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2.
Int J Colorectal Dis ; 32(12): 1711-1717, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28884225

RESUMO

BACKGROUND: Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates. METHODS: In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected. RESULTS: In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy. CONCLUSION: EMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.


Assuntos
Pólipos Adenomatosos/cirurgia , Pólipos do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Pólipos Adenomatosos/patologia , Fatores Etários , Idoso , Perda Sanguínea Cirúrgica , Pólipos do Colo/patologia , Neoplasias Colorretais/patologia , Esquema de Medicação , Ressecção Endoscópica de Mucosa/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Humanos , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
3.
BMC Gastroenterol ; 16(1): 56, 2016 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-27229709

RESUMO

BACKGROUND: Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. METHODS: This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. DISCUSSION: If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. TRIAL REGISTRATION: NCT02657044 (Clinicaltrials.gov), registered January 8, 2016.


Assuntos
Adenoma/cirurgia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/economia , Ressecção Endoscópica de Mucosa/métodos , Adenoma/patologia , Colonoscopia , Neoplasias Colorretais/patologia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Ressecção Endoscópica de Mucosa/efeitos adversos , Custos de Cuidados de Saúde , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida
4.
Oncogene ; 35(31): 4069-79, 2016 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-26804178

RESUMO

Endoglin, a transforming growth factor-ß co-receptor, is highly expressed on angiogenic endothelial cells in solid tumors. Therefore, targeting endoglin is currently being explored in clinical trials for anti-angiogenic therapy. In this project, the redundancy between endoglin and vascular endothelial growth factor (VEGF) signaling in angiogenesis and the effects of targeting both pathways on breast cancer metastasis were explored. In patient samples, increased endoglin signaling after VEGF inhibition was observed. In vitro TRC105, an endoglin-neutralizing antibody, increased VEGF signaling in endothelial cells. Moreover, combined targeting of the endoglin and VEGF pathway, with the VEGF receptor kinase inhibitor SU5416, increased antiangiogenic effects in vitro and in a zebrafish angiogenesis model. Next, in a mouse model for invasive lobular breast cancer, the effects of TRC105 and SU5416 on tumor growth and metastasis were explored. Although TRC105 and SU5416 decreased tumor vascular density, tumor volume was unaffected. Strikingly, in mice treated with TRC105, or TRC105 and SU5416 combined, a strong inhibition in the number of metastases was seen. Moreover, upon resection of the primary tumor, strong inhibition of metastatic spread by TRC105 was observed in an adjuvant setting. To confirm these data, we assessed the effects of endoglin-Fc (an endoglin ligand trap) on metastasis formation. Similar to treatment with TRC105 in the resection model, endoglin-Fc-expressing tumors showed strong inhibition of distant metastases. These results show, for the first time, that targeting endoglin, either with neutralizing antibodies or a ligand trap, strongly inhibits metastatic spread of breast cancer in vivo.


Assuntos
Neoplasias da Mama/irrigação sanguínea , Endoglina/antagonistas & inibidores , Metástase Neoplásica/prevenção & controle , Neovascularização Patológica/prevenção & controle , Animais , Anticorpos Monoclonais/uso terapêutico , Neoplasias da Mama/patologia , Feminino , Humanos , Indóis/uso terapêutico , Pirróis/uso terapêutico , Proteína Smad1/metabolismo , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/fisiologia , Peixe-Zebra
5.
Br J Cancer ; 112(1): 122-30, 2015 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-25393365

RESUMO

BACKGROUND: Constitutive Wnt activation is essential for colorectal cancer (CRC) initiation but also underlies the cancer stem cell phenotype, metastasis and chemosensitivity. Importantly Wnt activity is still modulated as evidenced by higher Wnt activity at the invasive front of clonal tumours termed the ß-catenin paradox. SMAD4 and p53 mutation status and the bone morphogenetic protein (BMP) pathway are known to affect Wnt activity. The combination of SMAD4 loss, p53 mutations and BMP signalling may integrate to influence Wnt signalling and explain the ß-catenin paradox. METHODS: We analysed the expression patterns of SMAD4, p53 and ß-catenin at the invasive front of CRCs using immunohistochemistry. We activated BMP signalling in CRC cells in vitro and measured BMP/Wnt activity using luciferase reporters. MTT assays were performed to study the effect of BMP signalling on CRC chemosensitivity. RESULTS: Eighty-four percent of CRCs with high nuclear ß-catenin staining are SMAD4 negative and/or p53 aberrant. BMP signalling inhibits Wnt signalling in CRC only when p53 and SMAD4 are unaffected. In the absence of SMAD4, BMP signalling activates Wnt signalling. When p53 is lost or mutated, BMP signalling no longer influences Wnt signalling. The cytotoxic effects of 5-FU are influenced in a similar manner. CONCLUSIONS: The BMP signalling pathway differentially modulates Wnt signalling dependent on the SMAD4 and p53 status. The use of BMPs in cancer therapy, as has been proposed by previous studies, should be targeted to individual cancers based on the mutational status of p53 and SMAD4.


