ABSTRACT
BACKGROUND: Cholangiocarcinoma (CCA) is still a deadly tumour. Histological and molecular aspects of thioacetamide (TAA)-induced intrahepatic CCA (iCCA) in rats mimic those of human iCCA. Carcinogenic changes and therapeutic vulnerabilities in CCA may be captured by molecular investigations in bile, where we performed bile proteomic and metabolomic analyses that help discovery yet unknown pathways relevant to human iCCA. METHODS: Cholangiocarcinogenesis was induced in rats (TAA) and mice (JnkΔhepa + CCl4 + DEN model). We performed proteomic and metabolomic analyses in bile from control and CCA-bearing rats. Differential expression was validated in rat and human CCAs. Mechanisms were addressed in human CCA cells, including Huh28-KRASG12D cells. Cell signaling, growth, gene regulation and [U-13C]-D-glucose-serine fluxomics analyses were performed. In vivo studies were performed in the clinically-relevant iCCA mouse model. RESULTS: Pathways related to inflammation, oxidative stress and glucose metabolism were identified by proteomic analysis. Oxidative stress and high amounts of the oncogenesis-supporting amino acids serine and glycine were discovered by metabolomic studies. Most relevant hits were confirmed in rat and human CCAs (TCGA). Activation of interleukin-6 (IL6) and epidermal growth factor receptor (EGFR) pathways, and key genes in cancer-related glucose metabolic reprogramming, were validated in TAA-CCAs. In TAA-CCAs, G9a, an epigenetic pro-tumorigenic writer, was also increased. We show that EGFR signaling and mutant KRASG12D can both activate IL6 production in CCA cells. Furthermore, phosphoglycerate dehydrogenase (PHGDH), the rate-limiting enzyme in serine-glycine pathway, was upregulated in human iCCA correlating with G9a expression. In a G9a activity-dependent manner, KRASG12D promoted PHGDH expression, glucose flow towards serine synthesis, and increased CCA cell viability. KRASG12D CAA cells were more sensitive to PHGDH and G9a inhibition than controls. In mouse iCCA, G9a pharmacological targeting reduced PHGDH expression. CONCLUSIONS: In CCA, we identified new pro-tumorigenic mechanisms: Activation of EGFR signaling or KRAS mutation drives IL6 expression in tumour cells; Glucose metabolism reprogramming in iCCA includes activation of the serine-glycine pathway; Mutant KRAS drives PHGDH expression in a G9a-dependent manner; PHGDH and G9a emerge as therapeutic targets in iCCA.
Subject(s)
Bile Duct Neoplasms , Cholangiocarcinoma , Animals , Arachnodactyly , Bile Duct Neoplasms/genetics , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/metabolism , Bile Ducts, Intrahepatic/pathology , Carcinogenesis/genetics , Cholangiocarcinoma/pathology , Contracture , Epigenesis, Genetic , ErbB Receptors/genetics , ErbB Receptors/metabolism , Glucose , Glycine/metabolism , Humans , Interleukin-6/genetics , Interleukin-6/metabolism , Mice , Phosphoglycerate Dehydrogenase/genetics , Proteomics , Proto-Oncogene Proteins p21(ras)/genetics , Proto-Oncogene Proteins p21(ras)/metabolism , Rats , Serine/metabolismABSTRACT
BACKGROUND: Biliary tract cancers (BTC) are rare but highly aggressive tumours with poor prognosis, usually detected at advanced stages. Herein, we aimed at identifying BTC-specific DNA methylation alterations. METHODS: Study design included statistical power and sample size estimation. A genome-wide methylation study of an explorative cohort (50 BTC and ten matched non-tumoral tissue samples) has been performed. BTC-specific altered CpG islands were validated in over 180 samples (174 BTCs and 13 non-tumoral controls). The final biomarkers, selected by a machine-learning approach, were validated in independent tissue (18 BTCs, 14 matched non-tumoral samples) and bile (24 BTCs, five non-tumoral samples) replication series, using droplet digital PCR. RESULTS: We identified and successfully validated BTC-specific DNA methylation alterations in over 200 BTC samples. The two-biomarker panel, selected by an in-house algorithm, showed an AUC > 0.97. The best-performing biomarker (chr2:176993479-176995557), associated with HOXD8, a pivotal gene in cancer-related pathways, achieved 100% sensitivity and specificity in a new series of tissue and bile samples. CONCLUSIONS: We identified a novel fully efficient BTC biomarker, associated with HOXD8 gene, detectable both in tissue and bile by a standardised assay ready-to-use in clinical trials also including samples from non-invasive matrices.
