tumour suppressors. We determined the expression profile of 667 miRNAs in colorectal cancer (CRC) tissues and paired non-tumoural tissues and identified 42 differentially expressed miRNAs. We chose miR-215, miR-375, miR-378, miR-422a and miR-135b for further validation on an independent cohort of 125 clinically characterized CRC patients and for in vitro analyses. MiR-215, miR-375, miR-378 and miR-422a were significantly decreased, whereas miR-135b was increased in CRC tumour tissues. Levels of miR-215 and miR-422a correlated with clinical stage. MiR-135b was associated with higher pre-operative serum levels of CEA and CA19-9. In vitro analyses showed that ectopic expression of miR-215 decreases viability and migration, increases apoptosis and promotes cell cycle arrest in DLD-1 and HCT-116 colon cancer cell lines. Similarly, overexpression of miR-375 and inhibition of miR-135b led to decreased viability. Finally, restoration of miR-378, miR-422a and miR-375 inhibited G1/S transition. These findings indicate that miR-378, miR-375, miR-422a and miR-215 play an important role in CRC as tumour suppressors, whereas miR-135b functions as an oncogene; both groups of miRNA contribute to CRC pathogenesis.

Clinicopathological features and prognosis of primary appendiceal adenocarcinoma

To explore the clinicopathological characteristics and prognostic factors of primary appendiceal adenocarcinoma. The clinicopathological data of 42 patients with primary appendiceal adenocarcinoma treated in the Cancer Hospital of Chinese Academy of Medical Sciences between March 1994 and October 2009 were retrospectively analyzed. The survival analysis was conducted using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Log-rank) and multivariate (Cox) models. A total of 42 patients (29 female and 13 males, median age 56 years) with appendiceal adenocarcinoma were included in this study. Of them, 26 (61.9%) were mucinous adenocarcinoma, 12 (28.6%) were intestinal-type adenocarcinoma and 4 (9.5%) were signet cell carcinoma. 18 patients underwent curative resection, 20 patients received cytoreductive surgery, and 4 patients underwent biopsy only. Thirty patients received systemic chemotherapy (5-Fu-based regimens). One patient who died of postoperative pulmonary embolism on day 8 was excluded from the survival analysis. The overall 1-, 3-, and 5-year survival rate was 80.3%, 46.0% and 38.3%, respectively. Univariate analysis revealed that presence of symptoms of acute appendicitis, curative resection, histological grade, histological subtype, preoperative CEA level, systematic chemotherapy, and stage were all significant factors affecting the survival. Multivariate analysis showed that the preoperative CEA level (P = 0.01), histological grade (P = 0.001), and stage (P = 0.001) were independent prognostic factors. High level of CEA, G2/3 grade, and advanced stage are associated with poor prognosis in patients with primary appendiceal adenocarcinoma.

The clinicopathological features of colorectal mucinous adenocarcinoma and a therapeutic strategy for the disease

BackgroundThe guidelines established by the National Comprehensive Cancer Network do not describe mucinous histology as a clinical factor that should influence the therapeutic algorithm. However, previous studies show conflicting results regarding the prognosis of colorectal mucinous adenocarcinoma. In this study, we described the clinicopathological features of mucinous adenocarcinoma in Japan, to identify optimal therapeutic strategies.Methods144 patients with mucinous and 2673 with non-mucinous adenocarcinomas who underwent primary resection in two major centers in Yokohama, Japan were retrospectively evaluated for clinicopathological features and treatment factors. A multivariate analysis for overall survival followed by the comparison of overall survival using Cox proportional hazard model were performed.ResultsPatients with mucinous adenocarcinoma had larger primary lesions, higher preoperative CEA levels, a deeper depth of invasion, higher rates of nodal and distant metastasis, and more metastatic sites. A multivariate analysis for overall survival revealed a mucinous histology to be an independent prognostic factor. In the subgroup analysis stratified by stage, Patients diagnosed as StageIII and IV disease had a worse survival in mucinous adenocarcinoma than non-mucinous, while survival did not differ significantly in patients diagnosed as Stage0-II disease. In StageIII, local recurrence in rectal cases and peritoneal dissemination were more frequently observed in patients with a mucinous histology.ConclusionsOur study indentified that mucinous adenocarcinoma was associated with a worse survival compared with non-mucinous in patients with StageIII and IV disease. In rectal StageIII disease with mucinous histology, additional therapy to control local recurrence followed by surgical resection may be a strategical alternative. Further molecular investigations considering genetic features of mucinous histology will lead to drug development and better management of peritoneal metastasis

