Cancer Research and Treatment

Original Articles

Clinical Significance of Discordance between Carcinoembryonic Antigen Levels and RECIST in Metastatic Colorectal Cancer: In-Ho Kim, Ji Eun Lee, Ji Hyun Yang, Joon Won Jeong, Sangmi Ro, Seong Taek Oh, Jun-Gi Kim, Moon Hyung Choi, Myung Ah Lee; Cancer Res Treat. 2018;50(1):283-292. Published online May 8, 2017; DOI: https://doi.org/10.4143/crt.2016.537

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Purpose
The purpose of this study was to investigate the prognostic implications of carcinoembryonic antigen (CEA) levels that are inconsistent with Response Evaluation Criteria in Solid Tumor (RECIST) responses in metastatic colorectal cancer patients.
Materials and Methods
We retrospectively evaluated 360 patients with at least one measurable lesion who received first-line palliative chemotherapy. CEA-response was defined as CEA-complete response (CR; CEA normalization), CEA-partial response (PR; ≥ 50% decrease in CEA levels), CEA-progressive disease (PD; ≥ 50% increase in CEA levels), and CEA-stable disease (SD; non-CR/PR/PD). Overall survival (OS) and progression-free survival (PFS) were evaluated according to CEA-response.
Results
In RECIST-PR patients, poorer CEA-response was associated with disease progression at the subsequent evaluation. In RECIST-SD patients, CEA-CR and -PR were associated with lower disease progression rates than CEA-PD at the subsequent evaluation. Correlations between survival outcome and CEA-response in same-category RECIST patients were assessed. In RECIST-PR patients, discordant CEA-response (CEA-PD/SD) was associated with poorer survival than CEA-CR/PR (median OS and PFS, 44.0 and 15.4 [CEA-CR], 28.9 and 12.5 [CEA-PR], 21.0 and 9.8 [CEA-SD], and 13.0 and 7.0 [CEA-PD] months, respectively; all p < 0.001). In RECIST-SD patients, favorable CEA-response produced better survival (median OS and PFS, 26.8 and 21.0 [CEA-CR], 21.0 and 11.0 [CEA-PR], 16.1 and 8.2 [CEA-SD], and 12.2 and 6.0 [CEA-PD] months, respectively; all p < 0.001). RECIST-PD patients with CEA-CR showed longer OS than those with CEA-PD. Multivariate analysis demonstrated that discordant CEA-response is a powerful prognostic factor for RECIST-PR and RECIST-SD patients.
Conclusion
Among patients of the same RECIST-response categories, CEA-response patterns are significantly prognostic and strongly predictive of subsequent evaluation outcomes.

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Presence of CD44v9-Expressing Cancer Stem Cells in Circulating Tumor Cells and Effects of Carcinoembryonic Antigen Levels on the Prognosis of Colorectal Cancer
Katsuji Sawai, Takanori Goi, Youhei Kimura, Kenji Koneri
Cancers.2024; 16(8): 1556. CrossRef
Dynamic monitoring of carcinoembryonic antigen, CA19-9 and inflammation-based indices in patients with advanced colorectal cancer undergoing chemotherapy
Nebojsa Manojlovic, Goran Savic, Bojan Nikolic, Nemanja Rancic
World Journal of Clinical Cases.2022; 10(3): 899. CrossRef
Current Applications and Discoveries Related to the Membrane Components of Circulating Tumor Cells and Extracellular Vesicles
Luis Enrique Cortés-Hernández, Zahra Eslami-S, Bruno Costa-Silva, Catherine Alix-Panabières
Cells.2021; 10(9): 2221. CrossRef
Tumor-Associated Macrophages Derived TGF-β‒Induced Epithelial to Mesenchymal Transition in Colorectal Cancer Cells through Smad2,3-4/Snail Signaling Pathway
Jianhui Cai, Limin Xia, Jinlei Li, Shichang Ni, Huayu Song, Xiangbin Wu
Cancer Research and Treatment.2019; 51(1): 252. CrossRef