Subject(s)
Biliary Tract Neoplasms , DNA Methylation , Homeodomain Proteins , Transcription Factors , Bile , Biliary Tract Neoplasms/genetics , Biliary Tract Neoplasms/pathology , Biomarkers, Tumor/genetics , Homeodomain Proteins/genetics , Humans , Mutation , Transcription Factors/geneticsABSTRACT
One of the critical issues to warrant the success of a proteome-wide analysis is sample preparation. Efficient protein extraction in the absence of interferent material is mandatory to achieve an ample proteome coverage by mass spectrometry. The study of biological fluids is always challenging due to their specific biochemical composition. However, there is increasing interest in their characterization as it will provide proteins that may advice disease setting, state, and progression. In particular, bile is proximal to liver and pancreas, and its study is especially attractive since it might provide valuable information for the clinical management of severe diseases afflicting these organs, which are at an urgent need of new biomarkers. Though previous efforts have been made to optimize protocols to analyze bile proteome, only partial descriptions were achieved due to its complex composition, where proteins represent less than 5% of the organic components. Here we describe a new method that significantly increases the bile proteome coverage while reducing by a factor of six the amount of sample required for the proteomic analysis.
Subject(s)
Proteome , Proteomics , Bile , Biomarkers , Mass SpectrometryABSTRACT
OBJECTIVE: Despite significant progresses in imaging and pathological evaluation, early differentiation between benign and malignant biliary strictures remains challenging. Endoscopic retrograde cholangiopancreatography (ERCP) is used to investigate biliary strictures, enabling the collection of bile. We tested the diagnostic potential of next-generation sequencing (NGS) mutational analysis of bile cell-free DNA (cfDNA). DESIGN: A prospective cohort of patients with suspicious biliary strictures (n=68) was studied. The performance of initial pathological diagnosis was compared with that of the mutational analysis of bile cfDNA collected at the time of first ERCP using an NGS panel open to clinical laboratory implementation, the Oncomine Pan-Cancer Cell-Free assay. RESULTS: An initial pathological diagnosis classified these strictures as of benign (n=26), indeterminate (n=9) or malignant (n=33) origin. Sensitivity and specificity of this diagnosis were 60% and 100%, respectively, as on follow-up 14 of the 26 and eight of the nine initially benign or indeterminate strictures resulted malignant. Sensitivity and specificity for malignancy of our NGS assay, herein named Bilemut, were 96.4% and 69.2%, respectively. Importantly, one of the four Bilemut false positives developed pancreatic cancer after extended follow-up. Remarkably, the sensitivity for malignancy of Bilemut was 100% in patients with an initial diagnosis of benign or indeterminate strictures. Analysis of 30 paired bile and tissue samples also demonstrated the superior performance of Bilemut. CONCLUSION: Implementation of Bilemut at the initial diagnostic stage for biliary strictures can significantly improve detection of malignancy, reduce delays in the clinical management of patients and assist in selecting patients for targeted therapies.
Subject(s)
Bile Duct Neoplasms , Cell-Free Nucleic Acids , Cholestasis , Bile , Bile Duct Neoplasms/diagnosis , Bile Duct Neoplasms/genetics , Bile Duct Neoplasms/pathology , Cholangiopancreatography, Endoscopic Retrograde , Cholestasis/etiology , Cholestasis/genetics , Constriction, Pathologic/diagnosis , Early Detection of Cancer , High-Throughput Nucleotide Sequencing , Humans , Prospective Studies , Sensitivity and SpecificityABSTRACT
The analysis of biological fluids to identify proteins that may indicate a disease setting, state and progression, is an increasingly explored field. Despite the expectatives created, there are several hurdles that must be solved to reach an extensive proteome coverage using mass spectrometry, mainly due to the complex composition of the matrices. In this regard, bile is specially challenging and yet, very attractive, as a proximal fluid that might provide valuable information for the management of liver and pancreas associated diseases. Proteins account for less than 5% of bile organic components and, although optimized protocols for protein extraction have been developed, only partial descriptions of bile proteome have been achieved. In this manuscript a new procedure is described that significantly improves protein recovery from rat bile, which reduces by a factor of six the sample amount required for a typical proteomics analysis. Moreover, the number of proteins reliably identified in a single nanoLC-MS/MS run from 1 µg protein was increased by three-fold. This procedure provides a valuable resource to dig deeper into the molecular composition of bile and open new avenues to identify new hallmarks of disease such as cholangiocarcinoma, hepatocellular carcinoma and pancreatic cancer for their better clinical management.