P-0116 Preoperative Cea Level is a New Indicator of Poor Prognosis in Patients with Invasive Ductal Adenocarcinoma of Pancreas

IntroductionSome clinicopathological indicators were reported as poor prognosis of invasive ductal adenocarcinoma of pancreas. The aim of this study is to find out the new indicator for prognosis. [Display omitted] MethodsTwo hundred forty-nine patients with invasive ductal adenocarcinoma of pancreas who underwent macroscopically radical resection between 2000 and 2009 were retrospectively analyzed. Eleven clinicopathological factors were obtained from a review of the medical charts. Analyses of survival were performed using Kaplan-Meier method, and differences between the curves were tested using log-rank test. Factors related to survival were analyzed with the Cox proportional hazards regression model. ResultsThe overall 1, 3, 5 year survival rates were 78.7, 32.1, 25.3% with 22.0 months in median survival time. Median follow up time of all survivors was 33.0 months. There were 27 patients who survived more than 5 years. There were 45 patients with CEA>5.0, 59 patients with CA199>500 and 23 patients with both. In the analyses of survival, 9 factors: preoperative CEA>5.0 ug/dl (p=0.02), CA199>500IU/l (p=0.04), right side tumor location (p=0.07), tumor size>2cm (p=0.07), pathological poor differentiation of tumor (p<0.01), UICC-T3 (p<0.01), positive lymph node (p<0.01), microscopical tumor residual tumor (R1) (p<0.01), less than 3 courses adjuvant GEM (p<0.01) were poorer prognostic factors by univariate analysis. Multivariate analysis revealed that preoperative CEA (p=0.038), pathological poor differentiation (p<0.01), insufficient adjuvant GEM (p<0.01), UICC-T3 (p<0.01), R1 (p<0.01) were independent poor prognostic factors. ConclusionElevated preoperative CEA level was the new indicator of the poor prognosis and the patients with that should be considered to be performed neoadjuvant therapy followed by surgery.

Combination of squamous cell carcinoma‐antigen, carcinoembryonic antigen, and carbohydrate antigen 19‐9 predicts positive pelvic lymph nodes and parametrial involvement in early stage squamous cell carcinoma of the uterine cervix

We examined the correlations between the pretreatment values of four tumor markers (squamous cell carcinoma [SCC]-antigen, carcinoembryonic antigen [CEA], carbohydrate antigen [CA]19-9, and CA125) and postsurgical high-risk factors (parametrial involvement and positive pelvic lymph nodes) in women with SCC of the uterine cervix who had International Federation of Gynecology and Obstetrics clinical stage IB and IIA disease and underwent radical hysterectomy. In this retrospective study, we reviewed 291 patients between April 1989 and December 2008. The first 200 subjects, studied between 1989 and 2001, served as the training set, and another 91 subjects, studied between 2002 and 2008, comprised the test set. To evaluate the correlations between pretreatment tumor markers and postsurgical high-risk factors, the χ²-test and logistic regression analysis were used for univariate and multivariate analysis, respectively. Multivariate analysis with receiver-operator curves showed that the combination of SCC-antigen, CEA, and CA19-9 strongly predicted postsurgical high-risk factors. Analysis of the training set showed that 66.7% (95% confidence interval, 52.6-84.8%) of patients who tested positive for at least two of these three tumor markers had postsurgical high-risk factors. Similar results were obtained with the test set. Preoperative levels of SCC-antigen, CEA, and CA19-9 are useful for predicting the status of postsurgical high-risk factors in women with SCC of the uterine cervix who undergo radical hysterectomy.

