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Analysis of neuroendocrine differentiation and the p53/BAX pathway in UICC stage III colorectal carcinoma identifies patients with good prognosis

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Abstract

Background and aims

Neuroendocrine differentiation is an independent prognostic factor in colorectal cancer. Moreover, an altered p53/BAX pathway is associated with a poor clinical outcome in Union Internationale Contre le Cancer (UICC) stage III disease. Because these markers are involved in different genetic events disrupted in colorectal cancer, we investigated the prognostic power of a multimarker analysis.

Patients and methods

Specimens were analyzed from 59 patients with UICC stage III disease who underwent surgery for colorectal adenocarcinoma at our institution and were followed up for 5 years or until death. Tumors were studied for both p53 mutation and BAX protein expression as well as for the expression of neuroendocrine markers. Statistical analysis of each marker alone or in combination was performed.

Results

p53 status/BAX expression and neuroendocrine differentiation are not correlated in stage III colorectal cancers. However, the combination of both independent events identified a subgroup of patients with an excellent prognosis: Patients whose tumors were neuroendocrine marker-negative and who exhibited an intact p53/BAX pathway lived longer (mean survival, 93 months; range, 82–104 months) than patients whose tumors were either neuroendocrine marker-positive or whose tumors had a completely disrupted apoptotic pathway (41 months; range, 26–57 months; p<0.00001). In multivariate regression analysis, neuroendocrine marker-positive, p53 mutated, low-BAX-expressing tumors revealed an almost fivefold higher risk for earlier death (p<0.0001).

Conclusion

Disruption of the p53/BAX pathway is not pathognomonic for colorectal cancers with neuroendocrine differentiation. Both represent independent prognostic markers in UICC stage III disease. Therefore, the combined analysis of p53 status, BAX expression and neuroendocrine differentiation allows one to identify subgroups of patients with either very good or very poor prognosis.

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Acknowledgements

We thank C. Cieluch, E. Berg, S. Scheele and J. Roszius for their excellent technical assistance. This study was supported by grants of the Deutsche Forschungsgemeinschaft and the Deutsche Krebshilfe.

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Authors and Affiliations

  1. Medizinische Klinik I, Gastroenterologie/Infektiologie/Rheumatologie, Charité-Campus Benjamin Franklin, Berlin, Germany

    Patricia Grabowski, Kerstin Maaser, Martin Zeitz & Hans Scherübl

  2. Abteilung für Hämatologie, Onkologie und Tumorimmunologie, Charité–Campus Buch, Berlin, Germany

    Isrid Sturm, Katharina Schelwies, Bernd Dörken & Peter T. Daniel

  3. Chirurgische Klinik, Charité–Campus Benjamin Franklin, Berlin, Germany

    Heinz-Johannes Buhr

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  1. Patricia Grabowski
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  2. Isrid Sturm
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Correspondence to Hans Scherübl.

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P. Grabowski and I. Sturm contributed equally to this work

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Grabowski, P., Sturm, I., Schelwies, K. et al. Analysis of neuroendocrine differentiation and the p53/BAX pathway in UICC stage III colorectal carcinoma identifies patients with good prognosis. Int J Colorectal Dis 21, 221–230 (2006). https://doi.org/10.1007/s00384-005-0779-5

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