Prognostic factors in locally advanced colon cancer treated by extended resection

The impact of clinical, pathologic, and surgical variables on the postoperative morbidity, mortality, and survival of patients undergoing extended resections of colon carcinoma were evaluated. METHODS: The medical records of 95 patients who underwent extended resections for colon carcinoma between 1953 and 1996 were reviewed. In all cases, in addition to colectomy, 1 or more organs and/or structures were resected en bloc due to a macroscopically based suspicion of tumor invasion. The clinical, pathologic, and surgical parameters were analyzed. Overall survival rates were analyzed according to the method of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Eighty-six patients were treated by curative surgeries and the remaining by palliative resections. Invasion of the organs and/or adjacent structures and regional lymph nodes was found microscopically in 48 and 31 patients, respectively. The median follow-up without postoperative mortality was 47.7 months. The 5-year overall survival rates was 52.6%. The 5-year overall survival rates for patients undergoing curative and palliative surgeries was 58.3% and 0%, respectively. The mean survival time in the palliative surgery group was 3.1 months. Multivariate analysis showed that Karnofsky performance status was strongly related to the risk of postoperative complications (P = .01), and postoperative deaths were associated with the type of surgery and Karnofsky performance status at the time of admission (P = .001). CONCLUSIONS: Some patients with locally advanced colon adenocarcinomas undergoing extended resections have a 5-year overall survival rates of 58.3%. Patients could benefit from palliative-intent procedures, but these measures should cautiously be indicated and avoided in patients with low Karnofsky performance status due to high rates of postoperative mortality and poor survival.

Assessment of prognosis in patients with stage II colon cancer

Assessment of prognosis of patients with stage II colon cancer.

Inadequate quality of surveillance after curative surgery for colon cancer

Colon cancer patients are at risk for recurrence. Recurrent disease might be curable if detected early by surveillance. However, data on the quality of surveillance are scarce. The objective of this study is to analyze the quality of surveillance after curative surgery for colon cancer among a cohort of Swiss patients.

Toxoplasma gondii infection: seroprevalence and associated risk factors among primary schoolchildren in Lagos City, Southern Nigeria

INTRODUCTION: Toxoplasma gondii infection has been described as the most widespread zoonotic infection of humans and other animals. Information concerning T. gondii infection among schoolchildren is unavailable in Lagos City, Nigeria. METHODS: This cross-sectional study investigated the seroprevalence and risk factors associated with T. gondii infection among primary schoolchildren (PSC) from a community located in the center of Lagos, southern Nigeria, from November 2013 to March 2014. A total of 382 PSC were screened for the presence of sera anti-T. gondii antibodies using a latex agglutination test (TOXO Test-MT, Tokyo, Japan). A cutoff titer of ≥ 1:32 was considered positive, while titers ≥ 1:1,024 indicated high responders. Questionnaires were also used to obtain data on possible risk factors from parents/guardians. RESULTS: The overall seroprevalence was 24% (91/382), and 83.5% (76/91) of seropositive PSC were classified as high responders. Among the risk factors tested, including contact with cats and soil, consumption of raw meat and vegetables, and drinking unboiled water, none showed statistical significance after multivariate adjustment. No associations were observed among age, gender, body mass index (BMI), and parents' occupation/educational level. CONCLUSIONS: The findings in this study show evidence of active infection, and hence, there is need for urgent preventive measures in this city. Further investigation is required to clarify the transmission routes. Policy makers also need to initiate prevention and control programs to protect pregnant women and immunocompromised patients in particular because they are more severely affected by T. gondii infection.

Risk factors for development of delirium among oncology patients

To determine the occurrence of delirium in oncology inpatients and to identify and evaluate admission characteristics associated with the development of delirium during inpatient admission, a prospective observational study was conducted of H 3 patients with a total of 145 admissions with histological diagnosis of cancer admitted to the oncology unit over a period of ten weeks. At the point of inpatient admission, all patients were assessed for the presence of potential risk factors for development of delirium. During the index admission patients were assessed daily for the presence of delirium using the Confusion Assessment Method. Delirium was confirmed by clinician assessment. Delirium developed in 26 of 145 admissions (18%) and 32 episodes of delirium were recorded with 6 patients having 2 episodes of delirium during the index admission. Delirium occurred on average 3.3 days into the admission. The average duration of an episode of delirium was 2.1 day. Four patients with delirium (15%) died. All other cases of delirium were reversed. Factors significantly associated with development of delirium on multivariate analysis were: advanced age, cognitive impairment, low albumin level, bone metastases, and the presence of hematological malignancy. Hospital inpatient admission was significantly longer in delirium group (mean: 8.8 days vs 4.5 days in nondelirium group, P

High constant incidence rates of second primary cancers of the head and neck: a pooled analysis of 13 cancer registries.

