Racial and socioeconomic disparities in overall survival in colorectal cancer (CRC) at West Cancer Center & Research Institute (WCCRI), Memphis, TN.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16122-e16122
Author(s):  
Vanessa Wookey ◽  
Gabriella Bufalino ◽  
Gregory A. Vidal ◽  
Bradley G. Somer ◽  
Lee S. Schwartzberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Private Insurance ◽  
Socioeconomic Disparities ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Median Income ◽  
Entire Cohort ◽  
Stage 4

e16122 Background: WCCRI, a comprehensive regional community oncology center in Memphis, Tennessee and the Mid-South region, serves a racially, geographically and socioeconomically diverse patient cohort. We sought to evaluate disparity of outcomes in survival by race and socioeconomic status, in addition to patient and tumor characteristics. Methods: All consecutive patients referred to and treated at WCCRI with colorectal adenocarcinoma from 2007-2013 were included. Individual chart review was performed to verify diagnosis, stage, and date and cause of death. Kaplan-Meier Overall Survival curves were generated for the entire cohort and by race, sex, tumor location and income derived from zip code. WCCRI survival data were compared to SEER data. Results: From 2007-2013, 1,176 patients were included in the analysis: 405 blacks, 757 whites, 14 others. Median age at diagnosis: Blacks 58 yrs, whites 61 yrs. Stage distribution at diagnosis: stage 1: 100, stage 2: 275, stage 3: 425, stage 4: 376. All stages combined, blacks trended towards shorter OS vs whites (5-year OS: 52.8% vs 58.3%; median survival 71.0 mos vs 98.6 mos; p= 0.095). Blacks presented at later stages (71.4% at stage 3 or 4 vs 66.3% for whites) but no statistically significant OS differences were seen when compared by stage. Patients at or below the median income of $39,590 for WCC had worse 5-year OS (51.6% vs. 61.1%; p= 0.006), as did patients without private insurance (5-year OS: uninsured: 48.0%, Medicare/Medicaid: 50.0%, private: 62.0%; p< 0.001). Adjusted for stage, 5-year OS was statistically significant for stage 4 (private: 18.0%, Medicare/Medicaid: 9.4%, uninsured: 8.3%; p= 0.020). A higher proportion of blacks were below the median income (69% vs 39%) but no statistically significant OS differences were seen when adjusted by race. Overall, cancer survival outcomes were similar to SEER results. Conclusions: At WCCRI, black patients with CRC presented at a later stage than whites, however, adjusted for stage, no significant racial difference in OS was found. Income and insurance status influenced survival outcomes. Overall, our results reveal racial and socioeconomic disparities in colorectal cancer in a diverse US population and further detailed multivariate data analyses are underway.

Racial and socioeconomic disparities in overall survival in colorectal cancer (CRC) at West Cancer Center (WCC), Memphis, TN.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 80-80
Author(s):  
Vanessa Wookey ◽  
Gabriella Bufalino ◽  
Gregory A. Vidal ◽  
Bradley G. Somer ◽  
Lee S. Schwartzberg ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Survival Data ◽  
Private Insurance ◽  
Socioeconomic Disparities ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Median Income ◽  
Entire Cohort ◽  
Stage 4

80 Background: WCC, a comprehensive regional community oncology center in Memphis, Tennessee and the Mid-South region, serves a racially, geographically and socioeconomically diverse patient cohort. We sought to evaluate disparity of outcomes in survival by race and socioeconomic status, in addition to patient and tumor characteristics. Methods: All consecutive patients referred to and treated at WCC with colorectal adenocarcinoma from 2007-2013 were included. Individual chart review was performed to verify diagnosis, stage, and date and cause of death. Kaplan-Meier Overall Survival curves were generated for the entire cohort and by race, sex, tumor location and income derived from zip code. WCC survival data were compared to SEER data. Results: From 2007-2013, 1,176 patients were included in the analysis: 405 blacks, 757 whites, 14 others. Median age at diagnosis: Blacks 58 yrs, whites 61 yrs. Stage distribution at diagnosis: stage 1: 100, stage 2: 275, stage 3: 425, stage 4: 376. All stages combined, blacks trended towards shorter OS vs whites (5-year OS: 52.8% vs 58.3%; median survival 71.0 mos vs 98.6 mos; p= 0.095). Blacks presented at later stages (71.4% at stage 3 or 4 vs 66.3% for whites) but no statistically significant OS differences were seen when compared by stage. Patients at or below the median income of $39,590 for WCC had worse 5-year OS (51.6% vs. 61.1%; p= 0.006), as did patients without private insurance (5-year OS: uninsured: 48.0%, Medicare/Medicaid: 50.0%, private: 62.0%; p< 0.001). Adjusted for stage, 5-year OS was statistically significant for stage 4 (private: 18.0%, Medicare/Medicaid: 9.4%, uninsured: 8.3%; p= 0.020). A higher proportion of blacks were below the median income (69% vs 39%) but no statistically significant OS differences were seen when adjusted by race. Overall, cancer survival outcomes were similar to SEER results. Conclusions: At WCC, black patients with CRC presented at a later stage than whites, however, adjusted for stage, no significant racial difference in OS was found. Income and insurance status affected survival outcomes. Overall, our results reveal racial and socioeconomic disparities in colorectal cancer in a diverse US population.

