| 1. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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A study of lymph node ratio as a prognostic marker in colon cancer.
- 2008
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Ingår i: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. - : Elsevier BV. - 1532-2157. ; 34:7, s. 771-5
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to evaluate and describe the lymph node ratio (LNR) as a prognostic parameter for patients with colon cancer. As lymphatic involvement is the key, focus was set at stage III disease. Interest was directed at the possibility of identifying high-risk groups and the clinical implementation and consequence. METHOD: The study was retrospective using a database of clinical data of all cancer patients treated at our unit. It has been continuous in registration, inclusion and update since 1999 including survival and clinical features. All patients (n=265) diagnosed with stage III colon cancer during 1999-2003 were included for the study. LNR was calculated and quartile groups were created. LNR and associated parameters were analysed towards 3-year disease-free survival (DFS). Basic patient data as well as surgery, pathology and postoperative treatment were taken into consideration. RESULTS: Significant differences in disease-free survival were found for TNM N-status, tumour differentiation grade and LNR quartile group. There was a difference in 3-year DFS from 80% in LNR group 1 compared with less than 30% in group 4. These results were of prognostic interest both independently and in interaction with each other. High-risk groups could be identified and in the worst prognosis LNR group we also found a tendency towards more side effects with adjuvant chemotherapy. CONCLUSION: The lymph node ratio, the quota between the number of lymph node metastasis and assessed lymph nodes, is a highly significant (p<0.001) prognostic factor in stage III colon cancer. It can be an aid in identifying risk groups that could benefit from a more intense postoperative surveillance and possibly bring changes in adjuvant treatment strategy. More studies of clinical data, genetic and biochemical markers are needed in this patient group to understand the possible difference in tumour behaviour and tailor the treatment.
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| 2. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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A study of lymph node ratio in stage IV colorectal cancer.
- 2008
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Ingår i: World journal of surgical oncology. - : Springer Science and Business Media LLC. - 1477-7819. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: The finding of metastasis in colorectal cancer, stage IV disease, has a major impact on prognosis and treatment strategy. Known important factors include the extent of the metastasis and the patients' performance status. The lymph node factors are of known importance in earlier cancer stages but less described in metastatic disease. The aim of the study was to evaluate lymph node status and ratio as prognostic markers in stage IV colorectal cancer. METHOD: The study was retrospective and assessing all patients operated, with bowel resection, for an initial stage IV colorectal cancer during 1999-2003 (n=136). Basic demographic data as well as given treatment was assessed. The Lymph node ratio (LNR), the quota between the number of lymph node metastasis and assessed lymph nodes, was calculated. LNR groups were created by ratio thirds, 3 equally sized groups. The analysis was made by LNR group and by eligibility for chemotherapy with cancer specific survival as outcome parameter. RESULTS: The median survival (CSS) for the entire group was 431 days with great variability. For the patients eligible for chemotherapy it ranged from 791 days in LNR-group 1 to 433 days for the patients in group 3. For patients ineligible for chemotherapy the corresponding figures were 209 and 91 days. The eligibility for chemotherapy was a major prognostic factor which also takes co-morbidity, age and performance status into consideration. The LNR (p<0.01) and the tumour differentiation grade were also significant (p<0.05) factors regarding survival. The LNR group 3 was also associated with a higher frequency of multiple metastasis locations (p<0.05) and of more side effects with chemotherapy and thus of reductions in dosage or pre-emptive treatment ending (p<0.05). CONCLUSION: Stage IV colorectal cancer is a heterogeneous group regarding the survival prognosis. The lymph node ratio was found to be a significant marker for the survival prognosis (p<0.0049). High and low risk groups could be identified with a survival difference of up to one year. It could be of importance when planning a treatment strategy or evaluating clinical data materials. A pathology report should include a node assessment even at presence of synchronous metastasis.
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| 3. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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A study of the MTHFR gene polymorphism C677T in colorectal cancer.