Assuntos
Proteínas Morfogenéticas Ósseas/metabolismo , Neoplasias Colorretais/metabolismo , Proteína Smad4/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Via de Sinalização Wnt , Proteínas Morfogenéticas Ósseas/genética , Neoplasias Colorretais/genética , Neoplasias Colorretais/patologia , Células HCT116 , Células HEK293 , Células HT29 , Humanos , Transdução de Sinais , Transfecção , Proteína Supressora de Tumor p53/genética , beta Catenina/genética , beta Catenina/metabolismo
6.
Br J Cancer ; 109(7): 1805-12, 2013 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-23969729

RESUMO

BACKGROUND: The expression of SMAD4, the central component of the transforming growth factor-ß (TGF-ß) and bone morphogenetic protein (BMP) signalling pathways, is lost in 50% of pancreatic cancers and is associated with a poor survival. Although the TGF-ß pathway has been extensively studied and characterised in pancreatic cancer, there is very limited data on BMP signalling, a well-known tumour-suppressor pathway. BMP signalling can be lost not only at the level of SMAD4 but also at the level of BMP receptors (BMPRs), as has been described in colorectal cancer. METHODS: We performed immunohistochemical analysis of the expression levels of BMP signalling components in pancreatic cancer and correlated these with survival. We also manipulated the activity of BMP signalling in vitro. RESULTS: Reduced expression of BMPRIA is associated with a significantly worse survival, primarily in a subset of SMAD4-positive cancers. In vitro inactivation of SMAD4-dependent BMP signalling increases proliferation and invasion of pancreatic cancer cells, whereas inactivation of BMP signalling in SMAD4-negative cells does not change the proliferation and invasion or leads to an opposite effect. CONCLUSION: Our data suggest that BMPRIA expression is a good prognostic marker and that the BMP pathway is a potential target for future therapeutic interventions in pancreatic cancer.


Assuntos
Receptores de Proteínas Morfogenéticas Ósseas Tipo I/metabolismo , Neoplasias Pancreáticas/metabolismo , Proteína Smad4/metabolismo , Angiopoietina-1/biossíntese , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos/biossíntese , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Receptores de Proteínas Morfogenéticas Ósseas Tipo I/genética , Linhagem Celular Tumoral , Proliferação de Células , Regulação Neoplásica da Expressão Gênica , Humanos , Invasividade Neoplásica , Neovascularização Patológica/metabolismo , Neoplasias Pancreáticas/mortalidade , Prognóstico , Pirazóis/farmacologia , Pirimidinas/farmacologia , Interferência de RNA , RNA Interferente Pequeno , Transdução de Sinais , Proteína Smad4/genética , Sobrevida , Fator de Crescimento Transformador beta/metabolismo , Fator A de Crescimento do Endotélio Vascular/biossíntese
7.
Oncogene ; 32(9): 1202-6, 2013 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-22469986

RESUMO

Development of colon cancer is a multistep process that is regulated by intrinsic and extrinsic cellular signals. Extrinsic factors include molecular patterns that are derived from either pathogens (PAMPs) or cellular damage (DAMPs). These molecules can promote tumourigenesis by activation of the innate immune system, but the individual contribution of ligands and their receptors remains elusive. The receptor for advanced glycation end products (Rage) is a pattern recognition receptor that binds multiple ligands derived from a damaged cell environment such as Hmgb1 and S100 protein. Here we show that Rage signalling has a critical role in sporadic development of intestinal adenomas, as Apc(Min/+) Rage(-/-) mice are protected against tumourigenesis.


