Prognosis in colorectal cancer beyond TNM

Abstract

Introduction Colorectal cancer is one of the neoplasms with the greatest social impact. Given the great molecular heterogeneity and diversity of pathophysiological mechanisms, it is difficult to define prognostic factors that could guide therapy. Objectives To identify the molecular prognostic factors that may be of interest in clinical practice and to synthesize the existing evidence. Material and methods The search for the articles was carried out using the PubMed platform and the keywords “sporadic colorectal cancer and prognosis”, for articles published between 2014 and 2019. We selected all articles published on studies in humans and written in English or Portuguese. Of the 215 articles found, 35 articles were selected to perform this review. Results Current evidence supports the use of four molecular markers in clinical practice − KRAS, NRAS and BRAF (EGFR signalling pathway) and the mismatch repair status. Conclusion The use of molecular biomarkers in clinical practice to define prognosis is still little supported by the existent evidence. The studies are slightly contradictory, so new projects and international collaborations must be carried out in this area to obtain more robust evidence.

Differences in Colorectal Cancer Survival Based on Primary Tumor Location: Retrospective Study from a Single Institution

“…Most publications conclude that among stage IV tumors, compared with LS and rectal tumors, RS tumors are associated with lower survival rates [5][6][7][8]. The results of this study also support this hypothesis.…”

“…We think that laterality is possibly a marker that reflects the clinical significance of differences in genetic alterations that occur in the different segments of the colon and rectum. Genetic alterations such as KRAS gene mutations, hypermethylation of cytosine-phosphate-guanine (CpG) islands (CIMP-high), BRAF mutations and microsatellite instability due to mutations or hypermethylation of mismatch repair genes (MSI-high) occur more frequently In tumors originating in the right colon than in the other segments of the colon and rectum [7].…”

“…Various publications have shown that this variable Ivyspring International Publisher may be related to the survival of patients with this type of tumor [1][2][3][4][5]. For patients with stage IV tumors originating in the right colon, survival is lower than that for patients with tumors originating in the left colon and rectum; this effect is independent of the chemotherapy treatment followed [5][6][7][8]. This may be the result of interactions among multiple factors.…”

Exploring Potential Epigenetic Biomarkers for Colorectal Cancer Metastasis

“…The incidence rates of CRC are among the highest in Australia and New Zealand [4]. While advancements in CRC management have led to improved outcomes, the prognosis varies significantly across different stages of the disease [5][6][7][8]. The American Joint Committee on Cancer (AJCC, 8th edition) TNM staging system is a widely accepted classification system of tumours [9].…”