Resection Of Colon Cancer Research Articles

Personalized laparoscopic resection of colon cancer with the use of indocyanine green lymph node mapping: Technical and clinical outcomes.

To describe the experience of utilization of real time indocyanide green (ICG) fluorescent imaging for mapping out drainage lymph node and hence personalized lymphadenectomy in colorectal resection. Perioperative injection of ICG before or during colon cancer resection by either intraluminal submucosal injection or laparoscopic peritumoural injection. The drainage lymph nodes were mapped out, and hence lymphadenectomy was performed enbloc with the main tumor. The effectiveness of mapping of drainage lymphatics and the procedure performed were recorded. A total of 21 patients (M:F=14: 7) had perioperative ICG injection to map out the drainage lymphatics. The overall success rate was 86%. Seven patients (33%) had endoscopic submucosal injection, while 14 patients (67%) had intraoperative peritumoural injection. Three patients who had endoscopic submucosal injection had ICG extravasation, and hence failed lymph node mapping. Four patients (19%) had a change in extent of resection according to the lymph node mapping results. Personalized oncological colorectal resection and lymphadenectomy can be performed with the aid of ICG technology. Laparoscopic subserosal ICG injection may be the preferred route, as it minimize extravasation and aids to identify drainage lymph nodes without prolonging minimally invasive surgery. Further studies are required to determine the best route, strength, and timing of ICG injection and concordance with pathology to tailor the extent of resection for individual patients.

Short- and long-term outcomes of single-incision laparoscopic surgery for right colon cancer: A multicenter propensity score-matched analysis.

Single-incision laparoscopic surgery (SILS) for colon cancer is a recent innovation in minimally invasive surgery that can improve short-term outcome. However, several biases exist in current favorable comparisons of SILS with conventional laparoscopic (CL) surgery. Moreover, the oncological outcomes in SILS remain unclear. The aim of this study was to identify outcomes following SILS and CL for right colectomy using a propensity score-matched analysis. A total of 553 patients underwent curative resection for right colon cancer (58 SILS and 495 CL). After propensity score matching, 58 patients in each group were matched. Before matching, median age was younger (p=0.037) and clinical stage was lower (p < 0.001) in the SILS group. After matching, operation time was shorter (172 versus 193 min, p=0.007) and blood loss was less (12 versus 20 mL, p=0.037) in the SILS group. Most of the SILS cases were performed (43.1%) or supervised (51.7%) by an expert surgeon. Median follow-up duration was 30 and 37 mo in the SILS and CL groups, respectively. Three-year relapse-free survival was 92.5% and 92.4% (p=0.781); and overall survival was 100% versus 98.1% (p=0.177). Under the control of expert surgeons, SILS appeared to be a safe and feasible approach and had similar oncological outcomes compared with CL in a propensity score-matched cohort of patients with right-sided colon cancer.

207 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of Treatment with Oral/ IV Iron

Abstract Aim Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay, recurrence, and requirement for blood transfusions. Method Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia and non- Iron Deficiency anaemia. IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, length of stay, recurrence and requirement for blood transfusions were collected plus treatment for anaemia. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P &amp;lt;0.05. Results 150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron). IDA oral and IV treatment versus non-IDA: Median age 74, 80 and 78 years (P = 0.814), Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant), Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596) Length of Stay (days) 6, 5; 7 (P 0.113), Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P &amp;gt;0.1), and Recurrence P &amp;gt;0.1. Conclusions In our series, iron treatment does not influence recurrence, length of stay, requirement for blood transfusions. Tumour location is not significantly different between IDA and non-IDA group. Patients treated with oral iron therapy are seen to have a larger drop in haemoglobin post operatively than the other groups.

Equivalent Operative Outcomes for Emergency Colon Cancer Resections Among Acute Care Surgeons and Specialists in Colorectal Surgery.

