Blood-Based Liquid Biopsies: A Noninvasive and Cost-Effective Tool for Improved Risk Assessment and Identification of Lymph Node Metastasis in Patients With Submucosal T1 Colorectal Cancer

Ashktorab, Hassan; Brim, Hassan

doi:10.1053/j.gastro.2021.04.038

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…Other studies have analyzed the use of LB for risk assessment of patients living with advanced cancers. [46][47][48] To our knowledge, this is the first study that also considers novel LB in a cost-effectiveness analysis for CRC screening.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis focuses on a new category of blood-based screening tests that could have better performance with the advent of efficient next-generation sequencing and application of artificial intelligence for cancer prediction. Other studies have analyzed the use of LB for risk assessment of patients living with advanced cancers . To our knowledge, this is the first study that also considers novel LB in a cost-effectiveness analysis for CRC screening.…”

Section: Discussionmentioning

confidence: 99%

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Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

Aziz,

Wagner,

Agyekum

et al. 2023

JAMA Netw Open

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ImportanceDespite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening.ObjectiveTo estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US.Design, Setting, and ParticipantsIn this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy–liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy.ExposuresNo screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy–liquid biopsy hybrid screening.Main Outcomes and MeasuresModel outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained.ResultsThis study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy–liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy–liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly.Conclusions and RelevanceIn this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

Aziz,

Wagner,

Agyekum

et al. 2023

JAMA Netw Open

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“…This particular factor constitutes a pivotal contributor to unfavorable outcomes [18,19] . Nomograms, adept at amalgamating a plethora of pivotal factors, offer personalized risk assessment and have gained extensive traction for prognostic evaluations among colorectal cancer patients [20][21][22][23] . In the current study, we harnessed the potency of multivariate logistic regression analysis to pinpoint independent predictive factors intricately linked to PNI among CRC patients.…”

Section: Discussionmentioning

confidence: 99%

A prediction nomogram for neural perineural invasion in colorectal cancer patients: A retrospective study

Que,

Wu,

et al. 2023

Preprint

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Background Perineural invasion (PNI), as the fifth recognized pathway for the spread and metastasis of colorectal cancer (CRC), has increasingly garnered widespread attention. The preoperative identification of whether colorectal cancer (CRC) patients exhibit PNI can assist clinical practitioners in enhancing preoperative decision-making, including determining the necessity of neoadjuvant therapy and the appropriateness of surgical resection. The primary objective of this study is to construct and validate a preoperative predictive model for assessing the risk of perineural invasion (PNI) in patients diagnosed with colorectal cancer (CRC). Materials and methods A total of 335 patients diagnosed with colorectal cancer (CRC) at a single medical center were subject to random allocation, with 221 individuals assigned to a training dataset and 114 to a validation dataset, maintaining a ratio of 2:1. Comprehensive preoperative clinical and pathological data were meticulously gathered for analysis. Initial exploration involved conducting univariate logistic regression analysis, with subsequent inclusion of variables demonstrating a significance level of p < 0.05 into the multivariate logistic regression analysis, aiming to ascertain independent predictive factors, all while maintaining a p-value threshold of less than 0.05. From the culmination of these factors, a nomogram was meticulously devised. Rigorous evaluation of this nomogram's precision and reliability encompassed Receiver Operating Characteristic (ROC) curve analysis, calibration curve assessment, and Decision Curve Analysis (DCA). The robustness and accuracy were further fortified through application of the bootstrap method, which entailed 1000 independent dataset samplings to perform discrimination and calibration procedures. Results The results of multivariate logistic regression analysis unveiled independent risk factors for perineural invasion (PNI) in patients diagnosed with colorectal cancer (CRC). These factors included tumor histological differentiation (grade) (OR = 0.15, 95% CI = 0.03–0.74, p = 0.02), primary tumor location (OR = 2.49, 95% CI = 1.21–5.12, p = 0.013), gross tumor type (OR = 0.42, 95% CI = 0.22–0.81, p = 0.01), N staging in CT (OR = 3.44, 95% CI = 1.74–6.80, p < 0.001), carcinoembryonic antigen (CEA) level (OR = 3.13, 95% CI = 1.60–6.13, p = 0.001), and platelet-to-lymphocyte ratio (PLR) (OR = 2.07, 95% CI = 1.08–3.96, p = 0.028).These findings formed the basis for constructing a predictive nomogram, which exhibited an impressive area under the receiver operating characteristic (ROC) curve (AUC) of 0.772 (95% CI, 0.712–0.833). The Hosmer-Lemeshow test confirmed the model's excellent fit (p = 0.47), and the calibration curve demonstrated consistent performance. Furthermore, decision curve analysis (DCA) underscored a substantial net benefit across the risk range of 13–85%, reaffirming the nomogram's reliability through rigorous internal validation. Conclusion We have formulated a highly reliable nomogram that provides valuable assistance to clinical practitioners in preoperatively assessing the likelihood of perineural invasion (PNI) among colorectal cancer (CRC) patients. This tool holds significant potential in offering guidance for treatment strategy formulation.

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“…Cancers have a significant health burden, and their incidence rates have increased worldwide since last decades [ 24 ]. Efforts for finding new effective cancer biomarkers have become an integral part of cancer research because they have multiple clinical implications in different stages of disease [ 25–27 , S. 28–31 ].…”

Section: Introductionmentioning

confidence: 99%

“…Cancer detection at early stage and treatment of metastatic and chemoresistant tumors need specific and effective biomarkers [ 25 , 27 , 32 , 33 ]. Recently, the role of piRNAs as potential biomarkers and therapeutic tools in cancers had been attracting much attention.…”

Section: Introductionmentioning

confidence: 99%

PIWI interacting RNAs perspectives: a new avenues in future cancer investigations

et al. 2021

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As a currently identified small non-coding RNAs (ncRNAs) category, the PIWI-interacting RNAs (piRNAs) are crucial mediators of cell biology. The human genome comprises over 30.000 piRNA genes. Although considered a new field in cancer research, the piRNA pathway is shown by the existing evidence as an active pathway in a variety of different types of cancers with critical impacts on main aspects of cancer progression. Among the regulatory molecules that contribute to maintaining the dynamics of cancer cells, the P-element Induced WImpy testis (PIWI) proteins and piRNAs, as new players, have not been broadly studied so far. Therefore, the identification of cancer-related piRNAs and the assessment of target genes of piRNAs may lead to better cancer prevention and therapy strategies. This review articleaimed to highlight the role and function of piRNAs based on existing data. Understanding the role of piRNA in cancer may provide perspectives on their applications as particular biomarker signature in diagnosis in early stage, prognosis and therapeutic strategies.

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Blood-Based Liquid Biopsies: A Noninvasive and Cost-Effective Tool for Improved Risk Assessment and Identification of Lymph Node Metastasis in Patients With Submucosal T1 Colorectal Cancer

Cited by 4 publications

References 15 publications

Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened

A prediction nomogram for neural perineural invasion in colorectal cancer patients: A retrospective study

PIWI interacting RNAs perspectives: a new avenues in future cancer investigations

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