Impact of comorbidities on overall survival of high-risk and advanced melanoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8536-8536
Author(s):  
Prashanth Peddi ◽  
Jeong Hoon Oh ◽  
Kevin B. Kim ◽  
Jeffrey E. Gershenwald ◽  
Shana L. Palla ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Survival Data ◽  
Advanced Melanoma ◽  
Cox Proportional Hazards Model ◽  
Prognostic Models ◽  
Cancer Center ◽  
Entire Cohort ◽  
Ajcc Stage ◽  
The Impact

8536 Background: Comorbidities have been shown to adversely affect survival among patients with cancer. Currently, the most important prognostic factor in patients with melanoma is AJCC stage. However, little is known regarding the impact of comorbidities on melanoma prognosis. The aim of our study was to determine the impact of the severity of concurrent comorbidities on the overall survival of patients with high-risk and advanced melanoma (defined as AJCC stages IIc, III and IV). Methods: We conducted a retrospective cohort study of eligible adult melanoma patients available in the MelCore prospective database at MD Anderson Cancer Center (MDACC) from 01-2003 to 12-2006 who were diagnosed and completed staging within 3 months of presentation to MDACC. Patients with ocular melanoma were excluded. Demographic, AJCC staging, and survival data were collected. The Adult Comorbidity Evaluation-27 (ACE-27) was utilized to collect comorbidity information and grade its severity. A Cox proportional hazards model was used. Results: Of 444 patients that met enrollment criteria, 176 (39.6%) had grade 0 (no comorbidities), 222 (50%) had grade 1 or 2 (mild or moderate comorbidities) and 46 (10.4%) had grade 3 (severe comorbidities). The median age of the entire cohort was 56.4 years (19.7-98.9), 141 (32%) were female, and 406 (91.4%) were white. The median overall survival after presentation to MDACC was 5.0 years for the entire cohort. Adjusted hazard ratios are shown in the table. Comorbidity and AJCC Stage were significantly associated with survival. Age, gender and race did not have a significant impact on overall survival. Conclusions: In our study, the presence of comorbidities at presentation were independent predictors of decreased survival, even when adjusted for AJCC stage. Our findings suggest that comorbidity should be incorporated into prognostic models and therapeutic decision-making for patients with high-risk or advanced melanoma. [Table: see text]

Socioeconomic disparities and outcomes in midgut neuroendocrine tumors.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 613-613
Author(s):  
Nicholas Manguso ◽  
Jessica Crystal ◽  
Brian Cox ◽  
Shirley C Paski ◽  
Andrew Eugene Hendifar ◽  
...  
Keyword(s):  
Socioeconomic Factors ◽  
Neuroendocrine Tumors ◽  
Demographic Data ◽  
Private Insurance ◽  
Academic Research ◽  
Socioeconomic Disparities ◽  
Cancer Center ◽  
Median Income ◽  
Metro Area ◽  
Lower Education

