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Assessment of SMAD4, p53, and Ki-67 alterations as a predictor of liver metastasis in human colorectal cancer

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Abstract

Purpose

The liver is the most common site of metastasis in patients with colorectal cancer (CRC), and this is a determinant of the prognosis. However, no reliable molecular predictors of liver metastasis have yet been identified.

Methods

Sixty-two surgical specimens of colorectal cancer were studied. The first group included 25 patients who achieved a disease-free survival period of at least 6 years (CRC-M0), and the second group included 37 patients with synchronous (n = 22) or metachronous (n = 15) liver metastasis (CRC-M1). SMAD4, p53, and Ki-67 expression levels were assessed immunohistochemically.

Results

The loss of SMAD4 expression and elevated Ki-67 expression were found significantly more frequently in CRC-M1 patients than in CRC-M0 patients (P = 0.0047 and P = 0.013, respectively). Statistically significant differences were also observed between the CRC-M0 group and the metachronous metastasis group. No difference was seen in the overexpression of p53 between the groups. A combination analysis of SMAD4 and Ki-67 revealed no cases with maintained levels of SMAD4 and a low Ki-67 expression had or developed liver metastasis.

Conclusion

The loss of SMAD4 expression and elevated Ki-67 expression was therefore found to significantly correlate with liver metastasis, regardless of the time of occurrence, thus indicating these factors to be predictive markers for liver metastasis in patients with CRC.

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References

  1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57:43–66.

    Article  PubMed  Google Scholar 

  2. The Editorial Board of the Cancer Statistics in Japan. Cancer statistics in Japan 2007. Available from: http://ganjoho.ncc.go.jp/public/statistics/backnumber/2007_en.html. Accessed 1 Nov 2008.

  3. Galanis E, Alberts SR, O’Connell MJ. New adjuvant therapy for colon cancer: justified hope or commercial hype. Surg Oncol Clin North Am 2000;9:813–823.

    CAS  Google Scholar 

  4. Macdonald JS. Adjuvant therapy of colon cancer. CA Cancer J Clin 1999;49:202–219.

    Article  CAS  PubMed  Google Scholar 

  5. Cascinu S, Georgoulias V, Kerr D, Maughan T, Labianca R, Ychou M. Colorectal cancer in the adjuvant setting: perspectives on treatment and the role of prognostic factors. Ann Oncol 2003;14(suppl 2):ii25–ii29.

    PubMed  Google Scholar 

  6. Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990;1:759–767.

    Article  Google Scholar 

  7. Arends JW. Molecular interactions in the Vogelstein model of colorectal carcinoma. J Pathol 2000;190:412–416.

    Article  CAS  PubMed  Google Scholar 

  8. Maitra A, Molberg K, Albores-Saavedra J, Lindberg G. Loss of Dpc4 expression in colonic adenocarcinomas correlates with the presence of metastatic disease. Am J Pathol 2000;157:1105–1111.

    CAS  PubMed  Google Scholar 

  9. Alazzouzi H, Alhopuro P, Salovaara R, Sammalkorpi H, Järvinen H, Mecklin JP, et al. SMAD4 as a prognostic marker in colorectal cancer. Clin Cancer Res 2005;11:2606–2611.

    Article  CAS  PubMed  Google Scholar 

  10. Miyaki M, Iijima T, Konishi M, Sakai K, Ishii A, Yasuno M, et al. Higher frequency of Smad4 gene mutation in human colorectal cancer with distant metastasis. Oncogene 1999;18:3098–3103.

    Article  CAS  PubMed  Google Scholar 

  11. Losi L, Bouzourene H, Benhattar J. Loss of Smad4 expression predicts liver metastasis in human colorectal cancer. Oncol Rep 2007;17:1095–1099.

    CAS  PubMed  Google Scholar 

  12. Tanaka T, Watanabe T, Kazama Y, Tanaka J, Kanazawa T, Kazama S, et al. Loss of Smad4 protein expression and 18qLOH as molecular markers indicating lymph node metastasis in colorectal cancer-a study matched for tumor depth and pathology. J Surg Oncol 2008;97:69–73.

    Article  CAS  PubMed  Google Scholar 

  13. McLeod HL, Murray GI. Tumour markers of prognosis in colorectal cancer. Br J Cancer 1999;79:191–203.

    Article  CAS  PubMed  Google Scholar 

  14. Bouzourene H, Gervaz P, Cerottini JP, Benhattar J, Chaubert P, Saraga E, et al. p53 and Ki-ras as prognostic factors for Dukes’ stage B colorectal cancer. Eur J Cancer 2000;36:1008–1015.

    Article  CAS  PubMed  Google Scholar 

  15. Nakada I, Tabuchi T, Nakachi T, Shimazaki J, Konishi S, Katano M, et al. Histological factors contributing to a high risk of recurrence of submucosal invasive cancer (pT1) of the colon and rectum after endoscopic therapy. Surg Today 2008;38:675–678.

    Article  PubMed  Google Scholar 

  16. Vogelstein B, Fearon ER, Hamilton SR, Kern SE, Preisinger AC, Leppert M, et al. Genetic alterations during colorectal-tumor development. N Engl J Med 1988;319:525–532.

    Article  CAS  PubMed  Google Scholar 

  17. Mitelman F, Mertens F, Johansson B. A breakpoint map of recurrent chromosomal rearrangements in human neoplasia. Nat Genet 1997;15:417–474.