Assuntos
Adenoma/metabolismo , Neoplasias Intestinais/metabolismo , Receptores Imunológicos/metabolismo , Animais , Camundongos , Receptor para Produtos Finais de Glicação Avançada , Receptores de Reconhecimento de Padrão/metabolismo , Transdução de Sinais
8.
Br J Cancer ; 106(9): 1495-8, 2012 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-22472880

RESUMO

BACKGROUND: Upregulation of the matrix metalloproteinases MMP-2 and MMP-9 in various cancers has been associated with worse survival of the patients. METHODS: We assessed MMP-2 and MMP-9 levels in normal colorectal mucosa from colorectal cancer patients in relation to the course of the disease. RESULTS: A high protein expression of MMP-2 as well as MMP-9 in normal mucosa was found to be correlated with worse 5-year survival. The combination of both parameters was an even stronger prognostic factor. These protein levels were found not to be related to the corresponding single nucleotide polymorphisms of MMP-2 (-1306C>T) and MMP-9 (-1562C>T). Multivariate analyses indicated that the MMP-2 and MMP-9 levels in normal mucosa are prognostic for survival, independent of TNM classification. CONCLUSION: MMP-2 and MMP-9 levels in normal mucosa are indicative of the course of disease in colorectal cancer patients.


Assuntos
Neoplasias Colorretais/metabolismo , Neoplasias Colorretais/mortalidade , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Mucosa/metabolismo , Idoso , Neoplasias Colorretais/genética , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 9 da Matriz/genética , Mucosa/patologia , Estadiamento de Neoplasias , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único/genética , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida
9.
Endoscopy ; 40(9): 773-4, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18716983

RESUMO

Patients with familial adenomatous polyposis (FAP) have a 5%-10% lifetime risk of developing duodenal cancer. In severe duodenal polyposis, pancreaticoduodenectomy according to Whipple has been considered the only way to cure duodenal polyposis. However, polyps recur even after surgery. We describe a patient with severe adenomatosis of the small bowel in the afferent loop of a Roux-en-Y anastomosis after a Whipple procedure, detected by double balloon endoscopy (DBE). This is the first description of the use of DBE for this indication, and emphasizes the need for surveillance of the small bowel after surgery, especially in the area of the biliary anastomosis.


Assuntos
Adenoma/diagnóstico , Adenoma/cirurgia , Polipose Adenomatosa do Colo/complicações , Neoplasias Duodenais/diagnóstico , Neoplasias Duodenais/cirurgia , Endoscopia/métodos , Adenoma/etiologia , Anastomose em-Y de Roux , Cateterismo , Colangiopancreatografia Retrógrada Endoscópica , Duodenopatias/cirurgia , Neoplasias Duodenais/etiologia , Duodenoscopia , Humanos , Pólipos Intestinais/cirurgia , Masculino , Pessoa de Meia-Idade , Pancreaticoduodenectomia , Pólipos/cirurgia , Recidiva
10.
Gut ; 57(8): 1083-9, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18367559

RESUMO

BACKGROUND: Endoscopic tri-modal imaging (ETMI) incorporates white light endoscopy (WLE), autofluorescence imaging (AFI) and narrow-band imaging (NBI). AIMS: To assess the value of ETMI for the detection and classification of neoplasia in patients with longstanding ulcerative colitis. DESIGN: Randomised comparative trial of tandem colonoscopies. SETTING: Academic Medical Centre Amsterdam, Netherlands. PATIENTS AND METHODS: Fifty patients with ulcerative colitis underwent surveillance colonoscopy with ETMI. Each colonic segment was inspected twice, once with AFI and once with WLE, in random order. All detected lesions were inspected by NBI for Kudo pit pattern analysis and additional random biopsies were taken. MAIN OUTCOME MEASURES: Neoplasia miss-rates of AFI and WLE, and accuracy of the Kudo classification by NBI. RESULTS: Among patients assigned to inspection with AFI first (n = 25), 10 neoplastic lesions were primarily detected. Subsequent WLE detected no additional neoplasia. Among patients examined with WLE first (n = 25), three neoplastic lesions were detected; subsequent inspection with AFI added three neoplastic lesions. Neoplasia miss-rates for AFI and WLE were 0% and 50% (p = 0.036). The Kudo classification by NBI had a sensitivity and specificity of 75% and 81%; however, all neoplasia was coloured purple on AFI (sensitivity 100%). No additional patients with neoplasia were detected by random biopsies. CONCLUSION: Autofluorescence imaging improves the detection of neoplasia in patients with ulcerative colitis and decreases the yield of random biopsies. Pit pattern analysis by NBI has a moderate accuracy for the prediction of histology, whereas AFI colour appears valuable in excluding the presence of neoplasia. TRIAL REGISTRATION NUMBER: ISRCTN05272746.


