To examine the reaction of tumour arteries to endothelin-1, we obtained arteries supplying blood flow to colorectal tumours from patients, as well as mesenteric arteries supplying the normal colon tissue from the same patients and mesenteric arteries from patients without a colorectal tumour pathology. The contraction in response to endothelin-1 and the relaxation produced by bradykinin was recorded in each of these arteries. Accordingly, the sensitivity to endothelin-1 but not the maximal response, was higher in the arteries supplying colorectal tumours than in mesenteric arteries supplying normal colon or in mesenteric arteries from patients with no tumour pathology. The contraction produced by endothelin-1 was not modified by exposure to L-NAME or meclofenamate in arteries supplying both the tumour and the normal colon. The endothelin ET(A) andET(B) receptors were expressed similarly in arteries supplying the tumour or normal colon. However, the antagonist of the endothelin ET(B) receptors BQ788 (10(-6) M) decreased the contractions in the arteries supplying the tumour but not in those supplying the normal colon. By contrast, the antagonist of endothelin ET(A) receptors BQ123 (10(-6) M) reduced the contraction equally in both these types of arteries. Likewise, in arteries precontracted with U46619, the relaxation in response to bradykinin was similar in all three types of arteries. Together, these results suggest that the arteries supplying human colorectal tumours are more sensitive to endothelin-1, which could be due to the enhanced activity of endothelin ET(B) receptors in the absence of any change in the modulatory effect of nitric oxide or prostanoids in the arterial response to this peptide.
(CRP), and clinicopathological variables were studied in a training set of 175 patients with CRC. Univariate and multivariate Cox regression models were used to determine the role of NAR. Independent predictors of survival identified in multivariate analysis were externally validated in an independent cohort of 128 patients with CRC. RESULTS: Univariate analyses showed that NAR (p<0.001), tumor size (p¼0.008), tumor depth (p¼0.001), lymph node metastais (p<0.001), TNM stage (p<0.001), CEA (p¼0.001), CA19-9 (p<0.001), CRP (p¼0.0013), and NLR (p¼0.014) were all predictors of overall survival in the training set. Multivariate analysis revealed the NAR (hazard ratio [HR] 4.75, 95% CI: 1.57-13.45), and TNM stage (HR 5.74, 95% CI: 2.04-18.46) as independent predictors of worse overall survival in this population. The NAR retained independent prognostic value in the external validation set (HR 3.22, 95% CI: 1.02-9.75). The predictive accuracy of the combined NAR and TNM classification (c score 0.7) appeared superior to that of the TNM classification alone (c score 0.6). CONCLUSIONS: The presence of a novel systemic inflammatory response, as measured by the NAR, is an independent and externally validated predictor of poor overall survival in patients with CRC.
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