    Article  CAS  PubMed  Google Scholar 

  18. Fearon ER, Cho KR, Nigro JM, Kern SE, Simons JW, Ruppert JM, et al. Identification of a chromosome 18q gene that is altered in colorectal cancers. Science 1990;247:49–56.

    Article  CAS  PubMed  Google Scholar 

  19. Kinzler KW, Vogelstein B. Lessons from hereditary colorectal cancer. Cell 1996;87:159–170.

    Article  CAS  PubMed  Google Scholar 

  20. Eppert K, Scherer SW, Ozcelik H, Pirone R, Hoodless P, Kim H, et al. MADR2 maps to 18q21 and encodes a TGFβ-regulated MAD-related protein that is functionally mutated in colorectal carcinoma. Cell 1996;86:543–552.

    Article  CAS  PubMed  Google Scholar 

  21. Howe JR, Roth S, Ringold JC, Summers RW, Järvinen HJ, Sistonen P, et al. Mutations in the SMAD4/DPC4 gene in juvenile polyposis. Science 1998;280:1086–1088.

    Article  CAS  PubMed  Google Scholar 

  22. Koyama M, Ito M, Nagai H, Emi M, Moriyama Y. Inactivation of both alleles of the DPC4/SMAD4 gene in advanced colorectal cancers: identification of seven novel somatic mutations in tumors from Japanese patients. Mutat Res 1999;406:71–77.

    CAS  PubMed  Google Scholar 

  23. Tanaka T, Watanabe T, Kazama Y, Tanaka J, Kanazawa T, Kazama S, et al. Chromosome 18q deletion and Smad4 protein inactivation correlate with liver metastasis: A study matched for T- and N-classification. Br J Cancer 2006;95:1562–1567.

    Article  CAS  PubMed  Google Scholar 

  24. Brown DC, Gatter KC. Ki 67 protein: the immaculate deception? Histopathology 2002;40:2–11.

    Article  CAS  PubMed  Google Scholar 

  25. Valera V, Yokoyama N, Walter B, Okamoto H, Suda T, Hatakeyama K. Clinical significance of Ki-67 proliferation index in disease progression and prognosis of patients with resected colorectal carcinoma. Br J Surg 2005;92:1002–1007.

    Article  CAS  PubMed  Google Scholar 

  26. Kitabatake T, Kojima K, Fukasawa M, Beppu T, Futagawa S. Correlation of thymidine phosphorylase staining and the Ki-67 labeling index to clinicopathologic factors and hepatic metastasis in patients with colorectal cancer. Surg Today 2002;32:322–328.

    Article  PubMed  Google Scholar 

  27. Palmqvist R, Sellberg P, Oberg A, Tavelin B, Rutegard JN, Stenling R. Low tumour cell proliferation at the invasive margin is associated with a poor prognosis in Dukes’ stage B colorectal cancers. Br J Cancer 1999;9:577–581.

    Article  Google Scholar 

  28. Allegra CJ, Paik S, Colangelo LH, Parr AL, Kirsch I, Kim G, et al. Prognostic value of thymidylate synthase, Ki-67, and p53 in patients with Dukes’ B and C colon cancer: a National Cancer Institute-National Surgical Adjuvant Breast and Bowel Project collaborative study. J Clin Oncol 2003;21:241–250.

    Article  CAS  PubMed  Google Scholar 

  29. Dziegiel P, Forgacz J, Suder E, Surowiak P, Kornafel J, Zabel M. Prognostic significance of metallothionein expression in correlation with Ki-67 expression in adenocarcinomas of large intestine. Histol Histopathol 2003;18:401–407.

    CAS  PubMed  Google Scholar 

  30. van Oijen MG, Medema RH, Slootweg PJ, Rijksen G. Positivity of the proliferation marker Ki-67 in noncycling cells. Am J Clin Pathol 1998;110:24–31.

    PubMed  Google Scholar 

  31. Ropponen KM, Kellokoski JK, Lipponen PK, Pietiläinen T, Eskelinen MJ, Alhava EM, et al. p22/WAF1 expression in human colorectal carcinoma: association with p53, transcription factor AP-2 and prognosis. Br J Cancer 1999;81:133–140.

    Article  CAS  PubMed  Google Scholar 

  32. Zeng ZS, Sarkis AS, Zhang ZF, Klimstra DS, Charytonowicz E, Guillem JG, et al. p53 nuclear overexpression: an independent predictor of survival in lymph node-positive colorectal cancer patients. J Clin Oncol 1994;12:2043–2050.

    CAS  PubMed  Google Scholar 

  33. Gallego MG, Aceñero MJ, Ortega S, Delgado AA, Cantero JL. Prognostic influence of p53 nuclear overexpression in colorectal carcinoma. Dis Colon Rectum 2000;43:971–975.

    Article  CAS  PubMed  Google Scholar 

  34. Baas IO, Mulder JW, Offerhaus GJ, Vogelstein B, Hamilton SR. An evaluation of six antibodies for immunohistochemistry of mutant p53 gene product in archival colorectal neoplasms. J Pathol 1994;172:5–12.

    Article  CAS  PubMed  Google Scholar 

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Kawakami, M., Yamaguchi, T., Takahashi, K. et al. Assessment of SMAD4, p53, and Ki-67 alterations as a predictor of liver metastasis in human colorectal cancer. Surg Today 40, 245–250 (2010). https://doi.org/10.1007/s00595-009-4028-3

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  • DOI: https://doi.org/10.1007/s00595-009-4028-3

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