ObjectiveCarcinomas of the colon and rectum are the third leading cause of cancer-related deaths. Although advances in the surgical treatment of primary colorectal cancers have lead to improvements in patient survival at early tumor stages, treatment of more progressive cancers has not resulted in dramatic improvements in patient survival. However, the selection of patient subgroups based on their prognosis and other characteristics could result in improved outcomes from adjuvant therapies in patients with Dukes B and C carcinomas.
MethodsThe authors reviewed the available data on the value of cell surface molecules in assessing the prognosis of colorectal carcinomas, paying specific attention to the evaluation of statistical analysis and multivariate procedures.
ResultsCell surface molecules have been identified on colorectal carcinoma cells whose expression appears to be related to malignant transformation, tumor progression, or patient prognosis. Among these cell surface molecules, various cell adhesion molecules, growth factor receptors, proteinases, and their receptors and inhibitors have been identified as potentially useful prognostic markers.
ConclusionsAlthough data exist on the prognostic values of certain cell surface markers, the use of multivariate analysis for the identification of valuable prognostic factors remains uncommon. Using reproducible and standardized multivariate analysis procedures, new tumor markers should be carefully examined for their biologic and prognostic relevance before being considered as potentially useful in the management of colorectal cancers.Carcinomas of the colon and rectum will affect approximately 6% of the population (1 of 17) in the United States during their lifetime. Approximately one third of the estimated 130,000 new patients per year will die within 5 years of cancer-related problems, mostly resulting from metastatic lesions. Thus, colorectal carcinomas are the third leading cause of cancer-related deaths among women and men, 1 and they are the most important malignancies of the gut.Colorectal carcinomas are one of the best models for the investigation of genetic alterations that lead to malignant transformation and tumor progression. Various chromosomal mutations and deletions are known to be necessary in the adenoma-carcinoma progression sequence that includes different stages of hyperplasia and malignant transformation to an invasive carcinoma.2 Little is known, however, about the genetic alterations and cellular mechanisms responsible for the final steps in the progression sequence that lead to invasion and metastasis.Tumor invasiveness and the development of metastases are the most important factors, besides the quality of primary surgery, in determining the prognosis of patients with colorectal carcinomas. 3,4 Patients with advanced local carcinomas or lymph node metastases can benefit from adjuvant therapy, 5 but metastatic involvement of lymph nodes or metastasis into distant organs reduces the median patient survival dramatically.6,7 Because of the en...