Improved screening has decreased but not eliminated the need for emergent surgery for colon cancer (CC), many of which are performed by acute care surgery (ACS) surgeons. This retrospective review compares outcomes for CC resections on the ACS service to the surgical oncology and colorectal services (SO/CRS). Retrospective review was performed for CC operations between 2014 and 2019. Data for margin status, cancer stage, number of lymph nodes dissected, time to medical oncology follow-up, and time to initiation of chemotherapy were collected. Patients with curative resection, who chose comfort care, presented on alternative services or with non-CC indications as well as those were lost to follow-up were excluded. 36 ACS patients and 269 SO/CRS patients underwent CC resections. Most ACS patients presented emergently compared to the SO/CC group (83.3% vs 1%, P < .05) as well as with more advanced tumor stage. There were no statistically significant differences for presence of metastatic disease, number of lymph nodes obtained, or time to post-surgical care (in days) and chemotherapy initiation (in days). 3 (8%) EGS patients had positive margins compared to 6 (2%) CRS/SO patients due to the presence of perforated tumors in the ACS group (p < .05). There were no statistically significant differences in 30-day or 1-year mortality despite the emergent presentation of the ACS patients. These findings suggest that despite emergent presentation and advanced disease burden, ACS surgeons provide quality care to CC patients, both in the operating room and in coordination of care.

ICG-Guided Lymphadenectomy during Surgery for Colon and Rectal Cancer-Interim Analysis of the GREENLIGHT Trial.

Lymphadenectomy is crucial for an optimal oncologic resection of colon and rectal cancers. However, without a direct visualization, an aberrant route of lymph node (LN) diffusion might remain unresected. Indocyanine-green (ICG) lymphatic mapping permits a real-time LNs visualization. We designed the GREENLIGHT trial to explore in 100 patients undergoing robotic colorectal resection the clinical significance of a D3 ICG-guided lymphadenectomy. The primary endpoint was the number of patients in whom ICG changed the extent of lymphadenectomy. We report herein the interim analysis on the first 70 patients. After endoscopic ICG injection 24 h (n = 49) or 72 h (n = 21) ahead, 19, 20, and 31 patients underwent right colectomy, left colectomy, and anterior rectal resection. The extent of lymphadenectomy changed in 35 (50%) patients, mostly (29 (41.4%)) for the identification of LNs (median two) outside the standard draining basin. Identification of such LNs was less frequent in rectal tumors that had undergone chemoradiotherapy (26.3%) (p > 0.05). A non-significant correlation between time-to-ICG injection and identification of aberrant LNs was observed (48.9% at 24 h vs. 23.8% at 72 h). The presence of LN metastases did not affect a proper fluorescent mapping. These data indicate that ICG lymphatic mapping provides relevant information in 50% of patients, thus increasing the accuracy of potentially curative resections.

Charlson comorbidity index predicts anastomotic leakage in patients with resected right-sided colon cancer.

Anastomotic leakage after right-sided colon cancer surgery is a serious complication that affects postoperative mortality. The Charlson comorbidity index (CCI) has been reported to be a useful predictor of postoperative complications. A total of 593 cases of right-sided colon cancer resections performed from 2016 to 2020 were examined. The patients were divided into two groups according to the presence or absence of anastomotic leakage (AL, n = 28; no-AL, n = 565); clinicopathological and surgical characteristics were compared between the groups. The AL group patients had a higher comorbidity rate (96.4% vs. 66.9%, p < 0.001), higher CCI score (p < 0.001), higher blood loss (42mL vs. 23mL, p = 0.046), and longer hospital stay (30days vs. 12days, p < 0.001) than the no-AL group patients. The percentages of chronic pulmonary disease (14.3% vs. 3.9%, p = 0.029), cerebrovascular disease (14.3% vs. 1.9%, p = 0.022), connective tissue disease (39.3% vs. 3.2%, p < 0.001), leukemia (3.6% vs. 0%, p = 0.042), and moderate to severe liver disease (7.1% vs. 0%, p = 0.002) were significantly higher in the AL group. In the multivariate analysis, CCI ≥ 2 was identified as an independent predictor of postoperative anastomotic leakage (hazard ratio 4.91, 95% confidence interval 2.23-10.85, p < 0.001). CCI could predict anastomotic leakage after right-sided colon cancer surgery.