613 Background: Demographic and socioeconomic disparities have been shown to effect cancer specific outcomes in numerous malignancies but the effect in midgut neuroendocrine tumors (mNETs) is unknown. We sought to investigate whether these factors are associated with survival in mNETs. Methods: The NCDB was queried to identify patients with mNETs between 2004 and 2015. Only patients treated at a single hospital with complete data were included. Overall Survival (OS) was compared based on demographic data, socioeconomic factors, insurance status and place of living. Results: A total of 14,083 patients were identified with a mean age of 72 years (range 18-90). The majority of patients were Caucasian (83.9%) and male (50.9%). Most patients had private insurance (50.5%) or medicare (41.3%). Patients typically lived in larger metropolitan areas (51.5%) and 60.7% lived in zip codes with median household incomes > $48,000. Only 14.7% lived in zip codes where > 20% did not graduate high school (no HSD). The majority were treated at community comprehensive cancer centers (43.8%) or academic/research centers (35.2%). Overall, 3358 (24.5%) presented with metastasis at diagnosis. The 5-year OS for the entire cohort was 78.5%. The 5-year survival was worse in patients with lower median income (73.8% [ < $38,000] vs 81.5% [ > $63,000],p < 0.0001), lower education (74.9% [ > 20% no HSD] vs 80.7% [ < 7% no HSD], p < 0.0001), those not living in proximity to a metro area (73.8% [not metro adjacent] vs 78.7% [metro/adjacent], p = 0.0004) and those treated at a community cancer center (73.6% [community] vs. 80.1% [academic], p < 0.0001). Factors predictive of worse OS were lower income ( < $38,000) (HR 1.16, 95% CI 1.04-1.28), lower education ( > 20% no HSD) (HR 1.14, 95% CI 1.02-1.26), no insurance (HR 1.66, 95% CI 1.33-2.06) and not living in proximity to a metro area (HR 1.27, 95% CI 1.10-1.47). Conclusions: Socioeconomic factors shown to have worse OS in patients with mNETs were lower median income, lower education, treatment at a community cancer center and not living in proximity to a metro area. Patient demographic and socioeconomic factors play an important role in OS for patients with mNETs and access to care must be considered in this subpopulation of cancer patients.

Impact of Patient Socioeconomic Disparities on Time to Tympanostomy Tube Placement

2021 ◽  
pp. 000348942110157
Author(s):  
Jennifer L. McCoy ◽  
Ronak Dixit ◽  
R. Jun Lin ◽  
Michael A. Belsky ◽  
Amber D. Shaffer ◽  
...  
Keyword(s):  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Private Insurance ◽  
Chronic Otitis Media ◽  
The United States ◽  
Socioeconomic Disparities ◽  
Tube Placement ◽  
Median Income ◽  
Public Insurance ◽  
Tympanostomy Tubes

Objectives: Extensive literature exists documenting disparities in access to healthcare for patients with lower socioeconomic status (SES). The objective of this study was to examine access disparities and differences in surgical wait times in children with the most common pediatric otolaryngologic surgery, tympanostomy tubes (TT). Methods: A retrospective cohort study was performed at a tertiary children’s hospital. Children ages <18 years who received a first set of tympanostomy tubes during 2015 were studied. Patient demographics and markers of SES including zip code, health insurance type, and appointment no-shows were recorded. Clinical measures included risk factors, symptoms, and age at presentation and first TT. Results: A total of 969 patients were included. Average age at surgery was 2.11 years. Almost 90% were white and 67.5% had private insurance. Patients with public insurance, ≥1 no-show appointment, and who lived in zip codes with the median income below the United States median had a longer period from otologic consult and preoperative clinic to TT, but no differences were seen in race. Those with public insurance had their surgery at an older age than those with private insurance ( P < .001) and were more likely to have chronic otitis media with effusion as their indication for surgery (OR: 1.8, 95% CI: 1.2-2.5, P = .003). Conclusions: Lower SES is associated with chronic otitis media with effusion and a longer wait time from otologic consult and preoperative clinic to TT placement. By being transparent in socioeconomic disparities, we can begin to expose systemic problems and move forward with interventions. Level of Evidence: 4

Comparison of Treatment, Cost, and Survival in Patients With Metastatic Colorectal Cancer in Western Washington, United States, and British Columbia, Canada

2020 ◽  
Vol 16 (5) ◽  
pp. e425-e432 ◽  
Author(s):  
Todd A. Yezefski ◽  
Dan Le ◽  
Leo Chen ◽  
Caroline H. Speers ◽  
Shasank Chennupati ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
British Columbia ◽  
Overall Survival ◽  
Metastatic Colorectal Cancer ◽  
Systemic Therapy ◽  
Survival Data ◽  
De Novo ◽  
Tumor Resection ◽  
Care Utilization ◽  
Western Washington