Influence of tumor size on the prognosis in patients with colon cancer

To investigate the impact of tumor size on the prognosis of patients with colon cancer. The clinicopathologic factors of 345 cases who underwent curative surgery for colon cancer from January 2004 to June 2008 in the Peking University Cancer Hospital were analyzed retrospectively. The optimal cut-off value was determined by receiver-operator characteristic (ROC) analysis. The overall 3-year survival rate was 85.1%. The optimal cut-off value was found to be 5.0 cm. The survival rate of patients with tumor size ≥5 cm and tumor size <5 cm was 79.5% and 90.5% respectively, and the difference was statistically significant(P=0.005). Multivariate analysis showed that preoperative CEA level (P=0.004), tumor size(P=0.020), regional lymph node metastasis(P=0.000), and lymphovascular invasion(P=0.002) were independent prognostic factors. Tumor size was significantly associated with overall survival in univariate and multivariate analyses in stage III( disease (P=0.011), but not in stage II( disease(P=0.827) using 5 cm as a cut-off. Tumor size of 5 cm is an independent prognostic parameter for patients with stage III( colon cancer but not for stage II(. Determination of the association between tumor size and survival should be base on TNM staging.

Angiolymphatic invasion exerts a strong impact on surgical outcomes for stage I lung adenocarcinoma, but not non-adenocarcinoma

Angiolymphatic invasion (ALI), representing lymphatic invasion (Ly) and intratumoral vascular invasion (V), is considered to be a useful prognostic factor for pathological stage I non-small cell lung carcinoma (NSCLC). However, the types of tumor for which prognoses are most influenced by ALI positivity have not previously been discussed, nor has the question of whether these findings should influence postoperative therapeutic decision-making after complete resection. The present study investigated 195 cases of stage I NSCLC treated by potentially curative surgical resection of the primary tumor and systematic lymphadenectomy. ALI-positive (ALI(+)) results were found in 31.8% of tumors, and 5.1% exhibited both Ly(+) and V(+). Five-year recurrence-free survival was significantly lower in ALI(+) cases (50.6%) than in ALI(−) cases (85.9%; p<0.0001, log-rank test). In particular, 5-year recurrence-free survival rate was only 10.0% for Ly(+)V(+) cases. ALI(+) correlated with high age, male sex, tumor size (>2.0cm), elevated preoperative serum carcinoembryonic antigen level (≥5.0ng/mL), high maximum standard uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) (≥5.0), pleural invasion, and histological classification of non-adenocarcinoma (ADC). According to histopathological subset analyses, ALI(+) was associated with shorter recurrence-free survival than ALI(−) only among ADC patients (p<0.0001, log-rank test), and not among non-ADC patients (p=0.7710). High preoperative serum CEA level, high SUVmax on FDG-PET, pleural invasion, Ly(+), and V(+) were significant risk factors for recurrence in univariate Cox survival analysis among stage I ADC patients. Importantly, Ly(+) and V(+) were identified as independent risk factors for recurrence by multivariate analysis. Histopathological detection of ALI as a risk factor for recurrence should be considered for inclusion in the staging criteria and as additional information for determining postoperative adjuvant treatment of stage I NSCLC, particularly among ADC patients, but not among non-ADC patients.

Central retroperitoneal recurrences from colorectal cancer: Are lymph node and locoregional recurrences the same disease?

BackgroundCentral retroperitoneal recurrences (CRRs) from colorectal carcinoma carry a poor prognosis. A CRR is sometimes defined as a locoregional recurrence (LR) and sometimes as a lymph node recurrence (NR). This study was conducted to determine the nature of CRR and evaluate prognostic factors after complete CRR resection. MethodsBetween January 1988 and December 2008, 31 patients underwent a complete resection of CRR. CRRs were divided into NR (n = 23) and LR (n = 8), whether pathological examination disclosed lymph node involvement or not. ResultsNo differences were found between LR and NR regarding TNM stage, primary tumour location, time interval from primary tumour resection to CRR, number of metastatic sites, number of metastatic lesions and therapeutic management. The median preoperative CEA level was higher in the NR group (p = 0.003). After a median follow-up of 47 months NRs were associated with better overall survival (OS) (p = 0.03). Three-year OS and disease-free survival (DFS) in the LR and NR groups were 27% and 0% versus 81% and 26%, respectively. Twenty-seven (87%) patients developed a re-recurrence within a median interval of 15 months. The number of metastatic sites or lesions, the size of the CRR, the type of chemotherapy, radiotherapy, the interval between the primary resection and CRR and the TNM stage had no impact on OS. ConclusionLR in patients with CRR had a poorer prognosis than NR. A multimodality approach with complete resection may yield long-term survival for NR.