Subject(s)
Bile Duct Neoplasms , Liver Neoplasms , Animals , Bile , Bile Ducts, Intrahepatic , Proteome , Rats , Tandem Mass SpectrometryABSTRACT
BACKGROUND AND AIMS: Cholangiocarcinoma (CCA) is a devastating disease often detected at advanced stages when surgery cannot be performed. Conventional and targeted systemic therapies perform poorly, and therefore effective drugs are urgently needed. Different epigenetic modifications occur in CCA and contribute to malignancy. Targeting epigenetic mechanisms may thus open therapeutic opportunities. However, modifications such as DNA and histone methylation often coexist and cooperate in carcinogenesis. We tested the therapeutic efficacy and mechanism of action of a class of dual G9a histone-methyltransferase and DNA-methyltransferase 1 (DNMT1) inhibitors. APPROACH AND RESULTS: Expression of G9a, DNMT1, and their molecular adaptor, ubiquitin-like with PHD and RING finger domains-1 (UHRF1), was determined in human CCA. We evaluated the effect of individual and combined pharmacological inhibition of G9a and DNMT1 on CCA cell growth. Our lead G9a/DNMT1 inhibitor, CM272, was tested in human CCA cells, patient-derived tumoroids and xenograft, and a mouse model of cholangiocarcinogenesis with hepatocellular deletion of c-Jun-N-terminal-kinase (Jnk)-1/2 and diethyl-nitrosamine (DEN) plus CCl4 treatment (JnkΔhepa + DEN + CCl4 mice). We found an increased and correlative expression of G9a, DNMT1, and UHRF1 in CCAs. Cotreatment with independent pharmacological inhibitors G9a and DNMT1 synergistically inhibited CCA cell growth. CM272 markedly reduced CCA cell proliferation and synergized with Cisplatin and the ERBB-targeted inhibitor, Lapatinib. CM272 inhibited CCA tumoroids and xenograft growth and significantly antagonized CCA progression in JnkΔhepa + DEN + CCl4 mice without apparent toxicity. Mechanistically, CM272 reprogrammed the tumoral metabolic transcriptome and phenotype toward a differentiated and quiescent status. CONCLUSIONS: Dual targeting of G9a and DNMT1 with epigenetic small molecule inhibitors such as CM272 is a potential strategy to treat CCA and/or enhance the efficacy of other systemic therapies.
Subject(s)
Bile Duct Neoplasms , Cell Proliferation/drug effects , Cholangiocarcinoma , DNA (Cytosine-5-)-Methyltransferase 1 , Enzyme Inhibitors/pharmacology , Histocompatibility Antigens , Histone-Lysine N-Methyltransferase , Animals , Bile Duct Neoplasms/drug therapy , Bile Duct Neoplasms/metabolism , CCAAT-Enhancer-Binding Proteins/metabolism , Cell Line, Tumor , Cholangiocarcinoma/drug therapy , Cholangiocarcinoma/metabolism , DNA (Cytosine-5-)-Methyltransferase 1/antagonists & inhibitors , DNA (Cytosine-5-)-Methyltransferase 1/metabolism , DNA Methylation/drug effects , DNA Methylation/physiology , Epigenesis, Genetic/drug effects , Gene Expression Regulation, Neoplastic/drug effects , Histocompatibility Antigens/metabolism , Histone Code/drug effects , Histone Code/physiology , Histone-Lysine N-Methyltransferase/antagonists & inhibitors , Histone-Lysine N-Methyltransferase/metabolism , Humans , Mice , Treatment Outcome , Ubiquitin-Protein Ligases/metabolism , Xenograft Model Antitumor Assays/methodsABSTRACT
Liver fibrosis, a common hallmark of chronic liver disease (CLD), is characterized by the accumulation of extracellular matrix secreted by activated hepatic fibroblasts and stellate cells (HSC). Fibrogenesis involves multiple cellular and molecular processes and is intimately linked to chronic hepatic inflammation. Importantly, it has been shown to promote the loss of liver function and liver carcinogenesis. No effective therapies for liver fibrosis are currently available. We examined the anti-fibrogenic potential of a new drug (CM414) that simultaneously inhibits histone deacetylases (HDACs), more precisely HDAC1, 2, and 3 (Class I) and HDAC6 (Class II) and stimulates the cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG) pathway activity through phosphodiesterase 5 (PDE5) inhibition, two mechanisms independently involved in liver fibrosis. To this end, we treated Mdr2-KO mice, a clinically relevant model of liver inflammation and fibrosis, with our dual HDAC/PDE5 inhibitor CM414. We observed a decrease in the expression of fibrogenic markers and collagen deposition, together with a marked reduction in inflammation. No signs of hepatic or systemic toxicity were recorded. Mechanistic studies in cultured human HSC and cholangiocytes (LX2 and H69 cell lines, respectively) demonstrated that CM414 inhibited pro-fibrogenic and inflammatory responses, including those triggered by transforming growth factor ß (TGFß). Our study supports the notion that simultaneous targeting of pro-inflammatory and fibrogenic mechanisms controlled by HDACs and PDE5 with a single molecule, such as CM414, can be a new disease-modifying strategy.