PURPOSE: Few studies have directly compared health care utilization, costs, and outcomes between patients treated in the US multipayer health system and Canada’s single-payer system. Using cancer registry and claims data, we assessed treatment types, costs, and survival for patients with metastatic colorectal cancer (mCRC) in Western Washington State (WW) and British Columbia (BC). MATERIALS AND METHODS: Patients age ≥ 18 years diagnosed with mCRC in 2010 and later were identified from the BC Cancer database and a regional database linking WW SEER to claims from Medicare and two large commercial insurers. Demographics, treatment characteristics, costs of systemic therapy, and survival data were obtained from these databases and compared between the two regions. RESULTS: A total of 1,592 patients from BC and 901 from WW were included in the study. Median age was similar (BC, 66 years; WW, 63 years), but patients in BC were more likely to be male (57.1% v 51.2%; P ≤ .01) and to have de novo metastatic disease (61.0% v 38.3%; P ≤ .01). The use of radiation therapy was similar between regions (BC, 31.2%; WW, 33.9%; P = .18), but primary tumor resection was more common in BC (74.1% v 66.3%; P ≤ .01) as was hepatic metastasectomy (12.4% v 2.3%; P ≤ .01). Similar percentages of patients received systemic therapy (BC, 68.8%; WW, 67.1%; P = .40), but costs were significantly higher for first-line systemic therapy in WW ($6,226 v $15,792 per patient per month; P ≤ .01). Median overall survival was similar (BC, 16.9 months; WW, 18 months). CONCLUSION: Cost of systemic therapy for mCRC was significantly higher for patients in WW than in BC, but this did not translate to a difference in overall survival.

A phase II study of chemoradiation followed by adjuvant temozolomide and poly-ICLC in patients with newly diagnosed glioblastoma: 12- and 18-month survival data (NABTT 0501)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 2002-2002
Author(s):  
M. R. Rosenfeld ◽  
M. Chamberlain ◽  
S. A. Grossman ◽  
D. M. Peereboom ◽  
G. J. Lesser ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adjuvant Treatment ◽  
Survival Data ◽  
Cell Activation ◽  
Killer Cell ◽  
External Beam Radiation ◽  
Newly Diagnosed ◽  
Beam Radiation ◽  
Entire Cohort ◽  
Newly Diagnosed Glioblastoma

2002 Background: Polyinosinic-polycytidylic (poly-ICLC), is a double-stranded RNA that stimulates a variety of host defense mechanisms including T-cell and natural killer cell activation, cytokine release and specific anti-proliferative and anti-viral effects. The objective of this study was to determine the safety and efficacy of poly-ICLC when added to adjuvant treatment for newly diagnosed glioblastoma. Methods: Newly diagnosed patients > 18 years with histologically proven glioblastoma received standard external beam radiation with concurrent low-dose temozolomide (TMZ) (75 mg/m2) followed by adjuvant cycles of TMZ for 5 days (150–200 mg/m2) (week 1) then intramuscular injections of poly-ICLC (20 mcg/kg) 3 times a week (weeks 2–8; total 21 injections) with week 9 off and no limit to the number of adjuvant cycles (TMZ + poly-ICLC). Imaging evaluations were performed before every cycle. Results: There were 97 patients enrolled (60 men); median age 56 yrs (range 21–85); median KPS 90 (range 60–100). Fourteen patients did not start adjuvant treatment (5 patient request and 4 investigator withdrawal; 2 progressive disease; 1 death; 1 toxicity; 1 other). The most frequent CTC grade 3–4 toxicities occurring in > 5% of subjects at least possibly related to poly-ICLC were leukopenia (20%), thrombocytopenia (14%), anemia (13%), neutropenia (10%), and SGPT (9%) or alkaline phosphatase (7%) elevation. Two deaths during adjuvant treatment were considered unlikely related to poly-ICLC. To date 71 of 97 patients have survived at least 12 months from diagnosis. The estimated median survival for the entire cohort was 17.2 months (95% CI: 15.5–19.3 months). Overall survival for the cohort at 12 months was 73.2% (95% CI: 63%-82%) and at 18 months 47.4% (95% CI: 37–58%). For only those subjects 18–70 years, overall survival at 18 months was 51.8% (95% CI: 41–63%). This is contrasted with EORTC 26981/22981 that reported an 18 month overall survival of 39.4% (95% CI: 33.8–45.1). Conclusions: The addition of poly-ICLC to a modified adjuvant treatment regimen for newly diagnosed GB is well-tolerated. Survival data at 12 and 18 months suggest increased efficacy compared to chemoradiation with adjuvant TMZ only. [Table: see text]

