A comprehensive overview of tumour deposits in colorectal cancer: towards a next TNM classification

2021 ◽  
pp. 102325
Author(s):  
Jean-François Delattre ◽  
Ayse Selcen Oguz Erdogan ◽  
Romain Cohen ◽  
Qian Shi ◽  
Jean-François Emile ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Tnm Classification ◽  
Comprehensive Overview

scholarly journals Beyond Microsatellite Instability: Evolving Strategies Integrating Immunotherapy for Microsatellite Stable Colorectal Cancer

2021 ◽  
Vol 22 (8) ◽  
Author(s):  
Federica Pecci ◽  
Luca Cantini ◽  
Alessandro Bittoni ◽  
Edoardo Lenci ◽  
Alessio Lupi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Microsatellite Instability ◽  
Mismatch Repair ◽  
Cancer Progression ◽  
Checkpoint Inhibitors ◽  
Tnm Classification ◽  
Standard Of Care ◽  
First Line Therapy ◽  
Combination Strategies ◽  
The Impact

Opinion statementAdvanced colorectal cancer (CRC) is a heterogeneous disease, characterized by several subtypes with distinctive genetic and epigenetic patterns. During the last years, immune checkpoint inhibitors (ICIs) have revamped the standard of care of several tumors such as non-small cell lung cancer and melanoma, highlighting the role of immune cells in tumor microenvironment (TME) and their impact on cancer progression and treatment efficacy. An “immunoscore,” based on the percentage of two lymphocyte populations both at tumor core and invasive margin, has been shown to improve prediction of treatment outcome when added to UICC-TNM classification. To date, pembrolizumab, an anti-programmed death protein 1 (PD1) inhibitor, has gained approval as first-line therapy for mismatch-repair-deficient (dMMR) and microsatellite instability-high (MSI-H) advanced CRC. On the other hand, no reports of efficacy have been presented in mismatch-repair-proficient (pMMR) and microsatellite instability-low (MSI-L) or microsatellite stable (MSS) CRC. This group includes roughly 95% of all advanced CRC, and standard chemotherapy, in addition to anti-EGFR or anti-angiogenesis drugs, still represents first treatment choice. Hopefully, deeper understanding of CRC immune landscape and of the impact of specific genetic and epigenetic alterations on tumor immunogenicity might lead to the development of new drug combination strategies to overcome ICIs resistance in pMMR CRC, thus paving the way for immunotherapy even in this subgroup.

scholarly journals MicroRNA-Assisted Hormone Cell Signaling in Colorectal Cancer Resistance

Cells ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 39
Author(s):  
Crescenzo Massaro ◽  
Elham Safadeh ◽  
Giulia Sgueglia ◽  
Hendrik G. Stunnenberg ◽  
Lucia Altucci ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Drug Resistance ◽  
Signaling Pathways ◽  
Cancer Progression ◽  
Therapy Resistance ◽  
Disease Recurrence ◽  
Hormone Signaling ◽  
Cancer Resistance ◽  
Comprehensive Overview ◽  
Substantial Progress

Despite substantial progress in cancer therapy, colorectal cancer (CRC) is still the third leading cause of cancer death worldwide, mainly due to the acquisition of resistance and disease recurrence in patients. Growing evidence indicates that deregulation of hormone signaling pathways and their cross-talk with other signaling cascades inside CRC cells may have an impact on therapy resistance. MicroRNAs (miRNAs) are small conserved non-coding RNAs thatfunction as negative regulators in many gene expression processes. Key studies have identified miRNA alterations in cancer progression and drug resistance. In this review, we provide a comprehensive overview and assessment of miRNAs role in hormone signaling pathways in CRC drug resistance and their potential as future targets for overcoming resistance to treatment.

scholarly journals PRE- AND POSTOPERATIVE IMAGING METHODS IN COLORECTAL CANCER

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Gleim Dias de SOUZA ◽  
Luciana Rodrigues Queiroz SOUZA ◽  
Ronaldo Mafia CUENCA ◽  
Vinícius Martins VILELA ◽  
Bruno Eduardo de Morais SANTOS ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Tnm Classification ◽  
Great Majority ◽  
Cancer Staging ◽  
Screening Tools ◽  
Screening Tests ◽  
Surgical Evaluation ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
American Society