ABSTRACT
Background and study aims The etiology of idiopathic acute pancreatitis (IAP) should always be defined. Our aim was to compare the diagnostic value of endoscopic ultrasound (EUS) versus secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) in patients with IAP. Patients and Methods Patients admitted to a single tertiary care University hospital with IAP were invited to participate in the study. Enrolled patients underwent EUS and S-MRCP in a single-blinded comparative study. EUS and S-MRCP were performed no sooner than 4 weeks after discharge. The diagnostic yield of EUS and S-MRCP and demographic variables were included in the analysis. Additional follow-up, results of subsequent serology, radiographic exams, and relevant histological analysis were considered in determination of the final diagnosis. Results A total of 34 patients were enrolled; EUS was normal in six, cholelithiasis was defined in 15, choledocholithiasis in two, pancreas divisum in three, branch-type intraductal papillary mucinous tumor (IPMT) in three, and chronic pancreatitis in five. S-MRCP identified choledocholithiasis in one, divisum in four, branch-type IPMT in three, chronic pancreatitis in two; 24 subjects diagnosed as normal by S-MRCP. Diagnostic correlation between EUS and S-MRCP was slight (kappaâ=â0.236, 95â% confidence interval: 0.055-0.416). EUS provided a statistically significantly higher diagnostic yield than S-MRCP: 79.4â% (CI95â%: 65â%-94â%) vs 29.4â% (CI95â%: 13â%-46â%) (Pâ=â0.0002). The sensitivity, specificity, and positive and negative predictive values of EUS and S-MRCP were 90â%, 80â%, 96â%, 57â% and 33â%, 100â%, 100â% and 16â%, respectively. Conclusion The diagnostic yield of EUS is higher than S-MRCP in patients with IAP.
ABSTRACT
Chronic liver diseases (CLD) represent a worldwide health problem. While CLDs may have diverse etiologies, a common pathogenic denominator is the presence of liver fibrosis. Cirrhosis, the end-stage of CLD, is characterized by extensive fibrosis and is markedly associated with the development of hepatocellular carcinoma. The most important event in hepatic fibrogenesis is the activation of hepatic stellate cells (HSC) following liver injury. Activated HSCs acquire a myofibroblast-like phenotype becoming proliferative, fibrogenic, and contractile cells. While transient activation of HSCs is part of the physiological mechanisms of tissue repair, protracted activation of a wound healing reaction leads to organ fibrosis. The phenotypic changes of activated HSCs involve epigenetic mechanisms mediated by non-coding RNAs (ncRNA) as well as by changes in DNA methylation and histone modifications. During CLD these epigenetic mechanisms become deregulated, with alterations in the expression and activity of epigenetic modulators. Here we provide an overview of the epigenetic alterations involved in fibrogenic HSCs transdifferentiation with particular focus on histones acetylation changes. We also discuss recent studies supporting the promising therapeutic potential of histone deacetylase inhibitors in liver fibrosis.
Subject(s)
Epigenesis, Genetic , Histone Deacetylases/metabolism , Liver Cirrhosis/drug therapy , Liver Cirrhosis/genetics , Molecular Targeted Therapy , Animals , DNA Methylation/drug effects , DNA Methylation/genetics , Epigenesis, Genetic/drug effects , Histone Deacetylase Inhibitors/pharmacology , Histone Deacetylase Inhibitors/therapeutic use , HumansABSTRACT
Cholangiocarcinoma (CCA) and pancreatic adenocarcinoma (PDAC) may lead to the development of extrahepatic obstructive cholestasis. However, biliary stenoses can also be caused by benign conditions, and the identification of their etiology still remains a clinical challenge. We performed metabolomic and proteomic analyses of bile from patients with benign (n = 36) and malignant conditions, CCA (n = 36) or PDAC (n = 57), undergoing endoscopic retrograde cholangiopancreatography with the aim of characterizing bile composition in biliopancreatic disease and identifying biomarkers for the differential diagnosis of biliary strictures. Comprehensive analyses of lipids, bile acids and small molecules were carried out using mass spectrometry (MS) and nuclear magnetic resonance spectroscopy (1H-NMR) in all patients. MS analysis of bile proteome was performed in five patients per group. We implemented artificial intelligence tools for the selection of biomarkers and algorithms with predictive capacity. Our machine-learning pipeline included the generation of synthetic data with properties of real data, the selection of potential biomarkers (metabolites or proteins) and their analysis with neural networks (NN). Selected biomarkers were then validated with real data. We identified panels of lipids (n = 10) and proteins (n = 5) that when analyzed with NN algorithms discriminated between patients with and without cancer with an unprecedented accuracy.
