Association of symptoms of colon cancer patients with tumor location and TNM tumor stage

Abstract

Objective. Colon cancer is the second most common cause of cancer death in Iceland and accounts for 8% of malignancies. We related information on symptoms of colon cancer patients with information on tumor location and pTNM-stage. Material and methods. The study is retrospective and population-based. Information on all patients diagnosed with colon cancer in Iceland in 1995–2004 was obtained. Information on symptoms of patients and blood hemoglobin was collected from patients' files. The pathological parameters were derived from a previously performed study. Results. A total of 768 patients (422 males, 346 females) participated in this study. Median age was 73 years. Nearly 60% had anemia at the time of diagnosis, 53% had visible blood in stools, and 65% had changes in bowel habits. Around 84% had visible blood in stools and/or anemia. Of those with right-sided tumors, 75% had anemia and were more likely to be diagnosed incidentally (40%) than those with left-sided tumors (20%). Left-sided tumors were associated with blood in stools (68% compared to 41%, p < 0.05) and changes in bowel habits (74% compared to 57%, p < 0.05). Multivariate analysis indicated that blood in stools was strongly associated with a lower TNM-stage (OR = 0.75, p < 0.05). Anemia was strongly associated with a higher TNM-stage (OR = 1.84, p < 0.05). Conclusion. Right-sided tumors were associated with anemia and incidental diagnosis; left-sided tumors were associated with visible blood in stools and changes in bowel habits. Visible blood in stools was significantly associated with lower TNM-stage, whereas abdominal pain, general and acute symptoms were associated with higher TNM-stage.     

The impact of tumor location on long-term survival outcomes in patients with right-sided colon cancer

Techniques in Coloproctology - The oncologic outcomes of right-sided cancers are generally grouped in studies. We hypothesized that tumor location (cecal vs. ascending vs. hepatic flexure) may...     

Early stage colon cancer

Evidence has now accumulated that colonoscopy and removal of polyps,especially during screening and surveillance programs,is effective in overall risk reduction for colon cancer.After resection of malignant pedunculated colon polyps or early stage colon cancers,long-term repeated surveillance programs can also lead to detection and removal of asymptomatic high risk advanced adenomas and new early stage metachronous cancers.Early stage colon cancer can be defined as disease that appears to have been completely resected with no subsequent evidence of involvement of adjacent organs,lymph nodes or distant sites.This differs from the clinical setting of an apparent"curative"resection later pathologically upstaged following detection of malignant cells extending into adjacent organs,peritoneum,lymph nodes or other distant sites,including liver.This highly selected early stage colon cancer group remains at high risk for subsequent colon polyps and metachronous colon cancer.Precise staging is important,not only for assessing the need for adjuvant chemotherapy,but also for patient selection for continued surveillance.With advanced stages of colon cancer and a more guarded outlook,repeated surveillance should be limited.In future,novel imaging technologies(e.g.,confocal endomicroscopy),coupled with increased pathological recognition of high risk markers for lymph node involvement(e.g.,"tumor budding")should lead to improved staging and clinical care.     

Prognostic value of TNM stage and tumor necrosis for renal cell carcinoma

Our objective was to assess the value of tumor necrosis and other factors for predicting the outcome of renal cell carcinoma (RCC). Our study comprised 328 RCC patients who were surgically treated at this hospital between 2001 and 2006. The five-year survival data was analyzed using a Kaplan-Meier statistical analysis. The prognostic factors were evaluated with a univariate analysis using a log-rank test and multivariate analysis using the Cox proportional hazards regression method. The mean follow-up period for these patients was 46.5 months (median 45.2 months). The univariate analysis revealed that age, tumor stage, TNM stage, grade, tumor necrosis, and histological type were statistically significant prognostic factors. The multivariate analysis showed that the TNM stage and tumor necrosis were the most important predictive factors in the patients' overall survival. In the TNM stage with and without tumor necrosis, the five-year overall survival rates in stages I+II were 80.5% and 89.2%, respectively (p=0.115), where as the five-year survival rates in stages III+IV were 32.7% and 84.0%, respectively (p<0.001). Collectively, our present data revealed that tumor necrosis was an important predictive factor for survival in advanced stage RCC. In conclusion, both the TNM stage and tumor necrosis provided the most important prognostic factors of survival in RCC. Tumor necrosis proved to be a poor prognostic factor in advanced RCCs.     

Molecular profiles and clinical outcome of stage UICC II colon cancer patients

Purpose

Published multigene classifiers suggesting outcome prediction for patients with stage UICC II colon cancer have not been translated into a clinical application so far. Therefore, we aimed at validating own and published gene expression signatures employing methods which enable their reconstruction in routine diagnostic specimens.

Methods

Immunohistochemistry was applied to 68 stage UICC II colon cancers to determine the protein expression of previously published prognostic classifier genes (CDH17, LAT, CA2, EMR3, and TNFRSF11A). RNA from macrodissected tumor samples from 53 of these 68 patients was profiled on Affymetrix GeneChips (HG-U133 Plus 2.0). Prognostic signatures were generated by ??nearest shrunken centroids?? with cross-validation. Previously published gene signatures were applied to our data set using ??global tests?? and leave-one-out cross-validation

Results

Correlation of protein expression with clinical outcome failed to separate patients with disease-free follow-up (group DF) and relapse (group R). Although gene expression profiling allowed the identification of differentially expressed genes (??DF?? vs. ??R??), a stable classification/prognosis signature was not discernable. Furthermore, the application of previously published gene signatures to our data was unable to predict clinical outcome (prediction rate 75.5% and 64.2%; n.s.). T-stage was the only independent prognostic factor for relapse with established clinical and pathological parameters including microsatellite status (multivariate analysis).

