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Prognosticators of Long-Term Outcomes of TNM Stage II Colorectal Cancer: Molecular Patterns or Clinicopathological Features.

Abstract

BACKGROUND

Patients with stage II colorectal cancer (CRC) have a higher risk of recurrence when they have certain risk factors, including clinical and pathological patterns. However, as the prognostic role of molecular patterns for stage II disease is still unclear, this study aimed to investigate it.

METHODS

A total of 509 patients with stage II CRC were enrolled, and all clinical, pathological, and molecular data were collected. Molecular patterns included microsatellite instability (MSI); elevated microsatellite alterations at selected tetranucleotides (EMAST) status; and expression of RAS/RAF genes, genes of the APC pathway, and other gene mutations. The endpoints were oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), local recurrence (LR), and distant recurrence (DR). Cox regression analysis was used.

RESULTS

Numerous molecular patterns influenced the oncological outcomes on univariate analysis, but no variable reached significance in LR. On multivariate analysis, a mucinous component (MC) > 50% (P < 0.01) was significant for OS and CSS. Lymphovascular invasion (LVI; P< 0.01), MC > 50% (P < 0.01), and EMAST-H (P = 0.02) significantly influenced DFS, whereas LVI (P < 0.01), MC > 50% (P < 0.01), and TP53 mutation (P = 0.02) were significant for DR.

CONCLUSIONS

In this study, MSI, EMAST, and RAS/RAF alterations did not influence the oncological outcomes. Overall, LVI and MC were two significant prognostic factors for DFS and DR. Thus, the histopathology, rather than the genes, plays a major role in the prognosis of patients with stage II CRC.

Authors+Show Affiliations

Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. changsc@vghtpe.gov.tw. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. changsc@vghtpe.gov.tw.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. National Yang-Ming University Hospital, Yilan, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.Division of Colorectal Surgery, Department of Surgery, Taipei Veteran General Hospital, No. 201, Sec. 2., Shipai Rd., Beitou District, Taipei, 11217, Taiwan. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31515570

Citation

Kuan, Tai-Chuan, et al. "Prognosticators of Long-Term Outcomes of TNM Stage II Colorectal Cancer: Molecular Patterns or Clinicopathological Features." World Journal of Surgery, 2019.
Kuan TC, Chang SC, Lin JK, et al. Prognosticators of Long-Term Outcomes of TNM Stage II Colorectal Cancer: Molecular Patterns or Clinicopathological Features. World J Surg. 2019.
Kuan, T. C., Chang, S. C., Lin, J. K., Lin, T. C., Yang, S. H., Jiang, J. K., ... Huang, S. C. (2019). Prognosticators of Long-Term Outcomes of TNM Stage II Colorectal Cancer: Molecular Patterns or Clinicopathological Features. World Journal of Surgery, doi:10.1007/s00268-019-05158-w.
Kuan TC, et al. Prognosticators of Long-Term Outcomes of TNM Stage II Colorectal Cancer: Molecular Patterns or Clinicopathological Features. World J Surg. 2019 Sep 12; PubMed PMID: 31515570.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognosticators of Long-Term Outcomes of TNM Stage II Colorectal Cancer: Molecular Patterns or Clinicopathological Features. AU - Kuan,Tai-Chuan, AU - Chang,Shih-Ching, AU - Lin,Jen-Kou, AU - Lin,Tzu-Chen, AU - Yang,Shung-Haur, AU - Jiang,Jeng-Kae, AU - Chen,Wei-Shone, AU - Wang,Huann-Sheng, AU - Lan,Yuan-Tzu, AU - Lin,Chun-Chi, AU - Lin,Hung-Hsin, AU - Huang,Sheng-Chieh, Y1 - 2019/09/12/ PY - 2019/9/14/entrez JF - World journal of surgery JO - World J Surg N2 - BACKGROUND: Patients with stage II colorectal cancer (CRC) have a higher risk of recurrence when they have certain risk factors, including clinical and pathological patterns. However, as the prognostic role of molecular patterns for stage II disease is still unclear, this study aimed to investigate it. METHODS: A total of 509 patients with stage II CRC were enrolled, and all clinical, pathological, and molecular data were collected. Molecular patterns included microsatellite instability (MSI); elevated microsatellite alterations at selected tetranucleotides (EMAST) status; and expression of RAS/RAF genes, genes of the APC pathway, and other gene mutations. The endpoints were oncological outcomes, including overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), local recurrence (LR), and distant recurrence (DR). Cox regression analysis was used. RESULTS: Numerous molecular patterns influenced the oncological outcomes on univariate analysis, but no variable reached significance in LR. On multivariate analysis, a mucinous component (MC) > 50% (P < 0.01) was significant for OS and CSS. Lymphovascular invasion (LVI; P< 0.01), MC > 50% (P < 0.01), and EMAST-H (P = 0.02) significantly influenced DFS, whereas LVI (P < 0.01), MC > 50% (P < 0.01), and TP53 mutation (P = 0.02) were significant for DR. CONCLUSIONS: In this study, MSI, EMAST, and RAS/RAF alterations did not influence the oncological outcomes. Overall, LVI and MC were two significant prognostic factors for DFS and DR. Thus, the histopathology, rather than the genes, plays a major role in the prognosis of patients with stage II CRC. SN - 1432-2323 UR - https://www.unboundmedicine.com/medline/citation/31515570/Prognosticators_of_Long-Term_Outcomes_of_TNM_Stage_II_Colorectal_Cancer:_Molecular_Patterns_or_Clinicopathological_Features L2 - https://dx.doi.org/10.1007/s00268-019-05158-w DB - PRIME DP - Unbound Medicine ER -