ABSTRACT
Single gallbladder injury after abdominal trauma is a rare finding. Early diagnosis of this disease is often difficult due to the variability of symptoms and unspecific results in the usual radiological tests. The usual management in patients with vesical trauma is surgery. We report a case of a patient with a gallbladder perforation after closed thoracoabdominal trauma diagnosed and treated with ERCP and a conservative management with good clinical evolution.
Subject(s)
Gallbladder/injuries , Cholangiopancreatography, Endoscopic Retrograde , Gallbladder/diagnostic imaging , Gallbladder/surgery , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Cholangiopancreatography, Endoscopic Retrograde , Abdominal Injuries/complications , Abdominal Injuries/surgery , Gallbladder/injuries , Gallbladder/surgery , Gallbladder , Ascites/drug therapy , Ascites/pathology , Ascites , Sphincterotomy, Endoscopic , Piperacillin/therapeutic useABSTRACT
INTRODUCCIÓN: Los pólipos serrados (PS) grandes, PS proximales, PS con displasia y la presencia de múltiples adenomas sésiles serrados (P/ASS), que englobamos bajo el término PS con riesgo aumentado de lesiones metacrónicas (PSRALM), se asocian a un mayor riesgo de presentar dichas lesiones, pero desconocemos si también se asocian a un mayor riesgo de neoplasia avanzada de colon (NA) sincrónica. OBJETIVO: Estimar la prevalencia de PSRALM y evaluar la asociación con NA sincrónica. MÉTODOS: Se trata de un estudio transversal de base poblacional que incluyó a todos los pacientes (1.538) con diagnostico histológico de PS de muestras procedentes de colonoscopias, rectosigmoidoscopias e intervenciones quirúrgicas de los hospitales públicos del Servicio Navarro de Salud durante el año 2011. Se analizaron parámetros demográficos y presencia de lesiones sincrónicas de colon (adenomas, adenomas avanzados [AA] y NA) RESULTADOS: La cuarta parte de los pacientes (384) presentaron PSRALM, con una edad media más avanzada, un ligero predominio en mujeres y sin diferencias en cuanto al IMC respecto a los pacientes sin PSRALM. En el análisis multivariante el grupo PSRALM presentó un mayor riesgo de AA y NA sincrónicos (OR: 2,38 [1,77-3,21] y OR: 2,29 [1,72-3,05] respectivamente) y en el caso de NA, este riesgo fue estadísticamente significativo en ambas localizaciones (proximal y distal), con OR superior para la proximal. Los distintos subtipos de PSRALM presentaron un mayor riesgo de AA y NA sincrónicos. CONCLUSIÓN: Los PSRALM fueron frecuentes entre los pacientes con PS y se asociaron a un mayor riesgo de presentar NA sincrónica
INTRODUCTION: Large serrated polyps (SP), proximal SP, SP with dysplasia and the presence of multiple sessile serrated adenomas/polyps (SSA/P), which we refer to as SP with increased risk of metachronous lesions (SPIRML), have been associated with an increased risk of advanced colon lesions on follow-up. It is unclear, however, whether SPIRML are also associated with an increased risk of synchronous advanced colorectal neoplasia (ACN). AIM: The aim of this study was to estimate the prevalence of SPIRML and to evaluate the association between SPIRML and synchronous ACN. METHODS: A cross-sectional population-based study in all patients (1,538) with histological diagnosis of SP obtained from colonoscopies, sigmoidoscopies and colonic surgery performed in Navarra Health Service hospitals (Spain) in 2011. Demographic parameters and synchronous colonic lesions (adenomas, advanced adenomas [AA] and ACN) were analyzed. RESULTS: One fourth of the sample (384 patients) presented SPIRML. These were older patients, with a slight predominance of women, and with no differences in body mass index (BMI) compared to patients without SPIRML. In the univariate analysis, patients with SPIRML showed an increased risk of adenoma, AA and ACN. In the multivariate analysis, the SPIRML group had a higher risk of synchronous AA and ACN (odds ratio [OR]: 2.38 [1.77-3.21] and OR: 2.29 [1.72-3.05], respectively); in the case of ACN, this risk was statistically significant in both locations (proximal or distal), with OR slightly higher for the proximal location. Different subtypes of SPIRML had a higher risk of AA and synchronous NA. CONCLUSION: SPIRML were common in patients with SP, and their presence was associated with an increased risk of synchronous CAN
Subject(s)
Humans , Intestinal Polyposis/pathology , Colonic Neoplasms/pathology , Neoplasms, Second Primary/pathology , Adenoma/pathology , Cross-Sectional Studies , Colorectal Neoplasms/pathology , Disease ProgressionABSTRACT