Correlation between serum angiopoietin-2 levels and lymph node metastasis in early gastric cancer

Objective To study the correlation between preoperative serum angiopoietin-2 (Ang2) levels and lymph node metastasis in early gastric cancer(EGC).Methods Preoperative serum Ang-2 and CEA levels in 62 patients with EGG and 30 normal controls were measured by ELISA technique respectively.The metastasis of lymph node in these cases were determined by HE staining.The relation between preoperative serum Ang-2 levels and lymph node metastasis in EGC and pathologic characterization was investigated.Results Compared with normal controls,preoperative serum Ang-2 levels in EGC group were significantly elevated [( 282.5 ± 110.6 ) μg/L vs ( 187.4 ± 32.7 ) μg/L,P ＜ 0.01].Preoperative serum Ang-2 levels in node-positive gastric cancer group was significantly higher than that in the node-negative gastric cancer group [(34 7.2 ± 79.5 ) μg/L vs (265.6 ± 90.2) μg/L,P ＜ 0.01],while CEA levels changed a little.Preoperative serum Ang-2 levels in the EGC group presented marked correlation with the differentiated degree of the tumor tissue,tumor size,depth of tumor invasion but it had no correlation with the histological type.Preoperative serum Ang-2 levels were an independent high-risk factor of lymph node metastasis in EGC according to multivariate logistic regression analysis.Conclusions Preoperative serum Ang-2 levels may be a good clinical predictor for lymph node metastasis of EGC,which is useful for the treatment direction. Key words: Angiopoietin-2/blood; Stomach neoplasms/metabolism/pathology; Lymphatic metastasis

Expression of the phosphorylated MEK5 protein is associated with TNM staging of colorectal cancer

BackgroundActivation of MEK5 in many cancers is associated with carcinogenesis through aberrant cell proliferation. In this study, we determined the level of phosphorylated MEK5 (pMEK5) expression in human colorectal cancer (CRC) tissues and correlated it with clinicopathologic data.MethodspMEK5 expression was examined by immunohistochemistry in a tissue microarray (TMA) containing 335 clinicopathologic characterized CRC cases and 80 cases of nontumor colorectal tissues. pMEK5 expression of 19 cases of primary CRC lesions and paired with normal mucosa was examined by Western blotting. The relationship between pMEK5 expression in CRC and clinicopathologic parameters, and the association of pMEK5 expression with CRC survival were analyzed respectively.ResultspMEK5 expression was significantly higher in CRC tissues (185 out of 335, 55.2%) than in normal tissues (6 out of 80, 7.5%; P < 0.001). Western blotting demonstrated that pMEK5 expression was upregulated in 12 of 19 CRC tissues (62.1%) compared to the corresponding adjacent nontumor colorectal tissues. Overexpression of pMEK5 in CRC tissues was significantly correlated to the depth of invasion (P = 0.001), lymph node metastasis (P < 0.001), distant metastasis (P < 0.001) and high preoperative CEA level (P < 0.001). Consistently, the pMEK5 level in CRC tissues was increased following stage progression of the disease (P < 0.001). Analysis of the survival curves showed a significantly worse 5-year disease-free (P = 0.002) and 5-year overall survival rate (P < 0.001) for patients whose tumors overexpressed pMEK5. However, in multivariate analysis, pMEK5 was not an independent prognostic factor for CRC (DFS: P = 0.139; OS: P = 0.071).ConclusionspMEK5 expression is correlated with the staging of CRC and its expression might be helpful to the TNM staging system of CRC.

Is elevated preoperative CEA level a significant predictor for decreased overall survival in patients with stage I to III rectal cancer?

