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. 2013 Dec;139(12):2013-20.
doi: 10.1007/s00432-013-1521-2. Epub 2013 Sep 26.

The relationship between genetic profiling, clinicopathological factors and survival in patients undergoing surgery for node-negative colorectal cancer: 10-year follow-up

Arfon G M T Powell  1 , Jenny Ferguson, Fahd Al-Mulla, Clare Orange, Donald C McMillan, Paul G Horgan, Joanne Edwards, James J Going
Affiliations

The relationship between genetic profiling, clinicopathological factors and survival in patients undergoing surgery for node-negative colorectal cancer: 10-year follow-up

Arfon G M T Powell et al. J Cancer Res Clin Oncol. 2013 Dec.

Abstract

Purpose: The introduction of the bowel cancer screening programme has resulted in increasing numbers of patients being diagnosed with node-negative disease. Unfortunately, approximately 30 % will develop recurrence following surgery. Given the toxicity associated with adjuvant chemotherapy, it is important to identify high-risk patients who may benefit from adjuvant therapy. This study aims to identify which clinicopathological factors and genetic profiling markers predict outcome in node-negative disease.

Methods: Forty-nine microsatellite stable (MSS) patients undergoing curative resection between 1991 and 1993 were included. Local immune response was assessed by Klintrup criteria and vascular invasion status assessed through Miller's elastin staining. Comparative genomic hybridisation (CGH) on a range of loci provided data on allelic imbalance. Analysis of survival included clinicopathological and CGH data in a multivariate (Cox) model.

Results: On binary logistical regression analysis, 4p deletion was independently associated with low Klintrup score (HR 0.16; 95 % CI (0.03-0.96); P = 0.045), venous invasion (HR 4.19; 95 % CI (1.08-16.29); P = 0.039) and higher Dukes' stage (HR 6.43; 95 % CI (1.22-33.97); P = 0.028). Minimum follow-up was 109 months and there were 24 cancer deaths. On multivariate analysis, high Klintrup score (HR 0.33; 95 % CI (0.12-0.93); P = 0.036), 4p- (HR 4.01; 95 % CI (1.58-10.21); P = 0.004) and 5q- (HR 3.81; 95 % CI (1.54-9.47); P = 0.004) were significantly associated with survival.

Conclusion: 4p-, 5q- and low Klintrup score were independently associated with poor cancer-specific survival in node-negative MSS colorectal cancer. Confirmatory work in a larger cohort is needed to determine whether these markers may be used to identify patients who may benefit from adjuvant chemotherapy.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Haematoxylin and eosin section of a patient with a good Klintrup score, b patient with a poor Klintrup score, c elastica H+E demonstrating vascular invasion, d a routine H+E counterpart
Fig. 2
Fig. 2
Kaplan–Meier graph a the relationship between vascular invasion and cancer-specific survival, b Klintrup score and cancer-specific survival and c 4p5q− score and cancer-specific survival in patients undergoing potentially curative resection for node-negative microsatellite stable colorectal rectal cancer
See this image and copyright information in PMC

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