ABSTRACT Introduction: Among the screening tests for colorectal cancer, colonoscopy is currently considered the most sensitive and specific technique. However, computed tomography colonography (CTC), magnetic resonance imaging (MRI), and transrectal ultrasonography have gained significant ground in the clinical practice of pre-treatment, screening and, more recently, post-treatment and surgical evaluation. Objective: To demonstrate the high accuracy of CT and MRI for pre and postoperative colorectal cancer staging. Methods: Search and analysis of articles in Pubmed, Scielo, Capes Periodicals and American College of Radiology with headings “colorectal cancer” and “colonography”. Weew selected 30 articles that contained radiological descriptions, management or statistical data related to this type of neoplasia. The criteria for radiological diagnosis were the American College of Radiology. Results : The great majority of patients with this subgroup of neoplasia is submitted to surgical procedures with the objective of cure or relief, except those with clinical contraindication. CTC colonography is not the most commonly used technique for screening; however, it is widely used for treatment planning, assessment of the abdomen for local complications or presence of metastasis, and post-surgical evaluation. MRI colonography is an alternative diagnostic method to CT, recommended by the American Society of Gastrointestinal Endoscopy. Although there are still no major studies on the use of MRI for screening, the high resolution examination has now shown good results for the American Joint Committee on Cancer TNM classification. Conclusion: MRI and CT represent the best means for colorectal neoplasm staging. The use of these methods as screening tools becomes beneficial to decrease complications and discomfort related to colonoscopy.

scholarly journals A Modified TNM Classification for Primary Operable Colorectal Cancer

2020 ◽  
Author(s):  
Chundong Zhang ◽  
Zubing Mei ◽  
Junpeng Pei ◽  
Masanobu Abe ◽  
Xiantao Zeng ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Validation Cohort ◽  
Tnm Classification ◽  
Characteristic Curve ◽  
External Validation ◽  
Model Fitting ◽  
Information Criteria ◽  
Stage I ◽  
Internal Validation ◽  
Clinical Benefits

Abstract Background The American Joint Committee on Cancer (AJCC) 8th tumor/node/metastasis (TNM) classification for colorectal cancer (CRC) has limited ability to predict prognosis. Methods We included 45,379 eligible stage I-III CRC patients from the Surveillance, Epidemiology, and End Results Program. Patients were randomly assigned individually to a training (N =31,772) or an internal validation cohort (N =13,607). External validation was performed in 10,902 additional patients. Patients were divided according to T and N stage permutations. Survival analyses were conducted by a Cox proportional hazard model and Kaplan-Meier analysis, with T1N0 as the reference. Area under receiver operating characteristic curve (AUC) and Akaike information criteria (AIC) were applied for prognostic discrimination and model-fitting, respectively. Clinical benefits were further assessed by decision curve analyses. Results We created a modified TNM (mTNM) classification: stages I (T1-2N0-1a), IIA (T1N1b, T2N1b, T3N0), IIB (T1-2N2a-2b, T3N1a-1b, T4aN0), IIC (T3N2a, T4aN1a-2a, T4bN0), IIIA (T3N2b, T4bN1a), IIIB (T4aN2b, T4bN1b), and IIIC (T4bN2a-2b). In the internal validation cohort, compared to the AJCC 8th TNM classification, the mTNM classification showed superior prognostic discrimination (AUC = 0.675 vs. 0.667, respectively; two-sided P <0.001) and better model-fitting (AIC = 70,937 vs. 71,238, respectively). Similar findings were obtained in the external validation cohort. Decision curve analyses revealed that the mTNM had superior net benefits over the AJCC 8th TNM classification in the internal and external validation cohorts. Conclusions The mTNM classification provides better prognostic discrimination than AJCC 8th TNM classification, with good applicability in various populations and settings, to help better stratify stage I-III CRC patients into prognostic groups.