Scanty data are available on the incidence (i.e., the absolute risk) of second cancers of the head and neck (HN) and its pattern with age. We investigated this issue using data from a multicentric study of 13 population-based cancer registries from Europe, Canada, Australia and Singapore for the years 1943-2000. A total of 99,257 patients had a first primary HN cancer (15,985 tongue, 22,378 mouth, 20,758 pharyngeal, and 40,190 laryngeal cancer), contributing to 489,855 person-years of follow-up. A total of 1,294 of the patients (1.3%) were diagnosed with second HN cancers (342 tongue, 345 mouth, 418 pharynx and 189 larynx). Male incidence rates of first HN cancer steeply increased from 0.68/100,000 at age 30-34 to 46.2/100,000 at age 70-74, and leveled off at older age; female incidence increased from 0.50/100,000 at age 30-34 to 16.5/100,000 at age 80-84. However, age-specific incidence of second HN cancers after a first HN cancer in men was around 200-300/100,000 between age 40-44 and age 70-74 and tended to decline at subsequent ages (150/100,000 at age 80-84); in women, incidence of second HN cancers was around 200-300/100,000 between age 45-49 and 80-84. The patterns of age-specific incidence were consistent for different subsites of second HN cancer and sexes; moreover, they were similar for age-specific incidence of first primary HN cancer in patients who subsequently developed a second HN cancer. The incidence of second HN cancers does not increase with age, but remains constant, or if anything, decreases with advancing age.

Test of four colon cancer risk-scores in formalin fixed paraffin embedded microarray gene expression data.

BACKGROUND: Prognosis prediction for resected primary colon cancer is based on the T-stage Node Metastasis (TNM) staging system. We investigated if four well-documented gene expression risk scores can improve patient stratification. METHODS: Microarray-based versions of risk-scores were applied to a large independent cohort of 688 stage II/III tumors from the PETACC-3 trial. Prognostic value for relapse-free survival (RFS), survival after relapse (SAR), and overall survival (OS) was assessed by regression analysis. To assess improvement over a reference, prognostic model was assessed with the area under curve (AUC) of receiver operating characteristic (ROC) curves. All statistical tests were two-sided, except the AUC increase. RESULTS: All four risk scores (RSs) showed a statistically significant association (single-test, P < .0167) with OS or RFS in univariate models, but with HRs below 1.38 per interquartile range. Three scores were predictors of shorter RFS, one of shorter SAR. Each RS could only marginally improve an RFS or OS model with the known factors T-stage, N-stage, and microsatellite instability (MSI) status (AUC gains < 0.025 units). The pairwise interscore discordance was never high (maximal Spearman correlation = 0.563) A combined score showed a trend to higher prognostic value and higher AUC increase for OS (HR = 1.74, 95% confidence interval [CI] = 1.44 to 2.10, P < .001, AUC from 0.6918 to 0.7321) and RFS (HR = 1.56, 95% CI = 1.33 to 1.84, P < .001, AUC from 0.6723 to 0.6945) than any single score. CONCLUSIONS: The four tested gene expression-based risk scores provide prognostic information but contribute only marginally to improving models based on established risk factors. A combination of the risk scores might provide more robust information. Predictors of RFS and SAR might need to be different.

High HSP27 and HSP70 expression levels are independent adverse prognostic factors in primary resected colon cancer

The expression of Heat Shock Proteins (HSPs) is increased in various cancers and has been shown to correlate with biological tumor behaviour. This study aimed to investigate the impact of HSP70, HSP60 and HSP27 expression in colon cancer.

Directory of Colon and Rectal Cancer Specialist Teams

The Directory of Colon and Rectal Cancer Specialist Teams has been produced under the auspices of the Northern Ireland Regional Advisory Committee on Cancer. It contains details of the full membership of the clinical teams providing care for colon and rectal cancer in each of Health and Social Services Board Area. Lead Clinicians For Colon and Rectal Cancer Services (PDF 74 KB) EHSSB (PDF 198 KB) NHSSB (PDF 107 KB) SHSSB (PDF 130 KB) WHSSB (PDF 131 KB)