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Multimodal Assessments Are Needed for Restaging after Neoadjunvant Chemoradiation Therapy in Rectal Cancer Patients: Bong-Hyeon Kye, Hyung-Jin Kim, Gun Kim, Jun-Gi Kim, Hyeon-Min Cho; Cancer Res Treat. 2016;48(2):561-566. Published online August 10, 2015; DOI: https://doi.org/10.4143/crt.2015.114

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Purpose
Restaging after neoadjuvant treatment is done for planning the surgical approach and, increasingly, to determine whether additional therapy or resection can be avoided for selected patients. Materials and Methods Local restaging after neoadjuvant chemoradiation therapy (nCRT) was performed in 270 patients with locally advanced (cT3or4 or N+) rectal cancer. Abdomen and pelvic computed tomography (APCT) was used in all 270 patients, transrectal ultrasound (TRUS) in 121 patients, and rectal magnetic resonance imaging (MRI) in 65 patients. Findings according to imaging modalities were correlated with pathologic stage using Cohen’s kappa (κ) to test agreement and intra-class correlation coefficient α to test reliability.
Results
Accuracy for prediction of yp T stage according to three imaging modalities was 45.2% (κ=0.136, α=0.380) in APCT, 49.2% (κ=0.259, α=0.514) in rectal MRI, and 57.9% (κ=0.266, α=0.520) in TRUS. Accuracy for prediction of yp N stage was 66.0% (κ=0.274, α=0.441) in APCT, 71.8% (κ=0.401, α=0.549) in rectal MRI, and 66.1% (κ=0.147, α=0.272) in TRUS. Of 270 patients, 37 (13.7%) were diagnosed as pathologic complete responder after nCRT. Rectal MRI for restaging did not predict complete response. On the other hand, TRUS did predict three complete responders (κ=0.238, α=0.401). Conclusion APCT, rectal MRI, and TRUS are unreliable in restaging rectal cancer after nCRT. We think that multimodal assessment with rectal MRI and TRUS may be the best option for local restaging of locally advanced rectal cancer after nCRT.