403 Background: The objective of the present investigation was to assess whether elevated pre-operative CEA level represents a significant predictor for decreased overall survival in stage I-III rectal cancer patients. Methods: The present study is based on the colorectal database of the authors` hospital, one of the largest tertiary care centers of Switzerland. All patients undergoing a resection for stage I - III rectal cancer were consecutively included between 1991 and 2008. Average follow-up time was 50.3 months. The impact of pre-operative CEA on overall survival was assessed in Cox proportional hazard regression analyses after risk-adjusting for age, gender, body mass index, performance status, tumor stage, tumor distance from the anal verge, and neoadjuvant treatment. Pre-operative CEA levels were classified as normal (&lt; 5 µg/liter) versus elevated (&gt;5 µg/liter). All tests were two-sided, the level of statistical significance was set at 0.05. Results: Overall, 534 consecutive patients undergoing resection for stage I - III rectal cancer were included. Median age was 65 years (range 24 to 91 years), 62% of patients were male, median ASA was II (range I – IV), median body mass index 25.3 kg/m2 (range 15.4 to 44.9 kg/m2). Pre-operative CEA levels were elevated in 21.7% of all patients. After risk-adjusting in Cox proportional hazard regression analyses pre-operative CEA level (p&lt;0.001; odds ratio: 2.020), distance from the anal verge &lt;5cm (p&lt;0.001, odds ratio: 2.434), older age (p&lt;0.001; odds ratio: 1.069) and higher tumor stage (p=0.004, odds ratio: 2.003) were all significant predictors for poor overall survival. Forward- and backward variable selection including bootstrap analyses confirmed these results. Conclusions: The present investigation based on a large cohort of consecutive stage I – III rectal cancer patients provides compelling evidence that elevated pre-operative CEA level is a strong predictor of decreased overall survival even after risk-adjusting in Cox proportional hazard regression analyses. Therefore, it is crucial that pre-operative CEA is used as a prognostic factor in the pre-operative assessment of stage I-III rectal cancer patients.

External Validation of a Biomarker Based Pre-Cystectomy Algorithm to Predict Nonorgan Confined Urothelial Cancers

The role of neoadjuvant chemotherapy before surgery in patients with muscle invasive bladder cancer remains debated and the need for tools to identify patients who would benefit from chemotherapy is pertinent. We previously published a preoperative algorithm to predict nonorgan confined disease. This algorithm included tumor markers (CEA, CA 125 and CA 19-9) as well as clinical parameters. In this study we validated the accuracy of this algorithm in an independent, external cohort. We used the Toronto Biobank to measure preoperative serum levels of CEA, CA 125 and CA 19-9 in 76 consecutive patients with clinically organ confined bladder cancer (cT2 or less) who underwent radical cystectomy. Clinical parameters were retrieved from our prospective bladder information system database and incorporated into our marker based algorithm. A numerical score was generated for each patient and a previously published cutoff was used to predict the presence of nonorgan confined disease. The accuracy of the model was quantified with the area under the curve, and the positive and negative predictive values were calculated. On pathological evaluation 38 patients (50%) had nonorgan confined tumors. The AUC of the algorithm was 0.79 (95% CI 0.69-0.89). The positive and negative predictive values were 79% (95% CI 71-87) and 74% (95% CI 66-82), respectively. We externally validated a pre-cystectomy model to predict pathological stage. The algorithm may possibly aid in selecting patients who would benefit from neoadjuvant chemotherapy before cystectomy.

術前血清CEA値が異常高値を示した盲腸癌の1例

術前血清CEA値が異常高値を示した盲腸癌の1例

Clinical and prognostic significance of preoperative serum CA153, CEA and TPS levels in patients with primary breast cancer

To investigate the clinical and prognostic values of preoperative serum CA153, CEA and TPS levels in patients with primary breast cancer. A total of 386 hospitalized patients with stage I ∼ IV breast cancer from Nov 1998 to Feb 2009 were followed up, and their clinicopathological data were analyzed retrospectively to determine the factors affecting their prognosis. First, preoperative serum CA153 expression level was significantly associated with the age of onset and tumor size (P < 0.05), the expression of serum CEA was correlated with tumor size (P < 0.05), and the expression of serum tissue polypeptide specific antigen (TPS) was correlated with tumor size and lymph node metastases (P < 0.05). Second, the overall survival was significantly shorter among patients with elevated serum CA153, CEA or TPS, respectively (P < 0.05 for overall). Finally, multivariate Cox regression analysis indicated that estrogen receptor status (ER) and elevated preoperative values of CA 153 are independent prognostic factors for overall survival (P < 0.05), and CA 153 is a risk factor but estrogen receptor status is a protective factor for overall survival. Higher preoperative expression of serum CA153, CEA or TPS is closely correlated with clinicopathological characteristics and overall survival. The prognosis is poorer in primary breast cancer patients with higher CA15-3 expression level, and pre-treatment CA153 expression level can be used as an independent prognostic parameter in patients with primarily breast cancer.

