Article

Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer

Annals of Surgical Oncology (Impact Factor: 3.94). 04/2012; 7(8):617-623. DOI: 10.1007/BF02725342

ABSTRACT Background: Preoperative plasma plasminogen activator inhibitor-1 (PAI-1) is a prognostic variable in patients with colorectal cancer.
It has been suggested, however, that plasma PAI-1 is a nonspecific prognostic parameter similar to the acute-phase reactant
C-reactive protein (CRP). In the present study we analyzed the association between plasma PAI-1 and serum CRP in patients
scheduled for elective resection of colorectal cancer. In addition, the prognostic value of PAI-1 and CRP was studied in this
patient cohort.

Methods: PAI-1 and CRP were analyzed in citrated plasma and serum, respectively, obtained preoperatively from 594 patients. Patients
who required preoperative blood transfusion received SAGM blood, in which soluble PAI-1 is not present. None of the patients
received pre- or postoperative adjuvant chemotherapy, and all were followed in the outpatient clinic for at least 5 years
or until death. The association of PAI-1 and CRP, respectively, with survival was tested using the median value of PAI-1 and
the upper normal limit for CRP. Analyses were performed by inclusion of all patients, and in the subgroup of patients, who
underwent curative resection.

Results: The median follow-up period was 6.8 (5.4–7.9) years. The median value of plasma PAI-1 was 35.8 ng/ml, and values greater
than 94 nmol/L identified patients with increased CRP levels. Comparison of the molecules showed that PAI-1 was weakly correlated
with CRP (r=.26;P<.0001). Both molecules showed a Dukes independent distribution. In univariate survival analyses high levels of PAI-1 were
found associated with poor prognosis and low levels with good prognosis (P=.02, HR: 1.3). Similarly, high levels of CRP were found associated with poor prognosis and low levels with good prognosis
(P<.0001, HR: 1.9). In a multivariate statistical analysis including Dukes classification, gender, age, tumor location, perioperative
blood transfusion, PAI-1 and CRP, plasma PAI-1 was a dependent prognostic variable, while serum CRP (P<.0001; HR: 1.4; 95% CI: 1.3–1.5) was found to be a Dukes independent prognostic variable. Similar analyses, excluding patients
with Dukes’ D disease showed serum CRP to be an independent prognostic variable (P<.0001; HR: 1.3: 95% CI: 1.2–1.5).

Conclusions: This study did not show a strong correlation between plasma PAI-1 and serum CRP in patients with colorectal cancer. Serum
CRP was found to be a Dukes independent prognostic variable in this patient cohort, and was found to identify a subgroup of
curatively resected patients at risk for short survival.

1 Follower
 · 
105 Views
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Resumen La administración perioperatoria de hemoderiva-dos alogénicos (TSA) es relativamente frecuente en los pacientes oncológicos sometidos a cirugía y, aunque nunca antes habían sido tan seguros como en la actualidad, sobre todo con respecto a la trans-misión de enfermedades infecciosas, sabemos que esta práctica no está exenta de efectos adversos. Uno de ellos es la inmunomodulación inducida por transfusiones alogénicas (IMITA), que mediante me-canismos no completamente esclarecidos induce un predominio de la respuesta Th2, caracterizada por la liberación de interleucina-4 (IL-4), IL-5, IL-6, IL-10 e IL-13 que inducen un predominio de la inmunidad hu-moral y una disminución o anulación de la inmunidad celular, creando un estado de susceptibilidad a la en-fermedad. Tampoco se conocen con exactitud los componentes de la TSA que participan en la induc-ción de IMITA, aunque diversos estudios han implica-do a los leucocitos del donante o los productos libe-rados por los mismos durante la conservación. En el paciente neoplásico sometido a cirugía, el grado de IMITA parece depender del volumen transfundido y va a potenciar otras alteraciones del sistema inmuni-tario producidas por la enfermedad de base, el esta-do nutricional e inflamatorio del paciente, el tipo de anestesia que se emplee, la magnitud del trauma qui-rúrgico y la medicación perioperatoria. Este estado de inmunodepresión, junto con las alteraciones de la microcirculación y la hipoxia tisular regional provo-cadas por la lesión de almacenamiento de los eritro-citos, puede llevar a un aumento de las infecciones postoperatorias y de la recurrencia del tumor, au-mentando por tanto la morbimortalidad de estos pa-cientes. Por ello, es necesario el desarrollo de pro-gramas multidisciplinarios para optimizar el manejo transfusional del paciente oncológico y reducir el nú-mero de TSA al mínimo indispensable, disminuyendo los riesgos inherentes a las mismas.
    Cirugía Española 01/2002; 72(3). DOI:10.1016/S0009-739X(02)72032-0 · 0.89 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Emerging on the horizon in cancer therapy is an expansion of the scope of treatment beyond cytotoxic approaches to include molecular management of cancer physiopathology. The goal in these integrative approaches, which extends beyond eradicating the affected cells, is to control the cancer phenotype. One key new approach appears to be modulation of the inflammatory cascade, as research is expanding that links cancer initiation, promotion, progression, angiogenesis, and metastasis to inflammatory events. This article presents a literature review of the emerging relationship between neoplasia and inflammatory eicosanoids (PGE2 and related prostaglandins), with a focus on how inhibition of their synthesizing oxidases, particularly cyclooxygenase (COX), offers anticancer actions in vitro and in vivo. Although a majority of this research emphasizes the pharmaceutical applications of nonsteroidal anti-inflammatory drugs and selective COX-2 inhibitors, these agents fail to address alternate pathways available for the synthesis of proinflammatory eicosanoids. Evidence is presented that suggests the inhibition of lipoxygenase and its by-products-LTB4, 5-HETE, and 12-HETE-represents an overlooked but crucial component in complementary cancer therapies. Based on the hypothesis that natural agents capable of modulating both lipoxygenase and COX may advance the efficacy of cancer therapy, an overview and discussion is presented of dietary modifications and selected nutritional and botanical agents (notably, omega-3 fatty acids, antioxidants, boswellia, bromelain, curcumin, and quercetin) that favorably influence eicosanoid production.
    Integrative Cancer Therapies 04/2002; 1(1):7-37; discussion 37. DOI:10.1177/1534735402001001002 · 2.01 Impact Factor

Preview

Download
1 Download