Impact of care at Memorial Sloan Kettering Cancer Center (MSKCC): A comprehensive cancer center on overall survival (OS) in patients (pts) with AJCC stage IV pancreas adenocarcinoma (PDAC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18128-e18128
Author(s):  
Fiona Boland ◽  
Ahmad Cheema ◽  
Maeve Aine Lowery ◽  
Kenneth H. Yu ◽  
Anna M. Varghese ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rates ◽  
Stage Iv ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Contributing Factors ◽  
Term Survival ◽  
Entire Cohort ◽  
Line Therapy ◽  
Centralized Care

e18128 Background: PDAC has a rising incidence and relatively static mortality rates. Current cytotoxic regimens confer median survivals of 8.5- 11 months (Von Hoff, Conroy, et al. NEJM 2013, 2011). National Cancer Institute-designated Comprehensive Cancer Centers potentially allow greater access to multidisciplinary consultation for complex cancer care. Although the widespread benefits of NCICCCs are acknowledged, there is limited data demonstrating superior outcomes for patients treated at these centers. Methods: Patients with stage IV PDAC, diagnosed between 01/01/13 and 12/31/14, were identified and followed until death or 12/31/2016. These patients had care centralized to MSKCC and the analysis was conducted to evaluate key patient (pt) and disease characteristics, systemic therapies and outcomes.Survival times were calculated from the date of diagnosis. Results: N=391 pts identified, 210 males (54%), 181 females (46%). Median age 66 years (range 27-91). Table 1 outlines key points. For entire cohort, median overall survival (mOS): 11.4 + 9 months, 1-year (yr) and 2-yr survival rates (SR) of 48% and 15.1% respectively. N= 165 (42%) received mFOLFIRINOX-based regimen as 1st-line therapy with mOS 13.2 + 8.9 months, 1-yr and 2-yr SR of 59.4.% and 20% respectively. N= 118 (30.1%) received gemcitabine + nab-paclitaxel- based regimen as 1st line therapy had a mOS of 11.6 + 9 months with 1-yr and 2-yr SR of 49.1% and 16.2% respectively. Conclusions: At MSKCC, a major referral center for PDAC, outcomes for stage IV disease compare favorably to contemporary trial outcomes with notable 2-yr survivorship (long-term survival analysis of MPACT trial showed 1-yr and 2-yr SR of 35% and 10% respectively). Contributing factors likely reflect multidisciplinary expertize, patient selection and biases. Centralized care for complex illnesses may improve outcomes. [Table: see text]

scholarly journals Effect of Chinese Herbal Medicine on the Survival of Colorectal Cancer Patients With Liver-Limited Metastases: A Retrospective Cohort Study, 2008 to 2017

2019 ◽  
Vol 18 ◽  
pp. 153473541988368 ◽  
Author(s):  
Cui Shao ◽  
Qian Zuo ◽  
Jietao Lin ◽  
Rong Jian Yu ◽  
Yuanfeng Fu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cohort Study ◽  
Herbal Medicine ◽  
Chinese Herbal Medicine ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Survival Outcomes ◽  
High Exposure ◽  
Chinese Herbal

Background: Colorectal cancer (CRC) remains one of the leading contributors to cancer-related mortality and morbidity worldwide. Traditional Chinese medicines have been widely employed to treat various types of cancer in China. This investigation aims to determine the association between Chinese herbal medicine (CHM) therapy and survival outcomes in CRC patients with liver-limited metastases. Methods: A retrospective cohort study was performed among patients with colorectal liver metastases at the First Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangzhou, China. Data from a series of consecutive patients were collected via an electronic medical record system or telephone follow-up. We defined high exposure as a period of CHM therapy lasting more than 6 months. The primary outcome was overall survival. Results: The study included the data of 191 patients from January 2008 to December 2017; 126 patients (65.97%) met the inclusion criteria of high exposure to CHM. Multivariate analyses revealed that high exposure to CHM was associated with better overall survival (hazard ratio = 0.444, 95% confidence interval = [0.213, 0.926], P = .030). The association was further confirmed by a subgroup exploratory analysis. Conclusion: Long-term CHM therapy is correlated with improved survival outcomes in CRC patients with liver-limited metastases.