- 2009
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Ingår i: Clinical colorectal cancer. - 1533-0028. ; 8:1, s. 43-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to examine the clinical significance of the methylenetetrahydrofolate reductase (MTHFR) gene polymorphism C677T in colorectal cancer (CRC). The hypothesis was that the genotype could affect the risk of cancer development and the results of cancer treatment. PATIENTS AND METHODS: Genotyping was made for a random 30% (n = 544) of all patients treated for CRC at our unit from 1999 to 2006 (n = 1812). Basic clinical and pathologic factors were analyzed by genotype group and also compared with those of the entire cohort. Tolerability of chemotherapy and possible side effects were analyzed by genotype. Survival was analyzed by genotype for all stages for patients treated between 1999 and 2003. The genotype prevalence was also compared with a control material of healthy blood donors. RESULTS: No genotype was associated with an increased risk of CRC or higher cancer stage. The patients with CT/TT genotype had significantly greater risk of suffering side effects from fluoropyrimidine (5-fluorouracil) treatment (P < .05). In stage III colon cancer, the patients with CT/TT genotype had a poorer prognosis than those with the CC genotype. The difference was significant in univariate (P < .003) and multivariate (P < .040) analysis. Though the genotype-associated side effect risks remained in stage IV, the effect on survival was not significant (P < .1). CONCLUSION: The MTHFR polymorphism C677T does, in our material, not affect the risk of CRC; however, it can affect the sensitivity to chemotherapy and the risk of side-effects and therefore survival in stage III and possibly stage IV colon cancer. It could be a future predictive factor in the choice of a treatment regimen.
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| 4. |
- Derwinger, Kristoffer, 1969
(författare)
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Prognostic and predictive factors in colorectal cancer
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of the thesis was to study prognostic and predictive factors in patients treated for colorectal cancer (CRC). Method: In paper I, a retrospective comparison was made between the patients treated in 1999 (n=180) with those treated in 2004 (n=175). During the period, a multidisciplinary team conference and an improved cooperation with the pathologists had been initiated. The focus of interest was the lymph node assessment, its’ development and how this affected clinical staging and treatment. In paper II, the lymph node diagnostics were studied in patients with stage III colon cancer 1999-2003 (n=265). Prognostic markers were evaluated along with the use of the lymph node ratio as a prognostic indicator to differentiate the risk assessment within the stage group. In paper III, single nucleotide pair (SNP) gene analyses was made for the metylentetrahydrofolate reduktase (MTHFR) gene polymorphism C677T in patients treated for colorectal cancer 1999-2006 (n=544). The functional polymorphisms were then correlated to pathology, stage, outcome and side effects of chemotherapy. Comparisons of genotype prevalence were made against a cohort of 299 blood donors as well as the pathology data of the other 1256 patients treated during this period. In paper IV, the presence of cyclin E in both tumour and mucosa was studied in 114 patients with stage I/II colon cancer treated 2003-2007. The expression was analyzed in both tumour and adjacent mucosa and the results were correlated to pathology, staging and prognosis. Results: In paper I, an improved lymph node assessment was shown to lead to stage migration and thus an increase of patients with stage III disease. A highly variable outcome in stage II associated to an inadequate assessment was also found. In paper II, stage III disease was found to have heterogeneous survival prognosis and the lymph node ratio was a significant marker for the outcome (p<0.001). In paper III, no correlations between polymorphism genotype and the risk of cancer or cancer stage were found. There was a significant correlation to the risk of suffering side-effects (p<0,05) and to the outcome in stage III colon cancer (p<0,003). In paper IV, cyclin E was found to be expressed in both full length form and shorter isoform in both tumour and adjacent mucosa. A high total expression of cyclin E correlated significantly to the risk of tumour recurrence (p<0,0063). Conclusion: The lymph node assessment is a key factor in CRC pathology and of importance for both clinics and research. Additional prognostic information can be gained in stage III colon cancer by use of the lymph node ratio. The function of the folic acid metabolism can affect the risks associated with 5-fluorouracil treatment and also the outcome in stage III colon cancer. Cyclin E is expressed in both tumour and mucosa and could be an independent prognostic factor in stage I/II colon cancer.
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| 5. |
- Derwinger, Kristoffer, 1969, et al.
(författare)
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Stage migration in colorectal cancer related to improved lymph node assessment
- 2007
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Ingår i: Eur J Surg Oncol. - 0748-7983. ; 33:7, s. 849-53
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to evaluate the clinical impact of improved cooperation between the treating surgeons and pathologists in a high volume surgical unit. As a measure we used the staging process with special focus on lymph node assessment. FINDINGS: Comparing two periods 5years apart, we found a significant increase in the number of nodes examined and also an increase in the number of metastasis-positive nodes. Concurrently, we observed a trend in stage migration from stage I/II towards stage III, whilst stage IV remained unchanged. This was one factor that contributed to an increase in the number of patients treated with adjuvant chemotherapy. We also found that the number of assessed nodes had an impact on survival in stage II. The major change in practise was the implementation of a multidisciplinary team conference and the associated possibility of reciprocal feedback. CONCLUSION: Lymph node status has a key role in cancer staging and in the selection of further therapy. The quality and the standard of the assessment can be improved through multidisciplinary cooperation and it has an impact on the clinical decisions and can affect long-term survival. A correct node status should be mandatory in the evaluation of prognostic factors.
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