Two Decades of Experience with Hepatic Cryotherapy for Advanced Colorectal Metastases

Only 15% of patients with colorectal liver metastases (CLM) are candidates for curative hepatectomy at time of diagnosis, limited by anatomical location and tumor burden. Ablative therapies may extend this. This study reports a single institution's long-term experience with hepatic cryotherapy for advanced CLM. Between April 1990 and June 2009, 304 patients were curatively treated with cryotherapy. Survival was estimated by Kaplan-Meier method. Prognostic factors for survivals were determined by using univariate and multivariate analyses. A total of 293 patients were included into analysis. The median number of lesions treated per patient was three (range, 1-13). The median overall survival was 29 (range, 3-220) months. The 1-, 3-, 5-, and 10-year survivals were 87%, 41.8%, 24.2%, and 13.3%, respectively. A total of 161 patients developed intrahepatic recurrences: cryosite (23%); edge recurrence (14%); and within the liver remnant (78%). The median disease-free survival (DFS) was 9 (range, 1-220) months. The 1-, 3-, 5-, and 10-year DFS rates were 37.9%, 17.2%, 13.4%, and 10.8%, respectively. Univariate analysis identified four factors that significantly affect survival: node-positive primary tumor (p=0.001), preoperative CEA level (p<0.001), number of lesions (p<0.001), and use of neoadjuvant chemotherapy (p<0.001). However, only primary tumor nodal status was independently prognostic (hazards ratio=2.023; 95% confidence interval, 1.444-2.835; p<0.001). Hepatic cryotherapy seems to be a safe and effective ablative technique for the treatment of colorectal liver metastases and may offer long-term survival in otherwise unresectable disease.

Surgical treatment and prognostic factors for obstructing left colorectal cancer

To investigate the outcomes of surgical treatment and the prognostic factors of long-term survival for obstructing left colorectal cancer. Clinicopathological and follow-up data of 93 patients with obstructing left colorectal cancer undergoing surgical treatment from January 2001 to December 2006 in the Affiliated Hospital of Medical College of Qingdao University were analyzed retrospectively. There were 53 males and 40 females. The median age was 61 years old. Fifty-one patients had concurrent medical condition. Radical resection was performed in 67 patients, including one-stage resection (n=21), Hartmann procedure (n=35), and Miles procedure (n=11). Surgery was palliative in 26 patients, including diverting stoma (n=14), bypass surgery (n=7), and palliative resection (n=5). All the 93 patients were followed up. The 1-, 3-, and 5-year survival rates were 94%, 59%, and 38%, respectively. Univariate and multivariate analyses showed that radical resection, TNM staging, and preoperative level of carcinoembryonic antigen were independent prognostic factors (all P<0.05). Radical resection, TNM stage, and preoperative CEA level are prognostic factors of obstructing left colorectal cancer. Early diagnosis, radical resection, and selection of appropriate surgical procedure are helpful to prolong survival time of patients with obstructing left colorectal cancer.

New Clinical Scoring System for Prognosis of Early Recurrence of Colorectal Liver Metastases After Surgical Treatment

To determine the relationship between the mRNA expression of MMP-2, MMP-9, TIMP-1, TIMP-2 and CEA in tumour tissue and preoperative serum levels of these tumour markers in patients with colorectal liver metastases (CLM). Additionally, to establish a new scoring system based upon these results in combination with the volume of the metastatic process to identify patients with a high risk of early recurrence of CLM. The correlation between the mRNA expression of CEA, TIMP-1, TIMP-2, MMP-2 and MMP-9 in tissue samples and preoperative serum levels of the named tumour markers was performed on 27 patients. The scoring system was proposed as a combination of all the independent parameters (mRNA expression of TIMP-1, MMP-9 and CEA in tumour tissue samples and preoperative serum levels of CEA and TIMP-1) in combination with the volume of the metastatic process. The evaluation was conducted in relation to the disease free interval (DFI). We observed a statistically significant relationship between the volume of liver metastases and DFI (p<0.0337). The scoring system divided the patients into groups with a tendency of early recurrence (p<0.0126). The high stages in our scoring systems augment the risk of recurrence. The proposed scoring system was shown to be an efficient instrument helpful in complex surgical and oncological access to patients after radical surgical treatment of CLM.

