Abstract. Bmi1 is overexpressed in gastrointestinal cancers, including colorectal cancer (CRC); however, its role as a non-invasive biomarker in CRC has not been established. The aim of this study was to compare the plasma Bmi1 mRNA levels prior to and following curative resection of the primary tumor in CRC patients and to determine their association with the clinicopathological parameters. The plasma Bmi1 mRNA level was measured by quantitative polymerase chain reaction and expressed as cycle threshold value. There was no significant difference between the overall pre-and postoperative plasma Bmi1 mRNA level (31.73±2.63 vs. 31.93±2.88, respectively; P=0.614) in 45 CRC patients. However, when grouped into non-metastatic and metastatic CRC patients, the postoperative Bmi1 transcript level was found to be significantly lower compared to the preoperative level in patients with non-metastatic CRC (32.13±2.677 31.44±2.764, respectively; P=0.041), whereas there was a trend towards a higher postoperative Bmi1 transcript level compared to the preoperative level in the metastatic counterpart (30.85±3.916 vs. 33.27±0.718, respectively; P=0.164). Furthermore, when the patients were categorized into two groups according to their plasma Bmi1 postoperative vs. preoperative level status, we observed that patients without a reduction in the postoperative plasma Bmi1 mRNA levels exhibited a significantly higher rate of distant metastasis following primary resection (P=0.017) and a significantly worse prognosis regarding disease-free survival (P=0.016) when compared to the reduced postoperative plasma Bmi1 level counterparts. In conclusion, plasma Bmi1 mRNA levels may serve as a non-invasive biomarker for monitoring occult metastasis and predicting the development of distant metastasis.
IntroductionColorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females, with >1.2 million new cancer cases and 608,700 deaths estimated to have occurred in 2008 (1). Recent advances in therapeutic strategies and surgical techniques have significantly improved the prognosis of CRC patients with primary disease; however, metastasis is a major concern for CRC patients and physicians. Thirty-five percent of CRC patients have metastatic tumors at the time of diagnosis and 33-50% of the patients without metastases will progress to stage IV during the course of their disease (1,2). Hence, it is necessary to develop prominent biomarkers for detecting the presence of occult metastasis, as well as for predicting the development of future metastasis, which may provide a useful reference for the therapeutic management of CRC patients.Potential stem cell marker, Bmi1, is a member of the polycomb-repressive complex 1, with a key role in gene silencing through chromatin modifications (3,4). In addition to the proposed role for Bmi1 as a key regulator of cell growth control/senescence mechanisms, accumulating evidence supports the role of Bmi1 in tumorigenesis. Bmi1 is overexpressed in a variety of human cancers and it...