Background: Colorectal cancer is one of the primary causes of cancer-related deaths and 5-fluorouracil (5-FU) therapy remains the cornerstone of treatment in these patients. Resistance to 5-FU represents a major obstacle; therefore, finding new predictive and prognostic markers is crucial for improvement of patient outcomes. Recently a new type of programmed cell death was discovered—necroptosis, which depends on receptor interacting protein 3 (RIPK3). Preclinical data showed that necroptotic cell death is an important effector mechanism of 5-FU-mediated anticancer activity.
Purpose: To investigate the predictive and prognostic performance of RIPK3 expression in primary tumors. Methods: Colon cancer patients (n=74) with metastatic stage were included in this retrospective study and all were treated with first-line 5-FU based chemotherapy. Immunohistochemical staining was performed.
Results: The progression free survival for the low expression group of RIPK3 was 5.6 months (95% CI, 4.4-6.8) vs 8.4 months (95% CI, 6.4-10.3) of the group with high expression (p=0.02). Moreover, patients with high expression of RIPK3 were associated with lower risk of disease progression HR 0.61 (95% CI, 0.38-0.97; p=0.044). Patients with high expression levels of RIPK3 also had significantly longer mean overall survival (OS) of 29.3 months (95% CI, 20.8-37.8) as compared with those with low expression: 18.5 months (95% CI, 15.06-21.9) (p= 0.036). In addition, univariate analysis showed that high level of RIPK3 expression was associated with a longer OS HR 0.59 (95% CI, 0.35-0.98; p=0.044).
Conclusions: This study suggests that expression of RIPK3 in primary tumors of metastatic colon cancer patients should be further investigated for its potential as a promising predictive and prognostic marker.
The current study sought to evaluate the predictive and prognostic performance of the maximum standardized uptake value (SUV max) prior to treatment in 43 patients with colon cancer and unresectable liver metastases. Patients with colon cancer who underwent 18 F-FDG-PET/computed tomography (CT) scans for staging before the start of first-line 5-fluorouracil-based chemotherapy were retrospectively analyzed. Expression of Beclin-1 in cancer cells was evaluated in primary tumors using immunohistochemical staining. The pretreatment SUV max for liver metastases was not able to predict progression-free survival but was significantly associated with poorer overall survival, with a hazard ratio of 2.05 (95 % CI, 1.016-4.155). Moreover, a negative correlation was noted between SUV max and expression of a marker of autophagy-Beclin-1 (rho =-0.42, p = 0.006). This suggests that the pretreatment SUV max in 18 F-FDG PET/CT is a useful tool to help predict survival outcome in patients with colon cancer and unresectable liver metastases and may significantly distinguish between patients with low and high levels of Beclin-1 expression (AUC = 0.809, 95% CI: 0.670-0.948, p = 0.001).
INTRODUCTION/BACKGROUND: The pancreatic adenocarcinoma (PA) is one of the most lethal malignancies being the fourth leading cause of cancer deaths worldwide. Despite the significant progress in diagnostic modalities the PA is still diagnosed at late stages when curative treatment is no longer possible. This unfavorable situation directs the clinician's attention towards palliation and quality of life improvement. MATERIALS AND METHODS: We performed a literature review of the recent developments in the area of palliative care for pancreatic cancer patients regarding the management of obstructive jaundice, pain and intestinal obstruction. The experience of our clinic with conventional surgery and nonsurgical methods is analysed and presented. OUR RESULTS: We report our experience with a group of 45 patients. One part of them received conventional surgical treatment, and the other one underwent endoscopic treatment. Both endoscopic stent insertion and surgical bypass appear to be effective treatments, but nonoperative palliation seems to be associated with lower complication rates, lower procedure-related mortality rates, and shorter initial periods of hospitalisation compared with surgical palliation. In one patient we performed recanalisation of a selfexpandable metallic stent by inserting a plastic stent into it. The jaundice was relieved successfully. CONCLUSION: The management of PA patient remains a challenge in spite of the clear progress made in diagnostic studies, surgical and palliation treatments. Multidisciplinary approach is necessary to optimise the overall care. Considering the late diagnosis of the majority of PA patients, palliative techniques should not be neglected, but well mastered.
The creation and maintenance of effective and functioning vascular access together with successful management of its frequent complications cause still more close collaboration of different specialists engaged with the morbidity, hospitalisation and treatment of patients with chronic kidney diseases (CKD). The organisation of a follow-up, including adequate assessment and monitoring of clinical parameters of vascular access as well as the quality of dialysis should be unified in all dialysis centres. This proactive approach and care are expected to lower the incidence of thrombosis, infections and achieve good long term results. Imaging and functional testing methods are crucial for the duration of dialysis treatment and better quality of life for patients. Collaboration between specialists nephrologists and other reference points (vascular surgeons, imaging specialists, general surgeons and therapists) underlies the modern algorithm for ECC treatment. Imaging and other functional, methods have a decisive significance for the duration of dialysis treatment and the good quality of life of the patients. The collaboration between nephrologists and other specialists (vascular surgeons, image specialists, general surgeons and internists) is the basis for contemporary algorithm for extracorporeal treatment.
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