Management of stage II colon cancer - the use of molecular biomarkers for adjuvant therapy decision

BMC Gastroenterology

Giorgio Stanta¹  Daniel Pettirosso¹  Renzo Barbazza¹  Serena Bonin¹  Marisa Donada¹ 

[1] DSM Department (Department of medical, surgical and health sciences), University of Trieste, Surgical Pathology Bldg, Strada di Fiume 447, I-34149, Trieste, Italy

关键词: CIMP;    MMR;    Thymidylate synthase;    Formalin-fixed and paraffin-embedded tissues;    5-Fluorouracil;    Adjuvant therapy;    Stage II;    Colon cancer;   

Others  :  858158
DOI  :  10.1186/1471-230X-13-36

 received in 2012-09-25, accepted in 2013-02-25,  发布年份 2013

【 摘 要 】

Background

There is uncertainty on the benefit of adjuvant chemotherapy in patients with stage II colorectal cancers. The aim of this study is to investigate the combined role of clinical, pathological and molecular parameters to identify those stage II patients who better benefit from adjuvant therapy.

Methods

We examined 120 stage II colon cancer patients. Of these, 60 patients received adjuvant 5-FU chemotherapy after surgery and the other 60 did not receive therapy. Immunohistochemical (IHC) analyses were performed to evaluate the expressions of Thymidylate synthetase (TYMS), TP53 (p53), β-catenin (CTNNB1) and CD8. For TYMS, its mRNA expression levels were also investigated by real time qRT-PCR. The entire case study was characterized by the presence of a defect in the MMR (mismatch repair) system, the presence of the CpG island methylator phenotype (CIMP or CIMP-High) and for the V600E mutation in the BRAF gene. At the histo-pathological level, the depth of tumour invasion, lymphovascular invasion, invasion of large veins, host lymphocytic response and tumour border configuration were recorded.

Results

The presence of the V600E mutation in the BRAF gene was a poor prognostic factor for disease free and overall survival (DFS; hazard ratio [HR], 2.57; 95% CI: 1.03 -6.37; p = 0.04 and OS; HR, 3.68; 95% CI: 1.43-9.47; p < 0.01 respectively), independently of 5-FU treatment. Adjuvant therapy significantly improved survival in patients with high TYMS levels (p = 0.04), while patients with low TYMS had a better outcome if treated by surgery alone (DFS; HR, 6.07; 95% CI, 0.82 to 44.89; p = 0.04). In patients with a defect in the MMR system (dMMR), 5-FU therapy was associated to reduced survival (DFS; HR, 37.98; 95% CI, 1.04 to 1381.31; p = 0.04), while it was beneficial for CIMP-High associated tumours (DFS; HR, 0.17; 95% CI, 0.02 to 1.13; p = 0.05).

Conclusions

Patients’ characterization according to MMR status, CIMP phenotype and TYMS mRNA expression may provide a more tailored approach for adjuvant therapy in stage II colon cancer.

【 授权许可】

   
2013 Donada et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 3.

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