Peritoneal metastases from colorectal cancer in the absence of lymph node metastases show a high survival rate despite unfavorable prognostic indicators

BackgroundPatients with colorectal cancer die as a result of metastases to liver, lymph nodes or the peritoneal surfaces. The primary is almost always controlled by colon or rectal cancer resection. MethodsConsecutive patients with isolated metastases to peritoneal surfaces (no lymph node, liver or systemic metastases) were referred to the Washington Cancer Institute from all over the United States and abroad. The study of this particular group of patients was to determine the impact of clinical and histologic features on overall survival. These variables were collected from the primary colorectal cancer resection performed at the referring institute and from the cytoreductive surgery (CRS) performed at the Washington Hospital Center. The data was prospectively accumulated and retrospectively analyzed. ResultsThirty-one consecutive patients had a complete cytoreduction. This restricted cohort of patients was studied in an attempt to eliminate confounding variables. The median age was 47 years (range 19–80). There were 14 (45%) males. The median overall survival following CRS was 67.9 months with a 5-year and 10-year survival of 51.9% and 43.6%, respectively. None of the clinical or histologic features, including peritoneal cancer index (PCI) and presence of signet ring cells, significantly predicted survival except for carbohydrate antigen 19-9 (CA19-9) (p = 0.0033). None of the involved abdominopelvic regions predicted a guarded outcome. ConclusionsIn this restricted group of lymph node negative colorectal PM patients with a complete cytoreduction, a high PCI or the presence of signet ring cells should not exclude patients from CRS and perioperative chemotherapy.

Clinical implication of KRAS mutation variants in patients with resected colon cancer.

179 Background: This study evaluated the clinical implication of KRAS mutation variants in patients with resected colon cancer (CC). Methods: We retrospectively reviewed 482 patients diagnosed with CC and underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The inclusion criteria were: pathologically diagnosed with primary CC; stage I–III CC according to the 7th edition of American Joint Committee on Cancer staging system; and with available test results for KRAS mutation status. In total, 345 patients met these criteria and were included in this study. Results: Among the 345 patients, 140 (40.6%) exhibited KRAS mutations, with their incidences as follows: 90/140 (64.3%) in Exon 2 Codon 12, 37/140 (26.4%) in Exon 2 Codon 13, 1/140 (0.1%) in Exon 3 Codon 59, 7/140 (5.0%) in Exon 3 Codon 61, and 5/140 (3.6%) in Exon 4 Codon 146. KRAS mutation status was not a significant prognostic factor for disease-free survival (DFS) or overall survival (OS). Although, there were no significant differences in survival between patients with Exon 2 Codon 12 and Exon 2 Codon 13 mutations, poorer DFS ( p = 0.085) and OS ( p = 0.005) were seen in those with Exon 3 Codon 61 mutation than in others. Conclusions: KRAS mutation status was not correlated with survival, but Exon 3 Codon 61 mutation might be a poor prognostic factor in resected CC patients.

Clinical Benefit of Preserving Inferior Mesenteric Vein in Laparoscopic Curative Resection for Descending and Splenic Flexure Colon Cancer: A Comparative Study of CT-based objective Evidence

Background: Although the presence of remnant long sigmoid colon after left hemicolectomy with inferior mesenteric vein (IMV) ligation is a major risk factor for venous ischemia, there is insufficient objective evidence to support the clinical benefit of IMV preservation in curative resection for distal transverse, descending and splenic flexure colon cancer. This study was to confirm the patency through CT after IMV preservation in laparoscopic left hemicolectomy for distal transverse, descending and splenic flexure colon cancer, and to analyze the clinical outcomes compared to the IMV ligation group.

Proper surgical extent for clinical stage I right colon cancer

Background: Preoperative evaluation identifying clinical stage affects the decision regarding the extent of surgical resection in right colon cancer. This study was designed to predict a proper surgical resection through the prognosis of clinical stage I right colon cancer.

ESSO40-0266 - Long-term oncological outcomes and survival after colorectal anastomotic leakage

Background: Anastomotic leakage (AL) is associated with increased short-term morbidity and mortality rates. The impact on long-term oncological outcomes remains unclear. The aim of this population-based study was to determine the impact of AL on long-term oncological outcomes of patients that underwent colon cancer (CC) or rectal cancer (RC) resection.

The association between tumour sidedness, clinicopathological characteristics and outcomes in patients undergoing curative resection for colon cancer.