INTRODUCCIÓN: La alteración en la expresión nuclear de proteínas de los genes reparadores del ADN valorada mediante inmunohistoquímica (IHQ) en el tejido tumoral es una técnica útil como cribado de síndrome de Lynch (SL). Una revisión reciente propone realizar este cribado no solo sobre todos los cánceres colorrectales (CCR) diagnosticados, sino también sobre adenomas avanzados (AA), especialmente en pacientes jóvenes. OBJETIVO: Evaluación de la prevalencia de IHQ alterada realizada sobre todos los adenomas con displasia de alto grado (DAG) diagnosticados en nuestra comunidad durante 2011, y descripción de las variables asociadas a su alteración. MÉTODOS: Se incluyeron todos los casos de pólipos adenomatosos con DAG diagnosticados desde los 3 laboratorios de anatomía patológica públicos de Navarra durante el año 2011, y se realizó un estudio estadístico para medir la asociación de diferentes variables, tanto de los pacientes como de las lesiones con la presencia de IHQ alterada. RESULTADOS: Se diagnosticaron 213 adenomas de colon con DAG, excluyéndose del análisis posterior 26 (12,2%) casos (2 SL ya diagnosticados, 22 casos sin estudio IHQ y 2 casos con IHQ no valorable), siendo el número final 187. Se encontraron hallazgos patológicos en 10 casos, suponiendo el 5,35%: 6 casos en MLH1 y PMS2, 2 casos en PMS2, un caso en MSH6 y un caso en MSH2 y MSH6. La presencia sincrónica de CCR, la presencia de un único AA, la localización proximal de la DAG y la edad < 50 años resultaron estadísticamente significativos en la asociación de dichas variables, con la expresión anómala de proteínas nucleares. CONCLUSIONES: El porcentaje de expresión nuclear patológica hallado en la IHQ es elevado, por lo que podría estar indicado realizar screening de rutina con IHQ en todas las DAG diagnosticadas, especialmente en pacientes jóvenes, con un único AA y con DAG proximal
INTRODUCTION: Alteration of mismatch repair system protein expression detected by immunohistochemistry (IHQ) in tumoural tissue is a useful technique for Lynch Syndrome (LS) screening. A recent review proposes LS screening through immunohistochemical study not only in all diagnosed cases of colorectal cancer (CRC) but also in advanced adenomas, especially in young patients. OBJECTIVE: To assess the prevalence of altered IHQ carried out in all adenomas with high-grade dysplasia (HGD) diagnosed in our community in 2011, as well as the variables associated with this alteration. METHODS: We included all the cases of adenomatous polyps with HGD diagnosed in the three public pathology laboratories of Navarre during 2011 and performed a statistical study to assess the association between different patient and lesion characteristics and altered IHQ results. RESULTS: A total of 213 colonic adenomas with HGD were diagnosed, and 26 (12.2%) cases were excluded from the final analysis (2 known LS, 22 without IHQ study and 2 with inconclusive IHQ studies). The final number of adenomas included was 187. Pathologic results were found in 10 cases (5.35%)-6 cases in MLH1 and PMS2, 2 cases in PMS2, 1 case in MSH6 and 1 case in MSH2 and MSH6. The factors showing a statistically significant association with the presence of abnormal proteins were the synchronous presence of CRC, the presence of only one advanced adenoma, proximal location of HGD and age < 50 years. CONCLUSIONS: The percentage of pathologic nuclear expression found in IHQ is high. Consequently, screening of all diagnosed HGD could be indicated, especially in young patients, with a single AA and proximal HGD
Subject(s)
Humans , DNA Repair , Immunohistochemistry/methods , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Genetic Markers , Adenoma/pathology , Biomarkers, Tumor/analysisABSTRACT
INTRODUCTION: Large serrated polyps (SP), proximal SP, SP with dysplasia and the presence of multiple sessile serrated adenomas/polyps (SSA/P), which we refer to as SP with increased risk of metachronous lesions (SPIRML), have been associated with an increased risk of advanced colon lesions on follow-up. It is unclear, however, whether SPIRML are also associated with an increased risk of synchronous advanced colorectal neoplasia (ACN). AIM: The aim of this study was to estimate the prevalence of SPIRML and to evaluate the association between SPIRML and synchronous ACN. METHODS: A cross-sectional population-based study in all patients (1,538) with histological diagnosis of SP obtained from colonoscopies, sigmoidoscopies and colonic surgery performed in Navarra Health Service hospitals (Spain) in 2011. Demographic parameters and synchronous colonic lesions (adenomas, advanced adenomas [AA] and ACN) were analyzed. RESULTS: One fourth of the sample (384 patients) presented SPIRML. These were older patients, with a slight predominance of women, and with no differences in body mass index (BMI) compared to patients without SPIRML. In the univariate analysis, patients with SPIRML showed an increased risk of adenoma, AA and ACN. In the multivariate analysis, the SPIRML group had a higher risk of synchronous AA and ACN (odds ratio [OR]: 2.38 [1.77-3.21] and OR: 2.29 [1.72-3.05], respectively); in the case of ACN, this risk was statistically significant in both locations (proximal or distal), with OR slightly higher for the proximal location. Different subtypes of SPIRML had a higher risk of AA and synchronous NA. CONCLUSION: SPIRML were common in patients with SP, and their presence was associated with an increased risk of synchronous ACN.
