Raffaello Mancini

Prognostic value of soluble P‐selectin levels in colorectal cancer

Measurement of soluble (s) P‐selectin levels has been proposed as a diagnostic tool for monitoring the clinical course of human neoplasms. Thus, our study was aimed at analyzing the role of sP‐selectin in association with clinicopathological variables in 181 patients with primary (n=149) or metastatic (n=32) colorectal cancer (CRC), 34 patients with benign diseases and 181 control subjects. The results obtained showed that sP‐selectin levels were higher in patients with CRC compared either to patients with benign disease (p= 0.006) or controls (p= 0.003). No differences were observed between the latter and patients with benign diseases. Increased median sP‐selectin levels were significantly associated with the presence of distant metastasis (68.2 ng/ml vs. 48.6 ng/ml, p= 0.002). Of interest, carcinoembryonic antigen (CEA) levels were independently associated to sP‐selectin (regression coefficient= 0.28, p< 0.002). Coxs proportional hazards survival analysis of primary CRC patients demonstrated that beside the stage of disease sP‐selectin levels had an independent prognostic role in predicting recurrent disease (HR= 2.22, p= 0.019) and mortality from CRC (HR= 3.44, p= 0.017). These results suggest that measurement of plasma sP‐selectin might represent a prognostic indicator in the management of patients with CRC.

Prognostic value of serum and tumor tissue CA 72-4 content in gastric cancer.

To date no general agreement has been reached regarding the prognostic significance of CEA, CA 19-9 and CA 72-4 as serum markers in gastric cancer, and only scattered information is available on the predictive value of marker expression in tumor tissue. Therefore, a longitudinal study was designed to analyze the presurgical serum and tumor tissue content of CA 72-4, CEA and CA 19-9 in 166 patients at different stages of gastric cancer, and to evaluate the possible correlation with clinicopathological features in respect to prognostic information on relapse-free survival. The results obtained showed that 48.4% of patients with tumor recurrence had positive presurgical CA 72-4 levels compared to approximately 24% of patients who remained free of disease. Furthermore, the median presurgical serum CA 72-4 levels were significantly elevated in relapsing patients. Serosa and lymph node involvement as well as positive presurgical serum CA 72-4 levels had independent prognostic value in predicting recurrence. A significant association between disease-free survival and lymph node involvement, depth of invasion and tumor tissue content of CA 72-4 was also demonstrated. We may therefore conclude that CA 72-4 antigen can be considered the marker of choice in the follow-up of gastric cancer patients and may be used as a prognostic indicator of relapse.

Role of P53 and Bcl-2 in advanced rectal carcinomas treated with adjuvant therapy

Summary Rectal adenocarcinomas is usually associated to a poorer outcome than colon cancers. In this study we analyzed the impact on overall survival of p53 and Bcl-2, evaluated by immunohistochemical techniques, in 126 advanced rectal cancer patients submitted to 5 fluorouracil based adjuvant therapy. Shorter overall survival was observed in patients bearing p53 positive and Bcl-2 negative tumors, although in multivariate analysis only p53 emerged as independent predictor of a worse outcome. These results seem to indicate that, in stage III-IV rectal cancer, p53 alterations may identify high risk patients to be enrolled in more aggressive and/or innovative adjuvant/neoadjuvant treatments.

Preoperative chemoradiation and total mesorectal excision surgery for low T3 rectal cancer

All but 3 of the patients underwent radical surgery including TME. A sphincter-saving surgery, which means a low anterior resection with or without a coloanal anastomosis, was performed in 97 patients (39.2% with a temporary stoma) with a higher rate in the PLAFUR trial (85% vs 78% in the FUMIR study). In a group of 49 patients surely candidated to APR (tumor distance <4 em from anal verge), a sphincter-saving procedure was Study size (no. of pts) Follow-up (months) Tumor distance from anal verge (em) Sphincter-saving surgery Toxicity zgrade 32 Pathological stages TO Tl-2 T3 NI-2 Local recurrence 5-year survival: Overall Local recurrence-free Disease-free