Role of transcription factor PROX1 in colon cancer metastasis

Initiation and progression of most colorectal cancers (CRCs) are driven by hyper-activation of the canonical Wnt/ß-catenin/TCF signaling pathway. However, a basal level of activation of this pathway is necessary for intestinal cell homeostasis; thus only CRC-specific effectors of this pathway could be exploited as potential clinical targets. PROX1 is an evolutionary conserved transcription factor with multiple roles in several tissues in embryogenesis, and increasing relevance in cancer. PROX1 is a colon cancer-specific Wnt target in the intestine, thus it might represent a therapeutic target. The role of PROX1 in promoting the transition from early to highly-dysplastic adenoma was previously described [1], Importantly, tumor metastasis is a leading cause of cancer-related mortality. Frequently, micrometastases are already present in patients at the time of diagnosis, therefore better understanding of the mechanisms regulating growth of macrometastatic lesions is important for the development of novel treatment approaches. In this study we showed that PROX1 is expressed in colon cancer stem cell and promotes the outgrowth of metastatic lesions. Firstly, we analyzed the expression of PROX1 in advanced CRCs and their metastases. We found that PROX1 over-expression is a feature of microsatellite stable tumors (~85% of microsatellite stable (MSS) CRCs), which generally have worse prognosis in comparison to microsatellite unstable CRCs. Analysis of primary CRCs and corresponding metastatic lesions showed that PROX1 expression is conserved, or increased in metastases. Further bioinformatics analysis of tumor and metastases gene expression profiles showed that PROX1 is co- expressed with stem cell and progenitor markers. Moreover, in inducible ApcmLgr5-EGFP-lres-CreERT2 model, Prox1+ cells marked a sub-population of Lgr5+ stem cells and subsequent transient amplifying cell population. Orthotopic model of CRC and lung colonization assays in mice demonstrated that PROX1 promotes tumor cell outgrowth in metastatic lesions, while it has no effect on primary tumor growth, invasion, and survival in circulation or cell extravasation. In vitro, PROX1 expressing tumor cells demonstrated strongly increased capacity to form spheroids, and increased survival and proliferation under hypoxic or nutrient-deprivation conditions. By monitoring cellular respiration under these conditions, we found that PROX1 expressing cells exhibit a better metabolic adaptation to changes in fuel source. Autophagy inhibitors, prevented growth both in vitro and in vivo of PROX1 expressing cells. Importantly, conditional inactivation of PROX1 after the establishment of metastases prevented further growth of macroscopic lesions resulting in stable disease. In summary, we identified a novel mechanism underlying the ability of metastatic colon cancer stem and progenitor cells to survive and grow in target organs through metabolic adaptation. Our results establish PROX1 as a key factor of CRC metastatic disease where it promotes survival of metastatic colon cancer stem-like cells, through their metabolic adaptation in sub-optimal microenvironments - L'initiation et la progression de la plupart des cancers colorectaux (CRC) sont entraînées par une hyper-activation de la voie métabolique Wnt/ß- caténine/TCF. Toutefois, un niveau d'activation minimal de Wnt est nécessaire pour l'homéostasie des cellules intestinales ; ainsi seuls des effecteurs spécifiques du CRC- de cette voie pourraient être exploités comme des cibles cliniques potentielles. PROX1 est un facteur de transcription évolutif conservé avec de multiples rôles dans plusieurs tissus durant l'embryogenèse et une pertinence croissante dans le cancer. PROX1 est une cible Wnt spécifique dans le cancer de l'intestin, donc il pourrait représenter une cible thérapeutique. Le rôle de PROX1 durant l'évolution de la maladie d'un stade précoce jusqu'à l'adénome hautement dysplasique a été décrit précédemment. Surtout, la métastase des tumeurs est une cause majeure de mortalité liée au cancer. Souvent, les micro-métastases sont déjà présentes chez les patients au moment du diagnostic, c'est pourquoi une meilleure compréhension des mécanismes régulant la croissance des lésions macrométastatiques est importante pour le développement de nouvelles approches thérapeutiques. Dans cette étude, nous avons prouvé que PROX1 est exprimé dans les cellules souches du cancer du côlon et favorise l'apparition de lésions métastatiques. Nous avons d'abord analysé l'expression de PROX1 dans des CRC avancés ainsi que dans leurs métastases. Nous avons constaté que la surexpression de PROX1 est une caractéristique des tumeurs stables microsatellites (~85% du MSS CRC), qui ont généralement un pronostic défavorable par rapport aux microsatellites CRC instables. L'analyse des CRC primaires et de leurs métastases liées a montré que l'expression de PROX1 est conservée, voire augmentée dans les métastases. A l'aide d'une base de données de tumeurs et métastases, nous avons observé une co- régulation de PROX1 entre cellules souches et marqueurs de progéniteurs mais pas avec des cellules différenciées. De plus, en utilisant un modèle Apcm Lgr5-EGFP-IRES-CreERT2 inductible, les cellules Prox1+ ont marqué une sous-population de cellules LGR& capable de produire une lignée. Un modèle orthotopique de cancer colorectal et des essais de colonisation du poumon chez la souris ont démontré que PROX1 favorise l'excroissance des cellules tumorales dans les lésions métastatiques, alors qu'il n'a aucun effet sur la croissance tumorale primaire, l'invasion ou une extravasation des cellules. In vitro, les cellules tumorales exprimant PROX1 ont démontré une forte augmentation de leur capacité à former des sphéroïdes, ainsi qu'une augmentation de la survie et de la prolifération dans des conditions hypoxiques ou lors de privation de nutriments. En contrôlant la respiration cellulaire dans ces conditions, nous avons constaté que les cellules exprimant PROX1 présentent une meilleure adaptation métabolique à l'évolution des sources de carburant. Des inhibiteurs de l'autophagie, suggérant une approche thérapeutique potentielle, ont tué à la fois in vitro et in vivo les cellules exprimant PROX1. Surtout, l'inactivation conditionnelle de PROX1 après l'apparition de métastases a empêché la croissance des lésions macroscopiques résultant en une maladie stable. En résumé, nous avons identifié un nouveau mécanisme mettant en évidence la capacité des cellules souches du cancer du côlon métastatique à survivre et à se développer dans les organes cibles grâce à l'adaptation métabolique. Nos résultats définissent PROX1 comme un facteur clé du cancer colorectal métastatique en favorisant la survie des cellules souches métastatiques apparentées au cancer du colon grâce à leur adaptation métabolique aux microenvironnements défavorables.