Subject(s)
Adenocarcinoma/epidemiology , Adenoma/epidemiology , Colonic Polyps/epidemiology , Colorectal Neoplasms/epidemiology , Neoplasms, Multiple Primary/epidemiology , Adenocarcinoma/pathology , Adenoma/pathology , Aged , Aged, 80 and over , Colonic Polyps/pathology , Colorectal Neoplasms/pathology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neoplasm Staging , Neoplasms, Multiple Primary/pathology , Prevalence , Retrospective Studies , Risk Factors , Spain/epidemiologyABSTRACT
INTRODUCTION: Alteration of mismatch repair system protein expression detected by immunohistochemistry (IHQ) in tumoural tissue is a useful technique for Lynch Syndrome (LS) screening. A recent review proposes LS screening through immunohistochemical study not only in all diagnosed cases of colorectal cancer (CRC) but also in advanced adenomas, especially in young patients. OBJECTIVE: To assess the prevalence of altered IHQ carried out in all adenomas with high-grade dysplasia (HGD) diagnosed in our community in 2011, as well as the variables associated with this alteration. METHODS: We included all the cases of adenomatous polyps with HGD diagnosed in the three public pathology laboratories of Navarre during 2011 and performed a statistical study to assess the association between different patient and lesion characteristics and altered IHQ results. RESULTS: A total of 213 colonic adenomas with HGD were diagnosed, and 26 (12.2%) cases were excluded from the final analysis (2 known LS, 22 without IHQ study and 2 with inconclusive IHQ studies). The final number of adenomas included was 187. Pathologic results were found in 10 cases (5.35%)-6 cases in MLH1 and PMS2, 2 cases in PMS2, 1 case in MSH6 and 1 case in MSH2 and MSH6. The factors showing a statistically significant association with the presence of abnormal proteins were the synchronous presence of CRC, the presence of only one advanced adenoma, proximal location of HGD and age <50 years. CONCLUSIONS: The percentage of pathologic nuclear expression found in IHQ is high. Consequently, screening of all diagnosed HGD could be indicated, especially in young patients, with a single AA and proximal HGD.
Subject(s)
Adenoma/enzymology , Colonic Neoplasms/enzymology , Colonic Polyps/enzymology , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , DNA Mismatch Repair , DNA Repair Enzymes/analysis , Adenoma/pathology , Adenomatous Polyps/enzymology , Adenomatous Polyps/pathology , Adult , Aged , Antibodies, Monoclonal , Colonic Neoplasms/pathology , Colonic Polyps/pathology , Colorectal Neoplasms, Hereditary Nonpolyposis/enzymology , Colorectal Neoplasms, Hereditary Nonpolyposis/epidemiology , Female , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Proteins/analysis , Prevalence , Retrospective Studies , RiskABSTRACT
INTRODUCCIÓN: La albúmina forma parte de la respuesta sistémica inflamatoria antitumoral, por lo que analizaremos su valor en el pronóstico pre-operatorio del carcinoma colorrectal (CCR).Pacientes y métodos Estudio retrospectivo y observacional de una serie de CCR resecados consecutiva y programadamente. Efectuamos un análisis estadístico univariante y multivariante de la supervivencia entre los casos con y sin hipoalbuminemia pretratamiento (< 3,5 g/dl), globalmente y en el subgrupo en estadio pTNM II . Adicionalmente, comparamos el índice de mortalidad debida al tumor a los 5 años entre los casos con y sin hipoalbuminemia. Resultados Revisamos 207 pacientes (mediana de seguimiento: 81 meses). En el análisis multivariante global los casos con normoalbuminemia presentaron unas curvas de supervivencia superiores a las de los pacientes con hipoalbuminemia: (HR = 2,82; IC 95% = [1,54-5,19]; p = 0,001). Este mejor pronóstico de la normoalbuminemia se mantiene en el estadio pTNM II: (HR = 3,76; IC 95% = [1,40-10,08]; p = 0,009). El índice de mortalidad a los 5 años fue inferior en los casos con normoalbuminemia: global=18,8 versus 42,9% (OR = 3,24; IC 95% = [1,48-7,12]; p = 0,001); estadio pTNM II=13,3 versus 44,4% (OR = 5,2; IC 95% = [1,36-20,34]; p = 0,004). CONCLUSIÓN: Una hipoalbuminemia pre-tratamiento < 3,5g/dl se relaciona, de modo independiente, con una menor supervivencia tras la resección, tanto globalmente como en los CCR en estadio pTNM II. De confirmarse estos resultados la hipoalbuminemia constituiría un sencillo y significativo marcador de mal pronóstico, disponible desde el momento del diagnóstico
