Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2016; 22(38): 8576-8583
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8576
Combination of three-gene immunohistochemical panel and magnetic resonance imaging-detected extramural vascular invasion to assess prognosis in non-advanced rectal cancer patients
Xiao-Fu Li, Zheng Jiang, Ying Gao, Chun-Xiang Li, Bao-Zhong Shen
Xiao-Fu Li, Department of Magnetic Resonance Imaging, The 2nd Affiliated Hospital, Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Zheng Jiang, Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Ying Gao, Department of Radiology, The Affiliated Hospital of Harbin Institute of Technology, Harbin 150001, Heilongjiang Province, China
Chun-Xiang Li, Laboratory of Medical Genetics, Harbin Medical University, Harbin 150086, Heilongjiang Province, China
Bao-Zhong Shen, Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Author contributions: Li XF wrote the paper; Li XF and Jiang Z contributed equally to this work; Li XF and Jiang Z performed the research; Li XF and Shen BZ designed the research; Jiang Z and Gao Y analyzed the data; Li CX contributed new reagents or analytic tools.
Institutional review board statement: This study was reviewed and approved by the institutional review board of Harbin Medical University.
Informed consent statement: The authors of this paper guarantee that all study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Bao-Zhong Shen, Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, 37 Yi Yuan Street, Nan Gang District, Harbin 150001, Heilongjiang Province, China. dr_shenbz@yeah.net
Telephone: +86-451-86297477 Fax: +86-451-86297477
Received: July 7, 2016
Peer-review started: July 7, 2016
First decision: August 19, 2016
Revised: August 24, 2016
Accepted: September 14, 2016
Article in press: September 14, 2016
Published online: October 14, 2016
Abstract
AIM

To identify a small, clinically applicable immunohistochemistry (IHC) panel that could be combined with magnetic resonance imaging (MRI)-detected extramural vascular invasion (EMVI) for assessment of prognosis concerning the non-advanced rectal cancer patients prior to operation.

METHODS

About 329 patients with pathologically confirmed rectal carcinoma (RC) were screened in this research, all of whom had been examined via an MRI and were treatment-naïve from July 2011 to July 2014. The candidate proteins that were reported to be altered by RC were examined in tissues by IHC. All chosen samples were adopted from the fundamental cores of histopathologically confirmed carcinomas during the initial surgeries.

RESULTS

Of the three proteins that were tested, c-MYC, PCNA and TIMP1 were detected with relatively significant expression in tumors, 35.9%, 23.7% and 58.7% respectively. The expression of the three proteins were closely connected with prognosis (P = 0.032, 0.003, 0.021). The patients could be classified into different outcome groups according to an IHC panel (P < 0.01) via these three proteins. Taking into consideration known survival covariates, especially EMVI, the IHC panel served as an independent prognostic factor. The EMVI combined with the IHC panel could categorize patients into different prognostic groups with distinction (P < 0.01).

CONCLUSION

These studies argue that this three-protein panel of c-MYC, PCNA, coupled with TIMP1 combined with MRI-detected EMVI could offer extra prognostic details for preoperative treatment of RC.

Keywords: Rectal cancer, Magnetic resonance imaging, Prognosis, Immunohistochemistry, Extramural vascular invasion

Core tip: Magnetic resonance imaging (MRI) to determine the stage of rectal cancer has been shown to be accurate and reproducible. The patients who showed MRI-detected extramural vascular invasion (EMVI) positivity had worse survival outcomes than those with EMVI negativity. However, the survival rates of patients with an EMVI-positive histology varies dramatically, which suggests that this factor does not relate to each individual tumor in terms of the biology or molecular features. The ideal staging system evolves from the consideration of them and the correlation of the prognosis with patient-specific tumor biomarkers. In this study, we hypothesized that the combination of imaging evidence of EMVI and biomolecular factors could provide additional predictive value in clinical practice, especially for non-advanced cancer patients.