Second primary cancers in the Vaud and Neuchâtel Cancer Registries

An increasing proportion of new cancers is registered in patients who have received a previous cancer diagnosis. As data are inconsistent across studies, we provided information for populations long covered by valid cancer registration. Data were derived from the Swiss cancer Registries of Vaud and Neuchâtel (885 000 inhabitants). Patients diagnosed with a new malignancy (except skin basal and squamous cell carcinomas) during the period 2005-2010 were included. Over the period 2005-2010, 24 859 patients were registered with incident cancer. Of these, 3127 (13%) had multiple primary cancers and 578 (2.3%) were synchronous. Breast, prostate, colorectum, skin, melanomas, and squamous cell carcinomas of the head and neck (SHN) and bladder/ureter were the most common sites of first neoplasms, whereas breast, lung, colorectum, prostate, melanoma, and SHN were the most common sites of second neoplasms. The most common pairing was breast with breast (31% synchronous), followed by the bladder/ureter with the prostate (72% synchronous), prostate with the colorectum, SHN with SHN, and SHN with lung. Five-year crude survival of patients with synchronous cancers (34%) was not significantly lower than that of patients with single neoplasms (39%).

EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe

Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. Methods: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th20th March 2013) and were invited to lecture on the subjects during the meeting (13th15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method. Results: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. Conclusions: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.

EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe

Background: Care for patients with colon and rectal cancer has improved in the last twenty years however still considerable variation exists in cancer management and outcome between European countries. Therefore, EURECCA, which is the acronym of European Registration of cancer care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012 the first multidisciplinary consensus conference about colon and rectum was held looking for multidisciplinary consensus. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries. Methods: The expert panel had delegates of the European Society of Surgical Oncology (ESSO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Pathology (ESP), European Society for Medical Oncology (ESMO), European Society of Radiology (ESR), European Society of Coloproctology (ESCP), European CanCer Organisation (ECCO), European Oncology Nursing Society (EONS) and the European Colorectal Cancer Patient Organisation (EuropaColon), as well as delegates from national registries or audits. Experts commented and voted on the two web-based online voting rounds before the meeting (between 4th and 25th October and between the 20th November and 3rd December 2012) as well as one online round after the meeting (4th-20th March 2013) and were invited to lecture on the subjects during the meeting (13th-15th December 2012). The sentences in the consensus document were available during the meeting and a televoting round during the conference by all participants was performed. All sentences that were voted on are available on the EURECCA website www.canceraudit.eu. The consensus document was divided in sections describing evidence based algorithms of diagnostics, pathology, surgery, medical oncology, radiotherapy, and follow-up where applicable for treatment of colon cancer, rectal cancer and stage IV separately. Consensus was achieved using the Delphi method. Results: The total number of the voted sentences was 465. All chapters were voted on by at least 75% of the experts. Of the 465 sentences, 84% achieved large consensus, 6% achieved moderate consensus, and 7% resulted in minimum consensus. Only 3% was disagreed by more than 50% of the members. Conclusions: It is feasible to achieve European Consensus on key diagnostic and treatment issues using the Delphi method. This consensus embodies the expertise of professionals from all disciplines involved in the care for patients with colon and rectal cancer. Diagnostic and treatment algorithms were developed to implement the current evidence and to define core treatment guidance for multidisciplinary team management of colon and rectal cancer throughout Europe.