148 Background: Right-sided colon cancer is associated with worse outcomes than left-sided disease, likely due to an association between tumour/host factors and tumour sidedness. The present study analyses the association between tumour sidedness, clinicopathological features and common mutations to better understand this discrepancy in outcomes. Methods: The association between tumour sidedness, clinicopathological characteristics and survival was examined within a cohort of patients undergoing curative surgery for TNM I-III colon cancer. Results: 3,419 patients were identified. 54% of cases were right-sided and associated with worse 3-year OS/CSS. On multivariate analysis for clinical factors: sex (OR 0.63), Systemic Inflammatory Grade (SIG), anaemia and differentiation (OR 0.80/0.31/0.57) were associated with T3 cancer sidedness and: sex, anaemia and differentiation (OR 0.61/0.46/0.57) were associated with T4 cancer sidedness. On further MVA including mutational factors anaemia/BRAF status remained significant in T3/T4 cancer respectively (OR 0.08/0.09). BRAF mutant status was associated with SIG in all patients/T3 disease (p=0.046/0.016). Conclusions: Worse outcomes seen in right-sided colon cancer are likely explained predominantly by factors including tumour stage, SIG, anaemia and BRAF mutational status. BRAF mutations are associated with the Systemic Inflammatory Response and further research is required to better understand this relationship taking into the tumour microenvironment, microsatellite instability.[Table: see text]

Phase II/III study of circulating tumor DNA as a predictive biomarker in adjuvant chemotherapy in patients with stage II colon cancer: NRG-GI005 (COBRA).

TPS233 Background: There are currently no validated predictive biomarkers for stage II resected colon cancer (CC) after adjuvant chemotherapy. However, circulating tumor DNA (ctDNA) shed into the bloodstream represents a highly specific and sensitive approach for identifying microscopic or residual tumor cells. For patients (pts) with CC, the detection of ctDNA is associated with persistent disease after resection and may outperform traditional clinical and pathological features in prognosticating risk for recurrence. We hypothesize that for pts whose stage II colon cancer has been resected and who have no traditional high-risk features, a positive ctDNA status may identify those who will benefit from adjuvant chemotherapy. Methods: In this prospective phase II/III clinical trial, pts (N = 1,408) with resected stage II CC without traditional high-risk features and whom the evaluating oncologist deems suitable for active surveillance (i.e., not needing adjuvant chemotherapy) will be randomized 1:1 into 2 arms: standard-of-care/observation (Arm A), or prospective testing for ctDNA (Arm B). Postoperative blood will be analyzed for ctDNA with the Guardant Reveal assay, covering CC-relevant mutations and CC-specific methylation profiling. Pts in Arm B with ctDNA detected will be treated with 6 months of adjuvant (FOLFOX) chemotherapy. For all pts in Arm A, ctDNA status will be analyzed retrospectively at the time of endpoint analysis. The primary endpoints are clearance of ctDNA with adjuvant chemotherapy (phase II) and recurrence-free survival (RFS) for “ctDNA-detected” pts treated with or without adjuvant chemotherapy (phase III). Secondary endpoints will include time-to-event outcomes (OS, RFS, TTR) by ctDNA marker status and treatment, prevalence of detectable ctDNA in stage II CC, and rates of compliance with assigned intervention. Archived normal and matched tumor and blood samples will be collected for exploratory correlative research. Enrollment continues across North America to the 540-patient phase II endpoint. Support: U10-CA-180868, -180822; UG1CA-189867; GuardantHealth. Clinical trial information: NCT04068103.

NRG-GI008: Colon adjuvant chemotherapy based on evaluation of residual disease (CIRCULATE-US).