Conclusions

Our protein and gene expression analyses do not support application of molecular classifiers for prediction of clinical outcome in current routine diagnostic as a basis for patient-orientated therapy in stage UICC II colon cancer. Further studies are needed to develop prognosis signatures applicable in patient care.     

Impact of primary tumor location on patterns of recurrence and survival of patients undergoing resection of liver metastases from colon cancer

BackgroundSeveral studies have described a worse prognosis for right-sided colon cancer compared to left-sided. The aim of this study was to compare patterns of recurrence and survival following resection of liver metastases (LM) from right-sided (RS) versus left-sided (LS) colon cancer.MethodsPatients undergoing resection for colon cancer LM between 2000 and 2017 were analyzed. Rectal cancer, multiple primaries and unknown location were excluded.ResultsOut of 995 patients, 686 fulfilled inclusion criteria (RS-LM = 322, LS-LM = 364). RS colon cancer had higher prevalence of metastatic lymph nodes (67.4% vs. 57.1%, P = 0.008). RS-LM were more often mucinous (16.8% vs. 8.5%, P = 0.001) and G3 (58.3% vs. 48.9%, P = 0.014). 451 (65.7%) patients experienced recurrence (RS-LM 68.9% vs. LS-LM 62.9%). In RS-LM group, recurrence was more often encephalic (2.3% vs. 0%, P = 0.029) and at multiple sites (34.2% vs. 23.5%, P = 0.012). The rate of re-resection was lower in RS-LM patients (27.9% vs. 37.5%, P = 0.024). Multivariate analysis showed RS-LM to have worse 5-year overall (35.8% vs. 51.2%, P = 0.002) and disease-free survival (26% vs. 43.6%, P = 0.002).ConclusionsRS-LM is associated with worse survival and aggressive recurrences, with lower chance of re-resection.     

胃镜活检组织kiss-1基因检测与肿瘤分期及预后的关系

目的:研究kiss-1基因在胃癌中的表达水平及其临床意义.方法:30例患者依照PCR技术检测出的kiss-1表达中位数分为高表达和低表达2组,对比临床病理学特征.结果:kiss-1基因低表达者较高表达者均伴有低肿瘤分期(f=1.87,F=1.00,P=0.025)、频发肿瘤周围静脉侵袭(t=3.51,F=1.22,P=0.009)和远处淋巴结转移(t=2.26,F=2.17,P=0.009).结论:kiss-1基因表达可以成为反映胃癌分期和预后的重要生物学标志物.     

Pathologic factors are more important than tumor location in long-term survival in colon cancer

Purpose

Proximal and distal colon cancers differ in terms of epidemiology, clinical presentation, and pathologic features. The aim of our study was to evaluate the impact of right-sided (RC), transverse (TC), and left-sided (LC) colon cancer on morbidity rates and oncological outcomes.

Methods

A retrospective analysis of patients with resected colon cancer between 2004 and 2014 was conducted. Cox proportional hazard models were used to assess predictors of overall (OS), and disease-specific survival (DSS), as well as disease-free survival (DFS).

Results

A total of 1189 patients were included. RC patients (n?=?618) were older, predominantly women, and had a higher comorbidity rate. LC (n?=?454) was associated with symptomatic presentation and increased rates of laparoscopic surgery. Multivisceral resections were more frequently performed in TC tumors (n?=?117). This group was admitted 1 day longer and had a higher complication rate (RC 35.6% vs. TC 43.6% vs. LC 31.1%, P0.032). Although the incidence of abscess/leak was similar between the groups, the necessity of readmission and subsequent reoperation for a leak was significantly higher in LC patients. Pathology revealed more poorly differentiated tumors and microsatellite instability in RC. Kaplan-Meier curves demonstrated worse 5-year OS for right-sided tumors (RC 73.0%; TC 76.2%. LC 80.8%, P0.023). However, after adjustment, no differences were found in OS, DSS, and DFS between tumor location. Only pathological features were independently correlated with prognosis, as were baseline characteristics for OS.

Conclusion

Tumor location in colon cancer was not associated with survival or disease recurrence. Pathological differences beyond tumor stage were significantly more important.

     

Association of the GNAS1 T393C polymorphism with tumor stage and survival in gastric cancer

AIM: To analyze the impact of the GNAS1 T393C polymorphism on prognosis and histopathology of gastric cancer.METHODS: Genomic DNA was extracted from paraffinembedded tissues of 122 patients with primary gastric carcinoma and from the blood of 820 healthy white individuals. Allelic discrimination was performed by quantitative real-time polymerase chain reaction. Genotyping was correlated with histopathologic parameters and with overall survival according to the Kaplan- Meier approach and with multivariate analysis by multiple stepwise regression. RESULTS: Thirty-nine (32%) patients displayed a CC genotype, 57 (46.7%) a CT genotype and 26 (21.3%) a TT genotype. The frequency of the C allele (fC) in the patient group was 0.55, which was not significantly different from that of healthy blood donors. The distribution was compatible with the Hardy-Weinberg equilibrium.Analysis of clinicopathological parameters did not show any significant correlation of the T393C genotype with gender (P = 0.50), differentiation (P = 0.29),pT-category (P = 0.19), pN-category (P = 0.30), pMcategory (P = 0.25), R-category (P = 0.95), the classifications Goseki (P = 1.00) and Ming (P = 0.74). Dichotomization between C+ (CC+CT) and C-genotypes (TT), however, revealed significantly more advanced tumor stages (P = 0.023) and lower survival rates (P = 0.043) for C allele carriers.CONCLUSION: The present study provides strong evidence to suggest that the GNAS1 T393C allele carrier status influences tumor progression and survival in gastric cancer with higher tumor stages and a worse outcome for C allele carriers.