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Effect of neoadjuvant therapy regimens on lymph nodes yield in rectal cancer
Emeka Ray‐Offor, Arun Nagarajan, Nir Horesh, Sameh H. Emile, Rachel Gefen, Zoe Garoufalia, Justin Dourado, Albert Parlade, Giovanna Da Silva, Steven Wexner
Journal of Surgical Oncology.2024; 130(1): 125. CrossRef
The predicting value of post neoadjuvant treatment magnetic resonance imaging: a meta-analysis
Yaniv Zager, Nir Horesh, Michael Abdelmasseh, Christopher T. Aquina, Bustamante Lopez Leonardo Alfonso, Mark K. Soliman, Matthew R. Albert, John R. T. Monson
Surgical Endoscopy.2024; 38(11): 6846. CrossRef
Restaging rectal cancer following neoadjuvant chemoradiotherapy
Dajana Cuicchi, Giovanni Castagna, Stefano Cardelli, Cristina Larotonda, Benedetta Petrello, Gilberto Poggioli
World Journal of Gastrointestinal Oncology.2023; 15(5): 700. CrossRef
How reliable is restaging MRI after neoadjuvant therapy in rectal cancer?
Rachel Gefen, Zoe Garoufalia, Nir Horesh, Michael R. Freund, Sameh Hany Emile, Albert Parlade, Mariana Berho, Daniela Allende, Giovanna DaSilva, Steven D. Wexner
Colorectal Disease.2023; 25(8): 1631. CrossRef
Can rectal MRI and endorectal ultrasound accurately predict the complete response to neoadjuvant immunotherapy for rectal cancer?
Menglan Zhai, Zhenyu Lin, Haihong Wang, Jinru Yang, Mingjie Li, Xin Li, Lan Zhang, Tao Zhang
Gastroenterology Report.2023;[Epub] CrossRef
ACR Appropriateness Criteria® Staging of Colorectal Cancer: 2021 Update
Elena K. Korngold, Courtney Moreno, David H. Kim, Kathryn J. Fowler, Brooks D. Cash, Kevin J. Chang, Kenneth L. Gage, Aakash H. Gajjar, Evelyn M. Garcia, Avinash R. Kambadakone, Peter S. Liu, Meghan Macomber, Daniele Marin, Jason A. Pietryga, Cynthia S. S
Journal of the American College of Radiology.2022; 19(5): S208. CrossRef
Could early tumour volume changes assessed on morphological MRI predict the response to chemoradiation therapy in locally-advanced rectal cancer?
A. Palmisano, A. Esposito, A. Di Chiara, A. Ambrosi, P. Passoni, N. Slim, C. Fiorino, L. Albarello, N. Di Muzio, R. Calandrino, R. Rosati, A. Del Maschio, F. De Cobelli
Clinical Radiology.2018; 73(6): 555. CrossRef
Application value of biplane transrectal ultrasonography plus ultrasonic elastosonography and contrast-enhanced ultrasonography in preoperative T staging after neoadjuvant chemoradiotherapy for rectal cancer
Ying Xiao, Dong Xu, Haixing Ju, Chen Yang, Liping Wang, Jinming Wang, John D. Hazle, Dongguo Wang
European Journal of Radiology.2018; 104: 20. CrossRef
Magnetic resonance imaging evaluation in neoadjuvant therapy of locally advanced rectal cancer: a systematic review
Roberta Fusco, Mario Petrillo, Vincenza Granata, Salvatore Filice, Mario Sansone, Orlando Catalano, Antonella Petrillo
Radiology and Oncology.2017; 51(3): 252. CrossRef
Accuracy of MRI in Restaging Locally Advanced Rectal Cancer After Preoperative Chemoradiation
Joris J. van den Broek, Floor S. W. van der Wolf, Max J. Lahaye, Luc A. Heijnen, Christof Meischl, Martin A. Heitbrink, W. Hermien Schreurs
Diseases of the Colon & Rectum.2017; 60(3): 274. CrossRef

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Novel Methods of Lymph Node Evaluation for Predicting the Prognosis of Colorectal Cancer Patients with Inadequate Lymph Node Harvest: Taek Soo Kwon, Sung Bong Choi, Yoon Suk Lee, Jun-Gi Kim, Seong Taek Oh, In Kyu Lee; Cancer Res Treat. 2016;48(1):216-224. Published online April 15, 2015; DOI: https://doi.org/10.4143/crt.2014.312

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Purpose
Lymph node metastasis is an important factor for predicting the prognosis of colorectal cancer patients. However, approximately 60% of patients do not receive adequate lymph node evaluation (less than 12 lymph nodes). In this study, we identified a more effective tool for predicting the prognosis of patients who received inadequate lymph node evaluation.
Materials and Methods
The number of metastatic lymph nodes, total number of lymph nodes examined, number of negative metastatic lymph nodes (NL), lymph node ratio (LR), and the number of apical lymph nodes (APL) were examined, and the prognostic impact of these parameters was examined in patients with colorectal cancer who underwent surgery from January 2004 to December 2011. In total, 806 people were analyzed retrospectively.
Results
In comparison of different lymph node analysis methods for rectal cancer patients who did not receive adequate lymph node dissection, the LR showed a significant difference in overall survival (OS) and the APL predicted a significant difference in disease-free survival (DFS). In the case of colon cancer patients who did not receive adequate lymph node dissection, LR predicted a significant difference in DFS and OS, and the APL predicted a significant difference in DFS.
Conclusion
If patients did not receive adequate lymph node evaluation, the LR and NL were useful parameters to complement N stage for predicting OS in colon cancer, whereas LR was complementary for rectal cancer. The APL could be used for prediction of DFS in all patients.

