ABSTRACT
Background: Colorectal cancer (CRC) exhibits molecular and morphological diversity, involving genetic, epigenetic alterations, and disruptions in signaling pathways. This necessitates a comprehensive review synthesizing recent advancements in molecular mechanisms, established biomarkers, as well as emerging ones like CDX2 for enhanced CRC assessment. Material and Methods: This review analyzes the last decade's literature and current guidelines to study CRC's molecular intricacies. It extends the analysis beyond traditional biomarkers to include emerging ones like CDX2, examining their interaction with carcinogenic mechanisms and molecular pathways, alongside reviewing current testing methodologies. Results: A multi-biomarker strategy, incorporating both traditional and emerging biomarkers like CDX2, is crucial for optimizing CRC management. This strategy elucidates the complex interaction between biomarkers and the tumor's molecular pathways, significantly influencing prognostic evaluations, therapeutic decision-making, and paving the way for personalized medicine in CRC. Conclusions: This review proposes CDX2 as an emerging prognostic biomarker and emphasizes the necessity of thorough molecular profiling for individualized treatment strategies. By enhancing CRC treatment approaches and prognostic evaluation, this effort marks a step forward in precision oncology, leveraging an enriched understanding of tumor behavior.
Subject(s)
Biomarkers, Tumor , CDX2 Transcription Factor , Colorectal Neoplasms , Membrane Proteins , Microsatellite Instability , Proto-Oncogene Proteins B-raf , Proto-Oncogene Proteins p21(ras) , Humans , Colorectal Neoplasms/genetics , Colorectal Neoplasms/pathology , Colorectal Neoplasms/metabolism , Colorectal Neoplasms/classification , CDX2 Transcription Factor/metabolism , CDX2 Transcription Factor/genetics , Biomarkers, Tumor/genetics , Biomarkers, Tumor/metabolism , Proto-Oncogene Proteins p21(ras)/genetics , Proto-Oncogene Proteins B-raf/genetics , Prognosis , Membrane Proteins/genetics , Membrane Proteins/metabolism , GTP Phosphohydrolases/genetics , GTP Phosphohydrolases/metabolism , DNA Mismatch Repair , Predictive Value of Tests , Precision MedicineABSTRACT
Neoadjuvant treatment has become the standard of care for locally advanced rectal cancer for many years. Several neoadjuvant therapeutic options are currently used, the most common being conventionally fractionated radiotherapy (or long-course radiotherapy) administered concomitantly with chemotherapy and hypofractionated radiotherapy (or short-course radiotherapy). This meta-analysis will give a better overview of the results of several studies that compare long-course radio-chemotherapy with short-course radiotherapy, emphasizing on the severe acute and late toxicities and the postoperative results of the analyzed studies. After identification, analysis and verification of eligibility criteria, eight studies were included in the meta-analysis. The methodological quality of the selected studies was assessed using the classic Oxford quality grading system (Jadad scale). The results obtained in this meta-analysis shows us that we can safely use both short-course radiotherapy and long-course radio-chemotherapy as neoadjuvant treatment for locally advanced rectal cancer, without significant differences regarding to severe acute or late toxicities, positive resection margins R+ or the number of local pelvic relapses at three years.