Presentation, management, and outcome of the pregnant female with colorectal cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 389-389
Author(s):  
E. L. Kachikwu ◽  
L. A. Leong ◽  
L. L. Lai
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Definitive Treatment ◽  
Entire Cohort ◽  
Delay In Diagnosis ◽  
Presenting Symptoms ◽  
Group A ◽  
Group B

389 Background: Most patients diagnosed with colorectal cancer (CRC) are older than 60 years old. However, there remains a population of women of reproductive age (17-49) who develop CRC. Few publications have described the presentation, management and outcome of patients who initially present while pregnant.The objective of this study is to assess the presentation, management and outcome of women aged 17-49 with a particular focus on the pregnant patient. Presenting symptoms, time from presentation to diagnosis, management of disease, and overall survival were the main endpoints of this study. Methods: A retrospective chart review was conducted of 72 women aged 18-49 who were treated for CRC between 2005 and 2009 at a single institution. We compared the non-pregnant women (n = 66, group A) with the pregnant women (n = 6, group B). Results: The median age at presentation was 43 and 36.5 years in group A and group B, respectively. All six patients in group B presented with significant anemia, severe abdominal pain, and bright red blood per rectum during pregnancy while 25% of group A were asymptomatic. Although all 6 of the group B patients presented while pregnant, five patients were diagnosed in the postpartum period. Only 1/6 patients were diagnosed while pregnant, in the 3rd trimester. Median time from presentation to diagnosis was 10 days in group A, and 175 days in group B. Definitive treatment for the group B women included resection with C-section (n = 1), resection followed by systemic chemotherapy (n = 3), and resection only (n = 2). 72% of group A and 100% of group B patients presented with advanced disease (stages III and IV). Median overall survival for the entire cohort was 24.4 months; 26.1 months for group A and 7.8 months for group B. There was one long-term survivor amongst the group B patients (5.3 years), who has had two recurrences. Conclusions: Overall, the majority of women aged 18-49 presented with advanced stages of CRC. Specifically, 5/6 pregnant women presented with stage IV disease. Given that many of the symptoms of CRC mimic symptoms of pregnancy, a higher index of suspicion of CRC may minimize the delay in diagnosis, decrease the proportion of higher stage cancers, and improve the cancer outcome in this cohort of patients. No significant financial relationships to disclose.

MET overexpression as a hallmark of the epithelial-mesenchymal transition (EMT) phenotype in colorectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 334-334 ◽  
Author(s):  
Kanwal Pratap Singh Raghav ◽  
Wenting Wang ◽  
Michael J. Overman ◽  
Scott Kopetz
Keyword(s):  
Gene Expression ◽  
Colorectal Cancer ◽  
Overall Survival ◽  
Protein Expression ◽  
Survival Data ◽  
Fold Increase ◽  
Clinicopathological Characteristics ◽  
Fisher Exact Test ◽  
Mesenchymal Transition ◽  
Emt Markers

334 Background: Dysregulation of the proto-oncogene MET (mesenchymal-epithelial transition factor gene) has been implicated in tumorigenesis and correlates with worse survival and chemo/radio-resistance in colorectal cancer (CRC). EMT has been identified as a dominant molecular characteristic of a subset of CRC tumors and represents a key feature in the developing colorectal taxonomy. The purpose of this study was to compare protein expression of MET with protein/gene expression of EMT markers and other clinicopathological characteristics, and to evaluate its impact on overall survival (OS). Methods: We performed an exploratory analysis of 590 CRC samples using data from The Cancer Genome Atlas. Fisher-exact test and Pearson’s method was used to determine the relationship between MET protein expression, clinicopathological characteristics and EMT marker protein expression by reverse-phase protein array (RPPA) and EMT-associated gene expression by RNA-sequencing. Regression tree method was applied to find the best cutoff point for MET using patients with available survival data. Overall survival (OS) was estimated non-parametrically using Kaplan-Meier curve and log-rank test was used to evaluate hazard ratio. Results: MET expression by RPPA did not correlate with traditional clinicopathologic characteristics. MET was overexpressed in 17% of CRC tumors and was significantly associated with OS (HR 2.92; 95% CI: 1.45 - 5.92). Correlation analysis of MET levels with gene expression of EMT markers AXL, CDH1, FGFR1, SNAIL, TWIST1/2, VIM, SLUG, ZEB1/2, FN1 demonstrated that the highest quartile of MET protein expression was associated with a 1.5 fold increase in ZEB1 (p = 0.002), a 1.4 fold increase in AXL (p = 0.005) and ZEB2 (p = 0.008), and a 1.3 fold increase in VIM (p = 0.02). MET expression also correlated strongly with protein expressions of SNAIL (transcription factor for EMT) (r = 0.96) and ERCC1 (r = 0.83) (a marker for oxaliplatin chemo-resistance). Conclusions: Increased MET protein expression is seen in 17% of CRC tumors and strongly correlates with a molecular EMT phenotype and poor survival in patients with CRC. MET protein expression may be a surrogate biomarker for this unique subset of CRC.

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