TPS212 Background: Currently, there are no biomarkers validated prospectively in randomized studies for resected colon cancer (CC) to determine need for adjuvant chemotherapy (AC). However, circulating tumor DNA (ctDNA) shed into the bloodstream represents a highly specific and sensitive approach (especially with serial monitoring) for identifying microscopic or residual tumor cells in CC patients (pts) and may outperform traditional clinical and pathological features in prognosticating risk for recurrence. CC pts who do not have detectable ctDNA (ctDNA-) are at a much lower risk of recurrence and may not need AC. Furthermore, for CC pts with detectable ctDNA (ctDNA+) who are at a very high risk of recurrence, the optimal AC regimen has not been established. We hypothesize that for pts whose colon cancer has been resected, ctDNA status may be used to risk stratify for making decisions about AC. Methods: In this prospective phase II/III trial, up to 1,912 pts with resected stage III A, B (all pts) and stage II, IIIC (ctDNA+ only) CC will be enrolled. Based on the post-operative ctDNA status using Natera’s Signatera assay, those who are ctDNA- (Cohort A) will be randomized to immediate AC with fluoropyrimidine (FP) + oxaliplatin (Ox) for 3-6 mos per established guidelines vs serial ctDNA monitoring. Patients who are ctDNA+ post-operatively or with serial monitoring (Cohort B) will be randomized to FP + Ox vs more intensive AC with addition of irinotecan (I) for 6 mos. The primary objectives for Cohort A are time to ctDNA+ status (phase II) and disease-free survival (DFS) in phase III in the immediate vs delayed AC arms. The primary objective for Cohort B is DFS in the FP + Ox vs FP + Ox + I arms for both phase II and phase III portions of the trial. Secondary objectives include prevalence of detectable ctDNA post-operatively, time-to event outcomes (overall survival &amp; time to recurrence) by ctDNA status, and the assessment of compliance to adjuvant therapy. Biospecimens including archival tumor tissue, post-operative and serial matched/ normal blood samples will be collected for exploratory correlative research. Study will activate in early 2022 across the NCTN. NCT#: Pending. Support: U10-CA-180868, -180822; UG1CA-189867; Natera.

Preoperative evaluation of vascular anatomy of right colic vessels using enhanced computed tomographic colonography.

The purpose of this study is to define the blood vessels from a surgical perspective and show the frequency of vascular anatomical anomalies as well as the positional relationship with the surrounding organs, including the number of jejunal veins that cross the dissection area in our series. From January 2016 to December 2018, 126 patients who received ileocecal resection or right hemicolectomy for colonic cancer in our institution were retrospectively analyzed by preoperative enhanced computed tomographic colonography images that were obtained using an 80-detector row CT scanner and workstation. The ileocolic artery/vein, right colic artery/vein and middle colic artery/vein were defined as the vessels that flow directly from or into the superior mesenteric artery/vein. All colic veins that flowed into the gastro-colic trunk were defined as accessory right colic veins. The accessory right colonic vein existed more than two in 62.6% of cases. In 11 cases (8.9%), the inflow point of the ileocecal vein was on the ventral side of the pancreas. There was one jejunal vein that straddled the dissection area in 31% and two in 6.3%. This study elucidated the vascular anatomy and positional relationship with surrounding organs that is required in central vascular ligation during complete mesocolic excision for right sided colon cancer.

Potential evidence of peritoneal recurrence in Stage-II colon cancer from the control arm of CALGB9581

BackgroundRelapse of early-stage colon cancer (CC) after curative-intent resection occurs. We hypothesized that known risk factors for peritoneal metastases (PM) can define a high-risk state (HRS) that predicts recurrence and mortality. MethodsCALGB9581 trial patients receiving no adjuvant treatment after stage-II CC resection were included. Positive radial margins, T4 invasion, obstruction/perforation or lymphovascular invasion defined the HRS. Cox proportional hazard models determined association with overall (OS) and disease-free survival (DFS). ResultsMedian follow-up in 873 included patients was 8.1 years. Five-year OS was 85.8%. HRS+ patients had lower 5-year DFS (68.7 vs. 82.4%, P = 0.003) and OS (75.5 vs. 87.8%, P = 0.001). HRS+ was independently predictive of worse DFS and OS (HR 1.52 and 1.64, P < 0.01). Among recurrences, HRS+ patients showed shorter median OS (3.3 vs. 5.3 years, P = 0.01). ConclusionsHRS criteria identify a cohort of CC patients at high-risk of recurrence and death. Studies of novel surveillance techniques in such patients are warranted.