INTRODUCTION: Albuminemia is part of the antitumoral systemic inflammatory response. We therefore analyzed its possible value in establishing the preoperative prognosis of colorectal carcinoma (CRC). PATIENTS AND METHODS: We conducted a retrospective, observational study of a series of consecutive patients who underwent CRC resection. Univariate and multivariate analyses of survival curves were performed in patients with and without pre-treatment hypoalbuminemia (< 3.5 g/dl), both in the overall group of patients and in the subgroup of those with pTNM stage II tumors. In addition, we compared the 5-year tumor-related mortality in patients with and without hypoalbuminemia. RESULTS: A total of 207 patients were reviewed (median follow-up: 81 months). In the overall multivariate analysis, survival curves were better in patients with normal albumin levels than in those with hypoalbuminemia (HR = 2.82; CI 95% = [1.54-5.19]; P = .001). This better prognostic value of normal albumin levels was also significant in pTNM stage II tumors: (HR = 3.76; CI 95% = [1.40-10.08]; P = .009). The 5-year mortality index was lower in patients with normal albumin levels: overall series = 18.8% vs 42.9% (OR =3.24; CI 95% = [1.48-7.12]; p = 0.001); pTNM stage ii=13.3% vs 44.4% (OR = 5.2; CI 95% = [1.36-20.34]; P = 0.004). CONCLUSIONS: Pre-treatment hypoalbuminemia (< 3.5 g/dl) was independently related to shorter survival after tumor resection, both in the overall series of patients and in pTNM stage II CRC. If these results are confirmed, hypoalbuminemia would be a simple and significant marker of poor prognosis, available at the initial diagnosis
Subject(s)
Humans , Hypoalbuminemia/diagnosis , Colorectal Neoplasms/diagnosis , Risk Factors , Biomarkers/analysis , Retrospective Studies , Inflammation Mediators/analysis , Inflammation/physiopathology , Survival AnalysisABSTRACT
INTRODUCTION: Albuminemia is part of the antitumoral systemic inflammatory response. We therefore analyzed its possible value in establishing the preoperative prognosis of colorectal carcinoma (CRC). PATIENTS AND METHODS: We conducted a retrospective, observational study of a series of consecutive patients who underwent CRC resection. Univariate and multivariate analyses of survival curves were performed in patients with and without pre-treatment hypoalbuminemia (<3.5g/dl), both in the overall group of patients and in the subgroup of those with pTNM stage ii tumors. In addition, we compared the 5-year tumor-related mortality in patients with and without hypoalbuminemia. RESULTS: A total of 207 patients were reviewed (median follow-up: 81 months). In the overall multivariate analysis, survival curves were better in patients with normal albumin levels than in those with hypoalbuminemia (HR=2.82; CI 95%=[1.54-5.19]; P=.001). This better prognostic value of normal albumin levels was also significant in pTNM stage ii tumors: (HR=3.76; CI 95%=[1.40-10.08]; P=.009). The 5-year mortality index was lower in patients with normal albumin levels: overall series=18.8% vs 42.9% (OR=3.24; CI 95%=[1.48-7.12]; p=0.001); pTNM stage ii=13.3% vs 44.4% (OR=5.2; CI 95%=[1.36-20.34]; P=0.004). CONCLUSIONS: Pre-treatment hypoalbuminemia (<3.5g/dl) was independently related to shorter survival after tumor resection, both in the overall series of patients and in pTNM stage ii CRC. If these results are confirmed, hypoalbuminemia would be a simple and significant marker of poor prognosis, available at the initial diagnosis.