Correlation between the number of positive nodes, number of dissected nodes and survival of patiens with colorectal cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 13585-13585
Author(s):  
J. C. Marin Marmolejo ◽  
C. R. Villegas Mejia ◽  
J. P. Cardona Arcila ◽  
E. Mulett Vasquez ◽  
M. Osorio Chica ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Medical Records ◽  
Tnm Classification ◽  
Prognostic Indicator ◽  
Absolute Number ◽  
Colon And Rectal Cancer ◽  
Nodal Dissection ◽  
The Difference

13585 Background: According to the TNM classification, the prognosis of patients suffering from colon and rectal cancer has been defined taking into account the number of nodes reported positively. Objective: This work is intending to establish a relation between the number of positive nodes and the number of dissected nodes, relating it with the overall survival. Methods: 5500 medical records of patients were reviewed. 771 out of these corresponded to gastrointestinal cancer (14%) from which 351(6.38%) corresponded to colorectal cancer. From this group, 291 patients (82.9%) underwent a surgery. A relation between the number of positive nodes and the number of dissected nodes was established and called proportion of positivity (positive nodes/ dissected nodes × 100) and this was in turn related to a five year overall survival. Two groups were analyzed: proportion of positivity > than 50% and proportion of positivity < than 50%. Results: A report of 209 patients showing nodes was obtained (59.5%), with a means of 10.4 (rank 0–31) of dissected nodes per patient and a means of positive nodes of 2.4 (rank 0–22). Comparing the two groups the statistic significance starts to be obvious from the 18 months and the difference between the two groups continues increasing until the five years. The survival to five years for the group with the proportion > than 50% was 39% (IC 95%:13.4–64.5) compared to the survival for the group with a proportion < than 50% that was 75.7% (IC 95%:67.6–83.7) p<0.05. Conclusions: The proposal shows that not only is the absolute number of positive dissected nodes as only prognostic indicator (TNM) but also that before nodes dissections with low number of them, it is possible to establish a reliable prognostic relationship by calculating the proportion of positivity. The above said does not consider that the nodal dissection can be less than recommended, on the contrary obtaining the biggest number of nodes will mean bigger equivalence of the proposal and a bigger possibility to detect positive nodes. No significant financial relationships to disclose.

Implementation of an electronic surveillance database for patients with colorectal cancer.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 231-231
Author(s):  
Yan Li ◽  
Michael Rizzo ◽  
Pamela Kim Washington ◽  
Olakunle Ajayi ◽  
Matthew Dixon
Keyword(s):  
Colorectal Cancer ◽  
Tnm Classification ◽  
Cancer Staging ◽  
Physician Assistants ◽  
Data Repository ◽  
Electronic Surveillance ◽  
National Guidelines ◽  
Recurrence Rates ◽  
Nccn Guidelines ◽  
Surveillance Database

231 Background: An electronic surveillance database was created to monitor patients for five years following curative treatment for colorectal cancer. The database serves as an alert system and data repository for imaging, serology, and colonoscopy surveillance tests preloaded for each patient in accordance with NCCN guidelines based upon TNM cancer staging. Methods: The chiefs of Surgery and Oncology defined end-user specifications for the Filemaker Pro database. Key features include preloaded tests based upon NCCN guidelines, expected date of completion, and exam results. The database also tracks tests overdue or ordered but not yet obtained. A new workflow consisting of a monthly report of new colorectal cases from Pathology and a meeting of surgical and oncology physicians and physician assistants to review the report, update the database with new patients, and identify patients due for follow-up was established. Results: 250 cases are currently being monitored. By 2019, the database is poised to be the largest in Kaiser Permanente (KP) dedicated to active surveillance following colorectal cancer treatment. Conclusions: In addition to ensuring that individual patients obtain surveillance tests at the intervals based upon national guidelines for each TNM classification, the database can also be used to assess surveillance results and recurrence rates. The database format has also proven invaluable for other services. The Thoracic service recently created a database modeled after colorectal surveillance to begin tracking lung cancer patients. Beginning in 2016, the colorectal database became a Regional KP initiative and will be incorporated into HealthConnect (electronic medical record).