Citations

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Exploring the value of multiple preprocessors and classifiers in constructing models for predicting microsatellite instability status in colorectal cancer
Yi Ma, Zhihao Shi, Ying Wei, Feng Shi, Guochu Qin, Zhengyang Zhou
Scientific Reports.2024;[Epub] CrossRef
An Intelligent System of Predicting Lymph Node Metastasis in Colorectal Cancer Using 3D CT Scans
Min Xie, Yi Zhang, Xinyang Li, Jiayue Li, Xingyu Zou, Yiji Mao, Haixian Zhang, Subrata Kumar Sarker
International Journal of Intelligent Systems.2024;[Epub] CrossRef
Rectal Cancer: Are 12 Lymph Nodes the Limit?
Paweł Mroczkowski, Łukasz Dziki, Tereza Vosikova, Ronny Otto, Anna Merecz-Sadowska, Radosław Zajdel, Karolina Zajdel, Hans Lippert, Olof Jannasch
Cancers.2023; 15(13): 3447. CrossRef
Minimally invasive surgery versus laparotomy of non-metastatic pT4a colorectal cancer: a propensity score analysis
Hui-Long Guo, Jing-Yao Chen, You-Zhen Tang, Qian-Lin Zeng, Qing-Long Jian, Ming-Zhe Li, Yu-Long He, Wen-Hui Wu
International Journal of Surgery.2023;[Epub] CrossRef
Construction of a Prognostic Nomogram for Colorectal Cancer Patients with Fewer than Twelve Lymph Nodes Examined: a Population-Based Study in the SEER Database and China
Hao Zhang, Hanqing Hu, Zilong Guan, Rui Chen, Chao Xu, Rui Huang, Guiyu Wang
Journal of Gastrointestinal Surgery.2022; 26(1): 214. CrossRef
A Preoperative Scoring System to Predict the Risk of Inadequate Lymph Node Count in Rectal Cancer
Hao Zhang, Chunlin Wang, Yunxiao Liu, Hanqing Hu, Guiyu Wang
Frontiers in Oncology.2022;[Epub] CrossRef
A Modified Tumor‐Node‐Metastasis Staging System for Colon Cancer Patients with Fewer than Twelve Lymph Nodes Examined
Hao Zhang, Yunxiao Liu, Chunlin Wang, Zilong Guan, Hang Yu, Chao Xu, Mingyu Zheng, Yuliuming Wang, Hanqing Hu, Rui Huang, Guiyu Wang
World Journal of Surgery.2021; 45(8): 2601. CrossRef
A clinical-radiomics nomogram for the preoperative prediction of lymph node metastasis in colorectal cancer
Menglei Li, Jing Zhang, Yibo Dan, Yefeng Yao, Weixing Dai, Guoxiang Cai, Guang Yang, Tong Tong
Journal of Translational Medicine.2020;[Epub] CrossRef
Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients
Giovanni Li Destri, Martina Barchitta, Antonio Pesce, Saverio Latteri, Dorotea Bosco, Antonio Di Cataldo, Antonella Agodi, Stefano Puleo
Journal of Investigative Surgery.2019; 32(1): 1. CrossRef
Application of highly efficient and lowly toxic bufadienolides screened from toad skin in lymphatic chemotherapy for colorectal cancer through a lymphatic metastatic model
Changzheng He, Zhenyu Zou, Shaoyou Xia, Xiaowei Xing, Shidong Hu, Zilong Hu, Yuxuan Li, Songyan Li, Hongliang Zhang, Yu Yang, Yichen Liu, Xiaolei Xu, Boyan Liu, Yufeng Wang, Yingxin Xu, Xiaohui Du
International Immunopharmacology.2019; 70: 241. CrossRef
Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer
J. Yu, X. Dai, H.‐H. Zou, J.‐C. Song, Y. Li, H.‐B. Shi, Q. Xu, H. Shen
Colorectal Disease.2018; 20(2): 116. CrossRef
Metastatic lymph node ratio demonstrates better prognostic stratification than pN staging in patients with esophageal squamous cell carcinoma after esophagectomy
Hongdian Zhang, Huagang Liang, Yongyin Gao, Xiaobin Shang, Lei Gong, Zhao Ma, Ke Sun, Peng Tang, Zhentao Yu
Scientific Reports.2016;[Epub] CrossRef