P067 Human intestinal CD103+SIRPα+ conventional dendritic cells from patients with Crohn′s disease prime IL-17+ T-cells

Abstract Background Crohn’s disease (CD) is a chronic inflammation of the human gastrointestinal tract. Intestinal conventional dendritic cells (cDC) maintain the balance between immunity against pathogens and tolerance towards nutrients and commensals. However, there is not much information about DC composition, phenotype and function in the human gut in CD. Methods Human intestinal resections were obtained from patients with ileocolonic CD and proximal colonic cancer. Both inflamed and non-inflamed tissue was obtained from the ileum and colon from CD patients. The non-affected tissue from the proximal (terminal ileum) and distal (proximal colon) sides of the colonic cancer resections (minimum 10cm distance from the tumor) constituted the reference tissue. Tissue was disaggregated and cDC and macrophages enriched by flow-sorting. Human intestinal cDC were identified within singlet viable leukocytes as CD14-CD64-HLA-DR+CD11c+. Type 1 cDC (cDC1) were defined as CD103+SIRPα- while type 2 cDC (cDC2) and identified as SIRPα+ and further divided into subsets based on the expression of CD103. Macrophages were identified within singlet viable leukocytes as CD14+CD64+HLA-DR+. All three cDC subsets and total macrophages were used to stimulate allogeneic CD4+ naïve T-cells which were further characterized by flow cytometry. Results All 3 human intestinal cDC subsets from non-CD controls were able to stimulate naïve T-cells as opposed to intestinal macrophages. Indeed, stimulated T-cells produced IL-10 and co-expressed FoxP3, being this capacity increased in both CD103+ subsets (CD103+SIRPα- and CD103+SIRPα+). Moreover, all three ileal cDC subsets stimulated T-cells more efficiently than their paired colonic counterparts, although the acquired T-cell profile did not differ among tissues. None of the cDC subets, on the contrary, induced the expression of IFNγ or IL-17 on stimulated T-cells. Referred to CD patients, all three colonic cDC subsets were more stimulatory than their counterparts from the control tissue, while CD103+SIRPα+ cDC from the inflamed ileum primed the generation of IL-17+ responding T-cells. Conclusion All human intestinal cDC subsets prime the generation of regulatory FoxP3+ and IL-10+ T-cells. This capacity was increased in both CD103+SIRPα- and CD103+SIRPα+, in agreement with the regulatory functions attributed to CD103+ cDC. All ileal cDC subsets were also more stimulatory than their colonic counterparts. Nevertheless, colonic cDC from CD patients were more stimulatory that non-CD controls, rendering CD103+SIRPα+ cDC from the inflamed tissue in CD with a higher capacity to generate Th17 cells, which suggests that their regulatory functions can be reshaped by the inflamed tissue microenvironment.

An exploration of immunohistochemistry-based prognostic markers in patients undergoing curative resections for colon cancer

BackgroundThe immune system recognizes and destroys cancer cells. However, cancer cells develop mechanisms to avoid detection by expressing cell surface proteins. Specific tumour cell surface proteins (e.g. HLA-G, PD-L1, CDX2) either alone or in combination with the relative presence of immune cells (CD3 and CD8 positive T-cells) in the tumour tissue may describe the cancer cells’ ability to escape eradication by the immune system. The aim was to investigate the prognostic value of immunohistochemical markers in patients with colon cancer.MethodsWe conducted a retrospective study including patients diagnosed with pT3 and pT4 colon cancers. Immunohistochemical staining with HLA-G, PD-L1, CDX2, CD3, and CD8 was performed on tissue samples with representation of the invasive margin. PD-L1 expression in tumour cells and immune cells was reported conjointly. The expression of CD3 and CD8 was reported as a merged score based on the expression of both markers in the invasive margin and the tumour centre. Subsequently, a combined marker score was established based on all of the markers. Each marker added one point to the score when unfavourable immunohistochemical features was present, and the score was categorized as low, intermediate or high depending on the number of unfavourable stains. Hazard ratios for recurrence, disease-free survival and mortality were calculated.ResultsWe included 188 patients undergoing colon cancer resections in 2011–2012. The median follow-up was 41.7 months, during which 41 (21.8%) patients had recurrence and 74 (39.4%) died. In multivariable regression analysis positive HLA-G expression (HR = 3.37, 95%CI [1.64–6.93]) was associated with higher recurrence rates, while a preserved CDX2 expression (HR = 0.23, 95%CI [0.06–0.85]) was associated with a lower risk of recurrence. An intermediate or high combined marker score was associated with increased recurrence rates (HR = 20.53, 95%CI [2.68–157.32] and HR = 7.56, 95%CI [1.06–54.16], respectively). Neither high expression of PD-L1 nor high CD3-CD8 score was significantly associated with recurrence rates. Patients with a high CD3-CD8 score had a significantly longer DFS and OS.ConclusionsIn tumour cells, expression of HLA-G and loss of CDX2 expression were associated with cancer recurrence. In addition, a combination of certain tumour tissue biomarkers was associated with colorectal cancer recurrence.

