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Comprehensive recurrence risk assessment after colectomy, for stage II and III colorectal cancer patients, using genetic profiling, microbiome, and circulating tumor markers
Background
Colorectal cancer (CRC) incidence increases in the western population and is considered of a major public health issue. To date, patients’ prognosis is mainly based on TNM staging of the primary tumor; however, clinical outcome varies among patients of same staging. Early diagnosis and treatment may lead to a better prognosis, especially when surgical excision and adjuvant treatment options are possible. Standard adjuvant treatment according to international guidelines is six months of Folfox or Capox. Considering the toxicity of the treatment, the cost, and the limited resources of the health systems, a propped tool for the assessment of recurrence risk is urgently warranted. The aim of the current study is the comprehensive and precise assessment of recurrence risk in stage II/III CRC patients with genomic and phenotypic analysis of the primary tumor, microbiome analysis in patients’ stools and analysis of circulating biomarkers.
Methods
All patients were enrolled following assessment for the quality of their surgical resections according to international guidelines. Only specimens scored as mesocolic or mesorectal plan were submitted for molecular analysis. Peripheral blood (18 ml in EDTA), stool and surgical section samples were collected from 156 CRC patients.
Results
In total, 104(66.7%) patients were males; 80(51.3%), 65(41.7%), 54(34.6%) and 66(42.3%) patients had detectable microbial DNA fragments for 16SrRNA, Escherichia coli, Bacteroides fragilis and Candida albicans, respectively. Seven (4.5%) patients were heterozygous for TLR polymorphisms, whereas 42(26.7%)-97(62.2%) were homozygous for vitamin D polymorphisms. Correlations will be performed with clinico-epidemiological characteristics, circulating tumor cell detection, genetic profiling of the primary tumor and fecal microbiome detected.
Conclusions
We anticipate that the results will contribute significantly to the process of “individualized precision medicine” in cancer care. Moreover, the results will be used for the rational design of confirmatory prospective clinical trial in which the recurrence score will be used as stratification factor or as a tool for treatment (or no treatment) decisions.
Legal entity responsible for the study
The authors.
Funding
Hellenic Foundation for Research and Innovation - Greece GastroIntestinal Cancer Research Group – Greece.
Disclosures
J. Souglakos: Honoraria (Institution): Servier; Advisory / Consultancy: Servier; Travel / Accommodation / Expenses: Servier. All other authors have declared no conflicts of interest.