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Oxaliplatin/5-FU without Leucovorin Chemotherapy in Metastatic Colorectal Cancer: Byoung Yong Shim, Kang Moon Lee, Hyeon-Min Cho, Hyun Jin Kim, Hong Joo Cho, Jinmo Yang, Jun-Gi Kim, Hoon-Kyo Kim; Cancer Res Treat. 2005;37(4):212-215. Published online August 31, 2005; DOI: https://doi.org/10.4143/crt.2005.37.4.212

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Purpose

Fluorouracil (5-FU) and leucovorin combination therapy have shown synergistic or additive effect against advanced colorectal cancer, but the frequency of mucositis and diarrhea is increased. Most previous studies have used high dose leucovorin (300~500 mg/m²). However, some studies of oxaliplatin and 5-FU with low-dose or high-dose leucovorin in Korea have shown similar response rates. Therefore, we studied the necessity of leucovorin and evaluated the objective tumor response rates and toxicities of a regimen of oxaliplatin and 5-FU without leucovorin every 2 weeks in metastatic colorectal cancer patients.

Materials and Methods

Twenty-four patients with metastatic colorectal cancer were enrolled between January 2002 and March 2003. Patients received 85 mg/m² of oxaliplatin on day 1, a bolus 5-FU 400 mg/m² on day 1 and a continuous 5-FU infusion at 600 mg/m²/ 22 hours days 1 and 2, every 2 weeks.

Results

Of the 24 patients treated, 17 patients received previous 5FU with leucovorin and/or other chemotherapy. Three patients could not be evaluated. Five partial responses were observed with overall response rate of 21% (n=24). Of the previous chemotherapy group (n=17), 4 partial responses were observed with response rate of 24%. Median overall survival was 18 months (range 4~32 months) and median progression free survival was 4 months (range 2~6 months). This regimen was well tolerated and only 1 grade 3 anemia was observed.

Conclusion

Oxaliplatin/5-FU combination therapy without leucovorin achieved a relatively high response rate even in patients resistant to the previous 5-FU chemotherapy, and toxicity was minimal.

Citations

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Clinicopathological Features and Oncological Outcomes of Early and Late Recurrence in Stage III Colorectal Cancer Patients after Adjuvant Oxaliplatin-Based Therapy
Yu-Tang Chang, Hsiang-Lin Tsai, Yen-Cheng Chen, Ching-Chun Li, Ching-Wen Huang, Po-Jung Chen, Wei-Chih Su, Tsung-Kun Chang, Yung-Sung Yeh, Tzu-Chieh Yin, Jaw-Yuan Wang, Weiren Luo
Journal of Oncology.2023; 2023: 1. CrossRef
Targeting the SPHK1/HIF1 Pathway to Inhibit Colorectal Cancer Stem Cells Niche
Saeideh Gholamzadeh Khoei, Hamid Sadeghi, Fateme Karimi Dermani
Journal of Gastrointestinal Cancer.2020; 51(2): 716. CrossRef
Efficacy of 5-FU or Oxaliplatin Monotherapy over Combination Therapy in Colorectal Cancer
Maria Toloudi, Panagiotis Apostolou, Ioannis Papasotiriou
Journal of Cancer Therapy.2015; 06(04): 345. CrossRef
Gene Expression Changes in Colorectal Cancer during Metronomic Chemotherapy and High-Concentration Drug Administration
Panagiotis Apostolou, Maria Toloudi, Irene Kalliara, Vasiliki Kipourou, Ioanna Tourna, Ioannis Papasotiriou
Journal of Cancer Therapy.2015; 06(08): 679. CrossRef

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