MTSS1 Overexpression Correlates with Poor Prognosis in Colorectal Cancer

BackgroundThe aims of this study were to investigate metastasis suppressor 1 (MTSS1) expression in benign and malignant colorectal tissues and to explore its significance in the prognosis of colorectal cancer (CRC) patients. MethodsMTSS1 expression was detected by immunohistochemistry in CRC, colorectal adenomatous polyp (precancerous lesion) and normal colorectal tissues. The relationship between MTSS1 expression in CRC tissues and clinicopathologic factors was analyzed with Mann–Whitney U test. MTSS1 protein expression was observed by Western blot in CRC tissues and adjacent nontumor colorectal tissues. Two factors between MTSS1 expression and CRC patient tumor node metastasis (TNM) stage were analyzed by Spearman rank correlation analysis. The Kaplan–Meier method and log-rank test were employed to compare the overall survival between MTSS1 negative/weak positive expression group and MTSS1 strong positive expression group. ResultsMTSS1 expression rates were significantly higher in CRC tissues (99 out of 135, 73.30%) than that in normal colorectal tissues (one out of seven, 14.29%), nontumor colorectal tissues (six out of 32, 18.75%), and adenomatous polyp tissues (four out of 15, 26.67%; P = 0.003, P < 0.001, P = 0.001, respectively). The upregulated MTSS1 expression in CRC tissues was significantly correlated to poor differentiation (P = 0.005), tissue invasion (P = 0.018), high preoperative CEA level (P = 0.022), present lymph node metastasis (P = 0.003), and high TNM stage (P = 0.002). MTSS1 expression was positively correlated with clinical TNM stage, that suggested the more advanced clinical TNM stage corresponding to the higher expression level of MTSS1 (rs = 0.327, P < 0.05). Western blotting demonstrated that MTSS1 expression was upregulated in 25 of 32 CRC tissues (75.0%) compared to corresponding adjacent nontumor colorectal tissues. The overall 5-year survival of MTSS1 strong positive expression CRC patients was significantly shorter than that of MTSS1 negative and weakly positive expression group. In multivariate analysis, MTSS1 expression maintained independent prognostic influence on overall survival (P = 0.004). ConclusionMTSS1 may be a good biomarker to be applied in the clinical setting to predict the prognosis of CRC patients with completely resected.

The Role of Carcinoembryonic Antigen After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer

The purpose of this study was to evaluate the role of CEA after neoadjuvant chemoradiotherapy in patients with rectal cancer. This study involved 109 patients with rectal cancer who were treated with preoperative chemoradiotherapy and curative resection. Preoperative serum CEA levels were measured twice, before chemoradiotherapy administration and 4 weeks after chemoradiotherapy. Surgery was performed 6 to 9 weeks after neoadjuvant chemoradiotherapy. The 3-year disease-free survival rate was 85.0%. On univariate analysis, prechemoradiotherapy CEA level, postchemoradiotherapy CEA level, tumor regression grade, ypT, ypN, circumferential resection margin, lymphatic invasion, venous invasion, and perineural invasion were associated with disease-free survival. Based on univariate analysis (group 1: prechemoradiotherapy CEA ≤ 3.5; group 2: prechemoradiotherapy CEA > 3.5, postchemoradiotherapy CEA ≤ 2.7; group 3: prechemoradiotherapy CEA >3.5, postchemoradiotherapy CEA > 2.7), we categorized patients into 3 groups according to their pre- and postchemoradiotherapy CEA levels (ng/mL). The 3-year disease-free survival rate was significantly better in groups 1 and 2 (94.7% and 88.0%) than in group 3 (52.6%, P < .001). On multivariate analysis, tumor regression grade (P = .036), ypN (P = .036), and CEA groups (P = .022) were identified as independent prognostic factors for disease-free survival. Furthermore, postchemoradiotherapy CEA ≤ 2.7 ng/mL was an independent predictor of good tumor regression (P = .001), ypT0 to 2 (P = .002), and ypN0 (P = .001). Combined pre- and postchemoradiotherapy CEA levels could be useful as a prognostic factor for disease-free survival in patients with rectal cancer who undergo treatment with neoadjuvant chemoradiotherapy and curative resection. Postchemoradiotherapy CEA may be helpful in a selection of patients who want more conservative surgery after chemoradiotherapy.