Assuntos
Colite Ulcerativa/complicações , Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Adulto , Idoso , Biópsia , Colonoscópios , Neoplasias Colorretais/etiologia , Reações Falso-Positivas , Feminino , Humanos , Mucosa Intestinal/patologia , Masculino , Microscopia de Fluorescência/métodos , Pessoa de Meia-Idade , Vigilância da População
11.
Oncogene ; 25(49): 6447-56, 2006 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-16878161

RESUMO

Nonsteroidal anti-inflammatory drugs show chemopreventive efficacy in colon cancer, but the mechanism behind this remains unclear. Elucidating this mechanism is seen as vital to the development of new chemopreventive agents. We studied the effects of aspirin on the oncogenic Wnt/beta-catenin pathway activity in colorectal cancer cell lines and observed that aspirin dose-dependently decreased the activity of this pathway, as judged by TCF-driven luciferase activity, reduced Wnt target gene expression and increased phosphorylation of beta-catenin by immunoblotting. Furthermore, the ubiquitination and cytoplasmic levels of beta-catenin were assessed by immunoblotting, and also the localization of beta-catenin was shown by green fluorescent protein-tagged beta-catenin and time-lapse fluorescent imaging. Importantly, aspirin treatment caused increased phosphorylation of protein phosphatase 2A (PP2A), an event associated with inhibition of PP2A enzymatic activity, which was confirmed by a reduction in enzymatic PP2A activity. Moreover, this inhibition of PP2A enzymatic activity was essential for the effects of aspirin on the Wnt/beta-catenin pathway as shown by transient transfection with PP2A constructs. The findings in this article provide a molecular explanation for the efficacy of aspirin in chemoprevention of colorectal cancer and shows biochemical evidence that PP2A is an important regulator of Wnt/beta-catenin pathway activity in these cells.


Assuntos
Aspirina/farmacologia , Fosfoproteínas Fosfatases/fisiologia , Transdução de Sinais/efeitos dos fármacos , Proteínas Wnt/metabolismo , beta Catenina/metabolismo , Ciclossomo-Complexo Promotor de Anáfase , Anti-Inflamatórios não Esteroides/farmacologia , Citoplasma/metabolismo , Regulação para Baixo/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Genes Reporter/efeitos dos fármacos , Células HCT116 , Humanos , Fosfoproteínas Fosfatases/metabolismo , Fosforilação/efeitos dos fármacos , Proteína Fosfatase 2 , Processamento de Proteína Pós-Traducional/efeitos dos fármacos , Fatores de Transcrição TCF/metabolismo , Células Tumorais Cultivadas , Ubiquitina/metabolismo , Complexos Ubiquitina-Proteína Ligase/genética
13.
Gut ; 51(5): 628-33, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12377798

RESUMO

BACKGROUND: Sonic hedgehog (Shh) is an important endodermal morphogenetic signal during the development of the vertebrate gut. It controls gastrointestinal patterning in general, and gastric gland formation in particular. We have previously shown that Shh regulates gastric gland proliferation in the adult but detailed analysis of its expression along the adult gastrointestinal tract has never been undertaken. We therefore studied Shh expression along the normal human and rodent adult gastrointestinal tract as well as in intestinal metaplasia of the stomach, gastric and intestinal metaplasia of the oesophagus, and gastric heterotopia in Meckel's diverticulum. METHODS: The studies were performed with in situ hybridisation and by immunohistochemistry using an antibody that recognises the Shh precursor form. RESULTS: We found that in the normal gastrointestinal tract, high levels of Shh were expressed in the fundic glands of the stomach. Shh expression was also found in fundic gland metaplasia and heterotopia. However, Shh expression was lost in intestinal metaplasia of the stomach. CONCLUSION: We found a strong correlation between Shh expression and fundic gland differentiation. Our current study therefore provides evidence that in addition to its role in gastric epithelial development, Shh plays a unique role in gastric epithelial differentiation in adults.


Assuntos
Fundo Gástrico/química , Divertículo Ileal/metabolismo , RNA Mensageiro/análise , Transativadores/análise , Adulto , Diferenciação Celular , Esôfago/metabolismo , Esôfago/patologia , Fundo Gástrico/citologia , Proteínas Hedgehog , Humanos , Imuno-Histoquímica/métodos , Hibridização In Situ/métodos , Mucosa Intestinal/metabolismo , Intestinos/patologia , Metaplasia , Transativadores/genética
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