K-ras gene mutation as an early prognostic marker of colon cancer

2016 ◽  
Vol 88 (1) ◽  
Author(s):  
Łukasz Szpon ◽  
Aleksander Stal ◽  
Marcin Zawadzki ◽  
Anna Lis-Nawara ◽  
Wojciech Kielan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Gene Mutation ◽  
Cancer Incidence ◽  
Early Stage ◽  
Tnm Classification ◽  
Gene Mutations ◽  
Diagnostic Methods ◽  
Female Group ◽  
Ras Gene ◽  
Colorectal Cancer Incidence

AbstractDue to increased colorectal cancer incidence there is a necessity of seeking new both prognostic and prediction factors that will allow to evolve new diagnostic tests. K-ras gene seems to be such a factor and its mutations are considered to be an early marker of progression of colorectal cancer.was to find a correlation between K-ras gene mutation in patients with diagnosed colorectal cancer and selected clinical parameters.A total of 104 patients (41 women and 63 men) with diagnosed colorectal cancer were included in this study. The average age of male group was 68.3 and in female group − 65.9. Samples were taken from paraffine blocks with tissue from diagnosed patients and K-ras gene mutation were identified. Afterwards the statistical analysis was made seeking the correlation between K-ras gene mutation incidence and clinical TNM staging system, tumour localisation, histological type, sex, age.K-ras gene mutations were detected in 20.1% of all colorectal cancers. Significantly higher rate of K-ras gene mutations were diagnosed among patients classified at stage I (40%), stage IIC (50%) and stage IV (50%) according to the TNM classification.The results of our study are compatible with other studies and indicate the correlation between K-ras gene mutation and colorectal cancer incidence. Identification of K-ras gene mutation may complement other diagnostic methods at early stage of colorectal cancer.

Is TNM classification related to early postoperative morbidity and mortality after colorectal cancer resections?

2004 ◽  
Vol 8 (S1) ◽  
pp. s89-s92 ◽  
Author(s):  
E. Christoforidis ◽  
I. Kanellos ◽  
T. Tsachalis ◽  
S. Angelopoulos ◽  
K. Blouhos ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Morbidity ◽  
Tnm Classification ◽  
Morbidity And Mortality

scholarly journals Fibre intake and incident colorectal cancer depending on fibre source, sex, tumour location and Tumour, Node, Metastasis stage

2015 ◽  
Vol 114 (6) ◽  
pp. 959-969 ◽  
Author(s):  
Alexandra Vulcan ◽  
Jenny Brändstedt ◽  
Jonas Manjer ◽  
Karin Jirström ◽  
Bodil Ohlsson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Tnm Classification ◽  
Population Based ◽  
Cereal Products ◽  
Fibre Intake ◽  
Node Metastasis ◽  
Tumour Location ◽  
Clinical Records ◽  
Tumour Node

AbstractStudies on fibre intake and incident colorectal cancer (CRC) indicate inverse associations. Differences by tumour stage have not been examined. We examined associations between fibre intake and its sources, and incidental CRC. Separate analyses were carried out on the basis of sex, tumour location and the Tumour, Node, Metastasis (TNM) classification. The Malmö Diet and Cancer Study is a population-based cohort study, including individuals aged 45–74 years. Dietary data were collected through a modified diet history method. The TNM classification was obtained from pathology/clinical records and re-evaluated. Among 27 931 individuals (60 % women), we found 728 incident CRC cases during 428 924 person-years of follow-up. Fibre intake was inversely associated with CRC risk (Ptrend=0·026). Concerning colon cancer, we observed borderline interaction between fibre intake and sex (P=0·052) and significant protective association restricted to women (Ptrend=0·013). Intake of fruits and berries was inversely associated with colon cancer in women (Ptrend=0·022). We also observed significant interactions between intakes of fibre (P=0·048) and vegetables (P=0·039) and sex on rectal cancer, but no significant associations were seen between intake of fibre, or its sources, in either of the sexes. Except for inverse associations between intake of fibre-rich cereal products and N0- and M0-tumours, we did not observe significant associations with different TNM stages. Our findings suggest different associations between fibre intake and CRC depending on sex, tumour site and fibre source. High fibre intake, especially from fruits and berries, may, above all, prevent tumour development in the colon in women. No clear differences by TNM classification were detected.

Can Lymph Node Ratio Take the Place of pN Categories in the UICC/AJCC TNM Classification System for Colorectal Cancer?

2011 ◽  
Vol 18 (9) ◽  
pp. 2453-2460 ◽  
Author(s):  
Lin-lin Tong ◽  
Peng Gao ◽  
Zhen-ning Wang ◽  
Yong-xi Song ◽  
Ying-ying Xu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Classification System ◽  
Lymph Node Ratio ◽  
Tnm Classification ◽  
Node Ratio
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