Clinical Implication of KRAS Mutation Variants in Patients With Resected Colon Cancer.

This study evaluated the clinical implication of KRAS proto-oncogene, GTPase (KRAS) mutation variants in patients with resected colon cancer (CC). We retrospectively reviewed 482 patients diagnosed with CC who underwent curative surgical resection at Kyungpook National University Chilgok Hospital. The inclusion criteria were: Pathologically diagnosed with primary CC; stage I-III CC according to the 7th edition of American Joint Committee on Cancer staging system; and with available test results for KRAS mutation status. In total, 345 patients met these criteria and were included in this study. Among the 345 patients, 140 (40.6%) exhibited KRAS mutations, with their incidences as follows: 90/140 (64.3%) in exon 2 codon 12, 37/140 (26.4%) in exon 2 codon 13, 1/140 (0.1%) in exon 3 codon 59, 7/140 (5.0%) in exon 3 codon 61, and 5/140 (3.6%) in exon 4 codon 146. KRAS mutation status was not a significant prognostic factor for disease-free survival or overall survival. Although there were no significant differences in survival between patients with exon 2 codon 12 and exon 2 codon 13 mutations, poorer disease-free survival (p=0.085) and overall survival (p=0.005) were seen in those with exon 3 codon 61 mutation than in others. KRAS mutation status was not correlated with survival, but exon 3 codon 61 mutation might be a factor for poor prognosis in patients after resection of CC.

Prognostic value of preoperative high-sensitivity modified Glasgow prognostic score in advanced colon cancer: a retrospective observational study

BackgroundSeveral studies have demonstrated that the preoperative Glasgow prognostic score (GPS) and modified GPS (mGPS) reflected the prognosis in patients undergoing curative surgery for colorectal cancer. However, there are no reports on long-term prognosis prediction using high-sensitivity mGPS (HS-GPS) in colorectal cancer. Therefore, this study aimed to calculate the prognostic value of preoperative HS-GPS in patients with colon cancer.MethodsA cohort of 595 patients with advanced resectable colon cancer managed at our institution was analysed retrospectively. HS-GPS, GPS, and mGPS were evaluated for their ability to predict prognosis based on overall survival (OS) and recurrence-free survival (RFS).ResultsIn the univariate analysis, HS-GPS was able to predict the prognosis with significant differences in OS but was not superior in assessing RFS. In the multivariate analysis of the HS-GPS model, age, pT, pN, and HS-GPS of 2 compared to HS-GPS of 0 (2 vs 0; hazard ratio [HR], 2.638; 95% confidence interval [CI], 1.046–6.650; P = 0.04) were identified as independent prognostic predictors of OS. In the multivariate analysis of the GPS model, GPS 2 vs 0 (HR, 1.444; 95% CI, 1.018–2.048; P = 0.04) and GPS 2 vs 1 (HR, 2.933; 95% CI, 1.209–7.144; P = 0.017), and in that of the mGPS model, mGPS 2 vs 0 (HR, 1.51; 95% CI, 1.066–2.140; P = 0.02) were independent prognostic predictors of OS. In each classification, GPS outperformed HS-GPS in predicting OS with a significant difference in the area under the receiver operating characteristic curve. In the multivariate analysis of the GPS model, GPS 2 vs 0 (HR, 1.537; 95% CI, 1.190–1.987; P = 0.002), and in that of the mGPS model, pN, CEA were independent prognostic predictors of RFS.ConclusionHS-GPS is useful for predicting the prognosis of resectable advanced colon cancer. However, GPS may be more useful than HS-GPS as a prognostic model for advanced colon cancer.